scholarly journals 218 Swallowing/Communication Screening in Older Adults Attending the Emergency Department and Association with Clinical Frailty Scale Scores

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Orla Boyle ◽  
Louise Kelly ◽  
Maeve Ryan ◽  
Deirdre Brady ◽  
Ruth Wade ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Screening Tool ◽  
Future Research ◽  
Language Therapy ◽  
Clinical Frailty Scale ◽  
Acute Setting ◽  
Communication Difficulties ◽  
Scale Scores ◽  
High Level

Abstract Background Dysphagia, frailty and negative patient outcomes are interlinked1. Changes in communication may result from the ageing process, chronic conditions, and/or neurologic conditions presenting in later years2. However, unlike other cohorts, including stroke, frail older patients are not routinely screened for swallowing/communication difficulties in acute settings. We investigated the proportion of Speech and Language Therapy (SLT) referrals generated for older patients attending our Emergency Department (ED) following use of a swallowing/communication screening tool and their association with Clinical Frailty Scale (CFS) scores. Methods A retrospective analysis of data collected over a four week period was completed. Older patients presenting to ED were screened by the interdisciplinary gerontological ED team using a screening tool, including a locally developed swallow/communication screen. Statistical analyses were performed using STATA Version 12. Results Of 176 patients screened (mean age 81.8 years, SD 5.9 years), median CFS score was 5 (IQR 3-6). Thirty-seven percent (66/176) of patients were referred for SLT assessment following initial screen. SLT referrals were more commonly required in patients with a CFS score of ≥4 (46.2% vs. 19.3%, P=0.001) and likelihood of requiring SLT referral increased with greater CFS score (P<0.0001). Conclusion Results suggest that screening for swallowing and communication difficulties in older patients yields a high level of SLT referrals, with a higher frequency of SLT referrals observed with increasing frailty scores. Further research is required to determine the optimum swallowing/communication screening tool in the acute setting. Future research will focus on evaluating outcomes of SLT assessments completed and determining the prevalence of swallowing and/or communication difficulties in this cohort.

scholarly journals Acceptability of older patients’ self-assessment in the Emergency Department (ACCEPTED)—a randomised cross-over pilot trial

2019 ◽  
Vol 48 (6) ◽  
pp. 875-880
Author(s):  
Valérie Boucher ◽  
Marie-Eve Lamontagne ◽  
Jacques Lee ◽  
Pierre-Hugues Carmichael ◽  
Julien Déry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Qualitative Data ◽  
Pilot Trial ◽  
Research Assistant ◽  
Self Assessment ◽  
Clinical Frailty Scale ◽  
Use Of Technology ◽  
Standard Assessment ◽  
Patient Self Assessment

Abstract Background patient self-assessment using electronic tablet could improve the quality of assessment of older Emergency Department(ED) patients. However, the acceptability of this practice remains unknown. Objective to compare the acceptability of self-assessment using a tablet in the ED to a standard assessment by a research assistant (RA), according to seniors and their caregivers. Design randomised crossover pilot study. Setting The Hôpital de l’Enfant-Jésus (CHU de Québec–Université Laval) (2018/05–2018/07). Subjects (1) ED patients aged ≥65, (2) their caregiver, if present. Methods participants’ frailty, cognitive and functional status were assessed with the Clinical Frailty scale, Montreal Cognitive Assessment, and Older American Resources and Services scale and patients self-assessed using a tablet. Test administration order was randomised. The primary outcome, acceptability, was measured using the Treatment Acceptability and Preferences (TAP) scale. Descriptive analyses were performed for sociodemographic variables. TAP scores were adjusted using multivariate linear regression. Thematic content analysis was performed for qualitative data. Results sixty-seven patients were included. Mean age was 75.5 ± 8.0 and 55.2% were women. Adjusted TAP scores for RA evaluation and patient self-assessment were 2.36 and 2.20, respectively (P = 0.08). Patients aged ≥85 showed a difference between the TAP scores (P < 0.05). Qualitative data indicates that this might be attributed to the use of technology. Data from nine caregivers showed a 2.42 mean TAP score for RA evaluation and 2.44 for self-assessment. Conclusions our results show that older patients believe self-assessment in the ED using an electronic tablet as acceptable as a standard evaluation by a research assistant. Patients aged ≥85 find this practice less acceptable.

scholarly journals Patient Versus Physician Perceptions of Frailty: A Comparison of Clinical Frailty Scale Scores of Older Adults in the Emergency Department

2019 ◽  
Vol 26 (9) ◽  
pp. 1089-1092 ◽  
Author(s):  
Scott M. Dresden ◽  
Timothy F. Platts‐Mills ◽  
Deepika Kandasamy ◽  
Lauren Walden ◽  
Marian E. Betz
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Clinical Frailty Scale ◽  
Physician Perceptions ◽  
Scale Scores

The Application of Relaxation Training Approaches to Patients With Neurogenic Disorders and Their Caregivers

2008 ◽  
Vol 18 (3) ◽  
pp. 90-98 ◽  
Author(s):  
Laura L. Murray
Keyword(s):  
Cognitive Deficits ◽  
Relaxation Training ◽  
Future Research ◽  
Relaxation Therapy ◽  
Language Therapy ◽  
Language Management ◽  
Methodological Rigor ◽  
Communicative Disorders ◽  
High Level ◽  
Neurogenic Disorders

