scholarly journals Are we adequately reviewing confusion inducing drugs in patients referred to the memory assessment service?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S193-S193
Author(s):  
Siddhant Hegde ◽  
Rashi Negi ◽  
Hari Shanmugaratnam
Keyword(s):  
Quality Improvement ◽  
Cognitive Impairment ◽  
Royal College ◽  
Support Worker ◽  
Short Term ◽  
Data Set ◽  
Memory Assessment ◽  
Dementia Syndrome ◽  
Diagnosis Of Dementia ◽  
The Impact

AimsThe aim of this quality improvement evaluation project is to establish the standard of current practice in relation to reviewing confusion inducing drugs (CIDs) at the time of referral, as it has been hypothesised that these medications contribute to short term cognitive impairment. This is essential in order to establish the validity of the diagnostic processes of dementia syndrome in the memory assessment services.BackgroundIt has long been established that anti-cholinergic medications (ACMs) have contributed to short-term cognitive impairment in patients taking them. This is compounded with the fact that these medications may be continued without review, for longer than was originally intended. The impact of polypharmacy, subsequent anti-cholinergic burden, and the overlapping presence of delirium, may call into question the validity of a diagnosis of dementia in patients who have not been correctly vetted during the course of their assessment. This quality improvement evaluation aims to assess whether patients’ medications are being reviewed before diagnosing a memory disorder. This is in accordance with guidance set out by the NG97 NICE guidelines, The Royal College of Psychiatrists Memory Service National Accreditation Programme (MSNAP), and the National Institute on Ageing and Alzheimer's Association (NIA-AA).MethodAll new referrals to the memory assessment service during July and August 2019 were systematically reviewed and data extracted from the memory referral document and entries on RIO from first point of contact. The following data were recorded: patient ID, GPCOG/6CIT score, final diagnosis, CID prescriptions and CID review.ResultThe results were collated using a data-set of 216 patients (136 females and 80 males,) of which the mean age was 79 years. It was noted that 36% of patients had not had any sort of cognitive assessment before referral, which identifies an area for improvement. However the most substantial finding was that only 10 patients (5%) had a CID prescription review documented in the RIO notes.ConclusionOur data suggest that in our memory assessment service, only a small proportion of patients are having a documented review of their CIDs prior to diagnosis of dementia. In order to improve this and thus improve compliance with guidelines from the Royal College of Psychiatrists MSNAP and the NIA-AA, measures will be taken to issue each dementia support worker and nurse with a CID prescription review card, which will list those medications to consider and flag for review.

scholarly journals The impact of cognitive impairment at admission on short-term functional outcome of elderly hip fracture patients

2010 ◽  
Vol 138 (5-6) ◽  
pp. 319-322 ◽  
Author(s):  
Emilija Dubljanin-Raspopovic ◽  
Dragana Matanovic ◽  
Marko Bumbasirevic
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Functional Outcome ◽  
Cognitive Status ◽  
Cognitively Impaired ◽  
Short Term ◽  
Functional Gain ◽  
The Impact ◽  
Cognitively Intact

Introduction The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. Objective To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Methods Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge - FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Results Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p<0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p<0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p<0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p>0.05). Conclusion The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favorable short term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

scholarly journals Effects of agricultural credit on wheat productivity of small farms in Sindh, Pakistan

2018 ◽  
Vol 78 (5) ◽  
pp. 592-610 ◽  
Author(s):  
Abbas Ali Chandio ◽  
Yuansheng Jiang ◽  
Feng Wei ◽  
Xu Guangshun
Keyword(s):  
Wheat Yield ◽  
Considerable Proportion ◽  
Small Scale ◽  
Small Farms ◽  
Short Term ◽  
Agricultural Credit ◽  
Data Set ◽  
Content Type ◽  
The Impact

Purpose The purpose of this paper is to evaluate the impact of short-term loan (STL) vs long-term loan (LTL) on wheat productivity of small farms in Sindh, Pakistan. Design/methodology/approach The econometric estimation is based on cross-sectional data collected in 2016 from 18 villages in three districts, i.e. Shikarpur, Sukkur and Shaheed Benazirabad, Sindh, Pakistan. The sample data set consist of 180 wheat farmers. The collected data were analyzed through different econometric techniques like Cobb–Douglas production function and Instrumental variables (two-stage least squares) approach. Findings This study reconfirmed that agricultural credit has a positive and highly significant effect on wheat productivity, while the short-term loan has a stronger effect on wheat productivity than the long-term loan. The reasons behind the phenomenon may be the significantly higher usage of agricultural inputs like seeds of improved variety and fertilizers which can be transformed into the wheat yield in the same year. However, the LTL users have significantly higher investments in land preparation, irrigation and plant protection, which may lead to higher wheat production in the coming years. Research limitations/implications In the present study, only those wheat farmers were considered who obtained agricultural loans from formal financial institutions like Zarai Taraqiati Bank Limited and Khushhali Bank. However, in the rural areas of Sindh, Pakistan, a considerable proportion of small-scale farmers take credit from informal financial channels. Therefore future researchers should consider the informal credits as well. Originality/value This is the first paper to examine the effects of agricultural credit on wheat productivity of small farms in Sindh, Pakistan. This paper will be an important addition to the emerging literature regarding effects of credit studies.

