Comprehensive geriatric assessment among elderly people in a convalescence unit: a best practice implementation project.

AIM: The aim of this project was to audit the usual assessment practices employed when admitting patients to a convalescence unit on the outskirts of Barcelona, Spain. The project implemented strategies to improve evidence-based practice using the Joanna Briggs Institute methodology. The specific objectives of this project were (1) to improve completion of the comprehensive geriatric assessment (CGA) record, (2) to improve professionals' CGA knowledge, (3) to promote interdisciplinary work, (4) to improve tailored therapeutic plan generation by implementing evidence-based practice criteria within the instrument, and (5) to evaluate the records and action plans derived from the CGA. METHODS: Pre-/post-implementation audit methodology was used the Practical Application of Clinical Evidence System and Getting Research into Practice, and was developed in multiple phases. The implementation phase took 6 months. A sample of 34 consecutive admissions had their CGA patient records evaluated. Descriptive statistics were calculated. RESULTS: A total of 64 records (34 pre/30 post) were reviewed to assess CGA completion. The baseline audit results showed that only two audit criteria were higher than 50%, indicating poor knowledge about the concept of CGA and poor compliance with the current program. Following the implementation of the strategies, which included education and the development of a checklist, there was an improvement in all the criteria audited: the record was correctly completed in 67% of cases, and 80% of team members were knowledgeable and competent in CGA. CONCLUSION: Several barriers were identified at baseline, and various strategies were implemented to improve CGA compliance. The results show that the project increased awareness of the importance of a comprehensive assessment of the care that patients receive, resulting in better CGA completion.

El signo de Chilaiditi y el diagnóstico diferencial con una perforación intestinal / Chilaiditi sign and differential diagnosis with intestinal perforation

No disponible

Linfoma óseo primario: estudio de 7 casos / Primary bone lymphoma: report of 7 cases

No disponible

Aplicación clínica del test «Detenerse al andar mientras se habla» (Stop walking while talking test). Relación con parámetros funcionales y otras pruebas de marcha y equilibrio / Clinical application of the 'Stop walking while talking test'. Relationship with geriatric assessment parameters and other tests of balance and gait

Objetivo. Estudiar la relación entre el test Stop walking while talking (SWWT) y los parámetros de valoración geriátrica y otras pruebas de equilibrio y marcha. Pacientes y métodos. Estudio prospectivo, observacional y transversal de 108 pacientes (62% mujeres), edad media: 80,5±8,4. Veintitrés vivían en el domicilio, 24 en una residencia y 61 estaban ingresados en una unidad de convalecencia. Se registró: índice de Barthel, Mini-mental state examination of Folstein (MMSE), comorbilidad (Charlson), la presencia de caída previa y miedo a caer. Se les aplicó a todos ellos el test Timed up and go (TUG), el test de Tinetti y el test SWWT. Según el SWWT los pacientes se dividieron en 2 grupos: stoppers y non-stoppers. Todos tenían capacidad de deambulación (con o sin ayudas). Resultados. Los del grupo de stoppers presentaron medias de edad 82,2±8,7; Barthel 64,6±20,7; MMSE 21,6±5,1; Charlson 1,8±1,7 y los non-stoppers de 78,5±7,6 (p=0,024), 86,0±18,1 (p<0,001), 24,3±4,0 (p=0,004) y 1,3±1,6 (p=0,130), respectivamente. De los 58 stoppers 39 (67,2%) tuvieron caída previa y 19 (32,8%) no (p=0,002); 43 (74,1%) miedo a caer y 15 (25,9%) no (p<0,009). De los 63 pacientes con TUG>20seg, 52 (82,5%) eran stoppers y 11 (17,5%) non-stoppers; de los 31 con TUG entre 10-20seg, 5 (16,1%) y 26 (83,9%); de los 14 con TUG<10, uno (7,1%) y 13 (92,9%) (p<0,0001), respectivamente. La puntuación en el test de Tinetti fue 15,4±5,1 y 23,9±4,6 (p<0,001), respectivamente. Conclusiones. El grupo de stoppers presentaba mayor edad, dependencia, deterioro cognitivo, caída previa, miedo a caer, puntuaciones inferiores en el test de Tinetti y tiempos más prolongados en el TUG (AU)

