scholarly journals Barriers to cognitive screening in acute stroke units

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tamar Abzhandadze ◽  
Dongni Buvarp ◽  
Åsa Lundgren-Nilsson ◽  
Katharina S. Sunnerhagen
Keyword(s):  
Acute Stroke ◽  
Care Facility ◽  
Sociodemographic Factors ◽  
Screening Tools ◽  
Outcome Variable ◽  
Cognitive Screening ◽  
Stroke Units ◽  
Explanatory Variables ◽  
Tree Methods ◽  
Selection Operator

AbstractCognitive impairment is common after stroke. However, not all patients with stroke undergo cognitive screening, despite recommendations. The aim of this retrospective, explorative study was to examine the barriers to cognitive screening in acute stroke units. Data were retrieved from two Swedish Stroke registries. The outcome variable was cognitive screening during the stay at acute stroke units. Forty-three candidate explanatory variables were considered for analysis, encompassing sociodemographic factors and stroke-related outcomes during the stay at acute stroke units. The Least Absolute Shrinkage and Selection Operator and decision-tree methods were used. Of the 1120 patients (56% male, mean age: 72 years, 50% with mild stroke), 44% did not undergo cognitive screening. Walking 10 m post-stroke was the most important attribute for decisions regarding cognitive screening. The classification accuracy, sensitivity, and specificity of the model were 70% (95% CI 63–75%), 71% (63–78%), and 67% (55–77%), respectively. Patient-related parameters that influenced cognitive screening with a valid and reliable screening instrument in acute stroke units included new stroke during the hospitalisation, aphasia at admission, mobility problems, impaired verbal output skills, and planned discharge to another care facility. The barriers to cognitive screening were both patient- and organisation-related, suggesting the need for patient-tailored cognitive screening tools as well as the implementation and systematic adherence to guidelines.

scholarly journals Effects of Sociodemographic Variables and Depressive Symptoms on MoCA Test Performance in Native Germans and Turkish Migrants in Germany

2021 ◽  
Vol 18 (12) ◽  
pp. 6335
Author(s):  
Görkem Anapa ◽  
Mandy Roheger ◽  
Ümran Sema Seven ◽  
Hannah Liebermann-Jordanidis ◽  
Oezguer A. Onur ◽  
...  
Keyword(s):  
Sex Education ◽  
Test Performance ◽  
Statistical Significance ◽  
Sociodemographic Factors ◽  
Migration Background ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Linear Regression Models ◽  
Turkish Migrants ◽  
And Migration

The validity of the Montreal Cognitive Assessment (MoCA) in migrants is questionable, as sociodemographic factors and the migration process may influence performance. Our aim was to evaluate possible predictors (age, education, sex, depression, and migration) of MoCA results in Turkish migrants and Germans living in Germany. Linear regression models were conducted with a German (n = 419), a Turkish (n = 133), and an overall sample. All predictor analyses reached statistical significance. For the German sample, age, sex, education, and depression were significant predictors, whereas education was the only predictor for Turkish migrants. For the overall sample, having no migration background and higher education were significant predictors. Migration background and education had an impact on MoCA performance in a sample of German and Turkish individuals living in Germany. Thus, culture-specific normative data for the MoCA are needed, and the development of culture-sensitive cognitive screening tools is encouraged.

scholarly journals Psychooncological distress in low-grade glioma patients—a monocentric study

