The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

The palliative care symptoms of people with dementia on admission to a mental health ward Key points

When patients with dementia are admitted to a mental health ward it is important to undertake a thorough assessment of palliative care needs. The Integrated Palliative care Outcome Scale for Dementia can support the assessment and management of palliative care symptoms and concerns in mental health wards. A recent systematic review suggests that between 2% and 8% in of people with dementia die during their admission to a mental health ward. 1 Furthermore, estimates suggest that between 16.4% and 46% of people with dementia will die within a year of discharge. 2,3 The high levels of distress and behavioural disturbance that typically trigger such an admission may overshadow a person's palliative care needs and will make the assessment of these needs more complex. As part of a single-site service improvement project, we sought to describe the palliative care needs of people with dementia on admission to a mental health ward and to examine the relationship between palliative care needs and neuropsychiatric symptoms. The site is a 14-bed mixed-sex inpatient dementia ward in the North of England. Data was collected for a 12-month period between 31 January 2022 and 31 January 2023. We examined routinely collected data on patient characteristics and outcomes. Neuropsy-chiatric symptoms were assessed using the Neuropsychiatric Inventory-Questionnaire (NPI-Q 4) which is routinely collected at admission and discharge. The NPI-Q was performed as an interview by a member of the nursing team. The symptoms were registered as present or not, and, if present, the severity of the symptom ranged from 1 to 3, giving an item score ranging from 0 to 3 and a sum score of the scale ranging from 0 to 30. The Integrated Palliative care Outcome Scale for Dementia (IPOS-Dem 5) was newly introduced to the ward as part of an approved service improvement project to improve the recognition of palliative symptoms. The IPOS-Dem is designed to detect and assess palliative symptoms in people with dementia The IPOS-Dem asks for symptoms across three domains: (1) physical symptoms, (2) emotional, social and existential (ESE) concerns, and (3) family concerns. Over the 12-month period 30 people were admitted to the ward. The average length of admission was 109 days (range 34-225). The majority of patients were male (60%) and the mean age was 75.6 years. Alzheimer's disease formed the main diagnosis (43%), followed by mixed dementia (26.7%); six people did not have a diagnosis at admission and five of these were subsequently diagnosed with dementia. At admission the number of average comor-bidities per person was 1.4 (SD 0.9). Most people were admitted to the ward from an acute hospital (66.7%), of these 12 (60%) were previously living at home and eight (40%) in residential care. Other routes to admission included residential care (20%) and from home (13.3%). Only one patient had an advanced care plan in place at admission. Two data sets were incomplete for the NPI-Q so the total number of patients assessed was 28. In terms of distress, the average NPI-Q total score on admission was 22 (SD 14), the most common symptoms were anxiety (89.3%), irritability/lability (85.7%) and agitation/aggression (85.7%). All patients had some symptoms that were recorded on the IPOS-Dem. Figure 1 shows details of symptom prevalence and severity. ESE concerns were the most prevalent and severe with a mean item score of 1.6 (SD 1.3), compared to physical symptoms with a mean score of 0.4 (SD 0.9) and family concerns with a mean score of 2.9 (SD 1.2). A Pearson correlation coefficient was computed to assess the relationship between NPI-Q and IPOS-Dem scores. Results indicated a non-significant small positive relationship, r(26) = 0.117, p = 0.552. Meaning that those people with the highest NPI scores also had the highest IPOS-Dem scores. The assessment of palliative care needs in people with dementia is challenging, 6 particularly in the population of people with dementia admitted to mental health wards who have some of the most complex care needs. However, if these palliative needs are undetected and undertreated, they are likely to add to a person's distress. Our findings indicate the range of concerns experienced at the point of admission and highlight the importance of undertaking a thorough assessment of palliative care needs. The diagnostic overshadowing of behavioural and psychological symptoms 7 particularly in the context of a mental health admission is a concern. We propose that the IPOS-Dem can provide a feasible and acceptable way to support the assessment and management of palliative care symptom and concerns in mental health wards. Int J Geriatr Psychiatry. 2023;e5995. wileyonlinelibrary.com/journal/gp

Life-Course Brain Health as a Determinant of Late-Life Mental Health: American Association for Geriatric Psychiatry Expert Panel Recommendations

