scholarly journals 221 Delirium Detection in the ED Utilizing the 4AT Delirium Screening Tool

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Louise Kelly ◽  
Caitriona Whelan ◽  
Maeve Ryan ◽  
Ruth Wade ◽  
Orla Boyle ◽  
...  
Keyword(s):  
At Risk ◽  
Assessment Tool ◽  
Clinical Care ◽  
Routine Screening ◽  
High Rate ◽  
Medical Emergency ◽  
Tertiary Referral Centre ◽  
Clinical Frailty Scale ◽  
Acute Setting ◽  
Increased Risk

Abstract Background Delirium is a medical emergency and is associated with increased risk of mortality, in-hospital complications, length of stay and institutionalisation. Delirium screening is recommended for patients at risk on admission. Despite this, delirium screening is frequently not undertaken in the acute setting leading to undiagnosed delirium and sub-optimal clinical care. We aim to investigate the prevalence of delirium in patients aged ≥75 years attending the Emergency Department (ED) of a tertiary referral centre. Methods Patients aged ≥75yrs presenting to the ED between 08.30 and 18.30, Monday- Friday were assessed by an interdisplinary gerontological service using a standardised assessment tool including the 4AT to screen for delirium. Data was collected and analysed via Excel. Results Of 163 patients screened over a 4 week period 47.9% (78/163) were male with a mean age of 81.8 years (SD 2.7). Twenty three percent (34/148) scored ≥4 indicating a possible delirium. Patients with delirium were older (85 yrs vs. 80 yrs, P<0.001), were more likely to score ≥4 on Clinical Frailty Scale (97% vs. 56%, P<0.001), and at risk of, or have malnutrition (MNA SF score <12) (86% vs. 40%, P<0.001). Conclusion Routine screening of patients in the acute setting detected a high rate of delirium at a level which is consistent with previous studies. Patients with delirium were older, more frequently frail and at risk of malnutrition. Our results support the evidence for routine screening for delirium in the acute setting.

scholarly journals Comparison of a Cancer Family History Collection and Risk Assessment Tool – ItRunsInMyFamily – with Risk Assessment by Health-Care Professionals

2021 ◽  
pp. 1-9
Author(s):  
Jordon B. Ritchie ◽  
Brandon M. Welch ◽  
Caitlin G. Allen ◽  
Lewis J. Frey ◽  
Heath Morrison ◽  
...  
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Genetic Counseling ◽  
Hereditary Cancer ◽  
Health Care Professionals ◽  
Assessment Tool ◽  
Family Health ◽  
Primary Care Providers ◽  
Care Providers ◽  
Increased Risk

<b><i>Introduction:</i></b> Primary care providers (PCPs) and oncologists lack time and training to appropriately identify patients at increased risk for hereditary cancer using family health history (FHx) and clinical practice guideline (CPG) criteria. We built a tool, “ItRunsInMyFamily” (ItRuns) that automates FHx collection and risk assessment using CPGs. The purpose of this study was to evaluate ItRuns by measuring the level of concordance in referral patterns for genetic counseling/testing (GC/GT) between the CPGs as applied by the tool and genetic counselors (GCs), in comparison to oncologists and PCPs. The extent to which non-GCs are discordant with CPGs is a gap that health information technology, such as ItRuns, can help close to facilitate the identification of individuals at risk for hereditary cancer. <b><i>Methods:</i></b> We curated 18 FHx cases and surveyed GCs and non-GCs (oncologists and PCPs) to assess concordance with ItRuns CPG criteria for referring patients for GC/GT. Percent agreement was used to describe concordance, and logistic regression to compare providers and the tool’s concordance with CPG criteria. <b><i>Results:</i></b> GCs had the best overall concordance with the CPGs used in ItRuns at 82.2%, followed by oncologists with 66.0% and PCPs with 60.6%. GCs were significantly more likely to concur with CPGs (OR = 4.04, 95% CI = 3.35–4.89) than non-GCs. All providers had higher concordance with CPGs for FHx cases that met the criteria for genetic counseling/testing than for cases that did not. <b><i>Discussion/Conclusion:</i></b> The risk assessment provided by ItRuns was highly concordant with that of GC’s, particularly for at-risk individuals. The use of such technology-based tools improves efficiency and can lead to greater numbers of at-risk individuals accessing genetic counseling, testing, and mutation-based interventions to improve health.

