The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Jugdeep K Dhesi - One of the best experts on this subject based on the ideXlab platform.
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where are we now in perioperative medicine results from a repeated uk survey of geriatric medicine delivered services for older people
Age and Ageing, 2019Co-Authors: Andrea Joughin, Judith Partridge, Tessa Ohalloran, Jugdeep K DhesiAbstract:INTRODUCTION: national reports highlight deficiencies in the care of older patients undergoing surgery. A 2013 survey showed less than a third of NHS trusts had Geriatrician-led perioperative medicine services for older surgical patients. Barriers to establishing services included funding, workforce and limited interspecialty collaboration. Since then, national initiatives have supported the expansion of Geriatrician-led services for older surgical patients.This repeat survey describes Geriatrician-led perioperative medicine services in comparison with 2013, exploring remaining barriers to developing perioperative medicine services for older patients. METHODS: an electronic survey was sent to clinical leads for geriatric medicine at 152 acute NHS healthcare trusts in the UK. Reminders were sent on four occasions over an 8-week period. The survey examined the nature of the services provided, extent of collaborative working and barriers to service development. Responses were analysed descriptively. RESULTS: eighty-one (53.3%) respondents provide geriatric medicine services for older surgical patients, compared to 38 (29.2%) in 2013. Services exist across surgical specialties, especially in orthopaedics and general surgery. Fourteen Geriatrician-led preoperative clinics now exist. Perceived barriers to service development remain workforce issues and funding. Interspecialty collaboration has increased, evidenced by joint audit meetings (33% from 20.8%) and collaborative guideline development (31% from 17%). CONCLUSION: since 2013, an increase in whole-pathway geriatric medicine involvement is observed across surgical specialties. However, considerable variation persists across the UK with scope for wider adoption of services facilitated through a national network.
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where are we in perioperative medicine for older surgical patients a uk survey of geriatric medicine delivered services in surgery
Age and Ageing, 2014Co-Authors: Judith Partridge, Geraint Collingridge, Adam L Gordon, Finbarr C Martin, Danielle Harari, Jugdeep K DhesiAbstract:Introduction: national reports have highlighted deficiencies in care provided to older surgical patients and suggested a role for innovative, collaborative, inter-specialty models of care. The extent of Geriatrician-led perioperative services in the UK (excluding orthogeriatric services) has not previously been described. This survey describes current services and explores barriers to further development. Methods: an electronic survey was sent to clinical leads for geriatric medicine at all 161 acute NHS health care trusts in the UK. Reminders were sent on three occasions over an 8-week period. The survey examined preoperative and postoperative care and organisational issues. Responses were analysed descriptively. Results: there were 130 respondents (80.7%). One-third (38) of respondents described providing some geriatric medicine input in older surgical patients. Preoperative services existed in 15 (12%), where 14 provided risk assessment and 13 preoperative optimisation. Twenty-six respondents (20%) delivered care postoperatively, of them 10 took a reactive approach, 11 a proactive approach and 5 provided a combination of reactive and proactive care. Barriers to establishing perioperative geriatric medicine services included funding, workforce issues and a lack of inter-specialty collaboration. Conclusion: a national appetite exists to provide Geriatrician-led services to older surgical patients yet the majority of existing services remain reactive and do not use comprehensive geriatric assessment as an organising principle. This survey suggests that funding for Geriatricians in perioperative care has not yet been universally established. Future efforts should focus on dissemination of experiential knowledge and published resources, collaboration with commissioners and empirical research to overcome the barriers described.
E M Damsgaard - One of the best experts on this subject based on the ideXlab platform.
