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Care trajectories and transitions at the end of life: a population-based cohort study. 生命末期的护理轨迹和过渡:一项基于人群的队列研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae218
Isabelle Dufour, Josiane Courteau, Véronique Legault, Claire Godard-Sebillotte, Pasquale Roberge, Catherine Hudon

Background: End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied.

Objective: To propose a typology of CTs, including care transitions, for older individuals in the 2 years preceding death.

Design: Retrospective cohort study.

Methods: We used multidimensional state sequence analysis and data from the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between a Canadian health survey and Quebec health administrative data.

Results: In total, 2080 decedents were categorised into five CT groups. Group 1 demonstrated low HCU until the last few months, whilst group 2 showed low HCU over the first year, followed by a steady increase. A gradual increase over the 2 years was observed for groups 3 and 4, though more pronounced towards the end for group 3. A persistent high HCU was observed for group 5. Groups 2 and 4 had higher proportions of cancer diagnoses and palliative care, as opposed to comorbidities and dementia for groups 3 and 5. Overall, 68.4% of individuals died in a hospital, whilst 27% received palliative care there. Care transitions increased rapidly towards the end, most notably in the last 2 weeks.

Conclusion: This study provides an understanding of the variability of CTs in the last two years of life, including place of death, a critical step towards quality improvement.

背景:对于 65 岁及以上的老年人来说,生命末期的特点往往是医疗保健使用(HCU)模式不理想,对健康和生活质量造成负面影响。了解这一时期的护理轨迹(CTs)和过渡可以突出潜在的改进领域,但对这一问题的研究还很少:目的:对老年人死亡前两年的护理轨迹(包括护理过渡)进行分类:设计:回顾性队列研究:我们使用了多维状态序列分析和护理轨迹丰富数据(TorSaDE)队列中的数据,该数据是加拿大健康调查和魁北克健康管理数据之间的联系:共有 2080 名死者被分为五个 CT 组。第一组在最后几个月前HCU较低,而第二组在第一年内HCU较低,随后稳步上升。第 3 组和第 4 组的 HCU 在两年内逐渐增加,但第 3 组在最后阶段更为明显。第 2 组和第 4 组的癌症诊断和姑息治疗比例较高,而第 3 组和第 5 组的合并症和痴呆症比例较低。总体而言,68.4%的患者死于医院,27%的患者在医院接受了姑息治疗。临终时,护理过渡迅速增加,尤其是在最后两周:这项研究有助于了解生命最后两年中 CT 的变化情况,包括死亡地点,这是提高质量的关键一步。
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引用次数: 0
The challenge of predicting frailty in geriatric oncology: insights from the hospital frailty risk score (HFRS) and the geriatric 8 (G8) screening tools. 老年肿瘤学中预测虚弱的挑战:从医院虚弱风险评分 (HFRS) 和老年 8 (G8) 筛查工具中获得的启示。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae236
Betuel Gomes, Juliana Fernandes
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引用次数: 0
Prevalence of concerns about falling in people with knee or hip osteoarthritis and the association with pain, function, and psychological factors-a cross-sectional study of 7442 patients treated in primary care. 膝关节或髋关节骨性关节炎患者担心跌倒的普遍程度以及与疼痛、功能和心理因素的关系--对 7442 名接受初级保健治疗的患者进行的横断面研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae224
Dorte T Grønne, Jesper Ryg, Katrine H Rubin, Kim Delbaere, Ewa M Roos, Søren T Skou

Background: Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA.

Methods: This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7-28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression.

Results: In total, 7442 patients were included [mean age 67 years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [β-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [-0.21 (-0.22; -0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex.

Conclusions: CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant.

