Els Devriendt

The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review

Colorectal cancer surgery is frequently performed in the older population. Many older persons have less physiological reserves and are thus more susceptible to adverse postoperative outcomes. Therefore, it seems important to distinguish the fit patients from the more vulnerable or frail. The aim of this review is to examine the evidence regarding the impact of frailty on postoperative outcomes in older patients undergoing surgery for colorectal cancer. A systematic literature search of Medline Ovid was performed focusing on studies that examined the impact of frailty on postoperative outcomes after colorectal surgery in older people aged ≥65years. The methodological quality of the studies was evaluated using the MINORS quality assessment. Five articles, involving four studies and 486 participants in total, were included. Regardless of varying definitions of frailty and postoperative outcomes, the frail patients had less favourable outcomes in all of the studies. Compared to the non-frail group, the frail group had a higher risk of developing moderate to severe postoperative complications, had longer hospital stays, higher readmission rates, and decreased long-term survival rates. The results of this systematic review suggest the importance of assessing frailty in older persons scheduled for colorectal surgery because frailty is associated with a greater risk of postoperative adverse outcomes. We conclude that, although there is no consensus on the definition of frailty, assessing frailty in colorectal oncology seems important to determine operative risks and benefits and to guide perioperative management.

Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: An observational study

BACKGROUND Patient safety is fundamental to healthcare quality. Attention has recently focused on the patient safety culture of an organisation and its impact on patient outcomes. A strong safety climate appears to be an essential condition for safe patient care in the hospital. A number of instruments are used to measure this patient safety climate or culture. The Safety Attitudes Questionnaire is a validated, widely used instrument to investigate multiple dimensions of safety climate at the clinical level in a variety of inpatient and outpatient settings. OBJECTIVES The purpose of this study is to explore the face- and content validity and the internal consistency of the Safety Attitudes Questionnaire in a large Belgian academic medical center. METHOD The translation into Dutch was done by three researchers. A panel of fifteen Dutch speaking experts evaluated the translation and its content validity. Content validity was quantified by the content validity index (CVI) and a modified kappa index. Face validity was evaluated by two nurses and two physicians who assessed the Dutch version of the SAQ. A cross-sectional design was used to test internal consistency of the SAQ items by calculating Cronbachs alpha and corrected item-total correlations. RESULTS Twenty-three of the 33 SAQ items showed excellent and seven items showed good content validity. One item had a fair kappa value (item 20) and two items had a low content validity index (items 15 and 16). The average CVI of the total scale was 0.83 and ranged from 0.55 to 0.97 for the six subscales. The face-validity was good with no fundamental remarks given. The SAQs overall Cronbachs alpha was 0.9 and changed minimally when removing items. The item-total correlations ranged from 0.10 to 0.63, no single items were strongly correlated with the sum of the other items. CONCLUSION We conclude that in this study the Dutch version of the Safety Attitudes Questionnaire showed acceptable to good psychometric properties. In line with previous evidence, this instrument seems to be an acceptable to adequate tool to evaluate the safety climate.

The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting

BackgroundThe interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context.MethodsIn a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants.ResultsThe primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process is the most important threat.ConclusionThe BelRAI-software allows standardized transmural information transfer and the centralization of medical, allied health professionals and nursing data. It is strictly secured and follows strict privacy regulations, allowing hospitals to optimize (transmural) communication and interaction. However, weaknesses and threats exist and must be tackled in order to promote large scale implementation.

Semi-automated Video-based In-home Fall Risk Assessment

The development of an in-home fall risk assessment tool is under in- vestigation. Several fall risk screening tests such as the Timed-Get-Up-and-Go-test (TGUG) only provide a snapshot taken at a given time and place, where automated in-home fall risk assessment tools can assess the fall risk of a person on a contin- uous basis. During this study we monitored four older people in their own home for a period of three months and automatically assessed fall risk parameters. We selected a subset of fixed walking sequences from the resulting real-life video for analysis of the time needed to perform these sequences. The results show a sig- nificant diurnal and health-related variance in the time needed to cross the same distance. These results also suggest that trends in the transfer time can be detected with the presented system.

Hoe denken ouderen over automatische contactloze monitoring? Een systematische literatuurstudie

INTRODUCTION Technologies for contactless monitoring are increasingly used in order to contribute to qualitative and cost-effective care for older persons. The purpose of this systematic literature review is to explore the attitudes and perceptions of older persons towards the use of systems for contactless monitoring. METHODOLOGY Relevant studies were identified through an extensive search strategy in Medline, Embase and Cinahl for studies published between January 1990 and August 19 2012; using a reference list offered by a group of experts in this field of research and through the exploration of the reference lists of all relevant studies. RESULTS Nine studies with a qualitative study design and one study with a combined study design were included in this literature review. Various aspects of the attitudes, perceptions and needs of older persons as potential or actual end-users of contactless monitoring are discussed in five themes. This refers to the perceptions of older persons on the potential usefulness of contactless monitoring, the communication of information obtained through monitoring, several concerns when contactless monitoring is used and the participation and involvement of the person who is monitored. All these facets can influence the willingness of older people to accept these monitoring systems. CONCLUSIONS This review can offer technology developers and care providers useful information to promote acceptance and successful integration of systems for contactless monitoring into daily practice by ensuring that they meet the needs, concerns and wishes of older persons as their end-users. Further exploration of the attitudes and perceptions of older people towards contactless monitoring through qualitative and quantitative research with a good methodological quality is required.

