The Experts below are selected from a list of 192 Experts worldwide ranked by ideXlab platform
Dorly J. H. Deeg - One of the best experts on this subject based on the ideXlab platform.
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Static and dynamic measures of frailty predicted decline in performance-based and self-reported physical functioning
Journal of clinical epidemiology, 2005Co-Authors: Martine T. E. Puts, Paul Lips, Dorly J. H. DeegAbstract:Abstract Objective To determine the effect of frailty on decline in physical functioning and to examine if chronic diseases modify this effect. Methods The study sample was derived from the Longitudinal Aging Study Amsterdam and included respondents with initial ages 65 and over at T 2 (1995/1996), who participated at T 1 (1992/1993) and T 2 and performed physical performance tests ( n = 1,152) or reported functional limitations ( n = 1,321) at T 2 and T 3 (1998/1999). Nine frailty markers were determined in two ways: low functioning at T 2 (Static Definition); and decline in functioning between T 1 and T 2 (dynamic Definition). Using logistic regression analyses, the effect of frailty was examined on change in physical functioning between T 2 and T 3 , adjusting for sex, age, education, and additionally chronic diseases. Results Static frailty was associated with performance decline only in the middle–old group (OR 2.43; 95%CI 1.23–4.80) and associated with decline in self-reported functioning (OR 2.44; 95%CI 1.77–3.36). Dynamic frailty was associated with decline in performance only in women (OR 1.72; 95%CI 1.11–2.67) and with self-reported functional decline (OR 1.77; 95%CI 1.29–2.43). These associations were independent of chronic diseases. Conclusion Frailty is more strongly associated with self-reported functional decline in older persons than with performance decline.
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Sex differences in the risk of frailty for mortality independent of disability and chronic diseases.
Journal of the American Geriatrics Society, 2005Co-Authors: Martine T. E. Puts, Paul Lips, Dorly J. H. DeegAbstract:To determine the effect of Static and dynamic frailty on mortality in older men and women. A prospective cohort study with three 3-year measurement cycles. Population based. The sample was derived from the Longitudinal Aging Study Amsterdam and consisted of respondents who participated in two cycles (T1: 1992/1993 and T2: 1995/1996) and for whom there was complete data on disability and chronic diseases (N=2,257). Nine frailty markers were assessed at T1 and T2. The frailty markers were defined in two ways: low functioning at T2 (Static frailty) and change in functioning between T1 and T2 (dynamic frailty). Survival time, calculated in days from T2 to January 1, 2000, was used as the outcome variable. Predictive ability was examined using Cox proportional hazards analyses separately for men and women. Women were frailer than men. Static frailty was significantly associated with mortality in men (relative risk (RR)=2.4) and in women (RR=2.6). Dynamic frailty was also associated with mortality in women (RR=2.6), but it was not significantly associated with mortality in men (RR=1.3). When disability and chronic diseases were included in the model as possible mediators, these RRs dropped to 1.6, 2.0, 2.1, and 1.2, respectively, of which the first three were still significant. Frailty was associated with mortality to a greater extent in women than in men, and this effect was independent of disability and chronic disease. In men, the Static Definition of frailty was more predictive of mortality than the dynamic Definition.
Kevin Stroupe - One of the best experts on this subject based on the ideXlab platform.
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Rate of Kidney Function Decline Associates with Mortality
Journal of the American Society of Nephrology : JASN, 2010Co-Authors: Ziyad Al-aly, Angelique Zeringue, Michael I. Rauchman, Jay R. Mcdonald, Tarek M. El-achkar, Sumitra Balasubramanian, Diana Nurutdinova, Hong Xian, Kevin StroupeAbstract:The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the Definition of CKD may transform a Static Definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual.
Ziyad Al-aly - One of the best experts on this subject based on the ideXlab platform.
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Rate of change in kidney function and the risk of death: the case for incorporating the rate of kidney function decline into the CKD staging system.
Nephron. Clinical practice, 2011Co-Authors: Ziyad Al-aly, Oscar CepedaAbstract:Chronic kidney disease (CKD) is associated with increased risk of death. A wave of recent studies used longitudinal data to examine the effect of the rate of decline of kidney function on the risk of death. The results from these studies show that there is an independent and graded association between the rate of kidney function decline and the risk of death. There is a need to incorporate the rate of decline in the Definition of CKD. This reDefinition of CKD will transform a Static Definition into a dynamic one that more accurately describes the disease state in an individual patient.