背景:对跌倒的担忧(CaF)在老年人中很常见,会导致他们逃避活动、社交孤立和身体功能下降。然而,人们对骨关节炎(OA)患者的CaF了解有限;然而,症状可能会增加CaF。我们旨在评估膝关节或髋关节 OA 患者的 CaF 患病率及相关因素:这项横断面研究使用了丹麦骨关节炎患者 "美好生活 "登记处的数据,其中包括在初级医疗机构接受治疗的骨关节炎患者。CaF采用国际短跌倒效能量表(Short FES-I,范围7-28,从低到高)进行评估。采用多变量线性 Tobit 回归评估了 CaF 与疼痛、功能和心理因素之间的关系:共纳入 7442 名患者[平均年龄 67 岁(标准差:9.6),67% 为女性]。短期 FES-I 平均值为 9.8 [95% 置信区间 (CI):9.7; 9.8]。48.1%(95% 置信区间:46.7;48.9)的参与者存在中度 CaF,11.3%(95% 置信区间:10.7;12.1)的参与者存在高度 CaF。CaF在年龄最大的参与者和女性中更为普遍。疼痛强度[β值(95% CI):0.52 (0.48; 0.55)]、椅子站立测试[-0.21 (-0.22; -0.19)]和运动恐惧[1.38 (1.19; 1.56)]与不同年龄组和性别的CaF增加显著相关:结论:CaF在OA患者中很常见,尤其是在年龄最大的参与者和女性中。疼痛加剧、功能降低和心理困扰与CaF有关;然而,这些关联的因果关系仍有待确定。将CaF评估和干预纳入初级保健中的OA管理似乎非常有意义。
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引用次数: 0
Core outcome set for studies evaluating interventions to prevent or treat delirium in long-term care older residents: international key stakeholder informed consensus study. 评估长期护理老年居民谵妄预防或治疗干预措施研究的核心结果集:国际主要利益相关者知情共识研究。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae227
Gregor Russell, Namrata Rana, Siobhan T Reilly, Anas Shehadeh, Valerie Page, Najma Siddiqi, Louise Rose

Background: Trials of interventions to prevent or treat delirium in older adults resident in long-term care settings (LTC) report heterogenous outcomes, hampering the identification of effective management strategies for this important condition. Our objective was to develop international consensus among key stakeholders for a core outcome set (COS) for future trials of interventions to prevent and/or treat delirium in this population.

Methods: We used a rigorous COS development process including qualitative interviews with family members and staff with experience of delirium in LTC; a modified two-round Delphi survey; and virtual consensus meetings using nominal group technique. The study was registered with the Core Outcome Measures in Effectiveness Trials (COMET) initiative (https://www.comet-initiative.org/studies/details/796).

Results: Item generation identified 22 delirium-specific outcomes and 32 other outcomes from 18 qualitative interviews. When combined with outcomes identified in our earlier systematic review, and following an item reduction step, this gave 43 outcomes that advanced to the formal consensus processes. These involved 169 participants from 12 countries, and included healthcare professionals (121, 72%), researchers (24, 14%), and family members/people with experience of delirium (24, 14%). Six outcomes were identified as essential to include in all trials of interventions for delirium in LTC, and were therefore included in the COS. These are: 'delirium occurrence'; 'delirium related distress'; 'delirium severity'; 'cognition including memory', 'admission to hospital' and 'mortality'.

Conclusions: This COS, endorsed by the American Delirium Society and the European and Australasian Delirium Associations, is recommended for use in future clinical trials evaluating delirium prevention or treatment interventions for older adults residing in LTC.

背景:针对长期护理机构(LTC)中老年人谵妄预防或治疗干预措施的试验报告结果各不相同,这阻碍了针对这一重要病症的有效管理策略的确定。我们的目标是在主要利益相关者之间就核心结果集(COS)达成国际共识,以便今后对预防和/或治疗该人群谵妄的干预措施进行试验:我们采用了一套严格的核心结果集开发流程,包括对具有长者照护中心谵妄经验的家庭成员和工作人员进行定性访谈;修改后的两轮德尔菲调查;以及采用名义小组技术的虚拟共识会议。该研究已在 "有效性试验中的核心结果测量"(COMET)计划中注册(https://www.comet-initiative.org/studies/details/796)。结果:结果:项目生成从 18 次定性访谈中确定了 22 项谵妄特异性结果和 32 项其他结果。结合我们早期系统性回顾中确定的结果,并经过项目缩减步骤,最终有 43 项结果进入了正式的共识流程。来自 12 个国家的 169 名参与者参与了这一过程,其中包括医护人员(121 人,占 72%)、研究人员(24 人,占 14%)以及家庭成员/有谵妄经历的人(24 人,占 14%)。有六项结果被认为是所有针对长者照护中心谵妄的干预试验中必须包括的,因此被纳入了 COS。它们是谵妄发生率"、"谵妄相关痛苦"、"谵妄严重程度"、"认知(包括记忆)"、"入院 "和 "死亡率":本 COS 得到了美国谵妄学会、欧洲和澳大利亚谵妄协会的认可,建议在未来评估针对居住在 LTC 中的老年人的谵妄预防或治疗干预措施的临床试验中使用。
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引用次数: 0
Associations between amyloid-β load and cognition in cerebrovascular disease beyond cerebral amyloid angiopathy: a systematic review and meta-analysis of positron emission tomography studies. 脑淀粉样血管病以外的脑血管疾病中淀粉样蛋白-β负荷与认知能力之间的关系:正电子发射断层扫描研究的系统回顾和荟萃分析。
IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-10-01 DOI: 10.1093/ageing/afae240
Jie Zhang, Cathy J Price, Ke Zhao, Yuanyuan Tang, Shuchang Zhong, Jingjing Lou, Xiangming Ye, Feng Liang

