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Carroll I, O'Connor M, Cunningham N, Ryan S, Corey G, McNamara D, Galvin R, Sheikhi A, Shannahan E, Mastalska A, Dillon J, Barry L. 309 A FRAILTY CENSUS OF INPATIENTS AGED 65 AND OVER ADMITTED TO A MODEL 4 HOSPITAL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Frailty is a risk factor for in-hospital mortality, long hospital stay and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty.
Methods
All patients aged ≥65 years and admitted to a medical or surgical inpatient setting, were screened over a 12-hour period (08:00-20:00) using validated frailty and co-morbidity scales. Age and Gender Demographics, Clinical Frailty Scale (CFS), Charlson Co-morbidity Index (CHI) and admitting specialty (Medical/Surgical) were collected. The data was fully anonymised and ethical approval was granted. Descriptive statistics were used to profile the cohort and Chi-squared tests applied for comparisons.
Results
Within a sample of 413 patients, 291(70%) were ≥65yrs. Of this cohort, 202(70%) were ≥75yrs. 207(71%) utilised in-patient medical services and 121(41%) surgical services while 37(12%) used both. The mean CFS was 6 indicating moderate frailty levels and the mean CCI score was 4 denoting moderate co-morbidity. Overall: 195(67%) had moderate-severe frailty (CSF ≥6) while 218 (75%) had moderate-severe co-morbidity (CCI Mod 3-4, Severe ≥5). Associations with age >75 and frailty (p=0.001) and medical service usage and frailty (p=0.004) were established. No significant differences were observed across genders for CFS (p=0.110) and CCI (p=0.465).
Conclusion
There is a high prevalence of frailty and co-morbidity within the admitted patient cohort ≥65yrs. Overcrowding across the hospital system and higher levels of frailty and comorbidity will contribute to increased lengths of stay and the need for specialist intervention, particularly for those ≥75yrs who represented 70% of patients screened. With an increased focus on the integration of care for older adults across care transitions, there is a clear need for expansion of frailty-based services and staff training in frailty care across the hospital and community setting.
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Affiliation(s)
- I Carroll
- University Hospital Limerick Department of Aging and Therapeutics, Medical Directorate, , Limerick, Ireland
| | - M O'Connor
- University Hospital Limerick Department of Aging and Therapeutics, Medical Directorate, , Limerick, Ireland
- University of Limerick School of Medicine, Faculty of Education and Health Sciences, , Limerick, Ireland
- University of Limerick Ageing Research Centre, , Limerick, Ireland
| | - N Cunningham
- University Hospital Limerick Department of Aging and Therapeutics, Medical Directorate, , Limerick, Ireland
- University of Limerick Department of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - S Ryan
- University Hospital Limerick Department of Aging and Therapeutics, Medical Directorate, , Limerick, Ireland
| | - G Corey
- University Hospital Limerick ALERT Limerick EM Education Research Training, Emergency Department, , Limerick, Ireland
| | - D McNamara
- University Hospital Limerick Medical Directorate, , Limerick, Ireland
- University of Limerick Department of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - R Galvin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, , Limerick, Ireland
- University of Limerick Ageing Research Centre, , Limerick, Ireland
| | - A Sheikhi
- University of Limerick Health Research Institute, , Limerick, Ireland
| | - E Shannahan
- University Hospital Limerick Department of Aging and Therapeutics, Medical Directorate, , Limerick, Ireland
- University of Limerick Ageing Research Centre, , Limerick, Ireland
| | - A Mastalska
- University Hospital Limerick Department of Aging and Therapeutics, Medical Directorate, , Limerick, Ireland
| | - J Dillon
- University Hospital Limerick Medical Directorate, , Limerick, Ireland
| | - L Barry
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, , Limerick, Ireland
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Leahy A, Corey G, Purtill H, O'Neill A, Devlin C, Barry L, Cummins N, Shanahan E, Shchetkovsky D, Ryan D, O'Connor M, Galvin R. 303 SCREENING INSTRUMENTS TO PREDICT ADVERSE OUTCOMES FOR UNDIFFERENTIATED OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: RESULTS OF SOAED PROSPECTIVE COHORT STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention in the acute or community setting. We assessed the validity of the ISAR (Identification of Seniors at Risk), Rockwood Clinical Frailty Scale (CFS), PRISMA-7 and InterRAI-ED at predicting adverse outcomes at 30 days and six months among older adults presenting to the ED.