scholarly journals Vascular cognitive impairment (VCI): Progress towards knowledge and treatment

2010 ◽  
Vol 4 (1) ◽  
pp. 4-13 ◽  
Author(s):  
Silvia Di Legge ◽  
Vladimir Hachinski
Keyword(s):  
Cognitive Impairment ◽  
Clinical Manifestations ◽  
Vascular Cognitive Impairment ◽  
Cognitive Outcome ◽  
Cognitive Domains ◽  
Mitochondrial Dna Damage ◽  
Complex Interactions ◽  
Dementia Syndrome ◽  
Data Elements ◽  
The Impact

Abstract Until recently, the study of cognitive impairment as a manifestation of cerebrovascular disease (CVD) has been hampered by the lack of common standards for assessment. The term vascular cognitive impairment (VCI) encompasses all levels of cognitive decline associated with CVD from mild deficits in one or more cognitive domains to crude dementia syndrome. VCI incorporates the complex interactions among classic vascular risk factors (i.e. arterial hypertension, high cholesterol, and diabetes), CVD subtypes, and Alzheimer's Disease (AD) pathology. VCI may be the earliest, commonest, and subtlest manifestation of CVD and can be regarded as a highly prevalent and preventable syndrome. However, cognition is not a standardized outcome measure in clinical trials assessing functional ability after stroke. Furthermore, with the exception of anti-hypertensive medications, the impact of either preventive or acute stroke treatments on cognitive outcome is not known. Although clinical, epidemiological, neuroimaging, and experimental data support the VCI concept, there is a lack of integrated knowledge on the role played by the most relevant pathophysiological mechanisms involved in several neurological conditions including stroke and cognitive impairment such as excitotoxicity, apoptosis, mitochondrial DNA damage, oxidative stress, disturbed neurotransmitter release, and inflammation. For this reason, in 2006 the National Institute of Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) defined a set of data elements to be collected in future studies aimed at defining VCI etiology, clinical manifestations, predictive factors, and treatment. These recommendations represent the first step toward developing diagnostic criteria for VCI based on sound knowledge rather than on hypotheses. The second step will be to integrate all studies using the agreed methodologies. This is likely to accelerate the search for answers.

scholarly journals Neuroimaging Research on Dementia in Brazil in the Last Decade: Scientometric Analysis, Challenges, and Peculiarities

2021 ◽  
Vol 12 ◽  
Author(s):  
Liara Rizzi ◽  
Ítalo Karmann Aventurato ◽  
Marcio L. F. Balthazar
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Functional Neuroimaging ◽  
Citation Impact ◽  
Scientometric Analysis ◽  
Gender Inequalities ◽  
Dementia Syndrome ◽  
The World ◽  
Dementia Research ◽  
The Impact

The last years have evinced a remarkable growth in neuroimaging studies around the world. All these studies have contributed to a better understanding of the cerebral outcomes of dementia, even in the earliest phases. In low- and middle-income countries, studies involving structural and functional neuroimaging are challenging due to low investments and heterogeneous populations. Outstanding the importance of diagnosing mild cognitive impairment and dementia, the purpose of this paper is to offer an overview of neuroimaging dementia research in Brazil. The review includes a brief scientometric analysis of quantitative information about the development of this field over the past 10 years. Besides, discusses some peculiarities and challenges that have limited neuroimaging dementia research in this big and heterogeneous country of Latin America. We systematically reviewed existing neuroimaging literature with Brazilian authors that presented outcomes related to a dementia syndrome, published from 2010 to 2020. Briefly, the main neuroimaging methods used were morphometrics, followed by fMRI, and DTI. The major diseases analyzed were Alzheimer's disease, mild cognitive impairment, and vascular dementia, respectively. Moreover, research activity in Brazil has been restricted almost entirely to a few centers in the Southeast region, and funding could be the main driver for publications. There was relative stability concerning the number of publications per year, the citation impact has historically been below the world average, and the author's gender inequalities are not relevant in this specific field. Neuroimaging research in Brazil is far from being developed and widespread across the country. Fortunately, increasingly collaborations with foreign partnerships contribute to the impact of Brazil's domestic research. Although the challenges, neuroimaging researches performed in the native population regarding regional peculiarities and adversities are of pivotal importance.