Background: There is growing interest in the comorbidity of vascular and neurodegenerative pathologies in patients with cerebrovascular disease (CVD) beyond cerebral amyloid angiopathy (CAA). However, the relationship between amyloid-β and vascular cognitive impairment (VCI) remains debated.

Objective: To investigate the association between VCI and amyloid-β deposition in non-CAA CVD patients.

Methods: PubMed, Embase, Web of Science, PsycINFO and CENTRAL databases were systematically searched. Observational studies, including case-control and cohort studies, associating cognitive scores with amyloid load measured by positron emission tomography were selected. Meta-analyses were performed to assess the strength of amyloid-cognition associations across CVD subtypes and cognitive domains. A random-effects model using the inverse variance method was used, with heterogeneity evaluated by Q-statistics and I2 statistics. Meta-regression analyses were conducted to examine the influence of moderators, and publication bias was assessed using funnel plots and Egger's test. All statistical analyses were performed using StataMP 18.

Results: Twenty-seven eligible studies encompassing 2894 participants were included. Among non-CAA CVD patients, global cognitive performance was significantly lower in those with higher amyloid-β deposition (standardized mean difference = -0.43, P < 0.001). The correlation strength varied across cognitive domains (executive function: r = -0.41; language: r = -0.36; memory: r = -0.29; all P < 0.001). The correlation was significant in patients with subcortical vascular disease (r = -0.43, P < 0.001) but not post-stroke patients (r = -0.19, P > 0.05).

Conclusions: Amyloid-β load is associated with cognitive decline in non-CAA CVD patients. This is more pronounced in patients with subcortical vascular disease than in post-stroke patients. Executive function is the most susceptible domain in VCI when the level of amyloid-β increases.