2021 ◽  
Author(s):  
Alessandra Ley ◽  
Marcel Kamp ◽  
Christiane von Sass ◽  
Daniel Hänggi ◽  
Michael Sabel ◽  
...  
Keyword(s):  
Depression Scale ◽  
Sociodemographic Factors ◽  
Low Grade Glioma ◽  
Screening Tools ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
Distress Screening ◽  
Clinical Trial Registration ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Summary Background Patients diagnosed with low-grade glioma (LGG) must live with constant knowledge of an upcoming malignant tumor transformation which may lead to increased anxiety and reduced quality of life. Here, we (1) analyzed the prevalence and risk factors for distress in LGG patients using (2) different screening tools to subsequently (3) evaluate their need for psychological support. Method Patients with LGG-suspicious findings in MRI studies as well as patients with histopathological confirmed LGG were screened using three established self-assessment instruments (Hospital Anxiety and Depression Scale, Distress Thermometer, EORTC-QLQ-C30-BN20). Screening results were correlated with sociodemographic factors. Results One hundred forty-nine patients (74 men and 75 women) were prospectively included. Patients were further divided into different subgroups regarding the time of screening and diagnosis. An increased level of distress was observed in 20.8% (mean score 1.21, 95% CI 1.15–1.28) of all patients screened by HADS. Significant associated factors were pre-existing psychiatric disorders (p = 0.003) and psychotropic medication (p = 0.029). HRQoL (p = 0.022) and global health item (p = 0.015), as well as future uncertainty (p = 0.047), assessed by the EORTC-QLQ-C30-BN20 were significantly higher in those patients without histopathological diagnosis. Increased distress was significantly correlated with results in chosen sub-items of the HRQoL questionnaire (p < 0.001). Conclusions Our results demonstrate the need for frequent distress screening. If specific tools are not available, HRQoL questionnaires can also be used. Patients with pre-existing psychological stress should be offered additional psychooncological support, irrespectively of the time of screening or tumor diagnosis. Clinical trial registration number: 4087

scholarly journals The Determinants of Telehealth Provision: Empirical Evidence from OECD Countries

2021 ◽  
Vol 18 (16) ◽  
pp. 8288
Author(s):  
Fuhmei Wang ◽  
Jung-Der Wang
Keyword(s):  
Health Services ◽  
Health Spending ◽  
Well Being ◽  
Oecd Countries ◽  
Outcome Variable ◽  
Explanatory Variables ◽  
Telehealth Service ◽  
Increase Productivity ◽  
Number Of Individuals ◽  
Health And Well Being

Health services provided through the telecommunications system aim to improve the population’s health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries’ experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3–5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing number of individuals in OECD countries are now readily served by telehealth systems under the COVID-19 pandemic. These findings could be regarded as a model for other countries for implementing the necessary infrastructure early on when any of these parameters reaches its threshold. Moreover, telehealth applied in developing countries could be elevated for wider populations to access basic health services and for the remote delivery of health care. A rational decision could be made to appropriately use additional resources in telehealth provision. With accessible e-health services, the population’s health could be improved, which in turn would possibly increase productivity and social welfare.

Life Course Socioeconomic Position, Intergenerational Social Mobility, and Hypertension Incidence in ELSA-Brasil

2021 ◽  
Author(s):  
José Aparecido Soares Lopes ◽  
Luana Giatti ◽  
Rosane Harter Griep ◽  
Antonio Alberto da Silva Lopes ◽  
Sheila Maria Alvim Matos ◽  
...  
Keyword(s):  
Life Course ◽  
Social Mobility ◽  
Socioeconomic Position ◽  
Linear Models ◽  
Sociodemographic Factors ◽  
Incidence Rates ◽  
Explanatory Variables ◽  
Rate Ratios

Abstract Background Life course epidemiology is a powerful framework to unravel the role of socioeconomic position (SEP) disparities in hypertension (HTN). This study investigated whether life course SEP is associated with HTN incidence. Specifically, to test whether cumulative low SEP throughout life and unfavorable intergenerational social mobility increased HTN incidence. METHODS Longitudinal analysis of 8,754 ELSA-Brasil participants without HTN or cardiovascular in visit 1 (2008–2010). The response variable was the incidence of HTN between visits 1 and 2 (2012–2014). The explanatory variables were childhood, youth, and adulthood SEP, cumulative low SEP, and intergenerational social mobility. Associations were estimated by incidence rate ratios (IRRs) obtained by generalized linear models, with Poisson distribution and logarithmic link function, after adjustment for sociodemographic, behavioral, and health factors. RESULTS The incidence of HTN was 43.2/1,000 person-years, being higher in males, elderly (70–74 years), self-declared black, and low SEP individuals. After considering sociodemographic factors, low SEP in childhood, youth, and adulthood remained statistically associated with increased HTN incidence. Individuals in the third (IRR: 1.26; 95% confidence interval (CI): 1.11–1.44) and fourth top quartiles (IRR: 1.29; 95% CI: 1.11–1.49) of cumulative low SEP, vs. first, as well as those with low stable intergenerational trajectory (IRR: 1.29; 95% CI: 1.16–1.43), vs. high stable, also had increased HTN incidence rates. Conclusions Socioeconomic disparities at all phases of the life cycle appear to raise HTN incidence rates, being the individuals with greater accumulation of exposure to low SEP and with more unfavorable intergenerational mobility at greatest risk, even in a short follow-up time.