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Rate of Kidney Function Decline Associates with Mortality
Journal of the American Society of Nephrology : JASN, 2010Co-Authors: Ziyad Al-aly, Angelique Zeringue, Michael I. Rauchman, Jay R. Mcdonald, Tarek M. El-achkar, Sumitra Balasubramanian, Diana Nurutdinova, Hong Xian, Kevin StroupeAbstract:The effect of rate of decline of kidney function on risk for death is not well understood. Using the Department of Veterans Affairs national databases, we retrospectively studied a cohort of 4171 patients who had rheumatoid arthritis and early stage 3 chronic kidney disease (CKD; estimated GFR 45 to 60 ml/min) and followed them longitudinally to characterize predictors of disease progression and the effect of rate of kidney function decline on mortality. After a median of 2.6 years, 1604 (38%) maintained stable kidney function; 426 (10%), 1147 (28%), and 994 (24%) experienced mild, moderate, and severe progression of CKD, respectively (defined as estimated GFR decline of 0 to 1, 1 to 4, and >4 ml/min per yr). Peripheral artery disease predicted moderate progression of CKD progression. Black race, hypertension, diabetes, cardiovascular disease, and peripheral artery disease predicted severe progression of CKD. After a median of 5.7 years, patients with severe progression had a significantly increased risk for mortality (hazard ratio 1.54; 95% confidence interval 1.30 to 1.82) compared with those with mild progression; patients with moderate progression exhibited a similar trend (hazard ratio 1.10; 95% confidence interval 0.98 to 1.30). Our results demonstrate an independent and graded association between the rate of kidney function decline and mortality. Incorporating the rate of decline into the Definition of CKD may transform a Static Definition into a dynamic one that more accurately describes the potential consequences of the disease for an individual.
Richard J. Novick - One of the best experts on this subject based on the ideXlab platform.
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Putting the puzzle together: the role of ‘problem Definition’ in complex clinical judgement
Medical education, 2016Co-Authors: Sayra Cristancho, Lorelei Lingard, Thomas L. Forbes, Michael Ott, Richard J. NovickAbstract:We teach judgement in pieces; that is, we talk about each aspect separately (patient, plan, resources, technique, etc.). We also let trainees figure out how to put the pieces together. In complex situations, this might be problematic. Using data from a drawing-based study on surgeons' experiences with complex situations, we explore the notion of 'problem Definition' in real-world clinical judgement using the theoretical lens of systems engineering. 'Emergence', the sensitising concept for analysis, is rooted in two key systems premises: that person and context are inseparable and that what emerges is an act of choice. Via a 'gallery walk' we used these premises to perform analysis on individual drawings as well as cross-comparisons of multiple drawings. Our focus was to understand similarities and differences among the vantage points used by multiple surgeons. In this paper we challenge two assumptions from current models of clinical judgement: that experts hold a fixed and Static Definition of the problem and that consequently the focus of the expert's work is on solving the problem. Each situation described by our participants revealed different but complementary perspectives of what a surgical problem might come to be: from concerns about ensuring standard of care, to balancing personal emotions versus care choices, to coordinating resources, and to maintaining control while in the midst of personality clashes. We suggest that it is only at the situation and system level, not at the individual level, that we are able to appreciate the nuances of defining the problem when experts make judgements during real-world complex situations. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.
Christoph Quix - One of the best experts on this subject based on the ideXlab platform.
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CAiSE - Towards quality-oriented data warehouse usage and evolution
Information Systems, 2000Co-Authors: Panos Vassiliadis, Mokrane Bouzeghoub, Christoph QuixAbstract:As a decision support information system, a data warehouse must provide high level quality of data and quality of service. In the DWQ project we have proposed an architectural framework and a repository of metadata which describes all the data warehouse components in a set of metamodels to which is added a quality metamodel, defining for each data warehouse metaobject the corresponding relevant quality dimensions and quality factors. Apart from this Static Definition of quality, we also provide an operational complement, that is a methodology on how to use quality factors and to achieve user quality goals. This methodology is an extension of the Goal-Question-Metric (GQM) approach, which allows to capture (a) the inter-relationships between different quality factors and (b) to organize them in order to fulfil specific quality goals. After summarizing the DWQ quality model, this paper describes the methodology we propose to use this quality model, as well as its impact on the data warehouse evolution.