LIVIVO - Search results -

Search results

Result 1 - 10 of total 38

Search options

Article ; Online: Patterns of unplanned hospital admissions in people with dementia.

Vardy, Emma

2022 Volume 51, Issue 6

MeSH term(s)	Death ; Dementia/diagnosis ; Dementia/epidemiology ; Dementia/therapy ; Hospitalization ; Hospitals ; Humans
Language	English
Publishing date	2022-05-19
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afac123
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 877: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 448: Show issues

Order via subito

This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Dementia with Lewy bodies.

Vardy, Emma

Clinical medicine (London, England)

2019 Volume 19, Issue 5, Page(s) 429–430

MeSH term(s)	Dementia ; Humans ; Lewy Bodies ; Lewy Body Disease
Language	English
Publishing date	2019-09-12
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.7861/clinmedicine.19-5-429b
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 5439: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Virtual wards: a rapid evidence synthesis and implications for the care of older people.

Norman, Gill / Bennett, Paula / Vardy, Emma R L C

Age and ageing

2023 Volume 52, Issue 1

Abstract: Background: Virtual wards are being rapidly developed within the National Health Service in the UK, and frailty is one of the first clinical pathways. Virtual wards for older people and existing hospital at home services are closely related.: Methods!# ...

Abstract	Background: Virtual wards are being rapidly developed within the National Health Service in the UK, and frailty is one of the first clinical pathways. Virtual wards for older people and existing hospital at home services are closely related. Methods: In March 2022, we searched Medline, CINAHL, the Cochrane Database of Systematic Reviews and medRxiv for evidence syntheses which addressed clinical-effectiveness, cost-effectiveness, barriers and facilitators, or staff, patient or carer experience for virtual wards, hospital at home or remote monitoring alternatives to inpatient care. Results: We included 28 evidence syntheses mostly relating to hospital at home. There is low to moderate certainty evidence that clinical outcomes including mortality (example pooled RR 0.77, 95% CI 0.60-0.99) were probably equivalent or better for hospital at home. Subsequent residential care admissions are probably reduced (example pooled RR 0.35, 95% CI 0.22-0.57). Cost-effectiveness evidence demonstrated methodological issues which mean the results are uncertain. Evidence is lacking on cost implications for patients and carers. Barriers and facilitators operate at multiple levels (organisational, clinical and patient). Patient satisfaction may be improved by hospital at home relative to inpatient care. Evidence for carer experience is limited. Conclusions: There is substantial evidence for the clinical effectiveness of hospital at home but less evidence for virtual wards. Guidance for virtual wards is lacking on key aspects including team characteristics, outcome selection and data protection. We recommend that research and evaluation is integrated into development of virtual ward models. The issue of carer strain is particularly relevant.
MeSH term(s)	Humans ; Aged ; State Medicine ; Systematic Reviews as Topic ; Hospitalization ; Hospitals ; Treatment Outcome
Language	English
Publishing date	2023-01-09
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afac319
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 877: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 448: Show issues

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article: Delirium can be safely managed in the community through implementation of a community toolkit: a proof-of-concept pilot study.

Vardy, Emma / Roberts, Siriol / Pratt, Helen

Future healthcare journal

2022 Volume 9, Issue 1, Page(s) 83–86

Abstract: Delirium is an acute confusional state due to physical illness and is a frequent cause of hospital admission. In this article, we describe the development and outcomes for a community delirium toolkit pilot across Greater Manchester during the COVID-19 ... ...

Abstract	Delirium is an acute confusional state due to physical illness and is a frequent cause of hospital admission. In this article, we describe the development and outcomes for a community delirium toolkit pilot across Greater Manchester during the COVID-19 pandemic. We conclude that delirium can be safely managed in the community by using a toolkit that incorporates structured assessment and management. Carers and patients benefited from the use of a co-designed information leaflet.
Language	English
Publishing date	2022-05-09
Publishing country	England
Document type	Case Reports
ZDB-ID	3016427-8
ISSN	2514-6653 ; 2514-6645
ISSN (online)	2514-6653
ISSN	2514-6645
DOI	10.7861/fhj.2021-0157
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

Article ; Online: Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components.

Shi, Chunhu / Dumville, Jo / Rubinstein, Fernando / Norman, Gill / Ullah, Akbar / Bashir, Saima / Bower, Peter / Vardy, Emma R L C

BMC medicine

2024 Volume 22, Issue 1, Page(s) 145

Abstract: Background: Technology-enabled inpatient-level care at home services, such as virtual wards and hospital at home, are being rapidly implemented. This is the first systematic review to link the components of these service delivery innovations to evidence ...

