Comprehensive Geriatric Assessment
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Association of a geriatric emergency department program with healthcare outcomes among veterans - Huded - 2022 - Journal of the American Geriatrics Society - Wiley Online Library

Association of a geriatric emergency department program with healthcare outcomes among veterans - Huded - 2022 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it

In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI-VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI-VET eligible Veterans who did not receive GERI-VET care. Propensity score matching was used to compare outcomes in the GERI-VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30-day admission.

 

Conclusions

A program designed to screen for geriatric syndromes and coordinate care among at-risk older Veterans was associated with increased multidisciplinary resource utilization and reduced ED and 30-day admissions without increasing ED length of stay or re-visitation.

 
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The Use and Knowledge of Validated Geriatric Assessment Instruments Among US Community Oncologists

The Use and Knowledge of Validated Geriatric Assessment Instruments Among US Community Oncologists | Comprehensive Geriatric Assessment | Scoop.it
PURPOSE:The use of a standardized geriatric assessment (GA) to inform treatment decisions in older adults with cancer improves quality of life, reduces treatment-related toxicity, and is guideline-...
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Comprehensive Geriatric Assessment for community‐dwelling, high‐risk, frail, older people - Briggs, R - 2022 | Cochrane Library

Comprehensive Geriatric Assessment for community‐dwelling, high‐risk, frail, older people - Briggs, R - 2022 | Cochrane Library | Comprehensive Geriatric Assessment | Scoop.it
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STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation | Age and Ageing | Oxford Academic

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it
Objectiveto validate STOPPFrail, a list of explicit criteria for potentially inappropriate medication (PIM) use in frail older adults with limited life expectancy.Designa Delphi consensus survey of an expert panel comprising academic geriatricians, clinical pharmacologists, palliative care physicians, old age psychiatrists, general practitioners and clinical pharmacists.SettingIreland.Subjectsseventeen panellists.MethodsSTOPPFrail criteria were initially created by the authors based on clinical experience and literature appraisal. Criteria were organised according to the physiological system; each criterion accompanied by an explanation. Using Delphi consensus methodology, panellists ranked their agreement with each criterion on a 5-point Likert scale and provided written feedback. Criteria with a median Likert response of 4/5 (agree/strongly agree) and a 25th centile of ≥4 were included in the final list.Resultsall panellists completed three Delphi rounds. Thirty criteria were proposed, 27 were accepted. The first two criteria suggest deprescribing medications without indication or where compliance is poor. The remaining 25 criteria include lipid-lowering therapies, alpha-blockers for hypertension, anti-platelets, neuroleptics, memantine, proton-pump inhibitors, H2-receptor antagonists, anti-spasmodic agents, theophylline, leukotriene antagonists, calcium supplements, bone anti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal anti-inflammatories, corticosteroids, 5-alpha-reductase inhibitors, alpha-1-selective blockers, muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor blockers, systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibiotics. Consensus could not be reached on the inclusion of acetylcholinesterase inhibitors. Full consensus was reached on the exclusion of anticoagulants and antidepressants from the list.ConclusionSTOPPFrail comprises 27 criteria relating to medications that are potentially inappropriate in frail older patients with limited life expectancy. STOPPFrail may assist physicians in deprescribing medications in these patients.
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Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical ...

Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical ... | Comprehensive Geriatric Assessment | Scoop.it
This randomized clinical trial assesses the effect of intra-arterial alteplase infusion vs placebo on functional outcomes (modified Rankin Scale scores) among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy.
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Prevalence of cerebral amyloid angiopathy: A systematic review and meta‐analysis - Jäkel - 2022 - Alzheimer's & Dementia - Wiley Online Library

Prevalence of cerebral amyloid angiopathy: A systematic review and meta‐analysis - Jäkel - 2022 - Alzheimer's & Dementia - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it