背景:除了脑淀粉样变性血管病(CAA)之外,人们对脑血管疾病(CVD)患者合并血管和神经退行性病变的问题越来越感兴趣。然而,淀粉样蛋白-β与血管性认知障碍(VCI)之间的关系仍存在争议:研究非 CAA 心血管疾病患者的 VCI 与淀粉样蛋白-β沉积之间的关系:方法:系统检索了 PubMed、Embase、Web of Science、PsycINFO 和 CENTRAL 数据库。筛选出将认知评分与正电子发射断层扫描测量的淀粉样蛋白负荷相关联的观察性研究,包括病例对照研究和队列研究。进行了元分析,以评估不同心血管疾病亚型和认知领域中淀粉样蛋白与认知相关性的强度。采用反方差法建立随机效应模型,通过Q统计量和I2统计量评估异质性。进行元回归分析以检查调节因子的影响,并使用漏斗图和 Egger 检验评估发表偏倚。所有统计分析均使用 StataMP 18 进行:共纳入了 27 项符合条件的研究,涉及 2894 名参与者。在非淀粉样蛋白-β沉积的心血管疾病患者中,淀粉样蛋白-β沉积较高者的整体认知能力明显较低(标准化平均差=-0.43,P<0.001)。不同认知领域的相关性强度各不相同(执行功能:r = -0.41;语言:r = -0.36;记忆:r = -0.29;所有 P <0.001)。皮层下血管疾病患者的相关性显著(r = -0.43,P <0.001),但卒中后患者的相关性不显著(r = -0.19,P >0.05):结论:淀粉样蛋白-β负荷与非CAA心血管疾病患者的认知能力下降有关。结论:淀粉样蛋白-β负荷与非脑血管疾病患者的认知能力下降有关,这在皮层下血管疾病患者中比脑卒中后患者中更为明显。当淀粉样蛋白-β水平升高时,执行功能是脑血管疾病患者最易受影响的领域。
{"title":"Associations between amyloid-β load and cognition in cerebrovascular disease beyond cerebral amyloid angiopathy: a systematic review and meta-analysis of positron emission tomography studies.","authors":"Jie Zhang, Cathy J Price, Ke Zhao, Yuanyuan Tang, Shuchang Zhong, Jingjing Lou, Xiangming Ye, Feng Liang","doi":"10.1093/ageing/afae240","DOIUrl":"10.1093/ageing/afae240","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in the comorbidity of vascular and neurodegenerative pathologies in patients with cerebrovascular disease (CVD) beyond cerebral amyloid angiopathy (CAA). However, the relationship between amyloid-β and vascular cognitive impairment (VCI) remains debated.</p><p><strong>Objective: </strong>To investigate the association between VCI and amyloid-β deposition in non-CAA CVD patients.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, PsycINFO and CENTRAL databases were systematically searched. Observational studies, including case-control and cohort studies, associating cognitive scores with amyloid load measured by positron emission tomography were selected. Meta-analyses were performed to assess the strength of amyloid-cognition associations across CVD subtypes and cognitive domains. A random-effects model using the inverse variance method was used, with heterogeneity evaluated by Q-statistics and I2 statistics. Meta-regression analyses were conducted to examine the influence of moderators, and publication bias was assessed using funnel plots and Egger's test. All statistical analyses were performed using StataMP 18.</p><p><strong>Results: </strong>Twenty-seven eligible studies encompassing 2894 participants were included. Among non-CAA CVD patients, global cognitive performance was significantly lower in those with higher amyloid-β deposition (standardized mean difference = -0.43, P < 0.001). The correlation strength varied across cognitive domains (executive function: r = -0.41; language: r = -0.36; memory: r = -0.29; all P < 0.001). The correlation was significant in patients with subcortical vascular disease (r = -0.43, P < 0.001) but not post-stroke patients (r = -0.19, P > 0.05).</p><p><strong>Conclusions: </strong>Amyloid-β load is associated with cognitive decline in non-CAA CVD patients. This is more pronounced in patients with subcortical vascular disease than in post-stroke patients. Executive function is the most susceptible domain in VCI when the level of amyloid-β increases.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":null,"pages":null},"PeriodicalIF":6.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“The Past is a Foreign Country”: Time Shelter and exploring dementia and memory impairment representation in literature and the arts "往事如烟":时光隧道,探索文学艺术中痴呆症和记忆障碍的表现形式
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.175
Adam Roche, Neasa Fitzpatrick, Iracema Leroi
