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  1. Article: Revolutionising outpatient clinic experience (RevOCE): the future of chronic kidney disease care and associated multimorbidity.

    Al-Chalabi, Saif / Santhirasekaran, Schanhave / Kalra, Philip A / Ritchie, James / Poulikakos, Dimitrios / Sinha, Smeeta

    Future healthcare journal

    2024  Volume 10, Issue Suppl 3, Page(s) 13–14

    Language English
    Publishing date 2024-04-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 3016427-8
    ISSN 2514-6653 ; 2514-6645
    ISSN (online) 2514-6653
    ISSN 2514-6645
    DOI 10.7861/fhj.10-3-s13
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: NEWS2 shows low sensitivity and high specificity for delirium detection: a single site observational study of 13,908 patients.

    Vardy, Emma Rlc / Santhirasekaran, Schanhave / Cheng, Michael / Anand, Atul / MacLullich, Alasdair M

    Clinical medicine (London, England)

    2022  Volume 22, Issue 6, Page(s) 544–548

    Abstract: Delirium affects 25% of hospital admissions of older people and is a serious medical condition with poor outcomes. 'New confusion' as a delirium indicator was incorporated into the 'alert, verbal, pain and unresponsive' (AVPU) level of consciousness ... ...

    Abstract Delirium affects 25% of hospital admissions of older people and is a serious medical condition with poor outcomes. 'New confusion' as a delirium indicator was incorporated into the 'alert, verbal, pain and unresponsive' (AVPU) level of consciousness scale in the National Early Warning Score 2 (NEWS2) in 2017. We measured sensitivity of non-alert NEWS2 (new confusion and/or V, P or U ratings) for delirium through comparison with the four 'A's test (4AT) delirium tool in 13,908 consecutive non-elective hospital admissions. We included NEWS2 scores 4 hours before or after 4AT. There were 2,802 (20%) admissions with positive 4AT and 594 (4.3%) with non-alert NEWS2 status. Sensitivity of NEWS2 for 4AT ≥4 was 17.8% (95% confidence interval (CI) 16.4-19.2), and specificity was 99.1% (95% CI 98.9-99.3). These findings suggest that NEWS2 in current practice has low sensitivity but high specificity for delirium. Further research is needed to improve routine inpatient monitoring for delirium.
    MeSH term(s) Humans ; Aged ; Delirium/diagnosis ; Inpatients ; Hospitalization
    Language English
    Publishing date 2022-11-21
    Publishing country England
    Document type Observational Study ; Journal Article
    ZDB-ID 2048646-7
    ISSN 1473-4893 ; 1470-2118
    ISSN (online) 1473-4893
    ISSN 1470-2118
    DOI 10.7861/clinmed.2022-0345
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5439: Show issues Location:
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    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
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  3. Article ; Online: Improving outpatient clinic experience: the future of chronic kidney disease care and associated multimorbidity.

    Al-Chalabi, Saif / Alderson, Helen / Garratt, Natalie / Green, Darren / Kalra, Philip A / Ritchie, James / Santhirasekaran, Schanhave / Poulikakos, Dimitrios / Sinha, Smeeta

    BMJ open quality

    2023  Volume 12, Issue 3

    Abstract: Background: Chronic kidney disease (CKD) is estimated to affect more than 2.5 million adults in England, and this is expected to rise to 4.2 million by 2036 (1). Population-level digital healthcare systems have the potential to enable earlier detection ... ...

    Abstract Background: Chronic kidney disease (CKD) is estimated to affect more than 2.5 million adults in England, and this is expected to rise to 4.2 million by 2036 (1). Population-level digital healthcare systems have the potential to enable earlier detection of CKD providing an opportunity to introduce interventions that attenuate progression and reduce the risk of end-stage kidney disease (ESKD) and cardiovascular diseases (CVD). Services that can support patients with CKD, CVD, and diabetes mellitus (DM) have the potential to reduce fragmented clinical care and optimise pharmaceutical management.
    Methods and results: The Salford renal service has established an outpatient improvement programme which aims to address these issues via two projects. Firstly, the development of a CKD dashboard that can stratify patients by their kidney failure risk equation (KFRE) risk. High-risk patients would be invited to attend an outpatient clinic if appropriate. Specialist advice and guidance would be offered to primary care providers looking after patients with medium risk. Patients with lower risk would continue with standard care via their primary care provider unless there was another indication for a nephrology referral. The CKD dashboard identified 11546 patients (4.4% of the total adult population in Salford) with T2DM and CKD. The second project is the establishment of the Metabolic CardioRenal (MRC) clinic. It provided care for 209 patients in the first 8 months of its establishment with a total of 450 patient visits. Initial analysis showed clustering of cardiorenal metabolic diseases with 85% having CKD stages 3 and 4 and 73.2% having DM. In addition, patients had a significant burden of CVD with 50.2% having hypertension and 47.8% having heart failure.
    Conclusion: There is a pressing need to create new outpatient models of care to tackle the rising epidemic of cardio-renal metabolic diseases. This model of service has potential benefits at both organisational and patient levels including improving patient management via risk stratification, increased care capacity and reduction of variation of care. Patients will benefit from earlier intervention, appropriate referral for care, reduction in CKD-related complications, and reduction in hospital visits and cardiovascular events. In addition, this combined digital and patient-facing model of care will allow rapid translation of advances in cardio-renal metabolic diseases into clinical practice.
    MeSH term(s) Adult ; Humans ; Multimorbidity ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/therapy ; Renal Insufficiency, Chronic/complications ; England/epidemiology ; Ambulatory Care Facilities ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/therapy
    Language English
    Publishing date 2023-07-31
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2022-002188
    Database MEDical Literature Analysis and Retrieval System OnLINE

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