RESEARCH IN CONTEXT

  1. Systematic review: Cerebral amyloid angiopathy (CAA) is an important cause of cognitive impairment and may also lead to intracerebral hemorrhages. Besides, CAA is tightly linked to the development of “amyloid-related imaging abnormalities" (ARIA), a rare and sporadic complication of CAA, that also frequently occurs as a side-effect of anti-amyloid β immunotherapy in Alzheimer's disease (AD) patients. Knowledge of the prevalence of CAA is important to understand the risk of each individual to develop clinical symptoms due to CAA and to understand the potential risks of developing CAA-related ARIA in immunotherapy. In this systematic review and meta-analysis we provide accurate estimates of the prevalence of CAA in AD, in the general population, in cognitively normal elderly, and in patients with (lobar) intracerebral hemorrhage.
  2. Interpretation: Based on neuropathological examination, the prevalence of moderate-to-severe CAA in AD is 48% and in the general population 23%. Prevalence of CAA based on MRI criteria was remarkably lower: 22% in AD and 7% in the general population. Both methods yielded similar CAA prevalence in cognitively normal elderly (5% to 7%), in patients with intracerebral hemorrhage (19% to 24%), and in patients with lobar intracerebral hemorrhage (50% to 57%). There was large heterogeneity in methodology and criteria for CAA both in neuropathology and neuroimaging studies.
  3. Future directions: These observations call for development of accurate biomarkers to detect CAA during life, including biomarkers in cerebrospinal fluid or blood. In addition, future studies should assess MRI biomarkers for CAA specifically in AD patients. In addition we propose harmonized and standardized protocols to facilitate uniform reporting of CAA, both in neuropathology and neuroimaging studies.
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Association of a geriatric emergency department program with healthcare outcomes among veterans - Huded - 2022 - Journal of the American Geriatrics Society - Wiley Online Library

Association of a geriatric emergency department program with healthcare outcomes among veterans - Huded - 2022 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it

In this prospective observational cohort study at an urban Veterans Affairs Medical Center ED, participants included Veterans aged 65 years and older treated in the ED from January 7, 2017 to February 29, 2020. Veterans with an Identification of Seniors At Risk (ISAR) score >2 were considered eligible for GERI-VET, receiving geriatric screens and care coordination in addition to standard ED treatment. The control group included GERI-VET eligible Veterans who did not receive GERI-VET care. Propensity score matching was used to compare outcomes in the GERI-VET group (N = 725) and a matched control group (n = 725). Key measures included ED resource utilization, outpatient referrals, ED admission, and 30-day admission.

 

Conclusions

A program designed to screen for geriatric syndromes and coordinate care among at-risk older Veterans was associated with increased multidisciplinary resource utilization and reduced ED and 30-day admissions without increasing ED length of stay or re-visitation.

 
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Containing the hospital days for older patients in the era of value‐based care - Tan - 2022 - Journal of the American Geriatrics Society - Wiley Online Library

Containing the hospital days for older patients in the era of value‐based care - Tan - 2022 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it

Geriatric and palliative care consultation models have the potential to impact healthcare utilization. Studies on inpatient geriatric hospital and consultation care models including the Acute Care for Elders (ACE) unit and Mobile Acute Care of the Elderly service have shown a reduction in hospital lengths of stay and readmission rates.4, 5 However, a systematic review and meta-analysis of inpatient geriatric consultation interventions showed no impact on readmission or length of stay.6 Similarly, while inpatient palliative care consultation services may reduce overall costs of hospitalization,7 a length of stay analysis showed palliative care interventions had no impact on the length of stay outside the intensive care unit (ICU).8

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Evidence on acupuncture therapies is underused in clinical practice and health policy | The BMJ

Evidence on acupuncture therapies is underused in clinical practice and health policy | The BMJ | Comprehensive Geriatric Assessment | Scoop.it

A recent overview of acupuncture systematic reviews found that of 77 diseases investigated, acupuncture showed a moderate or large effect with moderate or high certainty evidence in eight diseases or conditions: improvement in functional communication of patients with post-stroke aphasia; relief of neck and shoulder pain; relief of myofascial pain; relief of fibromyalgia related pain; relief of non-specific lower back pain; increased lactation success rate within 24 hours of delivery; reduction in the severity of vascular dementia symptoms; and improvement of allergic rhinitis nasal symptoms.9

However, instead of endorsement in health policies and wide use in clinical practice, only a few healthcare systems incorporated acupuncture into clinical practice guidelines and national health coverage for these conditions.131415

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Defining Optimal Respiratory Support for Patients With COVID-19 | Critical Care Medicine | JAMA | JAMA Network

Defining Optimal Respiratory Support for Patients With COVID-19 | Critical Care Medicine | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
Noninvasive respiratory support is an essential component of critical care. Both noninvasive ventilation, with its different interface types and modes (including helmet and face masks), and high-flow nasal oxygen (HFNO) are successfully used to manage patients with acute hypoxemi
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Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial | Critical Ca...

Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial | Critical Ca... | Comprehensive Geriatric Assessment | Scoop.it
This randomized clinical trial compares the effect of continuous positive airway pressure or high-flow nasal oxygen vs conventional oxygen therapy on clinical outcomes in hospitalized patients with COVID-19 and acute hypoxemic respiratory failure (AHRF).
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Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients | NEJM

Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients | NEJM | Comprehensive Geriatric Assessment | Scoop.it
Abstract Background Remdesivir improves clinical outcomes in patients hospitalized with moderate-to-severe coronavirus disease 2019 (Covid-19). Whether the use of remdesivir in symptomatic
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Establishing a proactive geriatrician led comprehensive geriatric assessment in older emergency surgery patients: Outcomes of a pilot study

Establishing a proactive geriatrician led comprehensive geriatric assessment in older emergency surgery patients: Outcomes of a pilot study | Comprehensive Geriatric Assessment | Scoop.it
Proactive geriatrician input identifies medical diagnoses and geriatric syndromes missed by the surgical teams. Managing these issues has contributed to a reduced length of stay in these patients.
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Oncologists Reveal Limited Use of Geriatric Assessment in Older Patients

Oncologists Reveal Limited Use of Geriatric Assessment in Older Patients | Comprehensive Geriatric Assessment | Scoop.it
Research has shown the use of standardized geriatric assessments (GAs) to aid in treatment decisions in older patients with cancer improves quality of life, reduces treatment-related toxicity, and is guideline recommended.1 However, a survey conducted among practicing oncologists and hematologists from the Cardinal Health Oncology Provider Extended Network revealed that most physicians rely on ECOG performance status and comorbidities to inform treatment decisions in older adults with cancer; fewer than a quarter of respondents said they use GAs in clinical practice.2

The survey collected responses from 349 physicians on whether they use GAs to inform treatment decisions in patients with geriatric cancer, and 60% responded that they do not use a formal GA for any older patients. Of the respondents who do use GAs, 13% perform them for all older patients and the rest use GAs for only some older patients.



The most common reasons for not using a GA were that they are “too cumbersome to incorporate into routine practice” (44%) and “add no value beyond the comprehensive history and physical exam” (36%) (TABLE 1).2

Between September 2019 and March 2020, oncologists were recruited from the Oncology Provider Extended Network to attend 1 of 6 live meetings and were asked questions on GAs. Participants were not aware they would be asked questions about GAs during the live meeting.

Regarding level of experience, 23% of survey participants had practiced between 1 and 10 years, 38% between 10 and 20 years, and 39% for more than 20 years. The majority of physicians came from the southern US (40%), followed by the Midwest (22%), Northeast (19%), and the West (18%).

Most participants defined “older” patients as 70 years or older (39%), followed by 75 years (32%), 65 years (22%), and 60 years (3%) as the cutoff (FIGURE).2 For patients 75 years and older, physicians answered that ECOG performance status (88%) and comorbidities (73%) were the 2 most frequently used patient characteristics in determining treatment decisions.2

Participants with fewer years of experience used GA more often than more experienced physicians. Among the 80 oncologists with 10 years or less in practice, 42 (53%) reported using a GA to inform treatment decisions for their older patients—12 (15%) used it for all their older patients, and 30 (38%) used it for some (TABLE 2).2 In the group of oncologists with more than 10 years in practice (n = 269), 100 (37%) reported using a GA, with 32 (12%) using it for all their older patients and 68 (25%) using it for some (P = .0997).

In an interview with Targeted Therapies in Oncology™, lead study author and chief scientific officer at Cardinal Health, Ajeet Gajra, MD, MBBS, FACP, discussed the relationship between oncologist experience level and utilization of GA.