Background Due to ageing populations, the WHO estimates that by 2050 the number of people living with dementia worldwide will more than triple to 152 million. For those working in geriatric medicine and memory services, we regularly interact with and advocate for patients coming to terms with memory impairments. One common theme often encountered during the patient dementia and cognitive impairment diagnosis journey is fear of loss of the sense of “self”, which can be informed by the negative and often inaccurate cultural narrative around dementia. Methods Recent promising breakthroughs in the development of disease modifying medications for Alzheimer’s disease, as well as greater emphasis on lifelong brain health and earlier diagnosis, represents a potential source of hope. This presentation will aim to explore the cultural narrative around the “lived experience” of dementia, which is often extremely negative and emphasises hopelessness. We look to some of the most commonly referenced narrative works, which can often form the foundation of many patient's prior knowledge of cognitive impairment and dementia before coming to the memory clinic. Results This presentation aims to examine the narrative works familiar to many patients (such as “The Father” and “Still Alice”) as well as some more recent efforts, including this year’s International Booker Prize-winning novel “Time Shelter” by Georgi Gospodinov. This darkly humorous book describes the arrival of a strange new ‘clinic for the past’ offering promising treatment for people with dementia. Conclusion Many works of narrative fiction explore dementia and memory impairment. While some are well-informed and researched, many lack empathy or even clinical accuracy. Narrative works can have an enormous impact on the widespread perception and understanding of diseases such as dementia. By exploring the potential for sensitive and accurate representation of dementia in popular culture, we aim to promote equity in this vulnerable and growing population.
背景 由于人口老龄化,世界卫生组织估计,到 2050 年,全球痴呆症患者人数将增加两倍多,达到 1.52 亿人。对于从事老年医学和记忆服务的人来说,我们经常与记忆障碍患者打交道,并为他们进行宣传。在诊断痴呆症和认知障碍的过程中,我们经常会遇到一个共同的问题,那就是害怕失去 "自我 "感,而围绕痴呆症的负面且往往不准确的文化叙事可能会导致这种恐惧。方法 最近在开发治疗阿尔茨海默病的药物方面取得了突破性进展,同时人们更加重视大脑的终生健康和早期诊断,这些都给人们带来了希望。本讲座旨在探讨有关痴呆症 "生活经历 "的文化叙事,这种叙事往往极其消极,并强调绝望。我们研究了一些最常被引用的叙事作品,这些作品往往构成了许多患者在来记忆诊所就诊之前对认知障碍和痴呆症的认知基础。结果 本讲座旨在研究许多患者熟悉的叙事作品(如《父亲》和《依然爱丽丝》)以及一些近期的作品,包括今年国际布克奖获奖小说《时间庇护所》(作者格奥尔基-戈斯波迪诺夫)。这本黑色幽默的作品描述了一家陌生的新 "过去诊所 "的到来,它为痴呆症患者提供了有希望的治疗。结论 许多叙事小说作品都探讨了痴呆症和记忆障碍问题。虽然有些作品资料翔实,研究深入,但许多作品缺乏共鸣,甚至缺乏临床准确性。叙事作品可以对痴呆症等疾病的广泛认知和理解产生巨大影响。通过探索在流行文化中对痴呆症进行敏感而准确的表述的潜力,我们旨在促进这一日益增长的弱势群体的公平。
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引用次数: 0
Bone-A-Fide Breakthrough: Machine Learning Cracks the Code on Osteoporosis Treatment Using the Irish Hip Fracture Database 真正的骨骼突破:机器学习利用爱尔兰髋部骨折数据库破解骨质疏松症治疗密码
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.027
Nur Atikah Mohd Asri, Azrin Muslim, Niamh O'Regan, Annette McEliggott
Background Osteoporosis is a metabolic bone disorder characterised by decreased bone mineral density and mass. Due to its asymptomatic nature, it often remains undiagnosed and untreated until a fracture occurs. Traditionally, treatment decisions for osteoporosis are based on clinical appropriateness while balancing the treatment's risks and benefits. Machine learning (ML) is revolutionising healthcare domains through pattern recognition of previously “unseen” observations. Presently, its application in osteoporosis is limited to early diagnosis. More research is needed to examine its role in guiding osteoporosis treatment. This study aims to identify new predictive attributes for osteoporosis treatment using ML techniques on data from the Irish Hip Fracture Database (IHFD). Methods Datasets from