GST Pass-through Across Indian Sates: Evidence from Difference-in-Differences

2018 ◽  
Vol 66 (1-2) ◽  
pp. 42-49
Author(s):  
Debashree Das
Keyword(s):  
Ordinary Least Squares ◽  
Rate Of Change ◽  
Control Group ◽  
Short Term ◽  
Difference In Differences ◽  
Data Set ◽  
Consumer Prices ◽  
Pass Through ◽  
The Impact ◽  
Special Category

This article analyses whether there exists any short-term inflationary pressure on Indian economy post Goods and Services Tax (GST) implementation. It was found that the introduction of GST showed no significant effect on the rate of change of consumer price index (CPI). Though, the effect of the GST implementation on consumer prices in India showed no significant change in the short term, the impact needs to monitored and observed for the long term, because the current state of economic conditions may have led to a delayed pass-through of the GST increase into consumer prices. To estimate the pass-through effect on prices due to GST implementation from 1 July 2017, various graphical and statistical methods are used to ascertain whether there has been any significant pass-through of GST on CPI– ordinary least squares (OLS) regression, and difference-in differences (DID) estimation technique has been used. The impact of post- and pre-implementation of GST has been analysed through DID by segregating the data set on the basis of treatment and control groups. The non-special category states have been taken as the treatment group and remaining special category states as control group. The results indicate that there is no significant evidence of upward bias in the CPI post GST implementation; these conventional estimates hold true for all states that were segmented based on revenue distribution and contribution to gross domestic product (GDP). JEL: D78, H20, H22

scholarly journals The impact of burning on lion Panthera leo habitat choice in an African savanna

2013 ◽  
Vol 59 (3) ◽  
pp. 335-339 ◽  
Author(s):  
Stephanie Eby ◽  
Anna Mosser ◽  
Ali Swanson ◽  
Craig Packer ◽  
Mark Ritchie
Keyword(s):  
National Park ◽  
Habitat Choice ◽  
Territory Size ◽  
Short Term ◽  
Data Set ◽  
Burned Areas ◽  
The Impact ◽  
Term Data ◽  
Prey Attraction

Abstract Carnivores play a central role in ecosystem processes by exerting top-down control, while fire exerts bottom-up control in ecosystems throughout the world, yet, little is known about how fire affects short-term carnivore distributions across the landscape. Through the use of a long-term data set we investigated the distribution of lions, during the daytime, in relation to burned areas in Serengeti National Park, Tanzania. We found that lions avoid burned areas despite the fact that herbivores, their prey, are attracted to burned areas. Prey attraction, however, likely results from the reduction in cover caused by burning, that may thereby decrease lion hunting success. Lions also do not preferentially utilize the edges of burned areas over unburned areas despite the possibility that edges would combine the benefit of cover with proximity to abundant prey. Despite the fact that lions avoid burned areas, lion territory size and reproductive success were not affected by the proportion of the territory burned each year. Therefore, burning does not seem to reduce lion fitness perhaps because of the heterogeneity of burned areas across the landscape or because it is possible that when hunting at night lions visit burned areas despite their daytime avoidance of these areas.

scholarly journals Predicting the Progression of Mild Cognitive Impairment Using Machine Learning: A Systematic, Quantitative and Critical Review

2020 ◽  
Author(s):  
Manon Ansart ◽  
Stephane Epelbaum ◽  
Giulia Bassignana ◽  
Alexandre Bone ◽  
Simona Bottani ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cognitive Impairment ◽  
Clinical Practice ◽  
Mild Cognitive Impairment ◽  
Parameter Tuning ◽  
Methodological Issues ◽  
Cognitive Assessments ◽  
Data Set ◽  
Mixed Effect ◽  
The Impact