Methods
A prospective cohort study of consecutive older adults (≥65 years) who presented to the ED at a University Hospital was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were performed by an experienced ED research nurse. Blinded follow-up telephone interviews were completed at 30 days and six months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity and specificity of the screening tools were calculated using 2×2 tables.
Results
419 patients were recruited with 49% female and a mean age of 76.9 years (SD 7.15). The prevalence of frailty varied across the screening tools (ISAR, 47% vs InterRAI-ED, 63%). At 30-days, mortality rate was 5.4%, ED re-attendance 16.9%, hospital readmission 13.6%, functional decline 47.1% and nursing home admission 7.3%. Older adults who screened positive for frailty demonstrated an increased risk of all adverse outcomes at 30 days and 6 months, regardless of frailty screening tool administered. All tools had a relatively high sensitivity but low specificity. The ISAR was the only tool which was statistically significant at predicting all outcomes at 30 days.
Conclusion
The ISAR, CFS, PRISMA-7 and InterRAI-ED demonstrated modest validity at predicting adverse outcomes at 30 days and 6 months. We would recommend the implementation of one of these frailty screening tools in Irish EDs to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention in the hospital or community setting.
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Affiliation(s)
- A Leahy
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - G Corey
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - H Purtill
- University of Limerick Department of Mathematics & Statistics, , Limerick, Ireland
| | - A O'Neill
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - C Devlin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - L Barry
- University of Limerick School of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - N Cummins
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - E Shanahan
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - D Shchetkovsky
- University Hospital Limerick Department of Emergency Medicine, , Limerick, Ireland
| | - D Ryan
- University Hospital Limerick Department of Emergency Medicine, , Limerick, Ireland
| | - M O'Connor
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - R Galvin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
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Corey G, Leahy A, Carroll I, Barry L, Galvin R. 319 CAN INDEX BARTHEL SCORE AT EMERGENCY DEPARTMENT PRESENTATION PREDICT ADVERSE OUTCOMES AMONG OLDER ADULTS AT 30 DAYS AND 6 MONTHS? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Frailty is acknowledged as a significant syndrome particularly in the older population. Monitoring frailty in late life aetiology and recognising the value of frailty as a marker of risk for adverse health outcomes is vital and ensures the identification of opportunities for intervention with this cohort in clinical practice. The aim of this prospective cohort study is to examine if an index Barthel Score at Emergency Department presentation predicts adverse outcomes among older adults at 30 days and 6 months.
Methods
Six-hundred and fifty older adults (≥65 years) attending a university model 4 hospital ED were recruited. Baseline evaluation included the Barthel Index. Adverse outcomes (hospital readmission or death) were recorded by a research nurse at 30 days and 6 months, blinded to Barthel score. Descriptive statistics were used to profile the population and report the incidence of adverse outcomes.
Results
At 30 days, 61 older adults had either being admitted to hospital (n=28) or died (n=33) and at 180 days a further 72 had been admitted (n=43) or died (n=29). A total of 29% (n=189) of the population had a Barthel score of ≤15 indicating moderate dependency. Of this cohort, 70% had an adverse outcome-readmitted or died within 180 days.
Conclusion
It may be worth looking at introducing the Barthel Index as a routine measure of activity for older adults presenting to the ED. This tool demonstrates an increased risk of adverse outcomes among older adults who present with moderate dependency. Early intervention either in the hospital or community setting with this ‘at risk’ cohort may serve to reduce adverse outcomes among this group.
