Patient and caregiver perspectives on a tool to identify undiagnosed dementia: A qualitative study

Abstract BACKGROUND Early detection of dementia may improve patient care and quality of life, yet as many as half of patients are undiagnosed. Electronic health record (EHR) data could potentially be used to help to identify patients at risk of having undiagnosed dementia who could be targeted for outreach and assessment, but acceptability to patients and caregivers is unknown. METHOD We conducted five focus groups at Kaiser Permanente Washington, an integrated healthcare system in Washington State, to explore feelings about timing of dementia diagnosis, use of EHR-33 based tools to predict risk of undiagnosed dementia, and communication about risk. Two team members analyzed transcripts using inductive thematic coding. RESULTS Participant groups included: patients with dementia or mild cognitive impairment, patients with neither diagnosis, and caregivers. People who were non-white or Hispanic were oversampled. Forty patients and caregivers (63% women; 59% non-white/Hispanic) participated in focus 39 groups. Participants supported early diagnosis, describing benefits such as time to adjust to the disease, plan, involve caregivers, and identify resources. They also acknowledged the possible psychosocial toll of receiving the diagnosis. Participants also supported use of an EHR-based tool, but some worried about accuracy and privacy. Participants emphasized that information about dementia risk should be communicated thoughtfully by a trusted provider and should include advice about prognosis, treatment options and other resources. CONCLUSION Overall, patients and caregivers supported using EHR-based tools to help identify patients at risk of having undiagnosed dementia. Such tools must be implemented carefully to address concerns and ensure patients and caregivers are adequately supported.

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Patient and caregiver perspectives on a tool to increase recognition of undiagnosed dementia: a qualitative study

BMC Geriatrics ◽

10.1186/s12877-021-02523-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lorella Palazzo ◽

Clarissa Hsu ◽

Deborah E. Barnes ◽

Marlaine Figueroa Gray ◽

Mikael Anne Greenwood-Hickman ◽

...

Keyword(s):

At Risk ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Focus Groups ◽

Treatment Options ◽

Improve Patient Care ◽

Dementia Diagnosis ◽

Kaiser Permanente ◽

Team Members ◽

People With Dementia

Abstract Background Early detection of dementia may improve patient care and quality of life, yet up to half of people with dementia are undiagnosed. Electronic health record (EHR) data could be used to help identify individuals at risk of having undiagnosed dementia for outreach and assessment, but acceptability to people with dementia and caregivers is unknown. Methods We conducted five focus groups at Kaiser Permanente Washington (KPWA), an integrated healthcare system in Washington State, to explore people’s feelings about timing of dementia diagnosis, use of EHR-based tools to predict risk of undiagnosed dementia, and communication about risk. We recruited people enrolled in KPWA who had dementia or mild cognitive impairment, people enrolled in KPWA who had neither diagnosis, and caregivers (i.e., loved ones of people with dementia who assist with various tasks of daily life). People who were non-white or Hispanic were oversampled. Two team members analyzed transcripts using thematic coding. Results Forty people (63% women; 59% non-white or Hispanic) participated in the focus groups. Themes that arose included: perceived pros and cons of early dementia diagnosis; questions and concerns about a potential tool to assess risk of undiagnosed dementia; and preferences related to patient-provider conversations disclosing that a person was at high risk to have undiagnosed dementia. Participants supported early diagnosis, describing benefits such as time to adjust to the disease, plan, involve caregivers, and identify resources. They also acknowledged the possible psychosocial toll of receiving the diagnosis. Participants supported use of an EHR-based tool, but some people worried about accuracy and privacy. Participants emphasized that information about risk of undiagnosed dementia should be communicated thoughtfully by a trusted provider and that the conversation should include advice about prognosis, treatment options and other resources when a new dementia diagnosis was made. Conclusion People with dementia or mild cognitive impairment, people with neither diagnosis, and caregivers of people with dementia supported using EHR-based tools to help identify individuals at risk of having undiagnosed dementia. Such tools must be implemented carefully to address concerns and ensure that people living with dementia and their caregivers are adequately supported.