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impact of Geriatrician performed comprehensive geriatric care on medication use and cognitive function in older adults referred to a non hospital based rehabilitation unit
The American Journal of Medicine, 2019Co-Authors: Dmitri Zintchouk, Merete Gregersen, Torsten Lauritzen, E M DamsgaardAbstract:Abstract Background and Purpose Eighty-eight percent of older adults referred to Danish non-hospital-based rehabilitation units used ≥5 regular drugs per day at the beginning of rehabilitation. The aim of the study was to explore whether Geriatrician-performed comprehensive geriatric care had an impact on medication use and cognitive function in older adults after a 90-day follow-up. Methods There were 368 individuals aged ≥65 years recruited from 2 Danish non-hospital-based rehabilitation units and randomized to geriatric care (the intervention group) or usual care (the control group). The medication adjustment was the key element of the geriatric intervention. The control group received standard rehabilitation with general practitioners as back-up. The outcomes were prevalence of hyperpolypharmacy (≥10 regular medications prescribed concurrently), the change in medication profile, and cognitive function measured using the Mini-Mental State Examination. Results In the intervention group, fewer persons were exposed to hyperpolypharmacy (odds ratio 0.5; 95% confidence interval, 0.3-0.9) compared with the control group after 90 days. The prevalence of use of proton pump inhibitors, loop diuretics, or antiasthmatic inhalers was lower, while the prevalence of cholecalciferol use was higher in the intervention group compared with the control group. The prevalence of other drug use and cognitive function between groups were not different. Conclusions Geriatrician-performed comprehensive geriatric care may reduce the prevalence of hyperpolypharmacy and optimize the medication profile in older adults referred to a non-hospital-based rehabilitation. No impact on cognitive function was found.
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Geriatrician performed comprehensive geriatric care in older adults referred to an outpatient community rehabilitation unit a randomized controlled trial
European Journal of Internal Medicine, 2018Co-Authors: Dmitri Zintchouk, Merete Gregersen, Torsten Lauritzen, E M DamsgaardAbstract:Abstract Background Older adults make increasing demands on all sectors of the healthcare system. We investigated the effect of Geriatrician-performed comprehensive geriatric care (CGC) in older adults referred to a community rehabilitation unit. Design Randomized controlled trial. Setting Two Danish non-hospital based rehabilitation units. Participants Persons aged 65 or older admitted from home or hospital. Intervention CGC performed by a Geriatrician at the rehabilitation unit. Outcomes Primary outcome was number of hospital admissions and emergency department (ED) visits. Secondary outcomes were number of ambulatory contacts, general practitioner (GP) contacts, activities of daily living (ADL) and overall quality of life (OQoL). Outcomes were measured within 90 days of admission to the rehabilitation units. Results 368 persons were randomized: 185 to the intervention group (IG) vs 183 to the control group (CG). Groups were comparable at baseline. The number of hospital admissions and ED visits, ambulatory contacts and out of hour GP visits or phone calls did not differ between the groups. The number of daytime GP consultations and visits or phone and email consultations was lower in the IG (P Conclusion Geriatrician-performed CGC in older adults in a community rehabilitation unit had no effect on the secondary healthcare utilization, but may reduce primary healthcare utilization and improve OQoL during the 90-day follow-up period. Trial registration ClinicalTrials.gov NCT01506219 .
Charlene Soobiah - One of the best experts on this subject based on the ideXlab platform.