January to March 2023 in University Hospital Waterford were sourced from the IHFD. Osteoporosis treatment decisions were obtained from discharge letters. Preliminary data cleaning was performed in Excel with zero-variance and near-zero predictor. Attributes excluded. The dataset was entered into the WEKA 3.8.6 environment for ML processing. Results The initial dataset containing 141 instances and 32 attributes was refined using the Correlation Feature Selection and Ranker Search Method, identifying key osteoporosis treatment predictors. The highest correlation attributes are pre-fracture total score, pre-fracture indoor score, and age. Moderately positive correlations are discharge destination, pre-fracture outdoor and shopping score, ASA grade, Length-of-stay, admission code, Admission 4AT score, Frailty scale, and fracture type. The implemented J48 Tree ML-trained model revealed Correctly Classified Instances and Incorrectly Classified Instances of 98.24% and 1.7%, respectively, indicating a high prediction accuracy rate. Conclusion This study demonstrates the potential of ML in enhancing osteoporosis treatment decision-making by leveraging datasets from the IHFD. Integrating ML algorithms with traditional approaches can provide a comprehensive, nuanced and personal approach to osteoporosis treatment and patient care. The study opens avenues for future research in applying big data and advanced analytics in healthcare, underscoring the evolving landscape of medical decision-making.
背景 骨质疏松症是一种代谢性骨病,其特点是骨矿物质密度和质量下降。由于无症状,骨质疏松症往往得不到诊断和治疗,直至发生骨折。传统上,骨质疏松症的治疗决策基于临床适宜性,同时平衡治疗的风险和收益。机器学习(ML)通过对以前 "看不见 "的观察结果进行模式识别,正在彻底改变医疗保健领域。目前,它在骨质疏松症中的应用仅限于早期诊断。需要进行更多的研究来探讨其在指导骨质疏松症治疗中的作用。本研究旨在通过爱尔兰髋部骨折数据库(IHFD)的数据,利用 ML 技术识别骨质疏松症治疗的新预测属性。方法 从 IHFD 中获取沃特福德大学医院 2023 年 1 月至 3 月的数据集。骨质疏松症治疗决定来自出院信。初步数据清理在 Excel 中进行,方差为零,预测因子接近零。排除属性。数据集被输入到 WEKA 3.8.6 环境中进行 ML 处理。结果 初始数据集包含 141 个实例和 32 个属性,使用相关性特征选择和排序器搜索法对数据集进行了改进,确定了关键的骨质疏松症治疗预测因子。相关性最高的属性是骨折前总评分、骨折前室内评分和年龄。中度正相关的属性有出院目的地、骨折前室外和购物得分、ASA 分级、住院时间、入院代码、入院 4AT 评分、虚弱量表和骨折类型。J48 树 ML 训练模型的正确分类率和错误分类率分别为 98.24% 和 1.7%,显示了较高的预测准确率。结论 本研究通过利用 IHFD 数据集,展示了 ML 在增强骨质疏松症治疗决策方面的潜力。将 ML 算法与传统方法相结合,可为骨质疏松症治疗和患者护理提供全面、细致和个性化的方法。这项研究为未来将大数据和高级分析应用于医疗保健领域的研究开辟了道路,凸显了医疗决策的不断发展。
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引用次数: 0
Establishing The Role Of The Clinical Nurse Specialist For The Older Adult In A Model 2 Hospital 在示范二甲医院中确立老年人临床护理专家的角色
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.209
Cliona Woulfe, Patricia Moloney, Emma Jennings
Background On average 87.5% of inpatients in our Model-2 Hospital are aged sixty-five years or above. Equally 57.5% of inpatients have medium to maximum dependency care needs. In order to meet the needs of this cohort of patients a new post “Clinical Nurse Specialist (CNS) For The Older Adult” was established in September 2023. Methods Using an online referral system, criteria for referral included i) new onset confusion or delirium, ii) clinical frailty score (CFS) of six or greater, iii) known Parkinson’s disease and iv) nursing or medical team clinical judgement. All reviewed patients received a comprehensive geriatric assessment using the Geriatric 5M framework (Mobility, Medications, Multi-Complexities, Mind and Matters Most) ensuring all aspects of patient care were assessed and promoting timely input from our multi-disciplinary team (Physiotherapy, Dietitian, Speech and Language Therapy, Occupational Therapy and Pharmacy). Results Over a period of 207 days the newly established CNS service received a total of 317 referrals. Two thirds (n=206, 65%) received CNS review, one third (n=111, 35%) did not; 45 (14%) were under the care of a consultant Geriatrician and not reviewed to avoid duplication and 66 (21%) were discharged before review could occur. Conclusion Referral numbers received since the established of the CNS post emphasises the need for the service in our hospital inpatient population. Development of the post has ensured that two-in-three referred patients receive a CNS lead CGA. Results from this pilot highlights the need to further develop and expand the service to target the one-in-five who missed review and further extension of the referral criteria.