Objective. To assess the relationship between the Stop Walking While Talking (SWWT) test and some parameters of the geriatric assessment, as well as other tests of balance and gait. Patients and methods. A prospective, observational and cross-sectional study conducted on 108 patients (62% women), with a mean age of 80.5±8.4 years. Twenty-three of them were living at home, 24 in a nursing home, and 61 in an intermediate care unit. A record was made of the Barthel index, Mini-Mental State Examination of Folstein (MMSE), comorbidity (Charlson index), the presence of previous falls, and fear of falling. Timed Up and Go (TUG), Tinetti test, and Stop Walking While Talking (SWWT) test, were performed on all the patients. Based on the results of the SWWT test patients were divided in two groups: "stoppers" and "non-stoppers". All patients were able to walk (with or without walking aids). Results. The stoppers group of patients had a mean age 82.2±8.7; Barthel index 64.6±20.7; MMSE 21.6±5.1; Charlson index 1.8±1.7, and the non-stoppers 78.5±7.6 (P=.024), 86.0±18.1 (P<.001), 24.3±4.0 (P=.004), and 1.3±1.6 (P=.130), respectively. Of the 58 stoppers patients, 39 (67.2%) had a previous fall, and 19 (32.8%) had not (P=.002); 43 (74.1%) had fear of falling, and 15 (25.9%) had not (P<0.009). Of the 63 patients with TUG>20seconds, 52 (82.5%) were stoppers and 11 (17.5%) non-stoppers. Of the 31 with TUG between 10-20seconds, 5 (16.1%) were stoppers and 26 (83.9%) non-stoppers. Of the 14 with TUG<10 seconds, 1 (7.1%) were stoppers, and 13 (92.9%) non-stoppers (P<0.0001). The score of Tinetti test in the stoppers group was 15.4±5.2, and in non-stoppers 23.9±4.6 (P<0.001). Conclusions. Those in the stopper group were significantly older, were more dependent in activities of daily living, had greater cognitive impairment, more previous falls, had greater fear of falling, lower scores on the Tinetti test, and longer times in the TUG (AU)

[Clinical application of the "Stop walking while talking test". Relationship with geriatric assessment parameters and other tests of balance and gait]. / Aplicación clínica del test «Detenerse al andar mientras se habla¼ (Stop walking while talking test). Relación con parámetros funcionales y otras pruebas de marcha y equilibrio.

OBJECTIVE: To assess the relationship between the Stop Walking While Talking (SWWT) test and some parameters of the geriatric assessment, as well as other tests of balance and gait. PATIENTS AND METHODS: A prospective, observational and cross-sectional study conducted on 108 patients (62% women), with a mean age of 80.5±8.4 years. Twenty-three of them were living at home, 24 in a nursing home, and 61 in an intermediate care unit. A record was made of the Barthel index, Mini-Mental State Examination of Folstein (MMSE), comorbidity (Charlson index), the presence of previous falls, and fear of falling. Timed Up and Go (TUG), Tinetti test, and Stop Walking While Talking (SWWT) test, were performed on all the patients. Based on the results of the SWWT test patients were divided in two groups: "stoppers" and "non-stoppers". All patients were able to walk (with or without walking aids). RESULTS: The stoppers group of patients had a mean age 82.2±8.7; Barthel index 64.6±20.7; MMSE 21.6±5.1; Charlson index 1.8±1.7, and the non-stoppers 78.5±7.6 (P=.024), 86.0±18.1 (P<.001), 24.3±4.0 (P=.004), and 1.3±1.6 (P=.130), respectively. Of the 58 stoppers patients, 39 (67.2%) had a previous fall, and 19 (32.8%) had not (P=.002); 43 (74.1%) had fear of falling, and 15 (25.9%) had not (P<0.009). Of the 63 patients with TUG>20seconds, 52 (82.5%) were stoppers and 11 (17.5%) non-stoppers. Of the 31 with TUG between 10-20seconds, 5 (16.1%) were stoppers and 26 (83.9%) non-stoppers. Of the 14 with TUG<10 seconds, 1 (7.1%) were stoppers, and 13 (92.9%) non-stoppers (P<0.0001). The score of Tinetti test in the stoppers group was 15.4±5.2, and in non-stoppers 23.9±4.6 (P<0.001). CONCLUSIONS: Those in the stopper group were significantly older, were more dependent in activities of daily living, had greater cognitive impairment, more previous falls, had greater fear of falling, lower scores on the Tinetti test, and longer times in the TUG.