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engaging knowledge users in a systematic review on the comparative effectiveness of Geriatrician led models of care is possible a cross sectional survey using the patient engagement evaluation tool
Journal of Clinical Epidemiology, 2019Co-Authors: Charlene Soobiah, Gayle Manley, Sharon Marr, Sylvia Teare, Jemila S Hamid, Sharon E Straus, Elliot Paus Jenssen, Andrea C TriccoAbstract:Abstract Background A systematic review (SR) was conducted to evaluate the comparative effectiveness of Geriatrician-led models of care, and an integrated knowledge translation (iKT) approach facilitated SR relevance. Activities to engage knowledge users (KUs) in the SR were evaluated for perceived level of engagement. Study Design and Setting KUs included patients, caregivers, Geriatricians, and policymakers from three Canadian provinces. Activities included 1) modified Delphi to select outcomes; 2) cross-sectional survey to select outcome measures, and 3) in-person meeting to discuss SR findings. KU engagement was assessed using the Patient Engagement Evaluation Tool (PEET) after the second and third activities. KUs rated the extent of successful engagement using a 7-point Likert scale ranging from “no extent” to “very large extent.” Results In total, 15 KUs completed the PEET: eight Geriatricians, four policymakers, two patients, and one caregiver. Median engagement scores across all activities (median range: 6.00-6.50) indicated that KUs felt engaged. Differences were observed for activity type; perceived engagement at in-person meeting resulted in higher meta-criteria scores for trust (P = 0.005), legitimacy (P = 0.003), fairness (P = 0.013), and competency (P = 0.035) compared with online activities. Conclusions KUs can be engaged meaningfully in SR processes. Their perceived engagement was higher for in-person than for online activities.
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a modified delphi and cross sectional survey to facilitate selection of optimal outcomes and measures for a systematic review on Geriatrician led care models
Journal of Clinical Epidemiology, 2019Co-Authors: Charlene Soobiah, Gayle Manley, Sharon Marr, Ainsley Moore, Elliot Pausjenssen, Sylvia Teare, Jemila S Hamid, Andrea C Tricco, Sharon E StrausAbstract:Abstract Objective The objective of this study was to identify relevant outcomes and measures to inform a systematic review (SR) on the comparative effectiveness of Geriatrician-led care models. Study Design and Setting In the modified Delphi to select outcomes for inclusion in the SR, knowledge users (KUs) from Ontario, Alberta, and Saskatchewan rated outcome importance using a Likert scale. A survey was then completed by Geriatricians to determine optimal measures for selected outcomes. Findings were analyzed using frequencies, means, and standard deviations (SDs). Results Thirty-three KUs (patients, caregivers, policymakers and Geriatricians) rated 27 outcomes in round 1 of the modified Delphi. Top-rated outcomes included function (mean 6.85 ± SD 0.36), cognition (6.47 ± SD 0.72), and quality of life (6.38 ± SD 0.91). Twenty-three KUs participated in round 2 and rated 24 outcomes. Top-rated outcomes in round 2 were function (6.87 ± SD 0.34), quality of life (6.45 ± SD 1.10), and cognition (6.43 ± SD 0.73). The survey was completed by 22 Geriatricians and the highest ranked measures were Activities of Daily Living (function), Mini-Mental State Examination (cognition), and the Medical Outcomes Study SF-36 (quality of life). Conclusion We identified the most relevant outcomes and measures for patients, caregivers, policymakers, and Geriatricians, allowing us to tailor the SR to KU needs.
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an evaluation of the comparative effectiveness of Geriatrician led comprehensive geriatric assessment for improving patient and healthcare system outcomes for older adults a protocol for a systematic review and network meta analysis
Systematic Reviews, 2017Co-Authors: Charlene Soobiah, Caitlin H Daly, Erik Blondal, Joycelyne E Ewusie, Meghan J Elliott, Rossini Yue, Jayna HolroydleducAbstract:Comprehensive geriatric assessment (CGA) is an integrated model of care involving a Geriatrician and an interdisciplinary team and can prioritize and manage complex health needs of older adults with multimorbidity. CGAs differ across healthcare settings, ranging from shared care conducted in primary care settings to specialized inpatient units in acute care. Models of care involving Geriatricians vary across healthcare settings, and it is unclear which CGA model is most effective. Our objective is to conduct a systematic review and network meta-analysis (NMA) to examine the comparative effectiveness of various Geriatrician-led CGAs and to identify which models improve patient and healthcare system level outcomes. An integrated knowledge translation approach will be used and knowledge users (KUs) including patients, caregivers, Geriatricians, and healthcare policymakers will be involved throughout the review. Electronic databases including MEDLINE, EMBASE, Cochrane library, and Ageline will be searched from inception to November 2016 to identify relevant studies. Randomized controlled trials of older adults (≥65 years of age) that examine Geriatrician-led CGAs compared to any intervention will be included. Primary and secondary outcomes will be selected by KUs to ensure the results are relevant to their decision-making. Two reviewers will independently screen the search results, extract data, and assess risk of bias. Data will be synthesized using an NMA to allow for multiple comparisons using direct (head-to-head) as well as indirect evidence. Interventions will be ranked according to their effectiveness using surface under the cumulative ranking curve (SUCRA). As the proportion of older adults grows worldwide, the demand for specialized geriatric services that help manage complex health needs of older adults with multimorbidity will increase in many countries. Results from this systematic review and NMA will enhance decision-making and the efficient allocation of scarce geriatric resources. Moreover, active involvement of KUs throughout the review process will ensure the results are relevant to different levels of decision-making. PROSPERO CRD42014014008
Dmitri Zintchouk - One of the best experts on this subject based on the ideXlab platform.