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Affiliation(s)
- G Corey
- University Hospital Limerick , Limerick, Ireland
- University of Limerick , Limerick, Ireland
| | - A Leahy
- University Hospital Limerick , Limerick, Ireland
| | - I Carroll
- University Hospital Limerick , Limerick, Ireland
| | - L Barry
- University of Limerick , Limerick, Ireland
| | - R Galvin
- University of Limerick , Limerick, Ireland
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Conneely M, Holmes A, O'Connor M, Leahy A, Gabr A, Saleh A, Okpaje B, Corey G, Barry L, Griffin A, O'Shaughnessy Í, Ryan L, Synott A, McCarthy A, Carroll I, Leahy S, Trepél D, Ryan D, Robinson K, Galvin R. 265 A PHYSIOTHERAPY-LED TRANSITION TO HOME INTERVENTION FOR OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE: A PILOT FEASIBILITY RANDOMISED-CONTROLLED TRIAL. Age Ageing 2022. [PMCID: PMC9620307 DOI: 10.1093/ageing/afac218.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Older adults frequently attend the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. A presentation to an ED can be viewed as an opportunity to assess those at risk of adverse outcomes and initiate a care plan in those deemed as ‘high risk'. Our aim was to evaluate the feasibility of a physiotherapy led integrated care intervention for older adults discharged from the ED (ED-PLUS). Methods Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (Trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. Functional decline was examined post-intervention using the Barthel Index. All outcomes were assessed by a research nurse blinded to group allocation. Results 29 participants were recruited, indicating 97% of our recruitment target. 90% of participants completed the ED-PLUS intervention. All participants expressed positive feedback about the intervention. The incidence of functional decline at 6 weeks was 10% in the ED-PLUS group versus 70-89% in the usual care and CGA-only groups. Conclusion High adherence and retention rates were observed among participants and preliminary findings indicate a lower incidence of functional decline in the ED-PLUS group. Recruitment challenges existed in the context of COVID-19. Data collection is ongoing for six-month outcomes.
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Affiliation(s)
- M Conneely
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - A Holmes
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - M O'Connor
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Leahy
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Gabr
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Saleh
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - B Okpaje
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - G Corey
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - L Barry
- University of Limerick School of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - A Griffin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - Í O'Shaughnessy
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - L Ryan
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Synott
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A McCarthy
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - I Carroll
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - S Leahy
- School of Science & Computing, Atlantic Technological University, ATU Galway City Department of Sport, Exercise & Nutrition, , Old Dublin Road, Galway, Ireland
| | - D Trepél
- Trinity College Dublin Trinity Institute of Neurosciences, School of Medicine, , Ireland
| | - D Ryan
- University Hospital Limerick Limerick EM Education Research Training, Emergency Department, , Dooradoyle, Limerick, Ireland
| | - K Robinson
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - R Galvin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
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Leahy A, Corey G, O’Neill A, Higginbotham O, Devlin C, Barry L, Cummins N, Shanahan E, Shchetkovsky D, Ryan D, O'Connor M, Galvin R. 1081 A COMPARISON OF THE ISAR TOOL AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED REATTENDANCE IN A COHORT OF ED ATTENDER. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.
Method
This was a prospective cohort study. Patients over 65 were recruited, baseline.
demographics were obtained and a research nurse assessed them using both the Clinical Frailty Scale and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.
Results
419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). The median ISAR and CFS score was 2,5 respectively at baseline. The mortality rate was 5.4% and rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score >/= 2 more was 1.84 (1.12, 3.02) and CFS > 4 was 1.85 (1.08, 3.16). The ISAR tool >/= 2, had a sensitivity of 74.29 (95% CI = 62.44, 83.99) and specificity of 41.18 (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS > 4 had a sensitivity of 71.43 (95% CI = 57.79, 82.70) and specificity of 45.23 (95% CI = 39.33, 51.23) for the same outcome.
