435 THE IMPACT OF COMPREHENSIVE GERIATRIC ASSESSMENT IN THE OUTCOMES OF OLDER ACUTE NEUROSURGICAL PATIENTS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
L Soutter ◽  
D Sivapathasuntharam ◽  
C Uff ◽  
S Yordanov
Keyword(s):  
Length Of Stay ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Clinical Pathways ◽  
Control Group ◽  
Clinical Approach ◽  
Neurosurgical Patients ◽  
Significant Difference ◽  
The Impact

Abstract Introduction As the population ages, an increasing proportion of the neurosurgical caseload is comprised of older patients. This trend is reinforced by technical advances and anaesthetic considerations within the field, allowing a higher proportion of patients eligible for surgery. Comprehensive geriatric assessment (CGA) is the gold standard clinical approach for evaluating older patients. Peri-operative care of older people (POPS) has provided strong evidence that CGA services can result in fewer post-operative complications. However, this evidence stems largely from trauma and orthopaedic surgery. Currently, there is little evidence of the impact CGA has on older neurosurgical patients. The study aimed to investigate whether CGA for older neurosurgical patients improved outcomes such as thirty-day mortality and length of stay. Methods A control group was established by collecting retrospective data for all acute neurosurgical patients over the age of 65. This was then compared with an intervention group who received CGA in the form of regular geriatric consultant reviews. 49 patients were recruited into each group. Results Analysis showed that the interventional group had a significantly higher mean age and level of frailty. They also had more confirmed complications with a significant difference in the diagnosis of pneumonia (p = 0.05) and hyponatremia (p = 0.015). Despite this, the thirty-day mortality was lower and average length of stay was on average two days shorter compared to the control group, although this did not reach statistical significance (p = 0.701). The study showed that more patients who received a CGA were discharged home (p = 0.209). Conclusion Our findings suggest that CGA input for older neurosurgical patients improves outcomes and should be incorporated routinely into neurosurgical clinical pathways.

scholarly journals The impact of comprehensive geriatric assessment for optimal treatment of older patients with cancer: A randomized parallel-group clinical trial

2020 ◽  
Vol 11 (3) ◽  
pp. 488-495 ◽  
Author(s):  
Sambavy Nadaraja ◽  
Lars-Erik Matzen ◽  
Trine Lembrecht Jørgensen ◽  
Lars Dysager ◽  
Anja Ør Knudsen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Optimal Treatment ◽  
Patients With Cancer ◽  
Parallel Group ◽  
The Impact

scholarly journals Adherence to Recommendations from Comprehensive Geriatric Assessment of Older Individuals with HIV

2019 ◽  
Vol 18 ◽  
pp. 232595821882165 ◽  
Author(s):  
Christiana Bitas ◽  
Sian Jones ◽  
Harjot Kaur Singh ◽  
Mildred Ramirez ◽  
Eugenia Siegler ◽  
...  
Keyword(s):  
Cohort Study ◽  
Social Workers ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Retrospective Cohort Study ◽  
Medical Records ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Older Individuals ◽  
The Impact

This retrospective cohort study sought to assess the effectiveness of comprehensive geriatric assessment (CGA) for older patients at an HIV clinic in a large US city. We systematically reviewed medical records of all patients who underwent CGA from June 2013 to July 2017. In addition, physicians and social workers completed an anonymous survey about the impact of CGA on their patients. For the 76 patients (median age 67.2; Q1, Q3 = 60.9, 72.6) seen by geriatricians at the clinic, there were 184 recommendations, 54 instances of counseling, and 11 direct actions. Overall adherence to recommendations was 32.8%, 34.9% for patient-directed, and 31.7% for provider-directed recommendations. No demographic or CGA variables were associated with adherence. Despite this lack of adherence, surveyed providers reported that they usually or always followed recommendations; the most frequently cited barrier to implementation was lack of feasibility. Further research will be needed to determine how CGA can improve outcomes for this population.