A Memory Clinic at a Geriatric Hospital: A Report on 577 Patients Assessed with the CAMDEX Over 9 Years

2003 ◽  
Vol 37 (3) ◽  
pp. 319-326 ◽  
Author(s):  
Joe A. Stratford ◽  
Dina Logiudice ◽  
Leon Flicker ◽  
Roslyn Cook ◽  
Wendy Waltrowicz ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
The Elderly ◽  
International Classification Of Diseases ◽  
Screening Tools ◽  
Cognitive Screening ◽  
Memory Clinic ◽  
Mental Test Score ◽  
Patient Demographics ◽  
Significant Difference ◽  
Icd 10

Objective: To report 9 years’ experience of an Australian memory clinic using the Cambridge Mental Disorders in the Elderly Examination (CAMDEX) assessment schedule, summarizing patient demographics, diagnoses at presentation and the utility of four instruments used in distinguishing patients with and without dementia. Methods: All patients seen at the clinic between December 1989 and September 1998 were assessed using the CAMDEX. Diagnoses were determined according to criteria of the International Classification of Diseases, tenth edition (ICD-10). Results: The mean age of 577 patients seen was 72.9 years and 60.8% were female. Over 40% fulfilled ICD-10 diagnostic criteria for dementia in Alzheimer's disease. A further 24% had another dementing illness. Only 28 patients were ‘normal’. There was no significant difference in the ability of the 107-item Cambridge cognitive examination, the 30-item mini-mental state examination, the 10-item abbreviated mental test score and the 26-item informant questionnaire on cognitive decline in the elderly to differentiate dementia patients from those who were normal or had functional psychiatric disorders. The four cognitive screening tools had high correlations with one another (r = −0.57 to 0.93). Conclusion: Patient demographics and diagnoses were similar to those found in other clinics. Most people who attended the memory clinic had significant cognitive or psychiatric disorders.

A qualitative study using the Theoretical Domains Framework to investigate why patients were or were not assessed for rehabilitation after stroke

2016 ◽  
Vol 31 (7) ◽  
pp. 966-977 ◽  
Author(s):  
Elizabeth A Lynch ◽  
Julie A Luker ◽  
Dominique A Cadilhac ◽  
Caroline E Fryer ◽  
Susan L Hillier
Keyword(s):  
Qualitative Study ◽  
Acute Stroke ◽  
Health Professionals ◽  
Assessment Tool ◽  
Theoretical Domains Framework ◽  
Assessment Practices ◽  
Stroke Units ◽  
Changing Practice ◽  
Referral Practices ◽  
Rehabilitation Assessment

Objective: To explore the factors perceived to affect rehabilitation assessment and referral practices for patients with stroke. Design: Qualitative study using data from focus groups analysed thematically and then mapped to the Theoretical Domains Framework. Setting: Eight acute stroke units in two states of Australia. Subjects: Health professionals working in acute stroke units. Interventions: Health professionals at all sites had participated in interventions to improve rehabilitation assessment and referral practices, which included provision of copies of an evidence-based decision-making rehabilitation Assessment Tool and pathway. Results: Eight focus groups were conducted (32 total participants). Reported rehabilitation assessment and referral practices varied markedly between units. Continence and mood were not routinely assessed (4 units), and people with stroke symptoms were not consistently referred to rehabilitation (4 units). Key factors influencing practice were identified and included whether health professionals perceived that use of the Assessment Tool would improve rehabilitation assessment practices (theoretical domain ‘social and professional role’); beliefs about outcomes from changing practice such as increased equity for patients or conversely that changing rehabilitation referral patterns would not affect access to rehabilitation (‘belief about consequences’); the influence of the unit’s relationships with other groups including rehabilitation teams (‘social influences’ domain) and understanding within the acute stroke unit team of the purpose of changing assessment practices (‘knowledge’ domain). Conclusion: This study has identified that health professionals’ perceived roles, beliefs about consequences from changing practice and relationships with rehabilitation service providers were perceived to influence rehabilitation assessment and referral practices on Australian acute stroke units.