Conclusion
The ISAR tool >/= 2 was the more sensitive at predicting ED reattendance at one month in comparison to the Clinical Frailty Scale. We would advocate using this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
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Affiliation(s)
- A Leahy
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - G Corey
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - A O’Neill
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - O Higginbotham
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - C Devlin
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - L Barry
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- School of Nursing and Midwifery , Faculty of Education and Health Sciences, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, , Limerick, Ireland
| | - N Cummins
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - E Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - D Shchetkovsky
- Department of Emergency Medicine, University Hospital Limerick , Limerick, Ireland
| | - D Ryan
- Department of Emergency Medicine, University Hospital Limerick , Limerick, Ireland
| | - M O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - R Galvin
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
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Leahy A, Corey G, O'Neill A, Higginbotham O, Devlin C, Barry L, Cummins N, Gabr A, Shanahan E, Shchetkovsky D, Ryan D, O'Connor M, Galvin R. 240 A COMPARISON OF THE ISAR AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED RE-ATTENDANCE IN OLDER ED ATTENDERS. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale (CFS) are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.
Methods
This was a prospective cohort study. Patients over 65 were recruited, baseline demographics were obtained and a research nurse assessed them using both the CFS and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.
Results
419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). At baseline, the median ISAR was 2 and CFS was 5. The mortality rate was 5.4% and the rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score ≥ 2 was 1.84 (1.12, 3.02) and CFS > 4 was 1.85 (1.08, 3.16). The ISAR tool ≥2 had a sensitivity of 74% (95% CI = 62.44, 83.99) and specificity of 41% (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS > 4 had a sensitivity of 71% (95% CI = 57.79, 82.70) and specificity of 45% (95% CI = 39.33, 51.23) for ED re-attendance.
Conclusion
The ISAR tool ≥2 was more sensitive at predicting ED reattendance at one month in comparison to the CFS. We advocate to use this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
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Affiliation(s)
- A Leahy
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - G Corey
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - A O'Neill
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - O Higginbotham
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - C Devlin
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - L Barry
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - N Cummins
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - A Gabr
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - E Shanahan
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | | | - D Ryan
- Department of Emergency Medicine , Limerick, Ireland
| | - M O'Connor
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - R Galvin
- School of Allied Health , HRI, , Limerick, Ireland
- University of Limerick , HRI, , Limerick, Ireland
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Mohamed Yoosuf A, Workman G, Byrne M, Corey G, Mitchell D, Jain S. EP-2259: Survey of Prostate Brachytherapy practice in the UK & Ireland 2014-2016. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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8
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Corey G, McAleese J, Harney J, Conkey D. Northern Ireland brain metastases radiotherapy audit. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Huang D, File TM, Wilcox M, Dryden M, Corey G, Shukla R. A 2012–2014 Global Antimicrobial Surveillance of Iclaprim Against Clinical Strains Causing Hospital-Associated Bacterial Pneumonia (HABP) and Skin and Skin Structure Infections (SSSI). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Thomas M. File
- Division of Infectious Diseases, Summa Health System, Akron, OH
| | | | - Matthew Dryden
- Royal Hampshire County Hospital, Winchester, United Kingdom
| | - G Corey
- Duke University Medical Center, Durham, NC
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Doernberg S, Gouskova N, Evans S, Boucher H, Corey G, Cosgrove S, Chambers H, Fowler V, Holland T. BAC DOOR: A Clinician Ranking Exercise for Better Staphylococcus aureus Bacteremia Trial Design. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Doernberg
- University of California, San Francisco, San Francisco, California
| | | | - Scott Evans
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | | | - G. Corey
- Duke University Medical Center, Durham, North Carolina
| | - Sara Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry Chambers