Abstract Purpose: Because relaxation therapy remains a popular complementary and alternative medicine approach, this review paper was written to (a) introduce speech-language clinicians to relaxation therapy procedures, (b) summarize research regarding outcomes associated with relaxation therapy in healthy and patient populations, including those with neurogenic cognitive and communicative disorders, and (c) identify future research needs and clinical applications regarding the use of relaxation therapy within speech-language management protocols. Method: A review of the literature pertaining to relaxation therapy among healthy adults, individuals with non-neurogenic disorders, and individuals with neurogenic cognitive-communicative disorders was conducted and critically summarized. Results and Conclusions: Preliminary data suggest that relaxation therapy, when applied alone or in concert with conventional speech-language therapy protocols, may be used to address a variety of neurogenic cognitive and communicative problems ranging from dysarthria in Parkinson's disease to high-level cognitive deficits in traumatic brain injury. Further research is needed, however, given the paucity of studies involving individuals with neurogenic cognitive or communicative disorders and that much of the extant literature regarding relaxation therapy has lacked the methodological rigor necessary to evoke confidence in the reported findings. Suggestions regarding how to broaden the scope of research regarding relaxation training are provided.

Risk Stratification of Older Patients in the Emergency Department: Comparison Between the Identification of Seniors At Risk and Triage Risk Screening Tool

2012 ◽  
Vol 15 (3) ◽  
pp. 288-294 ◽  
Author(s):  
Fabio Salvi ◽  
Valeria Morichi ◽  
Barbara Lorenzetti ◽  
Lorena Rossi ◽  
Liana Spazzafumo ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Risk Stratification ◽  
Older Patients ◽  
Screening Tool ◽  
Risk Screening

Power of Modified Brown-Forsythe and Mixed-Model Approaches in Split-Plot Designs

Methodology ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 9-22 ◽  
Author(s):  
Pablo Livacic-Rojas ◽  
Guillermo Vallejo ◽  
Paula Fernández ◽  
Ellián Tuero-Herrero
Keyword(s):  
Repeated Measures ◽  
Statistical Power ◽  
Mixed Model ◽  
Covariance Structure ◽  
Simulation Method ◽  
Future Research ◽  
Repeated Measures Design ◽  
Fixed And Random Effects ◽  
Split Plot ◽  
High Level

Abstract. Low precision of the inferences of data analyzed with univariate or multivariate models of the Analysis of Variance (ANOVA) in repeated-measures design is associated to the absence of normality distribution of data, nonspherical covariance structures and free variation of the variance and covariance, the lack of knowledge of the error structure underlying the data, and the wrong choice of covariance structure from different selectors. In this study, levels of statistical power presented the Modified Brown Forsythe (MBF) and two procedures with the Mixed-Model Approaches (the Akaike’s Criterion, the Correctly Identified Model [CIM]) are compared. The data were analyzed using Monte Carlo simulation method with the statistical package SAS 9.2, a split-plot design, and considering six manipulated variables. The results show that the procedures exhibit high statistical power levels for within and interactional effects, and moderate and low levels for the between-groups effects under the different conditions analyzed. For the latter, only the Modified Brown Forsythe shows high level of power mainly for groups with 30 cases and Unstructured (UN) and Autoregressive Heterogeneity (ARH) matrices. For this reason, we recommend using this procedure since it exhibits higher levels of power for all effects and does not require a matrix type that underlies the structure of the data. Future research needs to be done in order to compare the power with corrected selectors using single-level and multilevel designs for fixed and random effects.

COVID-19 Outbreak Prediction with Machine Learning

2020 ◽  
Author(s):  
Sina Faizollahzadeh Ardabili ◽  
Amir Mosavi ◽  
Pedram Ghamisi ◽  
Filip Ferdinand ◽  
Annamaria R. Varkonyi-Koczy ◽  
...  
Keyword(s):  
Machine Learning ◽  
Prediction Models ◽  
Fuzzy Inference ◽  
Control Measures ◽  
Future Research ◽  
Complex Nature ◽  
Inference System ◽  
Wide Range ◽  
Standard Models ◽  
High Level

Several outbreak prediction models for COVID-19 are being used by officials around the world to make informed-decisions and enforce relevant control measures. Among the standard models for COVID-19 global pandemic prediction, simple epidemiological and statistical models have received more attention by authorities, and they are popular in the media. Due to a high level of uncertainty and lack of essential data, standard models have shown low accuracy for long-term prediction. Although the literature includes several attempts to address this issue, the essential generalization and robustness abilities of existing models needs to be improved. This paper presents a comparative analysis of machine learning and soft computing models to predict the COVID-19 outbreak as an alternative to SIR and SEIR models. Among a wide range of machine learning models investigated, two models showed promising results (i.e., multi-layered perceptron, MLP, and adaptive network-based fuzzy inference system, ANFIS). Based on the results reported here, and due to the highly complex nature of the COVID-19 outbreak and variation in its behavior from nation-to-nation, this study suggests machine learning as an effective tool to model the outbreak. This paper provides an initial benchmarking to demonstrate the potential of machine learning for future research. Paper further suggests that real novelty in outbreak prediction can be realized through integrating machine learning and SEIR models.

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