PWE-086 Improving identification and management of alcohol-related brain injury (ARBI) in acute care settings
Notice bibliographique
Résumé
<h3>Introduction</h3> Alcohol Related Brain Injury (ARBI) is a hidden harm in drinkers. The most commonly used clinical definition is given in DSM IV, however this has been shown to be vague and subjective with poor utility in acute care settings. Estimates of prevalence have been reported at 0.03% per 3 00 000 however, as no routine, standardised algorithm for assessment of ARBI exists; this is most likely an underestimate. A systematic review of brain injury confirmed neurodegenerative changes in heavy drinkers, but importantly also highlighted the potential for reversibility of these changes with sustained abstinence. Therefore, recognition of ARBI at the earliest opportunity has the potential to facilitate the implementation of comprehensive care pathways that optimise medical and psychosocial care, and prevent the cycle of readmissions for increasingly complex physical and psychological harms. <h3>Methods</h3> In April 2017 we implemented an innovative clinical pathway. Patients meeting risk criteria based on number of previous admissions or carers concerns had an automatic referral to a specialist nurse for assessment utilising the Montreal Cognitive Assessment tool (MoCA©). A score of <23 was considered positive for potential ARBI. This triggered initiation of our ARBI care pathway and a referral to a psychiatrist for confirmation of diagnosis. We performed a 3 month follow-up descriptive evaluation. <h3>Results</h3> Over an period of 8 months (April to Nov 2017) 163 patients met criteria for screening; 118 males and 45 females, mean age=52 years (SD=11); range 26–80 years. 60 scored ≤23 (36.8%) of which 35 (58.3%) had a confirmed diagnosis of ARBI from a psychiatrist. At 3 months 22 patients had received follow-up. Compared with baseline MoCA scores were significantly higher (improved); mean difference=3.7 (95%CI: 1.2 to 6.3; p=0.07), mean hospital attendance was reduced from 3.2 to 1.9, and mean admissions were reduced from 1.8 to 1.1. Results from family reported outcome measures (FROMS) has highlighted several outcomes that our patient families found most valuable; a) receiving an assessment to confirm or reject the presence of ARBI, b) helping them understand their loved ones condition c) helping them plan for the future. <h3>Conclusions</h3> We have demonstrated potential benefits of this point-of-care screening which can facilitate the initiation of referral and treatment pathways which can improve patient outcomes. Our Results are descriptive, but may contribute to the design of clinical trials that are needed to determine utility, acceptability and validity of our Methods and the MoCA as a screening instrument in this setting.
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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 | 0,000 | 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 ».