Abstract	Background: Technology-enabled inpatient-level care at home services, such as virtual wards and hospital at home, are being rapidly implemented. This is the first systematic review to link the components of these service delivery innovations to evidence of effectiveness to explore implications for practice and research. Methods: For this review (registered here https://osf.io/je39y ), we searched Cochrane-recommended multiple databases up to 30 November 2022 and additional resources for randomised and non-randomised studies that compared technology-enabled inpatient-level care at home with hospital-based inpatient care. We classified interventions into care model groups using three key components: clinical activities, workforce, and technology. We synthesised evidence by these groups quantitatively or narratively for mortality, hospital readmissions, cost-effectiveness and length of stay. Results: We include 69 studies: 38 randomised studies (6413 participants; largely judged as low or unclear risk of bias) and 31 non-randomised studies (31,950 participants; largely judged at serious or critical risk of bias). The 69 studies described 63 interventions which formed eight model groups. Most models, regardless of using low- or high-intensity technology, may have similar or reduced hospital readmission risk compared with hospital-based inpatient care (low-certainty evidence from randomised trials). For mortality, most models had uncertain or unavailable evidence. Two exceptions were low technology-enabled models that involve hospital- and community-based professionals, they may have similar mortality risk compared with hospital-based inpatient care (low- or moderate-certainty evidence from randomised trials). Cost-effectiveness evidence is unavailable for high technology-enabled models, but sparse evidence suggests the low technology-enabled multidisciplinary care delivered by hospital-based teams appears more cost-effective than hospital-based care for those with chronic obstructive pulmonary disease (COPD) exacerbations. Conclusions: Low-certainty evidence suggests that none of technology-enabled care at home models we explored put people at higher risk of readmission compared with hospital-based care. Where limited evidence on mortality is available, there appears to be no additional risk of mortality due to use of technology-enabled at home models. It is unclear whether inpatient-level care at home using higher levels of technology confers additional benefits. Further research should focus on clearly defined interventions in high-priority populations and include comparative cost-effectiveness evaluation. Trial registration: https://osf.io/je39y .
MeSH term(s)	Humans ; Inpatients ; Hospitalization ; Patient Care ; Patient Readmission ; Hospitals
Language	English
Publishing date	2024-04-02
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2131669-7
ISSN	1741-7015 ; 1741-7015
ISSN (online)	1741-7015
ISSN	1741-7015
DOI	10.1186/s12916-024-03312-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

Article ; Online: NEWS2 and the older person.

Vardy, Emma Rlc / Lasserson, Daniel / Barker, Robert O / Hanratty, Barbara

Clinical medicine (London, England)

2022 Volume 22, Issue 6, Page(s) 522–524

Abstract: The National Early Warning Score (NEWS), published in 2012, made no specific adjustments for older people. The updated NEWS2 (2017) incorporated new confusion as a category for consciousness. In this article, we consider the role of NEWS2 in detection of ...

Abstract	The National Early Warning Score (NEWS), published in 2012, made no specific adjustments for older people. The updated NEWS2 (2017) incorporated new confusion as a category for consciousness. In this article, we consider the role of NEWS2 in detection of acute clinical deterioration in older people and how the score may be used to inform care, highlighting the additional aspects, such as care escalation decisions, that may ensue. We consider the evidence of NEWS and NEWS2 in assessment of the older person in different settings, including the potential benefits and limitations for care home residents. We suggest that NEWS2 may need adaptation for older people in future iterations, and that it should be used in conjunction with other clinical assessments, such as the Clinical Frailty Scale and the four 'A's test (4AT) for delirium.
MeSH term(s)	Aged ; Humans ; Confusion ; Early Warning Score ; Clinical Deterioration ; Delirium
Language	English
Publishing date	2022-11-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2048646-7
ISSN	1473-4893 ; 1470-2118
ISSN (online)	1473-4893
ISSN	1470-2118
DOI	10.7861/clinmed.2022-0426
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 5439: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Acceptability of physical activity signposting for pre-frail older adults: a qualitative study to inform intervention development.