We performed a systematic review of studies focusing on the automatic prediction of the progression of mild cognitive impairment to Alzheimer's disease (AD) dementia, and a quantitative analysis of the methodological choices impacting performance. This review included 172 articles, from which 234 experiments were extracted. For each of them, we reported the used data set, the feature types, the algorithm type, performance and potential methodological issues. The impact of these characteristics on the performance was evaluated using a multivariate mixed effect linear regressions. We found that using cognitive, fluorodeoxyglucose-positron emission tomography or potentially electroencephalography and magnetoencephalography variables significantly improved predictive performance compared to not including them, whereas including other modalities, in particular T1 magnetic resonance imaging, did not show a significant effect. The good performance of cognitive assessments questions the wide use of imaging for predicting the progression to AD and advocates for exploring further fine domain-specific cognitive assessments. We also identified several methodological issues, including the absence of a test set, or its use for feature selection or parameter tuning in nearly a fourth of the papers. Other issues, found in 15% of the studies, cast doubts on the relevance of the method to clinical practice. We also highlight that short-term predictions are likely not to be better than predicting that subjects stay stable over time. These issues highlight the importance of adhering to good practices for the use of machine learning as a decision support system for the clinical practice.

scholarly journals Data impact studies with the AROME WMED reanalysis of the HyMeX SOP1

2020 ◽  
Author(s):  
Nadia Fourrié ◽  
Mathieu Nuret ◽  
Pierre Brousseau ◽  
Olivier Caumont
Keyword(s):  
Hydrological Cycle ◽  
Radar Data ◽  
Scale Model ◽  
Small Data ◽  
Observation Data ◽  
Short Term ◽  
Data Set ◽  
The Impact ◽  
Forecast Quality ◽  
Wind Profilers

Abstract. This paper presents the results of several observing system experiments (OSEs) performed with AROME-WMED. This model is the HyMeX (Hydrological cycle in the Mediterranean Experiment) dedicated version (Fourrié et al., 2019) of the French operational meso-scale model AROME. The second and final reanalyses assimilated most of all available data for a 2 month period corresponding to the first Special Observation Period of HyMeX. In order to assess the impact of various observation data set assimilation on the forecasts, several OSEs or also-called denial experiments, were carried out. In this study, impact of a dense reprocessed network of high quality Global Navigation Satellite System (GNSS) Zenithal Total Delay (ZTD) observations, reprocessed wind-Profilers, lidar-derived vertical profiles of humidity (ground and airborne) and Spanish radar data, is thus discussed. Among the evaluated observations, it is found that the ground-based GNSS ZTD data set provides the largest impact on the analyses and the forecasts as it represents an evenly spread and frequent data set providing information at each analysis time over the AROME-WMED domain. The impact of the reprocessing of GNSS ZTD data also improves the forecast quality but this impact is not statistically significant. The assimilation of the Spanish radar data improves the very short term forecast quality as well as the short term forecasts but this impact remains located over Spain. Marginal impact from wind profilers was observed on wind background quality. No impacts have been found regarding lidar data as they represent a very small data set.

scholarly journals Underdiagnosis of Dementia among Indigenous Older Adults with Cognitive Impairment

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 644-644
Author(s):  
Takashi Amano ◽  
Carlos Andres Gallegos ◽  
William Waters ◽  
Wilma Freire
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Binary Logistic Regression ◽  
Lower Probability ◽  
Binary Logistic Regression Analysis ◽  
Data Set ◽  
Timely Diagnosis ◽  
Diagnosis Of Dementia ◽  
Higher Educational Attainment ◽  
And Function

Abstract Early and timely diagnosis of dementia has been recognized as key to improving health outcomes. However, underdiagnosis among the indigenous population has not been adequately investigated. This study examines the association between indigenous ethnic identity and receiving a diagnosis of dementia and identifies factors associated with receiving a diagnosis of dementia. Data were drawn from Ecuador’s Survey of Health, Welfare and Aging (SABE) – 2009, based on a probability sample of households in Ecuador with at least one person 60 years or older. This is a robust data set that allows for understanding ethnic dimensions and disparities, especially because of the successful recruitment of indigenous households. The final sample consisted of 1,437 people who had cognitive impairment. Whether participants had ever been told that he/she had dementia was compared between the groups of people who identified themselves either as indigenous or others. Binary logistic regression analysis was utilized. Indigenous participants had a lower probability than others of receiving a diagnosis of dementia after controlling for health and function related covariates. This association became statistically insignificant after including socioeconomic factors in the model. The final model revealed that people who had higher educational attainment were more likely to receive a diagnosis of dementia. Findings suggest that underdiagnosis among indigenous older adults can be explained by their lower socioeconomic status rather than by health and functional status. This finding implies the possibility of developing strategies to promote timely diagnosis by targeting populations who are especially susceptible to underdiagnosis of dementia.

Sign in / Sign up

Export Citation Format

Share Document