scholarly journals Frailty as a Predictor for Mortality Among Patients With COVID-19: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Xiaoming Zhang ◽  
Jing Jiao ◽  
Jing Cao ◽  
Xiao-Peng Huo ◽  
Chen Zhu ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Frailty Index ◽  
Relevant Literature ◽  
Nursing Home Residents ◽  
Cochrane Library ◽  
Early Screening ◽  
Clinical Frailty Scale ◽  
Increased Risk

Abstract BackgroundA great number of studies have explored the association between frailty and mortality among COVID-19 patients, suggesting inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue. MethodsThree databases, including PubMed, Embase, and Cochrane Library from inception to 20th October, 2020 were conducted to search for relevant literature. The Newcastle–Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size. Additionally, potential publication bias and sensitivity analysis was performed.ResultsThere are 11 studies that were included, with a total of 22105 COVID-19 patients for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95%CI:42%-60%). Patients infected with COVID-19 with frailty had an increased risk of mortality, compared to those without frailty, and the pooled HR was 2.27 (95%CI:1.79-2.89). In addition, subgroup analysis based on population showed that the pooled HR for hospitalized patients and nursing home residents was 2.24 (95%CI:1.74-2.89) and 2.95 (95%CI:1.19-7.32), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS)(HR=2.41;95%CI:1.60-3.62), frailty index(HR=2.95;95%CI:1.19-7.32), hospital frailty risk score (HR=1.96;95%CI:1.79-2.15) and palliative performance scale (HR= 2.89;95%CI:1.42-5.87). ConclusionOur study indicates that frailty was an independent predictor for mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups, and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.

scholarly journals Nutritional status assessment among elderly population in a rural area of South India

2020 ◽  
Vol 7 (7) ◽  
pp. 2760
Author(s):  
S. Palanivel Rajan ◽  
S. Jeevithan ◽  
D. Shanmugapriya ◽  
L. Padmavathy
Keyword(s):  
At Risk ◽  
Rural Areas ◽  
Early Identification ◽  
Elderly Population ◽  
Tertiary Care ◽  
High Rate ◽  
Care Hospital ◽  
South Indian ◽  
Increased Risk ◽  
Study Participants

Background: With growing science and technology, the proportion of elderly population is increasing worldwide. Ageing with coupled with increased risk of malnutrition in elderly and is often the neglected part resulting in increased morbidity and mortality. Early identification and intervention of the malnutrition among elderly population plays a crucial role in improve the health of the elderly. Objective of the study was to estimate the prevalence of malnutrition among elderly in rural south Indian population.Methods: A Community based cross sectional study was conducted over a period of 2 months among 392 elderly population residing in a rural field practice area of a tertiary care hospital in Coimbatore. Elderly population both males and females > 60 years of age were screened for malnutrition and at risk for malnutrition using Mini Nutrition Assessment (MNA) tool. Data was analysed using Excel. p<0.05 were considered significant.Results: Majority of the study participants were in the age group of 60-70 years. 21.4% of the study participants were malnourished and 32.65% were at risk for malnutrition. The risk of malnutrition (40.57%) and malnutrition (25.71%) were high in females and is statistically significantly (p<0.05).Conclusions: Malnutrition among elderly is increasing at high rate even in rural areas. Early identification and intervention has to be done.

scholarly journals Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiao-Ming Zhang ◽  
Jing Jiao ◽  
Jing Cao ◽  
Xiao-Peng Huo ◽  
Chen Zhu ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Nursing Home Residents ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Early Screening ◽  
Clinical Frailty Scale ◽  
Increased Risk

Abstract Background A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue. Methods Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle–Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed. Results Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44–59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66–2.38) and 2.48 (95% CI: 1.78–3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68–4.07) and 2.09 (95% CI: 1.40–3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52–5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66–2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81–2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region. Conclusion Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.

scholarly journals Individuals at increased risk for development of bipolar disorder display structural alterations similar to people with manifest disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pavol Mikolas ◽  
Kyra Bröckel ◽  
Christoph Vogelbacher ◽  
Dirk K. Müller ◽  
Michael Marxen ◽  
...  
Keyword(s):  
At Risk ◽  
Bipolar Disorder ◽  
High Risk ◽  
Help Seeking ◽  
Large Scale ◽  
Assessment Tool ◽  
Early Recognition ◽  
Structural Alterations ◽  
Populations At Risk ◽  
Increased Risk