背景 我们的模范二型医院平均有 87.5%的住院病人年龄在 65 岁或以上。同样,57.5%的住院病人需要中度至高度依赖护理。为了满足这部分患者的需求,我们于 2023 年 9 月设立了一个新职位 "老年临床护理专家 (CNS)"。方法 使用在线转介系统,转介标准包括 i) 新发意识模糊或谵妄;ii) 临床虚弱评分(CFS)达到或超过 6 分;iii) 已知帕金森病;iv) 护理或医疗团队临床判断。所有接受复查的患者均接受了全面的老年医学评估,评估采用老年医学 5M 框架(行动能力、药物治疗、多重复杂性、心理和最重要事项),确保对患者护理的各个方面进行评估,并促进多学科团队(物理治疗、营养师、言语和语言治疗、职业治疗和药房)的及时投入。结果 在 207 天的时间里,新成立的 CNS 服务共收到 317 份转诊申请。其中三分之二(206 人,占 65%)接受了 CNS 复查,三分之一(111 人,占 35%)未接受复查;45 人(占 14%)接受了老年病学顾问的治疗,为避免重复,未接受复查;66 人(占 21%)在复查前已出院。结论 自设立 CNS 职位以来所收到的转诊数量表明,我们医院的住院病人非常需要这项服务。该职位的设立确保了三分之二的转诊患者能够获得由 CNS 领导的 CGA。此次试点的结果表明,有必要进一步发展和扩大这项服务,将目标对准五分之一错过复查的患者,并进一步扩大转诊标准。
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引用次数: 0
Work of ART: Profiling the First 100 Patients Discharged Home From an Acute Hospital with the Active Recovery Team (ART) ART 的工作:剖析在积极康复团队(ART)的帮助下从急症医院出院回家的前 100 名患者
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.186
Edel McDaid, Ciara Ryan, Eoin Daly
Background The Active Recovery Team (ART) is a new therapy lead rehabilitation team that offers supported discharge and admission avoidance from a large acute hospital. This interdisciplinary team consists of a physiotherapist, occupational therapist, medical social worker and two therapy assistants. ART accepts referrals from all services within the hospital including the emergency department. Methods As ART is a new service, a retrospective audit of the first 100 patients who discharged on the pathway was completed. Demographics included age, sex, referring specialty, presenting complaint, frailty (measured by the Clinical Frailty Score) and level of input received. ART use the coding of low, medium and high intensity to describe the intervention provided based on dosage (visits) and complexity. Results Most (67%) of the group were female and mean age was 77 years. Only 8% were pre-frail (CFS 0-3), 86% were living with mild to moderate frailty (CFS 4-6) and 6% considered severely frail (CFS 7-9). The type of intervention patients received was 31% low, 33% medium and 36% high intensity. Referrals came from a range of specialties, but the highest percentage of referrals were from emergency medicine (29%), medicine (20%), orthopaedics (18%) and geriatric medicine (16%). Most (53%) initially presented post a fall at home. Most frequent reason for ART referral (78%) was that the patient was discharging home not at their functional baseline but had potential to an achieve a specific goal(s) with further input (most frequently within domains of mobility indoors/outdoors, transfers, stairs and activities of daily living). Conclusion This is an effective pathway that improves the transition from hospital to home. ART offer patients an opportunity for further rehabilitation at home with continuity of care from the acute hospital. Future work will examine the impact of ART on length of stay, readmission rate and explore patient satisfaction with this service.