This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities. Furthermore, our statement underscores the significance of prevention, early detection, and intervention in identifying cognitive decline, mood changes, and related mental illness. Action should also be taken to understand and address the needs of communities that traditionally have unequal access to preventive health information and services. By implementing culturally relevant and tailored evidence-based practices and advancing research in geriatric psychiatry, behavioral neurology, and geroscience, we can enhance the quality of life for older adults facing the unique challenges of aging. This position statement emphasizes the intrinsic link between brain health and mental health in aging, urging healthcare professionals, policymakers, and a broader society to prioritize comprehensive strategies that safeguard and promote brain health from birth through later years across all communities. The AAGP Expert Panel has the goal of launching further activities in the coming months and years.Fil: Eyre, Harris A.. Brain Capital Alliance; Estados Unidos. Organisation for Economic Co-Operation and Development; Francia. Rice University; Estados Unidos. Meadows Mental Health Policy Institute; Estados Unidos. Deakin University; Australia. Baylor College of Medicine; Estados Unidos. University of Texas Health Sciences Center; Estados Unidos. University of California; Estados Unidos. FondaMental Fondation; Estados Unidos. Universidad Adolfo Ibañez; Chile. Trinity College Dublin; IrlandaFil: Stirland, Lucy E.. University of California; Estados Unidos. University of Edinburgh; Reino UnidoFil: Jeste, Dilip V.. Global Research Network on Social Determinants of Mental Health and Exposomics; Estados UnidosFil: Reynolds, Charles F.. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Berk, Michael. Deakin University; Australia. University of Melbourne; AustraliaFil: Ibañez, Agustin Mariano. Universidad de San Andrés; Argentina. University of California; Estados Unidos. Universidad Adolfo Ibañez; Chile. L'organisation de Coopération Et de Développement Economiques; FranciaFil: Dawson, Walter D.. Oregon Health & Science University; Estados Unidos. Portland State University; Estados Unidos. University of California; Estados Unidos. L'organisation de Coopération Et de Développement Economiques; Francia. Brain Capital Alliance; Estados UnidosFil: Lawlor, Brian. University of California; Estados UnidosFil: Leroi, Iracema. University of California; Estados UnidosFil: Yaffe, Kristine. University of California; Estados UnidosFil: Gatchel, Jennifer R.. Harvard Medical School; Estados UnidosFil: Karp, Jordan F.. University of Arizona; Estados UnidosFil: Newhouse, Paul. Vanderbilt University Medical Center; Estados Unidos. Geriatric Research, Education, and Clinical Center; Estados UnidosFil: Rosand, Jonathan. Massachusetts General Hospital; Estados Unidos. Broad Institute of MIT and Harvard; Estados UnidosFil: Letourneau, Nicole. Alberta Children’s Hospital Research Institute; CanadáFil: Bayen, Eleonore. Hôpital Universitaire Pitié Salpêtrière; Francia. University of California; Estados UnidosFil: Farina, Francesca. University of California; Estados Unidos. Northwestern University; Estados UnidosFil: Booi, Laura. University of California; Estados Unidos. University of Leeds; Reino UnidoFil: Devanand, Devangere P.. Columbia University. Department of Psychiatry. New York State Psychiatric Institute; Estados UnidosFil: Mintzer, Jacobo. Medical University of South Carolina; Estados UnidosFil: Madigan, Sheri. University of Calgary; Canadá. Alberta Children’s Hospital Research Institute; CanadáFil: Jayapurwala, Inez. Brain Health Nexus; Estados UnidosFil: Wong, Stephen T. C.. Houston Methodist Hospital; Estados Unidos. Weill Cornell Medicine; Estados UnidosFil: Falcoa, Veronica Podence. Deakin University; Australia. Hospital Beatriz Ângelo; PortugalFil: Cummings, Jeffrey L.. University of Nevada; Estados UnidosFil: Reichman, William. University of Toronto; CanadáFil: Lock, Sarah Lenz. Global Council on Brain Health, Policy and Brain Health; Estados UnidosFil: Bennett, Marc. University College Dublin; Irlanda. University of Cambridge; Reino UnidoFil: Ahuja, Rajiv. The Milken Institute; Estados UnidosFil: Steffens, David C.. Columbia University; Estados UnidosFil: Elkind, Mitchell S. V.. Medical University of South Carolina; Estados UnidosFil: Lavretsky, Helen. University of California at Los Angeles. School of Medicine; Estados Unido