AbstractIn psychiatry, there has been a growing focus on identifying at-risk populations. For schizophrenia, these efforts have led to the development of early recognition and intervention measures. Despite a similar disease burden, the populations at risk of bipolar disorder have not been sufficiently characterized. Within the BipoLife consortium, we used magnetic resonance imaging (MRI) data from a multicenter study to assess structural gray matter alterations in N = 263 help-seeking individuals from seven study sites. We defined the risk using the EPIbipolar assessment tool as no-risk, low-risk, and high-risk and used a region-of-interest approach (ROI) based on the results of two large-scale multicenter studies of bipolar disorder by the ENIGMA working group. We detected significant differences in the thickness of the left pars opercularis (Cohen’s d = 0.47, p = 0.024) between groups. The cortex was significantly thinner in high-risk individuals compared to those in the no-risk group (p = 0.011). We detected no differences in the hippocampal volume. Exploratory analyses revealed no significant differences in other cortical or subcortical regions. The thinner cortex in help-seeking individuals at risk of bipolar disorder is in line with previous findings in patients with the established disorder and corresponds to the region of the highest effect size in the ENIGMA study of cortical alterations. Structural alterations in prefrontal cortex might be a trait marker of bipolar risk. This is the largest structural MRI study of help-seeking individuals at increased risk of bipolar disorder.

scholarly journals Frailty Severity and Hospitalization After Dialysis Initiation

2021 ◽  
Vol 8 ◽  
pp. 205435812110233
Author(s):  
David Clark ◽  
Kara Matheson ◽  
Benjamin West ◽  
Amanda Vinson ◽  
Kenneth West ◽  
...  
Keyword(s):  
At Risk ◽  
Negative Binomial ◽  
Dialysis Initiation ◽  
Negative Binomial Regression Model ◽  
Relative Hazard ◽  
Dialysis Patients ◽  
Clinical Frailty Scale ◽  
Frail Patients ◽  
Increased Risk ◽  
Cumulative Time

Background: Frailty is associated with hospitalization and mortality among dialysis patients. To now, few studies have considered the degree of frailty as a predictor of hospitalization. Objective: We evaluated whether frailty severity was associated with hospitalization after dialysis initiation. Design: Retrolective cohort study. Setting: Nova Scotia, Canada. Patients: Consecutive adult, chronic dialysis patients who initiated dialysis from January 1, 2009 to June 30, 2014, (last follow-up June, 2015). Methods: Frailty Severity, as determined by the 7-point Clinical Frailty Scale (CFS, ranging from 1 = very fit to 7 = severely frail), was measured at dialysis initiation and treated as continuous and in categories (CFS scores of 1-3, 4/5, and 6/7). Hospitalization was characterized by cumulative time admitted to hospital (proportion of days admitted/time at risk) and by the joint risk of hospitalization and death. Time at risk included time in hospital after dialysis initiation and patients were followed until transplantation or death. Results: Of 647 patients (mean age: 62 ± 15), 564 (87%) had CFS scores. The mean CFS score was 4 (“corresponding to “vulnerable”) ± 2 (“well” to “moderately frail”). In an adjusted negative binomial regression model, moderate-severely frail patients (CFS 6/7) had a >2-fold increased risk of cumulative time admitted to hospital compared to the lowest CFS category (IRR = 2.18, 95% confidence interval [CI] = 1.31-3.63). In the joint model, moderate-severely frail patients had a 61% increase in the relative hazard for hospitalization (hazard ratio [HR] = 1.61, 95% CI = 1.29-2.02) and a 93% increase in the relative hazard for death compared to the lowest CFS category (HR = 1.93, 95% CI = 1.16-3.22). Limitations: Potential unknown confounders may have affected the association between frailty severity and hospitalization given observational study design. The CFS is subjective and different clinicians may grade frailty severity differently or misclassify patients on the basis of limited availability. Conclusions: Among incident dialysis patients, a higher frailty severity as defined by the CFS is associated with both an increased risk of cumulative time admitted to hospital and joint risk of hospitalization and death.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

2020 ◽  
Author(s):  
Judd Sher ◽  
Kate Kirkham-Ali ◽  
Denny Luo ◽  
Catherine Miller ◽  
Dileep Sharma
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Drug Therapy ◽  
Dental Implant ◽  
Case Series ◽  
Cochrane Central Register ◽  
Bisphosphonate Treatment ◽  
Implant Placement ◽  
Increased Risk ◽  
History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

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