scholarly journals Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review

2017 ◽  
Vol 29 (11) ◽  
pp. 1771-1784 ◽  
Author(s):  
Annie Pye ◽  
Anna Pavlina Charalambous ◽  
Iracema Leroi ◽  
Chrysoulla Thodi ◽  
Piers Dawes
Keyword(s):  
Hearing Impairment ◽  
Cognitive Assessment ◽  
Negative Impact ◽  
Sensory Modality ◽  
Vision Impairment ◽  
Assessment Tools ◽  
Screening Tools ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Age Related

ABSTRACTBackground:Cognitive screening tests frequently rely on items being correctly heard or seen. We aimed to identify, describe, and evaluate the adaptation, validity, and availability of cognitive screening and assessment tools for dementia which have been developed or adapted for adults with acquired hearing and/or vision impairment.Method:Electronic databases were searched using subject terms “hearing disorders” OR “vision disorders” AND “cognitive assessment,” supplemented by exploring reference lists of included papers and via consultation with health professionals to identify additional literature.Results:1,551 papers were identified, of which 13 met inclusion criteria. Four papers related to tests adapted for hearing impairment; 11 papers related to tests adapted for vision impairment. Frequently adapted tests were the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MOCA). Adaptations for hearing impairment involved deleting or creating written versions for hearing-dependent items. Adaptations for vision impairment involved deleting vision-dependent items or spoken/tactile versions of visual tasks. No study reported validity of the test in relation to detection of dementia in people with hearing/vision impairment. Item deletion had a negative impact on the psychometric properties of the test.Conclusions:While attempts have been made to adapt cognitive tests for people with acquired hearing and/or vision impairment, the primary limitation of these adaptations is that their validity in accurately detecting dementia among those with acquired hearing or vision impairment is yet to be established. It is likely that the sensitivity and specificity of the adapted versions are poorer than the original, especially if the adaptation involved item deletion. One solution would involve item substitution in an alternative sensory modality followed by re-validation of the adapted test.

Timing of Aspirin and Secondary Preventative Therapies in Acute Stroke: Support for Use of Stroke Units

2005 ◽  
Vol 50 (2) ◽  
pp. 69-72 ◽  
Author(s):  
J Reid ◽  
M-J MacLeod ◽  
D Williams
Keyword(s):  
Acute Stroke ◽  
Ct Scanning ◽  
Medical Ward ◽  
Stroke Patients ◽  
Stroke Units ◽  
General Medical Ward ◽  
Brain Scans ◽  
Angiotensin Ii Antagonist ◽  
Acute Stroke Unit ◽  
Ct Brain

Background: We aimed to study the timing of aspirin prescription in ischaemic stroke comparing patients admitted to an acute stroke unit (ASU) directly or via a general medical ward. We also analysed prescription of secondary preventive therapies in stroke patients in an ASU. Methods: Retrospective analysis was made of medical notes and prescription records of 69 patients admitted to an ASU over a three month period to establish timing of aspirin prescription with respect to onset of stroke symptoms, CT brain scan and route of admission to the ASU. Results: CT brain scans were obtained at a median of 2.1 days post stroke (IQ range 1.3–4.3). Patients directly admitted to the ASU received aspirin earlier post admission compared to those admitted via a medical ward (0.7 vs 2.2 days, p<0.01) and were also more likely to receive aspirin prior to CT scan being performed (57% vs 19%, p=0.02). 86% of stroke patients were discharged on an antiplatelet therapy, 79% on a statin, 37% on a thiazide diuretic and 32% on an ACE inhibitor or angiotensin II antagonist. Conclusion: Aspirin was given more promptly in acute stroke and more commonly prior to CT scanning in an ASU compared to a medical ward. Statin therapy is used extensively in stroke but there is a much lower rate of initiation of other secondary preventive therapies (e.g. anti-hypertensive therapy) in hospital. These findings demonstrate a hesitancy in early use of aspirin amongst general physicians and lends support for the use of stroke units.

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