Is preoperative state anxiety a risk factor for postoperative delirium among elderly hip fracture patients

To determine if preoperative state anxiety is a risk factor for postoperative delirium in older hip fracture patients.

Automated in-home gait transfer time analysis using video cameras

Previous studies have shown that gait speed is an important measure of functional ability in the elderly. Continuous monitoring of the gait speed of older adults in their home environment may therefore allow the detection of changes in gait speed which could be predictive of health changes of the monitored person. In this study, a system consisting of multiple wall-mounted cameras that can automatically measure the time an older adult needs to cross a predefined transfer zone in the home environment is presented. The purpose of this study is the preliminary validation of the algorithm of the camera system which consists of several preprocessing steps and the automatic measurement of the transfer times. This validation is done through data collection in the homes of four older adults for periods varying from eight to twelve weeks. Trends in the measured transfer times are visualised and subsequently compared with the results of clinical assessments obtained during the acquisition period such as Timed-Get-Up-and-Go tests. The results indicate that it is possible to identify long-term trends in transfer times which can be indicative of adverse health-related events.

Geriatric support in the emergency department: a national survey in Belgium.

BackgroundOlder people in the emergency department (ED) represent a growing population and increasing proportion of the workload in the ED. This study investigated the support for frail older people in the ED, by exploring the collaboration between the geriatric services (GS) and the EDs in Belgian hospitals.MethodsAn electronic cross-sectional survey in all Belgian hospitals with an ED (n = 100) about care aspects, collaboration, education and infrastructure for older patients in the ED was collected. Descriptive analyses were performed at national level.ResultsForty-nine of 100 surveys were completed by the GS. The heads of the ED returned only 12 incomplete questionnaires and these results are therefore not reported.Twenty-six of the 49 heads of GSs (53%) indicated that there was an agreement, mainly informal, between the geriatric and the emergency department concerning the management of older people on the ED.A geriatrician was available for specific problems, by phone or in person, in 96% of the EDs during daytime on weekdays. Almost all responding hospitals (96%) had an inpatient geriatric consultation team, of which 85% was available for specific problems at the ED, by phone or bedside during the daytime on weekdays. Twenty-nine heads of the GSs (59%) reported that older patients were screened at ED admission during the day to identify ‘at risk’ patients. The results of the screening were used in the context of further treatment (76%), to decide on hospital admission (27%), or to justify admission on a geriatric ward (55%). In the year preceding the survey, 25% of the responding hospitals had organised geriatric training for ED healthcare workers. Thirty-four heads of the GS (69%) felt that the infrastructure of the ED was insufficient to give high-quality care for older persons.ConclusionCollaborations between EDs and GS are emerging in Belgium, but are currently rather limited and not yet sufficiently embedded in the ED care. Exploratory studies are necessary to identify how these collaborations can be improved.

Does the get up and go test improve predictive accuracy of the Triage Risk Screening Tool or Rowland questionnaire in older patients admitted to the emergency department

Objectives To assess the diagnostic characteristics of the get up and go test (GUGT) as a stand-alone test and in combination with the Flemish Triage Risk Screening Tool (fTRST) and Rowland questionnaire. One aim was to determine whether the diagnostic accuracy of these instruments could be improved for predicting unplanned emergency department (ED) readmission following ED discharge. Methods We carried out a prospective cohort study at the ED of the University Hospitals Leuven, Belgium. All patients aged at least 75 years (n=380) completed fTRST, Rowland, and GUGT testing at the index ED admission. Diagnostic characteristics for unplanned ED readmission were determined for hospitalized and discharged patients 1 and 3 months after the index ED visit. Results In both hospitalized and discharged patients, fTRST and Rowland (cut-off ≥2) had good to excellent sensitivity and negative predictive value (NPV) but low to moderate specificity and accuracy; GUGT had low sensitivity and good to excellent NPV and specificity. The combined fTRST/GUGT or Rowland/GUGT had moderate to excellent NPV (56.3–94.3%). The combined fTRST (cut-off ≥2)/GUGT had low sensitivity and moderate to excellent specificity. Sensitivity of the combined Rowland (cut-off ≥4)/GUGT was good at the 1-month follow-up and moderate at the 3-month follow-up for hospitalized patients; it was low for discharged patients. Specificity was low for hospitalized patients and good for discharged patients. Conclusion Neither the objective measure of mobility (GUGT) nor the combined fTRST/GUGT or Rowland/GUGT improved the results. Our analysis shows that the predictive accuracy of the stand-alone, self-reported screening instruments fTRST and Rowland (cut-off=2) is still good. This study also confirmed their previously known limitations.

Comprehensive Geriatric Assessment in the Emergency Department

Many older people who are admitted to hospital come via the emergency department which is a key interface in the health and social care system where older people with crises can be assessed. So it is important that emergency departments are appropriately supported in the management of older people.