The underdetection of cognitive impairment in nursing homes in the Dublin area. The need for on-going cognitive assessment
Notice bibliographique
Résumé
Sampling of NHs:\nAll general private and voluntary NHs belonging to the former Irish Health Service Executive East Coast Area (Dublin Mid-Leinster) were sampled. Three areas, namely 1, (Dun Laoire), 2 (Dublin South East) and 10 (Wicklow) which represent the former East Coast Eastern Regional Health Authority provided the sampling frame. Four of the 53 NHs were randomly selected. The chance of a NH being sampled was directly proportional to its size.\n\nSampling of residents:\nThe total capacity of the four NHs was 187 beds, and at the time of study, 174 beds were occupied. A sample of 100 residents was randomly drawn, 25 from each NH. Over-sampling occurred at each facility to allow for refusals (please see Appendix 1 in the supplementary data available on the journal website at http://www.ageing.oxfordjournals.org). Only 18 residents or their next of kin refused participation. The MMSE was administered to all 100 residents.\n\nEthical considerations:\nEthical approval was granted by Trinity College Dublin. Informed consent was obtained in all NHs, and proxy consent got for those residents known to lack capacity.\n\nInstruments:\nThe MMSE was used to assess CI [14]. When used for screening purposes, a cut score of 23/24 is conventionally used for detection of significant impairment. In contrast when the intention is to classify CI severity as was the case in this study, Folstein et al. recommendations were followed, i.e. normal cognitive function = 27?30, mild CI (MCI) = 21?26, moderate CI = 11?20 and severe CI = 0?10.\n\nResidents who scored within the normal ranges (MMSE ? 27) were re-assessed using the Montreal Cognitive Assessment (MoCA). The MoCA test is a screening instrument for the detection of mild CI. It was developed to discriminate individuals between mild CI and normal cognitive function [15]. The MoCA test scores 0?30 points. Scores of 26 or above are considered normal. Where residents were classified on the MMSE as severely impaired (MMSE ? 10), a proxy appraisal (the Dementia Screening Scale, DSS) was completed [The DSS total score varies between 0 and 14 with higher scores indicating worse CI [8]]. Using a Likert scale (no impairment, mild, moderate and severe), Directors of Nursing (DONs) perception of resident's cognitive status was also assessed.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».