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Analytical Methods for the Determination of Sartans in Pharmaceutical Formulations and Biological Fluids: A Review

Current Analytical Chemistry ◽

10.2174/1573411014666181114091850 ◽

2020 ◽

Vol 16 (3) ◽

pp. 208-222

Author(s):

Miglena Smerikarova ◽

Stanislav Bozhanov ◽

Vania Maslarska

Keyword(s):

Biological Fluids ◽

Pharmaceutical Preparations ◽

Improve Patient Care ◽

Pharmaceutical Formulations ◽

Treatment Of Hypertension ◽

Therapeutic Doses ◽

Reliable Methods ◽

Improve Patient

Background: Sartans are mostly used as a part of combination with additional medicines in the therapy of essencial hypertension. Preferred combinations are ARB and thiazide diuretics (Hydrochlorothiazide (HCT) and Chlorthalidone (CHL)) or ARB and calcium antagonists. The number of sartans mostly prescribed by specialists is only seven - Candesartan (CDS), Eprosartan (EPS), Irbesartan (IBS), Losartan (LOS), Olmesartan (OMS), Telmisartan (TMS) and Valsartan (VLS). Methods: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. According to our knowledge, a review devoted to the analysis of sartans was published in 2014. Results: Spectral methods are widely used in the analysis of bulk drugs and pharmaceutical dosage forms due to their relatively simple procedures, low reagent and sample consumption, speed, precision and accuracy combined with accessibility and comparatively low cost of common apparatus. Many papers for determination of sartans in bulk drugs and pharmaceutical preparations based on liquid chromatographic techniques were published in the available literature. Among these methods, HPLC takes the leading place but UPLC and HPTLC are also present. Conclusion: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. Since 2014, many articles have been published on the sartans analysis and this provoked our interest to summarize the latest applications in the analysis of sartans in pharmaceutical formulations and biological media. Articles published from 2014 to 2018 are covered.

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Improving the quality of care for patients at risk for venous thromboembolism

American Journal of Health-System Pharmacy ◽

10.2146/ajhp100176 ◽

2010 ◽

Vol 67 (10_Supplement_6) ◽

pp. S3-S8

Author(s):

Stuart T. Haines

Keyword(s):

At Risk ◽

Quality Of Care ◽

Venous Thromboembolism ◽

Patients At Risk

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Piloting a Statewide Emergency Department Take‐Home Naloxone Program: Improving the Quality of Care for Patients at Risk of Opioid Overdose

Academic Emergency Medicine ◽

10.1111/acem.14435 ◽

2021 ◽

Author(s):

Aaron Dora‐Laskey ◽

Joan Kellenberg ◽

Chin Hwa Dahlem ◽

Elizabeth English ◽

Monica Gonzalez Walker ◽

...

Keyword(s):

At Risk ◽

Emergency Department ◽

Quality Of Care ◽

Opioid Overdose ◽

Patients At Risk

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Incorporation of Quality-of-Life Considerations into Decision Models for the Use of Colony-Stimulating Factors in Chemotherapy Patients at Risk for Febrile Neutropenia

Febrile Neutropenia ◽

10.1007/978-3-642-60443-0_4 ◽

1997 ◽

pp. 17-22 ◽

Cited By ~ 4

Author(s):

G. H. Lyman ◽

N. M. Kuderer

Keyword(s):

Quality Of Life ◽

At Risk ◽

Febrile Neutropenia ◽

Decision Models ◽

Colony Stimulating Factors ◽

Patients At Risk ◽

Chemotherapy Patients

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Embedding neuroscience in psychiatry training

BJPsych Advances ◽

10.1192/bja.2020.27 ◽

2020 ◽

Vol 26 (6) ◽

pp. 379-380

Author(s):

Christopher O'Loughlin

Keyword(s):