“I think this [difference between more experienced and less experienced oncologists] likely has to do with a greater emphasis and recognition of the importance of geriatric assessment,” Gajra said. “Geriatric oncology is a newer field. As we know, NCCN [National Comprehensive Cancer Network] created their fi rst set of adult oncology guidelines back in 2005. And then, ASCO [American Society of Clinical Oncology] and other organizations have reiterated the importance of geriatric assessment or having their own guidelines. And most recently in 2018, ASCO renewed or gave an update of their own guidelines. So, I feel there’s greater recognition by organizations in more recent times.” 3,4

Investigators also asked which validated GA instruments doctors were aware of. Most knew of the Mini–Mental State Exam (MMSE; 63%), the comprehensive geriatric assessment (37%), and the Cancer and Aging Research Group (CARG) GA tool (22%); however, 19% of participants were not aware of any of these or other GAs listed in the question.



When asked about the specific GAs used outside clinical trials, 54% have used MMSE, 23% have used the comprehensive GA,12% the CARG GA tool, and 9% the Chemotherapy Risk Assessment Scale for High-Age Patients; however, 33% answered that they had never used any validated GA instruments outside a clinical trial.

Investigators posed additional questions to better understand oncologists’ strategies for assessing older adults and potential barriers to GA use. When asked how they usually assess physical function, most answered that they rely on ECOG performance status (82%) and history and physician examination (HPE; 42%). The most frequently used cognitive assessments were HPE (78%) or MMSE (12%). Social support was assessed via HPE (44%) or GA (27%).

Although guidelines recommend the use of a GA for patients 65 years and older, the use of these tools within community oncology practices is unclear. These survey results highlight an important gap between what is being recommended in clinical practice guidelines and what oncologists are routinely performing. These findings beg the question whether increased education of the benefits of GA-directed therapy would alter oncologists’ practices and potentially increase the utilization of GA in their treatment routine for older patients.



When asked how the use of GA could become more widespread, Garjra said, “I think [it] is important, especially [among] practicing community oncologists, to spread the word, and I feel...that perhaps we need to spread the word via different organizations—perhaps partnering with something like...the Community Oncology Alliance [COA]. I think organizations like ASCO or NCCN can partner with COA, which [hosts a conference that] is attended by community oncologists. I think that’s where a major deficit is. Also, a lot of these doctors are older or have been in practice awhile, so I think that is perhaps a way to reach them.”

REFERENCES

1. Kenis C, Bron D, Libert Y, et al. Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Ann Oncol. 2013;24(5):1306-1312. doi:10.1093/annonc/mds619

2. Gajra A, Jeune-Smith Y, Fortier S, et al. The use and knowledge of validated geriatric assessment instruments among US community oncologists. JCO Oncol Pract. Published online March 9, 2022. doi:10.1200/OP.21.00743

3. Balducci L, Cohen HJ, Engstrom PF, et al; National Comprehensive Cancer Network. Senior adult oncology clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2005;3(4):572-590. doi:10.6004/jnccn.2005.0032

4. Mohile SG, Dale W, Somerfi eld MR, et al. Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology. J Clin Oncol. 2018;36(22):2326-2347. doi:10.1200/JCO.2018.78.8687
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Evaluación de la función renal en la insuficiencia cardiaca | Revista Clínica Española

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Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art

Oropharyngeal dysphagia (OD) is a condition recognized by the World Health Organization
and defined as the difficulty or inability to move a bolus safely and effectively
from the oral cavity to the esophagus, and can include aspirations, choking, and residue.
OD is pandemic among different phenotypes of older people, affecting between 27% and
91% of the population 70 years or older. Although OD can be diagnosed by well-defined
clinical methods and complementary explorations, in the clinical setting OD is seldom
systematically screened and treated, and awareness among the medical/geriatric community
is scarce.
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Discriminative Ability for Adverse Outcomes After Hip Fracture Surgery: A Comparison of Three Commonly Used Comorbidity-Based Indices - Abstract - Gerontology 2022, Vol. 68, No. 1 - Karger Publishers

Discriminative Ability for Adverse Outcomes After Hip Fracture Surgery: A Comparison of Three Commonly Used Comorbidity-Based Indices - Abstract - Gerontology 2022, Vol. 68, No. 1 - Karger Publishers | Comprehensive Geriatric Assessment | Scoop.it
Introduction: Preoperative risk assessment can predict adverse outcomes following hip fracture surgery, helping with decision-making and management strategies. Several risk adjustment models based on coded comorbidities such as Charlson Comorbidity Index (CCI), modified Elixhauser’s Comorbidity Measure (mECM), and modified frailty index (mFI-5) are
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Harmonizing neuropsychological assessment for mild neurocognitive disorders in Europe - Boccardi - 2022 - Alzheimer's & Dementia - Wiley Online Library

Harmonizing neuropsychological assessment for mild neurocognitive disorders in Europe - Boccardi - 2022 - Alzheimer's & Dementia - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it

RESEARCH IN CONTEXT

  1. Systematic review: With inclusive strings, we identified literature, resources, projects, and participants for a workshop to harmonize neuropsychological assessment for European clinics, as existing initiatives were either limited to individual countries or to research settings (Table S2).

