Addressing Health Care Needs For Frail Seniors In Canada: The Role of InterRAI Instruments

Fiscal pressure on the Canadian health care system results from rising numbers of frail seniors with multiple concurrent medical co-morbidities and geriatric syndromes. Improving outcomes in such seniors is contingent on a comprehensive geriatric assessment (CGA) to identify strengths and deficits and to facilitate the development of a comprehensive care plan. InterRAI instruments are standardized, reliable, and validated suites of tools to conduct CGAs; they offer several benefits, including helping clinicians identify important health issues among patients, develop appropriate care plans, and monitor patient progess. These instruments also provide several benefits beyond the bedside, including quality indicators to assess care quality, and case-mix classification algorithms to facilitate funding of health services. Finally, interRAI instruments, which are implemented in several health care settings across Canada and abroad, provide a standardized and common language that is compatible with electronic medical records and will facilitate greater integration of the health care system

A telegeriatric service in a small rural hospital: A case study and cost analysis

Introduction Small hospitals in rural areas usually have an insufficient caseload of frail old people to justify the regular presence of a geriatrician. This study examined the costs of providing a telegeriatric service by videoconference in a rural hospital, compared to the costs of a visiting geriatrician that travels to undertake in-person consultations. Methods A cost analysis was undertaken to compare the costs of the telegeriatric service model with the costs of a visiting geriatrician service model. A recently established telegeriatric service at Warwick Hospital was used as a case study. Results In the base case model (assuming four patients per round and a round-trip travel distance of 312 kilometres), an estimated AUD$131 per patient consultation can be saved in favour of the telegeriatric service model. Key drivers of costs are the number of patients per round and the travel distance and time in the visiting geriatrician model. At a workload of four patients per round, it is less expensive to conduct a telegeriatric service than a visiting geriatrician service when the round-trip travel time exceeds 76 minutes. Discussion Even under quite conservative assumptions, a telegeriatric service offers an economically feasible approach to the delivery of specialist geriatric assessment in rural and remote settings

Promoting Activity in Geriatric Rehabilitation: A Randomized Controlled Trial of Accelerometry

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background Low activity levels in inpatient rehabilitation are associated with adverse outcomes. The study aimed to test whether activity levels can be increased by the provision of monitored activity data to patients and clinicians in the context of explicit goal setting. Methods A randomized controlled trial in three sites in Australia included 255 inpatients aged 60 and older who had a rehabilitation goal to become ambulant. The primary outcome was patients’ walking time measured by accelerometers during the rehabilitation admission. Walking times from accelerometry were made available daily to treating therapists and intervention participants to motivate patients to improve incidental activity levels and reach set goals. For the control group, ‘usual care’ was followed, including the setting of mobility goals; however, for this group, neither staff nor patients received data on walking times to aid the setting of daily walking time targets. Results The median daily walking time in the intervention group increased from 10.3 minutes at baseline to 32.1 minutes at day 28, compared with an increase from 9.5 to 26.5 minutes per day in the control group. Subjects in the intervention group had significantly higher non-therapy walking time by about 7 minutes [mean (95% CI): 24.6 (21.7, 27.4)] compared to those in the control group [mean(95% CI): 17.3 (14.4, 20.3)] (p = 0.001). Conclusions Daily feedback to patients and therapists using an accelerometer increased walking times during rehabilitation admissions. The results of this study suggest objective monitoring of activity levels could provide clinicians with information on clinically important, mobility-related activities to assist goal setting. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12611000034932 http://www.ANZCTR.org.au

Derivation of a frailty index from the interRAI acute care instrument

Background: A better understanding of the health status of older inpatients could underpin the delivery of more individualised, appropriate health care

Quality indicators in the care of older persons in the emergency department: a systematic review of the literature

ObjectiveA systematic review of the literature was undertaken to assess the methodological quality of existing quality indicators (QIs) for the emergency department (ED) care of older persons