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impact of Geriatrician performed comprehensive geriatric care on medication use and cognitive function in older adults referred to a non hospital based rehabilitation unit
The American Journal of Medicine, 2019Co-Authors: Dmitri Zintchouk, Merete Gregersen, Torsten Lauritzen, E M DamsgaardAbstract:Abstract Background and Purpose Eighty-eight percent of older adults referred to Danish non-hospital-based rehabilitation units used ≥5 regular drugs per day at the beginning of rehabilitation. The aim of the study was to explore whether Geriatrician-performed comprehensive geriatric care had an impact on medication use and cognitive function in older adults after a 90-day follow-up. Methods There were 368 individuals aged ≥65 years recruited from 2 Danish non-hospital-based rehabilitation units and randomized to geriatric care (the intervention group) or usual care (the control group). The medication adjustment was the key element of the geriatric intervention. The control group received standard rehabilitation with general practitioners as back-up. The outcomes were prevalence of hyperpolypharmacy (≥10 regular medications prescribed concurrently), the change in medication profile, and cognitive function measured using the Mini-Mental State Examination. Results In the intervention group, fewer persons were exposed to hyperpolypharmacy (odds ratio 0.5; 95% confidence interval, 0.3-0.9) compared with the control group after 90 days. The prevalence of use of proton pump inhibitors, loop diuretics, or antiasthmatic inhalers was lower, while the prevalence of cholecalciferol use was higher in the intervention group compared with the control group. The prevalence of other drug use and cognitive function between groups were not different. Conclusions Geriatrician-performed comprehensive geriatric care may reduce the prevalence of hyperpolypharmacy and optimize the medication profile in older adults referred to a non-hospital-based rehabilitation. No impact on cognitive function was found.
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Geriatrician performed comprehensive geriatric care in older adults referred to an outpatient community rehabilitation unit a randomized controlled trial
European Journal of Internal Medicine, 2018Co-Authors: Dmitri Zintchouk, Merete Gregersen, Torsten Lauritzen, E M DamsgaardAbstract:Abstract Background Older adults make increasing demands on all sectors of the healthcare system. We investigated the effect of Geriatrician-performed comprehensive geriatric care (CGC) in older adults referred to a community rehabilitation unit. Design Randomized controlled trial. Setting Two Danish non-hospital based rehabilitation units. Participants Persons aged 65 or older admitted from home or hospital. Intervention CGC performed by a Geriatrician at the rehabilitation unit. Outcomes Primary outcome was number of hospital admissions and emergency department (ED) visits. Secondary outcomes were number of ambulatory contacts, general practitioner (GP) contacts, activities of daily living (ADL) and overall quality of life (OQoL). Outcomes were measured within 90 days of admission to the rehabilitation units. Results 368 persons were randomized: 185 to the intervention group (IG) vs 183 to the control group (CG). Groups were comparable at baseline. The number of hospital admissions and ED visits, ambulatory contacts and out of hour GP visits or phone calls did not differ between the groups. The number of daytime GP consultations and visits or phone and email consultations was lower in the IG (P Conclusion Geriatrician-performed CGC in older adults in a community rehabilitation unit had no effect on the secondary healthcare utilization, but may reduce primary healthcare utilization and improve OQoL during the 90-day follow-up period. Trial registration ClinicalTrials.gov NCT01506219 .