  2. Interpretation: Our consensus Clinician's Uniform Dataset (cUDS), similar to UDS-3, and our methodology for generating harmonized norms would (a) improve detection of Alzheimer‘s disease (AD) and of non-AD or atypical-AD syndromes in mild cognitive impairment (MCI); (b) reduce costs; (c) benefit patients, health care systems, and clinical research within a consistent framework; (d) align clinical and research procedures; and (e) achieve modern, reliable, and cost-effective standard of care for neurocognitive disorders.

  3. Future directions will consist of exploring hurdles and needs to implement the cUDS in academic and non-academic memory clinics, creating and validating local versions for European languages, and creating tools to support adoption.

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Interprofessional geriatric and palliative care intervention associated with fewer hospital days - Min - 2022 - Journal of the American Geriatrics Society - Wiley Online Library

Interprofessional geriatric and palliative care intervention associated with fewer hospital days - Min - 2022 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it
Abstract Background With increasing complexity of our aging inpatient population, we implemented an interprofessional geriatric and palliative care intervention on a hospitalist service. Thi
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The association between the community SARS exposure and allostatic load among Chinese older adults - Ye - 2022 - Journal of the American Geriatrics Society - Wiley Online Library

The association between the community SARS exposure and allostatic load among Chinese older adults - Ye - 2022 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it

Objectives
Previous studies have found that severe acute respiratory syndrome (SARS) was associated with the physical and psychological stress of those infected. However, research is spars
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Increasing the usefulness of acupuncture guideline recommendations | The BMJ

Increasing the usefulness of acupuncture guideline recommendations | The BMJ | Comprehensive Geriatric Assessment | Scoop.it

Conventional medical communities increasingly consider acupuncture, contributing two thirds of all guidelines addressing acupuncture interventions. These recommendations are, however, still limited in their usefulness because of poor reporting of target populations, incomplete description of acupuncture intervention, failure to specify alternative care options, lack of comprehensive consideration of all patient important outcomes, failure to elucidate and apply patients’ values and preferences, and disregard of a large portion of the available body of acupuncture evidence. While limited available evidence suggests that existing barriers to implementation of acupuncture recommendations have commonality across cultures, few research efforts have focused on implementing acupuncture guidelines.

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COVID-19 Therapeutics for Nonhospitalized Patients | Infectious Diseases | JAMA | JAMA Network

COVID-19 Therapeutics for Nonhospitalized Patients | Infectious Diseases | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This Viewpoint provides a summary of currently available therapeutics for nonhospitalized patients with COVID-19 in the setting of the Omicron variant including principles for equitable allocation.
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Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared With Previous Waves | Global Health | JAMA | JAMA Network

Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared With Previous Waves | Global Health | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This study describes the characteristics and clinical outcomes of patients hospitalized in South Africa during the Omicron wave compared with the same variables from earlier COVID-19 waves.
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Preparing Hospitals’ Medical Oxygen Delivery Systems for a Respiratory “Twindemic” | Critical Care Medicine | JAMA | JAMA Network

Preparing Hospitals’ Medical Oxygen Delivery Systems for a Respiratory “Twindemic” | Critical Care Medicine | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This Medical News feature examines the challenges that hospitals face as they prepare for a spike in severe cases of COVID-19 and other respiratory illnesses that require supplemental oxygen.
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Prognostic nomogram for risk of mortality after hip fracture surgery in geriatrics

Prognostic nomogram for risk of mortality after hip fracture surgery in geriatrics | Comprehensive Geriatric Assessment | Scoop.it
This novel nomogram for stratifying the mortality risk after hip fracture surgery in geriatrics incorporated age, CCI, serum albumin, sodium, and hemoglobin. Internal validation indicated that the model has good accuracy and usefulness. This nomogram had improved convenience and precision compared w …
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