Measuring the Reduced Shear

Neglecting the second order corrections in weak lensing measurements can lead to a few percent uncertainties on cosmic shears, and becomes more important for cluster lensing mass reconstructions. Existing methods which claim to measure the reduced shears are not necessarily accurate to the second order when a point spread function (PSF) is present. We show that the method of Zhang (2008) exactly measures the reduced shears at the second order level in the presence of PSF. A simple theorem is provided for further confirming our calculation, and for judging the accuracy of any shear measurement method at the second order based on its properties at the first order. The method of Zhang (2008) is well defined mathematically. It does not require assumptions on the morphologies of galaxies and the PSF. To reach a sub-percent level accuracy, the CCD pixel size is required to be not larger than 1/3 of the Full Width at Half Maximum (FWHM) of the PSF. Using a large ensemble (> 10^7) of mock galaxies of unrestricted morphologies, we find that contaminations to the shear signals from the noise of background photons can be removed in a well defined way because they are not correlated with the source shapes. The residual shear measurement errors due to background noise are consistent with zero at the sub-percent level even when the amplitude of such noise reaches about 1/10 of the source flux within the half-light radius of the source. This limit can in principle be extended further with a larger galaxy ensemble in our simulations. On the other hand, the source Poisson noise remains to be a cause of systematic errors. For a sub-percent level accuracy, our method requires the amplitude of the source Poisson noise to be less than 1/80 ~ 1/100 of the source flux within the half-light radius of the source, corresponding to collecting roughly 10^4 source photons.Comment: 18 pages, 3 figures, 4 tables, minor changes from the previous versio

Observation of Bernstein Waves Excited by Newborn Interstellar Pickup Ions in the Solar Wind

A recent examination of 1.9 s magnetic field data recorded by the Voyager 2 spacecraft in transit to Jupiter revealed several instances of strongly aliased spectra suggestive of unresolved high-frequency magnetic fluctuations at 4.4 AU. A closer examination of these intervals using the highest resolution data available revealed one clear instance of wave activity at spacecraft frame frequencies from 0.2 to 1 Hz. Using various analysis techniques, we have characterized these fluctuations as Bernstein mode waves excited by newborn interstellar pickup ions. We can find no other interpretation or source consistent with the observations, but this interpretation is not without questions. In this paper, we report a detailed analysis of the waves, including their frequency and polarization, that supports our interpretation

Real-time analysis and display of quantitative measures to track and improve clinical workflow

PURPOSE: Radiotherapy treatment planning is a complex process with multiple, dependent steps involving an interdisciplinary patient care team. Effective communication and real-time tracking of resources and care path activities are key for clinical efficiency and patient safety. MATERIALS AND METHODS: We designed and implemented a secure, interactive web-based dashboard for patient care path, clinical workflow, and resource utilization management. The dashboard enables visualization of resource utilization and tracks progress in a patient\u27s care path from the time of acquisition of the planning CT to the time of treatment in real-time. It integrates with the departmental electronic medical records (EMR) system without the creation and maintenance of a separate database or duplication of work by clinical staff. Performance measures of workflow were calculated. RESULTS: The dashboard implements a standardized clinical workflow and dynamically consolidates real-time information queried from multiple tables in the EMR database over the following views: (1) CT Sims summarizes patient appointment information on the CT simulator and patient load; (2) Linac Sims summarizes patient appointment times, setup history, and notes, and patient load; (3) Task Status lists the clinical tasks associated with a treatment plan, their due date, status and ownership, and patient appointment details; (4) Documents provides the status of all documents in the patients\u27 charts; and (5) Diagnoses and Interventions summarizes prescription information, imaging instructions and whether the plan was approved for treatment. Real-time assessment and quantification of progress and delays in a patient\u27s treatment start were achieved. CONCLUSIONS: This study indicates it is feasible to develop and implement a dashboard, tailored to the needs of an interdisciplinary team, which derives and integrates information from the EMR database for real-time analysis and display of resource utilization and clinical workflow in radiation oncology. The framework developed facilitates informed, data-driven decisions on clinical workflow management as we seek to optimize clinical efficiency and patient safety