1,720,964 research outputs found
Emergency department: risk stratification in the elderly
Get PDFBackground & aims. The older adults have very frequent access to the Emergency Department (ED). The aim of this study is to explore the ability of some geriatric screening tools validated for the ED to predict outcomes (mortality, hospitalization, ED readmission and institutional-ization) at 6 months. Methods. Older adults consecutively admitted to Cagliari University’s ED between May and December of 2017 were enrolled. In ED older patients were screened with three tools: Identification of Seniors at Risk tool (ISAR); Triage Risk Screening Tool (TRST); International Resident Assessment Instrument Emergency Department Screener (InterRAI ED Screener). At 6 months patients were contacted by phone to verify: mortality, ED readmission, hospital admission, and institutionalization. Results. Of the 421 patients (median age 77, Interquartile Range 71-83; 55.8% women) enrolled, 72.4% were positive at the ISAR, 50.1% at the TRST; moreover 44.9% of enrolled subjects needed a urgent geriatric evaluation at the InterRAI ED Screener. The dead subjects had ISAR, TRST and InterRAI ED Screener with greater severity compared to the alive ones. The ISAR and the TRST were also more severe in subjects who had ED readmission, while those hospitalized, in addition to the ISAR, had the more severe Inter-RAI ED Screener. However, applying stepwise logistic regression, of the three tools used, only the ISAR was a predictor for hospitalization (OR = 1.23; CI = 1.03-1.48; P = 0.02; AUC = 0.63). Conclusions. The association of ISAR and InterRAI ED Screener may be useful in ED to intercept both critical issues typical of the elderly, and the need and priority of the geriatric evaluation
Six-item cognitive impairment test (6-CIT)’s accuracy as a cognitive screening tool: best cut-off levels in emergency department setting
Get PDFBackground: Nowadays, elderly patients represent a significant number of
accesses to the Emergency Department (ED). Working rhythms do not allow to
perform complete cognitive analysis, which would, however, be useful for the
health care. This study aims to define the optimal cut-off values of the six-item
Cognitive Impairment Test (6-CIT) as a cognitive screening tool in ED.
Methods: This study included 215 subjects, evaluated at the Emergency
Department of the University Hospital of Monserrato, Cagliari, Italy, from July
to December 2021. The accuracy of 6-CIT as a cognitive screening tool was
assessed by comparison with Mini Mental State Examination (MMSE).
Results: The correlation coefficient between the two tests was −0.836 (CI:
−0.87 to −0.79; p < 0.0001), and 6-CIT showed AUC = 0.947 (CI: 0.908–0.973;
p < 0.0001). The 8/9 6-CIT cut-off score presented 86.76% sensitivity (CI: 76.4–
93.8) and 91.84% specificity (CI: 86.2–95.7), and Youden index for this score was
0.786.
Conclusion: Our study demonstrates that 6-CIT is a reliable cognitive screening
tool in ED, offering excellent sensitivity and specificity with a 8/9 points cut-off
score
Nutritional Status and Potentially Inappropriate Medications in Elderly
Get PDF(1) Background: The association between polypharmacy and malnutrition has been investigated in several studies; however, few of these specifically deepened the relationship between potentially inappropriate medication and malnutrition. With a descriptive approach, the primary aim of our study was to evaluate the impact of the nutritional status, assessed with the Mini Nutritional Assessment (MNA), on potentially inappropriate medications (PIM), estimated 10-year survival, and the risk of adverse drug reactions in elderly patients; the secondary aim was to evaluate how the Screening Tool of Older People’s Prescriptions (STOPP), Screening Tool to Alert to Right Treatment (START), and BEERS 2019 criteria identify PIM compared to nutritional status. (2) Methods: In this study, 3091 subjects were enrolled, of whom 2748 (71.7%) were women; the median age was 80 years, with an interquartile range between 75 and 85 years of age. The subjects were assessed at the outpatient service for frail older people of the University Hospital of Cagliari. The study population was evaluated for their: MNA, Charlson Comorbidity Index, 10-year survival estimation, BEERS 2019, STOPP and START criteria, and ADR Risk scores. (3) Results: We divided the study population into three groups: MNA1 (MNA score ≥ 24), MNA2 (23.5–17), and MNA3 (<17): the severity of comorbidities, STOPP and START alerts, and BEERS 2019 criteria were significantly worse in both MNA2 and MNA3 compared to MNA1—with the exception of BEERS “non-anti-infective medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults”. Moreover, the estimated 10-year survival was significantly higher in MNA1 than in MNA2 and MNA3, and also in MNA2 compared to MNA3. Finally, the ADR risk scores were significantly lower in MNA1 than in MNA2 and MNA3. (4) Conclusions: Our study demonstrated the association between nutritional status and PIM checked with the BEERS 2019 criteria, and, for the first time, with the STOPP and START criteria
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Correlazione tra accumulo di lipidi neutri nei linfomonociti e deficit cognitivo in una popolazione di ultrassessantacinquenni.
Get PDFThere is a great need for new research models, which are simple and accessible diagnostic procedures, to monitor progression of suspected age-related neurological disorders. Here, we determined whether changes in neutral lipids (NLs) and in the ability to form clusters represented early events occurring in freshly isolated (naïve) peripheral blood mononuclear cells (PBMCs) from aged subjects affected by different neurological disorders.
We examined 192 subjects, 65 years or older, attending the outpatient services of the geriatric care unit of Cagliari University Hospital for geriatric check-ups, analysing NLs by oil red O (ORO) staining method, and the rate of cluster formation (CF) of the subjects' PBMCs.
ORO score was higher in PBMCs from subjects with any type of dementia than in PBMCs from controls. ORO score did not differ significantly between Alzheimer's disease (AD), mixed dementia (MD) and vascular dementia (VD), but in mild cognitive impairment (MCI), it was significantly higher than in controls, and significantly lower than in AD, MD and VD. There was also significant inverse correlation between ORO staining and Mini Mental State Examination (MMSE) scores. CF showed a similar pattern to that of ORO, being significantly lower in controls than in dementia patients, and higher in dementia than in MCI. Subjects with dementia but not vision problems had lower ORO staining and CF scores than subjects with either eye disorders or dementia.
We suggest that the presence of NLs in the cytoplasm of unstimulated-PBMCs, combined with their potential tendency to form clusters, may represent a novel, non-invasive approach to detecting and monitoring neuronal injury in the early stages of disease
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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