Patient Care ◽

Royal College ◽

Treatment Options ◽

Improve Patient Care ◽

Medical Specialty ◽

Psychiatry Training ◽

Clinical Assessments ◽

The Uk ◽

Improve Patient ◽

Scientific Fields

SUMMARYTraining in neuroscience is vital to the future of psychiatry as a medical specialty. Trainees and trainers alike demonstrate a desire to keep up to date with developments in the associated scientific fields. Neuroscience increasingly underpins clinical assessments, treatment options and patients’ expectations. Psychiatry training in the UK can embrace neuroscience at many levels, from discussing patient presentations with supervisors, to teaching programmes supported by the Royal College of Psychiatrists’ activities. Although challenges remain, neuroscience literacy enhances the specialty and will improve patient care.

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Nutritional Risk Screening and Assessment

Journal of Clinical Medicine ◽

10.3390/jcm8071065 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1065 ◽

Cited By ~ 23

Author(s):

Emilie Reber ◽

Filomena Gomes ◽

Maria F. Vasiloglou ◽

Philipp Schuetz ◽

Zeno Stanga

Keyword(s):

Quality Of Life ◽

At Risk ◽

Nutritional Support ◽

Nutritional Risk ◽

Nutritional Management ◽

Risk Screening ◽

Care Plans ◽

Patients At Risk ◽

Nutritional Risk Screening

Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.

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1042. Stenotrophomans maltophilia Bacteremia, A 10-Year Tertiary Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.879 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S311-S311 ◽

Cited By ~ 1

Author(s):

Ahmed Hamdi ◽

Madiha Fida ◽

Omar AbuSaleh ◽

Elena Beam

Keyword(s):

At Risk ◽

Broad Spectrum ◽

Treatment Options ◽

Hemodynamic Instability ◽

Fluoroquinolone Resistance ◽

Common Source ◽

High Morbidity ◽

Tertiary Center ◽

Risk Sources ◽

Patients At Risk

Abstract Background Stenotrophomonas maltophilia is a hospital acquired infection that is associated with high morbidity and mortality. There has been a reported rise in S. maltophilia infections, presumed secondary to the increase in the population at risk. Methods We retrospectively reviewed all hospitalized adult patients in Mayo Clinic, MN with S. maltophilia bacteremia from January 2008 through January 2018. We analyzed patient population and described patients at risk, sources of infection, and changes in antimicrobial susceptibility profile. Results A total of 94 patients were analyzed, including 52 males, median age of 56 (46–65.75 IQR). The population included 60 infections in those with malignancies and 30 infections in transplant recipients. At presentation, 58 (61.7%) were febrile, while 54 (58.1%) presented with hemodynamic instability. Majority (70.2%) received broad-spectrum antimicrobials within 2 weeks of presentation. The most common source was catheter associated infection (n = 60), 15 cases were secondary to gastrointestinal, and 9 due to a pulmonary source. Almost half, 46 (48.9%) required ICU admission. Two patients were diagnosed with endocarditis. Most isolates, 61(64.9%), were resistant to ceftazidime, 2 (2.2%) resistant to TMP/SMX and 20 (21.5%) were resistant to levofloxacin. Exposure to a quinolone in the 30 days prior to presentation did not impact fluoroquinolone resistance. Five patients were exposed to Trimethoprim/Sulfamethoxazole (TMP/SMX) in the 30 days prior to presentation, which was associated with higher rate of TMP/SMX resistance compared with those without exposure (80% vs. 98.8%, P = 0.004). Treatment options commonly included combination therapy, and TMP/SMX was a primary agent used in the majority, 59 (62.8%). All-cause in-hospital mortality was 26.6%. All-cause mortality was lower for line associated infections (16.67%) vs. other sources (44.12%) with P = 0.0038. Conclusion S. maltophilia bacteremia should be considered in hospitalized patients with recent use of broad-spectrum antibiotics. Although TMP/SMX continues to have reliable activity, use of empiric ceftazidime pending susceptibility testing should be avoided as trend toward increasing resistance is noted. We noted a drop in TMP/SMX susceptibility in those with recent reported TMP/SMX use. Disclosures All authors: No reported disclosures.

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