Money, Annemarie / Harris, Danielle / Hawley-Hague, Helen / McDermott, Jane / Vardy, Emma / Todd, Chris

BMC geriatrics

2023 Volume 23, Issue 1, Page(s) 621

Abstract: Frailty is a medical condition common in older adults characterised by diminished strength and reduced physiologic function in which individuals are more vulnerable to multiple adverse health outcomes. Pre-frailty is an intermediate stage associated with ...

Abstract	Frailty is a medical condition common in older adults characterised by diminished strength and reduced physiologic function in which individuals are more vulnerable to multiple adverse health outcomes. Pre-frailty is an intermediate stage associated with some minor health outcomes. However, the main risk is progression toward moderate/severe frailty. Evidence shows physical activity interventions to be effective in slowing or modifying the progression of frailty. Researchers at the University of Manchester are developing a behaviour change intervention targeting pre-frail older adults, signposting them to group-based physical activity classes known to be effective for delaying/slowing frailty. This paper reports on the initial intervention development work with key stakeholders exploring the practicality of taking forward this intervention and identifying uncertainties to be explored in the feasibility stage. These included issues around physical activity messaging, the use of the term 'frail', identification/recruitment of pre-frail older adults, and the acceptability of behaviour change techniques. There was overwhelming support for a proactive approach to addressing pre-frailty issues. Given that a large proportion of older adults are estimated to be pre-frail, interventions aimed at this group have the potential to support healthy ageing, positively impacting on frailty outcomes and providing wider population health benefits.
MeSH term(s)	Humans ; Aged ; Frail Elderly ; Frailty/diagnosis ; Frailty/therapy ; Frailty/epidemiology ; Exercise/physiology ; Qualitative Research
Language	English
Publishing date	2023-10-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-023-04202-8
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

Article ; Online: Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions.

Anand, Atul / Cheng, Michael / Ibitoye, Temi / Maclullich, Alasdair M J / Vardy, Emma R L C

Age and ageing

2022 Volume 51, Issue 3

Abstract: Background: Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 'A's Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of ...

Abstract	Background: Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 'A's Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission). Methods: The 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian, UK (n = 43,946) and Salford, UK (n = 38,824) over a period of $\sim$3 years were analysed using logistic regression models adjusted for age and sex. Results: 4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (≥4/12) were present in 18% of patients in Lothian, and 25% of patients in Salford. Thirty-day mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0/12 group in Lothian (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99-6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98-3.87). Length of stay was more than double in patients with 4AT scores of 1-3/12 (indicating cognitive impairment) or ≥ 4/12 compared with 4AT 0/12. Median home time at 1 year was reduced by 112 days (Lothian) and 61 days (Salford) in the 4AT ≥4 group (P < 0.001). Conclusions: Scores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment.
MeSH term(s)	Aged ; Delirium/diagnosis ; Emergency Service, Hospital ; Geriatric Assessment ; Hospitals ; Humans ; Length of Stay
Language	English
Publishing date	2022-03-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afac051
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 877: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 448: Show issues

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

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

In stock of ZB MED Cologne/Königswinter

Zs.A 5439: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article: Quality improvement and delirium.

Vardy, Emma R L C / Thompson, Rebecca E

European geriatric medicine

2019 Volume 11, Issue 1, Page(s) 33–43

Abstract: Purpose: Quality improvement (QI) is a useful methodology that can be used to make timely improvements in clinical practice. This review gives a broad picture of what QI is and the methodology this entails. An overview of how QI has been applied in the ... ...

Abstract	Purpose: Quality improvement (QI) is a useful methodology that can be used to make timely improvements in clinical practice. This review gives a broad picture of what QI is and the methodology this entails. An overview of how QI has been applied in the field of delirium to date is provided as well as a discussion of how this area may be developed in the future. Methods: As part of the review, a literature search was completed to assess the literature published to date on QI and delirium. Literature relating to delirium in the context of a variety of clinical specialties is also presented as well as a summary of short films that can be used for purposes of awareness raising. Results: We found that QI has so far been an under-utilized methodology in the context of delirium and that studies that adhere to general guidance on reporting are few. Conclusion: We suggest that well-designed QI studies would be beneficial to improve the assessment, management and care of delirium. The methodology may also be used to embed educational resources. In this review, we describe the theory behind QI and also suggest some resources that may be useful in any QI delirium project.
MeSH term(s)	Delirium/diagnosis ; Humans ; Quality Improvement
Language	English
Publishing date	2019-12-03
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-019-00268-z
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

Order via subito

Details ▾
- Full text online
- Order with fees

To top

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

Order via subito

More links

Kategorien

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

Order via subito