- University of California, San Francisco, San Francisco, California
| | | | - Thomas Holland
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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Cerda C, Börgel L, Corey G, Schulthess M, Martínez C. Asbestos, asbestosis, mesotheliomas: non solved problems. Toxicol Lett 2016. [DOI: 10.1016/j.toxlet.2016.07.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Corey G, McElvanna K, Bryson P, Conkey D, Houston R, Harrison, Park R, Harte R, Cole A. A ten-year review of anal cancer management in Northern Ireland. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2016.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McGivern U, Mitchell DM, O'Hare J, Corey G, O'Sullivan JM. How does neoadjuvant bicalutamide 150 mg monotherapy compare to lutenising hormone-releasing hormone agonist (LHRHa) therapy in localized prostate cancer treated with radical radiotherapy? A case-matched comparison of PSA kinetics and biochemical outcome. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
146 Background: In patients treated with neoadjuvant lutenising hormone-releasing hormone agonist (LHRHa) therapy prior to radical prostate radiotherapy the PSA nadir in the first week of radiotherapy has been correlated with subsequent biochemical failure free survival (BFFS). Bicalutamide monotherapy (BC) is increasingly being used as a neoadjuvant therapy in place of LHRHa. We wished to compare the initial PSA response to neoadjuvant BC or LHRHa in this setting as well as examining subsequent biochemical failure rates. Methods: We retrospectively reviewed the case notes of consecutive men with prostate cancer treated with BC monotherapy prior to radical prostate radiotherapy from April 2004 to December 2008 and case-matched them to men treated with neoadjuvant LHRHa. PSA levels and kinetics prior to radiotherapy and subsequent BFFS were analysed. Results: Eighty nine men treated with BC with a median follow-up of 42 months were case matched to 89 men treated with LHRHa. There were no significant differences in age, initial PSA, Gleason, or T stage. The median nadir PSA on day 1 of radiotherapy was 2.2ng/mL (0.1-11.2) for BC patients and 0.9ng/mL (0.1-11.2) for LHRHa patients (p=0.0007). There were no significant differences in PSA velocity or doubling time during the neoadjuvant period. A PSA of <1.0ng/mL on day 1 of radiotherapy was seen in 29 (32%) and 47 (52%) of BC and LHRHa patients respectively. Biochemical failure was seen in 10 (11.2%) and 2 (2.2%) of BC and LHRHa patients respectively. PSA kinetics did not predict for subsequent BFFS at this duration of FU for men receiving neoadjuvant BC. Conclusions: In this case-matched study, neoadjuvant BC therapy does not provide the same level of pre-radiotherapy PSA suppression when compared to neoadjuvant LHRHa. Higher biochemical failure rates are seen in patients treated with BC than LHRHa however this may be a result of prolonged castration. No significant financial relationships to disclose.
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Affiliation(s)
- U. McGivern
- Northern Ireland Cancer Centre, Belfast, United Kingdom; Northern Ireland Cancer Centre, Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - D. M. Mitchell
- Northern Ireland Cancer Centre, Belfast, United Kingdom; Northern Ireland Cancer Centre, Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - J. O'Hare
- Northern Ireland Cancer Centre, Belfast, United Kingdom; Northern Ireland Cancer Centre, Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - G. Corey
- Northern Ireland Cancer Centre, Belfast, United Kingdom; Northern Ireland Cancer Centre, Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
| | - J. M. O'Sullivan
- Northern Ireland Cancer Centre, Belfast, United Kingdom; Northern Ireland Cancer Centre, Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, United Kingdom
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Burke DA, Corey G, Storrs FJ. Psoralen plus UVA protocol for Compositae photosensitivity. Am J Contact Dermat 1996; 7:171-6. [PMID: 8957334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients allergic to sesquiterpene lactones found in Compositae plants may develop severe photosensitivity, which can result in persistent light reaction. Treatment of these exquisitely photosensitive individuals can be very difficult, often requiring hospitalization. Although some treatment regimens have used psoralen plus UVA (PUVA) therapy, no specific outpatient protocol has been established OBJECTIVE The purpose of this study was to develop an effective PUVA outpatient regimen to treat compositae photosensitivity. METHODS A prednisone-assisted PUVA protocol was established in which the prednisone does was decreased weekly, and the PUVA dose was increased during the same time interval. RESULTS Both patients enrolled in the study experienced dramatic improvement in their previously unresponsive eruptions. CONCLUSIONS Two men aged 66 and 80 years were subjected to this protocol. Both men had chronic photodistributed dermatitis that resolved with this treatment and in one instance has remained clear for 18 months without needing further PUVA therapy.
