The effects of age, delirium and frailty on outcome after vascular surgery

The life expectancy of the western population is increasing. As a result of improved surgical techniques, more elderly patients are suitable for surgery, especially vascular surgery. Frailty is a combination of illness, psychosocial stressors and subclinical burden, and frail patients are at increased risk for complications. The aim of this thesis was to investigate which factors contribute to impaired outcome after vascular surgery. In chapter 2, we investigated stent-related complications after endovascular aneurysm repair (EVAR) in octogenarians. In our cohort, they had the same amount of postoperative complications compared to younger patients, but with fewer re-interventions. The amount of aneurysm related deaths however, did not differ between groups. Therefore, an adjusted follow-up scheme could be considered. In chapter 3 and 4 we focussed on postoperative delirium (POD). In both a meta-analysis and our own cohort, we determined the incidence and specific risk factors for POD. The incidence ranged from 5-39% in the literature. Multivariate regression analysis revealed preoperative cognitive impairment, open aortic surgery or amputation surgery, smoking, hypertension and age >80 years as risk factors in our own cohort. In chapter 5, we found that frailty was significantly associated with the amount and severity of postoperative complications. Also, we found that some domains of frailty had a more pronounced impact than others. Chapter 6 focussed on outcome after carotid endarterectomy (CEA). We found that the presence of metabolic syndrome had no negative effect

Developmental assessment in cases of PIMD:The opinion of support staff and psychologists about the suitability of the GTI and Bayley-III

Introduction: Developmental assessment is important to be able to adjust the support that is offered to a person with PIMD to his/her possibilities and needs. The focus of this poster is the suitability of two developmental assessment instruments: the Bayley-III and the GTI (GedragsTaxatie-Instrument; Behaviour assessment instrument). Objective: The objective was to make an inventory of the opinion of support staff and psychologists working with adults with PIMD about the suitability of the two instruments. Method: The Low Motor/Low Vision version of the Bayley-III and the GTI have been administered to 24 adults with PIMD (age range: 29-57 years), who were referred by the psychologists from two different organisations in the Netherlands. The support staff and psychologists completed evaluation forms about the suitability of the instruments for the target group. Results: The results showed that, although there is overlap between the GTI and the Bayley-III in terms of test content, both instruments are useful in the developmental assessment of adults with PIMD. The respondents evaluated the GTI more positively. The reported advantage of the Bayley-III was the fact that the test result gives information about the developmental level in the form of age equivalents in different domains. To be able to obtain a valid test result with the Bayley-III, the psychologists proposed adjustments, like broadening the floor and ceiling rules and allowing the use of materials that are familiar to the person who is being assessed. Conclusion/Discussion: The conclusion is that both the GTI and the Bayley-III are useful in the developmental assessment of adults with PIMD and that more research is necessary into the correct application of the Bayley-III in the diagnostic process of both adults and children with PIMD

Evaluation of an online version of the CFT 20-R in third and fourth grade children

There is growing demand for digital intelligence testing. In the current study, we evaluated the validity of an online version of the revised German Culture Fair Intelligence Test (CFT 20-R). A total of 4100 children from the third and fourth grades completed the online version using a smartphone or tablet. Subsequently, 220 of these children also completed the paper-pencil (PP) version. The internal consistency and construct validity of the online version appeared to be acceptable. The correlation between the raw scores and school grades in German and mathematics was slightly lower than expected. On average, the raw scores for the PP version were revealed to be higher, which was probably due to a learning effect. At the item level, the results show small differences for the subtests Series and Matrices, possibly caused by small differences in the presentation of the items. The correspondence between the versions did not depend on children’s levels of impulsivity or intelligence. Altogether, the results support the hypothesis that the online version of the CFT 20-R is a valid measure of general fluid intelligence and highlight the need for separate norms. (DIPF/Orig.