背景 积极康复团队(ART)是一个新成立的以治疗为主导的康复团队,为一家大型急症医院的病人提供支持性出院服务,避免病人入院。该跨学科团队由一名物理治疗师、一名职业治疗师、一名医务社工和两名治疗助理组成。ART 接受医院内包括急诊科在内的所有服务部门的转介。由于 ART 是一项新服务,因此我们对前 100 名通过该路径出院的患者进行了回顾性审核。人口统计学数据包括年龄、性别、转诊科室、主诉、体弱程度(以临床体弱程度评分法衡量)和所接受投入的水平。ART 采用低、中、高强度编码,根据剂量(人次)和复杂程度来描述所提供的干预。结果 小组中大多数(67%)为女性,平均年龄为 77 岁。只有 8% 的患者属于前期虚弱(CFS 0-3),86% 的患者属于轻度至中度虚弱(CFS 4-6),6% 的患者属于严重虚弱(CFS 7-9)。患者接受的干预类型中,31%为低强度,33%为中强度,36%为高强度。转诊患者来自各个专科,但转诊比例最高的是急诊科(29%)、内科(20%)、骨科(18%)和老年医学科(16%)。大多数患者(53%)最初是在家中摔倒后就诊。转介 ART 的最常见原因(78%)是患者出院回家时功能未达到基线,但有潜力通过进一步治疗实现特定目标(最常见的领域包括室内/室外活动能力、转移、爬楼梯和日常生活活动)。结论 这是一条有效的康复途径,可以改善从医院到家庭的过渡。ART 为患者提供了在家中接受进一步康复治疗的机会,并保持了急症医院护理的连续性。未来的工作将研究 ART 对住院时间、再入院率的影响,并探讨患者对这项服务的满意度。
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引用次数: 0
Clinical, Patient And Service Outcomes For Patients In A Rehabilitation Hospital With An Onsite Flexible Endoscopic Evaluation Of Swallowing Service 一家提供现场灵活内窥镜吞咽评估服务的康复医院的临床、患者和服务成果
IF 6.7 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-30 DOI: 10.1093/ageing/afae178.333
Kara Flaherty, Aideen Lawlor, Laura Douglas
Background Dysphagia has been reported in almost half of hospital patients who are over 65 years.1 In 2023 a Flexible Endoscopic Evaluation of Swallowing (FEES) service was introduced into the hospital. The purpose of this study was to profile the patients who were referred for FEES and determine the prevalence and severity of dysphagia. Methods Information on patient diagnosis, dysphagia related clinical outcome measures and waiting times when compared to Videofluoroscopy referral were collected from 30 patients who attended for FEES assessment in a rehabilitation hospital from August 2023 - May 2024. Results 97% of the patients who engaged in FEES were above the age of 65. Patients presented with a range of diagnoses including frailty (20%), progressive neurological conditions (18%), other (16.6%), stroke (13.3%), Chronic Obstructive Pulmonary Disease (13.3%), Acquired Brain Injury (3%), Gastroenterology (3%), and surgical (3%). Dysphagia was identified in 97% of patients, with 60% presenting within the moderate to severe range on the Australian Therapy Outcome Measures. 33% of patients presented with silent aspiration, with a third of these patients presenting as clinically asymptomatic. Following FEES evaluation, 40% of patients were recommended a change in diet texture or fluid consistency, with 54% and 70% of these patients being recommended a downgrade in diet or fluids respectively. The service has allowed for more timely access to instrumental swallow assessment with completion of FEES within an average of 4 days compared to referral for Videofluoroscopy; 24 days average. Conclusion This study has enabled us to profile patients accessing FEES. FEES facilitates quicker access to instrumental swallow assessment and identification of aspiration. It has also enabled targeted person centered dysphagia rehab. Reference 1. Doan, T.N et al (2022) Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis. Journal of Clinical Medicine, 11(9), p.2605.
背景 据报道,几乎半数 65 岁以上的医院患者都有吞咽困难1。2023 年,医院引入了灵活内窥镜吞咽评估(FEES)服务。本研究的目的是对转诊至 FEES 的患者进行分析,并确定吞咽困难的发生率和严重程度。方法 收集 2023 年 8 月至 2024 年 5 月期间在一家康复医院接受 FEES 评估的 30 名患者的信息,包括患者诊断、吞咽困难相关临床结果测量以及与视频荧光镜转诊相比的等待时间。结果 97% 接受 FEES 评估的患者年龄在 65 岁以上。患者的诊断范围包括虚弱(20%)、进行性神经系统疾病(18%)、其他(16.6%)、中风(13.3%)、慢性阻塞性肺病(13.3%)、获得性脑损伤(3%)、胃肠病(3%)和外科(3%)。97%的患者被确诊为吞咽困难,其中60%的患者在 "澳大利亚治疗结果衡量标准"(Australian Therapy Outcome Measures)中属于中度至重度吞咽困难。33%的患者表现为无声吸入,其中三分之一的患者无临床症状。经过 FEES 评估后,40% 的患者被建议改变饮食质地或液体浓度,其中 54% 和 70% 的患者分别被建议降低饮食或液体浓度。与转诊接受视频荧光镜检查(平均需要 24 天)相比,该服务能让患者更及时地接受仪器吞咽评估,平均在 4 天内完成 FEES 评估。结论 通过这项研究,我们了解了使用 FEES 的患者的情况。FEES 有助于更快地进行仪器吞咽评估和吸入识别。此外,它还实现了有针对性的以人为本的吞咽困难康复治疗。参考文献 1.Doan, T.N et al (2022) Prevalence and methods for assessment of oropharyngeal dysphagia in older adults: a systematic review and meta-analysis.临床医学杂志》,11(9),第 2605 页。
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Age and ageing
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