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Affiliation(s)
- D A Burke
- Department of Dermatology, Oregon Health Sciences University, Portland, USA
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Abstract
This study presents a profile of patients with chronic recalcitrant eczematous disease referred by dermatologists for contact allergy evaluation. Allergic contact dermatitis (ACD) and irritant responses were carefully defined, as was the presence or absence of atopy obtained by history. Of 410 patients studied, 44% had no history of atopic disease and 46% were classed as definitely atopic. Among relevant ACD patch test reactors (n = 198), 51.5% had atopy, compared with 40.9% with no atopy but this difference was not significant. Likewise, among atopics (n = 189), 54% had definite, relevant ACD patch test responses while 33.9% had negative ACD (again not significant). Significance was seen in the higher mean number of positive allergic patch tests in the atopic group (2.7 versus 2.0, p = 0.0223). Irritant patch tests were highest among patients with both ACD and atopy (p = 0.0308) and the proportion of irritant responses correlated with increasing numbers of positive ACD tests. We conclude that atopics are at least as likely to have ACD as are non-atopics. Irritancy is increased in these patients with chronic dermatitis and the frequency of irritant reactions correlates with both greater numbers of ACD responses and with presence of atopy.
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Affiliation(s)
- P A Klas
- Oregon Health Sciences University, Department of Dermatology, Portland, USA
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Câmara VDM, Corey G. Epidemiologic surveillance for substances banned from use in agriculture. Bull Pan Am Health Organ 1994; 28:355-9. [PMID: 7858649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Corey G, Rodríguez H, Aguilar C, Greve E, Bustos R, Valenzuela ME. [Meningococcus carriers]. Bol Oficina Sanit Panam 1979; 87:238-46. [PMID: 159065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Rodríguez H, Corey G, Cánepa SI. [Arterial pressure in an urban community in Chile]. Bol Oficina Sanit Panam 1978; 84:207-17. [PMID: 148281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Corey G, Rodríguez H. [Measles 1970--1976: various aspects of the last 2 epidemic outbreaks]. Rev Chil Pediatr 1978; 49:229-35. [PMID: 117526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Corey G. [Various epidemiological and etiological aspects of acute infantile diarrhea]. Rev Chil Pediatr 1975; 46:251-63. [PMID: 1234360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Wu E, Grado C, Avendaño F, Corey G. [Viral etiology of infantile diarrhea]. Rev Chil Pediatr 1975; 46:119-24. [PMID: 1219942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Convit J, Pinardi ME, Rojas FA, Gonzáles I, Corey G, Arvelo JJ, Monzón H. Tests with three antigens in leprosy-endemic and non-endemic areas. Bull World Health Organ 1975; 52:193-8. [PMID: 1083307 PMCID: PMC2366354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A study comparing the 48-h and 30-day reactions produced by three antigens was made in areas of low and high leprosy endemicity in Venezuela and in areas of Chile, a non-endemic country. The antigens used for the intradermal tests were standard Mitsuda antigen, supernatant from standard Mitsuda antigen, and PPD. The results indicate that there is no difference in the Mitsuda reaction of persons living in areas of high or low endemicity, but they show a statistically significant difference between the reactions in persons who live in endemic areas and those of persons living in a country where the disease has not been described. The difference in the Fernandez reaction obtained with the supernatant was not statistically significant between the two population groups in the endemic country, but was highly significant when comparing the endemic and the non-endemic countries.
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