Screening for mild cognitive impairment in the preoperative setting: A narrative review

Contains fulltext : 251958.pdf (Publisher’s version ) (Open Access)Cognitive impairment predisposes patients to the development of delirium and postoperative cognitive dysfunction. In particular, in older patients, the adverse sequelae of cognitive decline in the perioperative period may contribute to adverse outcomes after surgical procedures. Subtle signs of cognitive impairment are often not previously diagnosed. Therefore, the aim of this review is to describe the available cognitive screeners suitable for preoperative screening and their psychometric properties for identifying mild cognitive impairment, as preoperative workup may improve perioperative care for patients at risk for postoperative cognitive dysfunction. Electronic systematic and snowball searches of PubMed, PsycInfo, ClinicalKey, and ScienceDirect were conducted for the period 2015–2020. Major inclusion criteria for articles included those that discussed a screener that included the cognitive domain ‘memory’, that had a duration time of less than 15 min, and that reported sensitivity and specificity to detect mild cognitive impairment. Studies about informant-based screeners were excluded. We provided an overview of the characteristics of the cognitive screener, such as interrater and test-retest reliability correlations, sensitivity and specificity for mild cognitive impairment and cognitive impairment, and duration of the screener and cutoff points. Of the 4775 identified titles, 3222 were excluded from further analysis because they were published prior to 2015. One thousand four hundred and forty-eight titles did not fulfill the inclusion criteria. All abstracts of 52 studies on 45 screeners were examined of which 10 met the inclusion criteria. For these 10 screeners, a further snowball search was performed to obtain related studies, resulting in 20 articles. Screeners included in this review were the Mini-Cog, MoCA, O3DY, AD8, SAGE, SLUMS, TICS(-M), QMCI, MMSE2, and Mini-ACE. The sensitivity and specificity range to detect MCI in an older population is the highest for the MoCA, with a sensitivity range of 81–93% and a specificity range of 74–89%. The MoCA, with the highest combination of sensitivity and specificity, is a feasible and valid routine screening of pre-surgical cognitive function. This warrants further implementation and validation studies in surgical pathways with a large proportion of older patients.21 p

Implementation of an automated early warning scoring system in a surgical ward:practical use and effects on patient outcomes

Introduction Early warning scores (EWS) are being increasingly embedded in hospitals over the world due to their promise to reduce adverse events and improve the outcomes of clinical patients. The aim of this study was to evaluate the clinical use of an automated modified EWS (MEWS) for patients after surgery. Methods This study conducted retrospective before-and-after comparative analysis of non-automated and automated MEWS for patients admitted to the surgical high-dependency unit in a tertiary hospital. Operational outcomes included number of recorded assessments of the individual MEWS elements, number of complete MEWS assessments, as well as adherence rate to related protocols. Clinical outcomes included hospital length of stay, in-hospital and 28-day mortality, and ICU readmission rate. Results Recordings in the electronic medical record from the control period contained 7929 assessments of MEWS elements and were performed in 320 patients. Recordings from the intervention period contained 8781 assessments of MEWS elements in 273 patients, of which 3418 were performed with the automated EWS system. During the control period, 199 (2.5%) complete MEWS were recorded versus 3991 (45.5%) during intervention period. With the automated MEWS systems, the percentage of missing assessments and the time until the next assessment for patients with a MEWS of 2 decreased significantly. The protocol adherence improved from 1.1% during the control period to 25.4% when the automated MEWS system was involved. There were no significant differences in clinical outcomes. Conclusion Implementation of an automated EWS system on a surgical high dependency unit improves the number of complete MEWS assessments, registered vital signs, and adherence to the EWS hospital protocol. However, this positive effect did not translate into a significant decrease in mortality, hospital length of stay, or ICU readmissions. Future research and development on automated EWS systems should focus on data management and technology interoperability.</p

Kennissynthese calamiteitentoezicht

In de loop der jaren zijn er patronen gesleten in het calamiteitentoezicht, waarbij het risico ontstaat dat het toezicht een formaliteit en daarmee krachteloos wordt. Het is wenselijk om uit deze patronen te breken en op zoek te gaan naar een ruimte waarin kan worden nagedacht over andere manieren van effectief toezicht houden. Het calamiteitentoezicht heeft zeker bijgedragen aan het meer leren van calamiteiten in de Nederlandse zorg. Maar, om in de toekomst nog steeds betekenisvol te kunnen zijn, zal het calamiteitentoezicht zich moeten (blijven) doorontwikkelen. Een verdere ontwikkeling van het calamiteitentoezicht vraagt om een balans tussen enerzijds de voorspelbaarheid van een werkwijze, die eraan bijdraagt dat een sector zich hierin kan ontwikkelen, en de sleetse ritualisering van een werkwijze, die niet langer bijdraagt aan de ontwikkeling van een sector of deze zelfs in de weg gaat staan. Dit leidt tot de volgende kernboodschap van dit rapport: Blijf het calamiteitentoezicht doorontwikkelen. Zoek daarbij een balans tussen de kracht van d

Biodiversity responses to Lateglacial climate change in the subdecadally-resolved record of Lake Hämelsee (Germany)

Anthropogenically-driven climate warming and land use change are the main causes of an ongoing decrease in global biodiversity. It is unclear how ecosystems, particularly freshwater habitats, will respond to such continuous and potentially intensifying disruptions. Here we analyse how different components of terrestrial and aquatic ecosystems responded to natural climate change during the Lateglacial. By applying a range of analytical techniques (sedimentology, palaeoecology, geochemistry) to the well-dated sediment archive from Lake Hämelsee (Germany), we show evidence for vegetation development, landscape dynamics and aquatic ecosystem change typical for northwest Europe during the Lateglacial. By particularly focussing on periods of abrupt climate change, we determine the timing and duration of changes in biodiversity in response to external forcing. We show that onsets of changes in biodiversity indicators (e.g. diatom composition, Pediastrum concentrations) lag changes in environmental records (e.g. loss-on-ignition) by a few decades, particularly at the Allerød/ Younger Dryas transition. Most biodiversity indicators showed transition times of 10–50 years, whereas environmental records typically showed a 50–100 year long transition. In some cases, transition times observed for the compositional turnover or productivity records were up to 185 years, which could have been the result of the combined effects of direct (e.g. climate) and indirect (e.g. lake stratification) drivers of ecosystem change. Our results show differences in timing and duration of biodiversity responses to external disturbances, suggesting that a multi-decadal view needs to be taken when designing effective conservation management of freshwater ecosystems under current global warming