Reduction in Surgical Site Infections in Neurosurgical Patients Associated With a Bedside Hand Hygiene Program in Vietnam

2007 ◽  
Vol 28 (05) ◽  
pp. 583-588 ◽  
Author(s):  
Le Thi Arm Thu ◽  
Michael J. Dibley ◽  
Vo Van Nho ◽  
Lennox Archibald ◽  
William R. Jarvis ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hand Hygiene ◽  
Surgical Site Infections ◽  
Control Group ◽  
Antimicrobial Use ◽  
Hand Sanitizer ◽  
Neurosurgical Patients ◽  
Quasi Experimental ◽  
Postoperative Length ◽  
The Impact

Objective. We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam. Design. A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention). A hand sanitizer with 70% isopropyl alcohol and 0.5% Chlorhexidine gluconate was introduced, and healthcare workers were trained in its use on ward A in September 2000. No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used. Patient SSI data were collected on standardized forms and were analyzed using Stata software (Stata). Results. A total of 786 patients were enrolled: 377 in the period before intervention (156 in ward A and 221 in ward B) and 409 in the period after intervention (159 in ward A and 250 in ward B). On ward A after the intervention, the SSI rate was reduced by 54% (from 8.3% to 3.8%; P = .09), and more than half of superficial SSIs were eliminated (7 of 13 vs 0 of 6 in ward B; P = .007). On ward B, the SSI rate increased by 22% (from 7.2% to 9.2%; P = .8). In patients without SSI, the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A (both from 8 to 6 days; P <.001) but not on ward B. Conclusions. Our study demonstrates that introduction of a hand sanitizer can both reduce SSI rates in neurosurgical patients, with particular impact on superficial SSIs, and reduce the overall postoperative length of stay and the duration of antimicrobial use. Hand hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes.

scholarly journals Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture

2021 ◽  
Vol 12 ◽  
Author(s):  
Simone Paterni ◽  
Chukwuma Okoye ◽  
Alessia M. Calabrese ◽  
Filippo Niccolai ◽  
Antonio Polini ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Geriatric Assessment ◽  
Mortality Risk ◽  
Comprehensive Geriatric Assessment ◽  
Older Patients ◽  
Glycated Hemoglobin ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Significant Difference

BackgroundPrevious studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking.AimTo investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture.MethodsProspective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture.ResultsAmong the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1.ConclusionsFrail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.

Reducing the Social Stigma Associated with Obsessive Compulsive Disorder: A Controlled Trial of an Intervention Program in a Turkish Community Sample

2020 ◽  
Vol 20 (2) ◽  
pp. 101-120
Author(s):  
Ayça Aktaç Gürbüz ◽  
Orçun YORULMAZ ◽  
Gülşah DURNA
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Intervention Program ◽  
Controlled Trial ◽  
Community Sample ◽  
Case Vignette ◽  
Control Group ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
The Impact

Scientific research into the reduction of stigmatization, particularly related to specific problems such as Obsessive-Compulsive Disorder (OCD), is scarce. In the present study, we examine the impact of a video-based antistigma intervention program for OCD in a pretest-posttest control group research. After being randomly assigned to either an intervention (n= 101) or control group (n= 96), the participants reported their attitudes on a hypothetical case vignette before and after OCD vs. Multiple Sclerosis (MS) videos, and again six months later as a follow up assessment. The mixed design analyses for the group comparisons indicated that although there was no significant difference in the measures of the control group, the participants watching the anti-stigma OCD video, in which the focus was psychoeducation and interaction strategies, reported significantly lower scores on social distances and negative beliefs for the case vignettes they read, and this difference was maintained six months later. Then, the present results indicate the effectiveness of our anti-stigma intervention program for OCD. Interventions to reduce stigmatization can also be viewed as effective tools for changing the attitudes of people toward OCD, although further research and applications are needed related to specific disorders if a longlasting impact is to be achieved.

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