Judith Partridge - One of the best experts on this subject based on the ideXlab platform.
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where are we now in perioperative medicine results from a repeated uk survey of geriatric medicine delivered services for older people
Age and Ageing, 2019Co-Authors: Andrea Joughin, Judith Partridge, Tessa Ohalloran, Jugdeep K DhesiAbstract:INTRODUCTION: national reports highlight deficiencies in the care of older patients undergoing surgery. A 2013 survey showed less than a third of NHS trusts had Geriatrician-led perioperative medicine services for older surgical patients. Barriers to establishing services included funding, workforce and limited interspecialty collaboration. Since then, national initiatives have supported the expansion of Geriatrician-led services for older surgical patients.This repeat survey describes Geriatrician-led perioperative medicine services in comparison with 2013, exploring remaining barriers to developing perioperative medicine services for older patients. METHODS: an electronic survey was sent to clinical leads for geriatric medicine at 152 acute NHS healthcare trusts in the UK. Reminders were sent on four occasions over an 8-week period. The survey examined the nature of the services provided, extent of collaborative working and barriers to service development. Responses were analysed descriptively. RESULTS: eighty-one (53.3%) respondents provide geriatric medicine services for older surgical patients, compared to 38 (29.2%) in 2013. Services exist across surgical specialties, especially in orthopaedics and general surgery. Fourteen Geriatrician-led preoperative clinics now exist. Perceived barriers to service development remain workforce issues and funding. Interspecialty collaboration has increased, evidenced by joint audit meetings (33% from 20.8%) and collaborative guideline development (31% from 17%). CONCLUSION: since 2013, an increase in whole-pathway geriatric medicine involvement is observed across surgical specialties. However, considerable variation persists across the UK with scope for wider adoption of services facilitated through a national network.
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where are we in perioperative medicine for older surgical patients a uk survey of geriatric medicine delivered services in surgery
Age and Ageing, 2014Co-Authors: Judith Partridge, Geraint Collingridge, Adam L Gordon, Finbarr C Martin, Danielle Harari, Jugdeep K DhesiAbstract:Introduction: national reports have highlighted deficiencies in care provided to older surgical patients and suggested a role for innovative, collaborative, inter-specialty models of care. The extent of Geriatrician-led perioperative services in the UK (excluding orthogeriatric services) has not previously been described. This survey describes current services and explores barriers to further development. Methods: an electronic survey was sent to clinical leads for geriatric medicine at all 161 acute NHS health care trusts in the UK. Reminders were sent on three occasions over an 8-week period. The survey examined preoperative and postoperative care and organisational issues. Responses were analysed descriptively. Results: there were 130 respondents (80.7%). One-third (38) of respondents described providing some geriatric medicine input in older surgical patients. Preoperative services existed in 15 (12%), where 14 provided risk assessment and 13 preoperative optimisation. Twenty-six respondents (20%) delivered care postoperatively, of them 10 took a reactive approach, 11 a proactive approach and 5 provided a combination of reactive and proactive care. Barriers to establishing perioperative geriatric medicine services included funding, workforce issues and a lack of inter-specialty collaboration. Conclusion: a national appetite exists to provide Geriatrician-led services to older surgical patients yet the majority of existing services remain reactive and do not use comprehensive geriatric assessment as an organising principle. This survey suggests that funding for Geriatricians in perioperative care has not yet been universally established. Future efforts should focus on dissemination of experiential knowledge and published resources, collaboration with commissioners and empirical research to overcome the barriers described.