Formal Diagnosis Research Articles

Methylphenidate use and misuse among medical residents in Israel: a cross-sectional study

BackgroundMethylphenidate (MPH) and other stimulants may be misused, mainly as cognitive enhancers and recreational drugs. Data regarding misuse among medical residents are scarce. This study aimed to evaluate the prevalence of and main reasons for methylphenidate (MPH) use and misuse among Israeli medical residents.MethodsIn this cross-sectional study, we sent an online questionnaire to medical residents who had completed their first residency exam and specialists with up to 2 years of experience. We asked about the use of MPH before and during residency and attitudes toward the use of MPH as a cognitive enhancer. We also added the Adult ADHD Self-Report Scale (ASRS) questionnaire, a validated tool used to screen for the presence of attention deficit hyperactivity disorder (ADHD). Users and misusers were classified based on self-report of use and formal ADHD diagnosis. Logistic regression analysis was used to evaluate factors associated with MPH misuse.ResultsFrom March 2021 to August 2021, 370 physicians responded to our questionnaire (response rate 26.4%). Twenty-eight met the exclusion criteria and were not included. The respondents’ average age was 36.5 years. Women comprised 63.5% of the respondents. Of the participants, 16.4% were classified as users and 35.1% as misusers. The prevalence of misusers was 45.6% among surgery and OB/GYN physicians, 39.4% among pediatricians and internists, and 24% among family physicians (P < 0.001). Misusers had a more liberal approach than others to MPH use as a cognitive enhancer. Factors associated with misuse of MPH included not being a native-born Israeli (OR-1.99, 95% CI 1.08, 3.67) and type of residency (OR-2.33, 95% CI 1.22, 4.44 and OR-4.08, 95% CI 2.06, 8.07 for pediatrics and internal medicine and surgery, respectively).ConclusionVery high levels of MPH misuse during residency may be related to stress, long working hours, night shifts, and the academic burden of the residency period. We believe that our findings should be considered by healthcare policymakers as they make decisions regarding the conditions of medical residencies. The use of MPH as a cognitive enhancer should be further studied and discussed.

Factors related to the occurrence of and recovery from gaming disorder: A qualitative study.

Gaming disorder (GD) has gained tremendous attention in the past 2 decades. Although the 11th revision of the International Classification of Diseases accepted GD as a formal diagnosis in 2018, debate continues about whether this condition constitutes an independent psychiatric disorder. Many scholars observed that we lack reliable information regarding the natural history of GD. Quantitative studies have identified many risk factors related to GD, but those risk factors were rarely connected, provided with context, or mapped into a coherent big picture to explain GD’s pathway and development process. This qualitative study aims to fill the gap by clarifying GD’s course of development in 15 patients. To do so, it adopts a qualitative, longitudinal, and retrospective approach that is based on the life histories and narratives of individuals with GD. Individual in-depth interviews were conducted with 15 young adult participants who were attending a residential, outpatient program specializing in GD treatment. Each interview lasted approximately 2.5 hr and was audio-recorded with the participant’s permission and informed consent. Four categories of research questions that targeted participants’ life stories—specifically how gaming addiction entered and manifested in their lives—guided the interviews and generated follow-up questions during each interview, using a theoretical sampling strategy. Recordings were transcribed, then subthemes and themes were identified, constructed, and organized based on a grounded theory, thematic analysis method. Results revealed 12 subthemes, which can be sequentially and suitably placed into three developmental stages. These stages provide a clearer understanding of how gaming behaviors progress from normal into pathological. Implications for prevention and treatment are discussed.

Identifying encephalopathy in patients admitted to an intensive care unit: Going beyond structured information using natural language processing.

Encephalopathy is a severe co-morbid condition in critically ill patients that includes different clinical constellation of neurological symptoms. However, even for the most recognised form, delirium, this medical condition is rarely recorded in structured fields of electronic health records precluding large and unbiased retrospective studies. We aimed to identify patients with encephalopathy using a machine learning-based approach over clinical notes in electronic health records. We used a list of ICD-9 codes and clinical concepts related to encephalopathy to define a cohort of patients from the MIMIC-III dataset. Clinical notes were annotated with MedCAT and vectorized with a bag-of-word approach or word embedding using clinical concepts normalised to standard nomenclatures as features. Machine learning algorithms (support vector machines and random forest) trained with clinical notes from patients who had a diagnosis of encephalopathy (defined by ICD-9 codes) were used to classify patients with clinical concepts related to encephalopathy in their clinical notes but without any ICD-9 relevant code. A random selection of 50 patients were reviewed by a clinical expert for model validation. Among 46,520 different patients, 7.5% had encephalopathy related ICD-9 codes in all their admissions (group 1, definite encephalopathy), 45% clinical concepts related to encephalopathy only in their clinical notes (group 2, possible encephalopathy) and 38% did not have encephalopathy related concepts neither in structured nor in clinical notes (group 3, non-encephalopathy). Length of stay, mortality rate or number of co-morbid conditions were higher in groups 1 and 2 compared to group 3. The best model to classify patients from group 2 as patients with encephalopathy (SVM using embeddings) had F1 of 85% and predicted 31% patients from group 2 as having encephalopathy with a probability >90%. Validation on new cases found a precision ranging from 92% to 98% depending on the criteria considered. Natural language processing techniques can leverage relevant clinical information that might help to identify patients with under-recognised clinical disorders such as encephalopathy. In the MIMIC dataset, this approach identifies with high probability thousands of patients that did not have a formal diagnosis in the structured information of the EHR.

Validation and bifactor structure of the French Adult ADHD Symptoms Rating Scale v1.1 (ASRS)

BackgroundThree scoring methods for the widely available Adult ADHD Symptoms Rating Scale v1.1 (ASRS) have been proposed to screen for ADHD, but these three methods have rarely been compared against formal clinical diagnoses. We aimed to validate the French version of the ASRS against a clinical interview using DSM-IV and DSM-5 diagnostic algorithms. MethodsOne hundred five adults from a convenience sample were evaluated with the ASRS and the DIVA 2.0, using both DSM-IV and DSM-5 criteria. We used Confirmatory Factor Analysis to investigate the underlying structure of the ASRS. Sensitivity, specificity, and classification accuracy were compared between the rating algorithms of the ASRS. ResultsThe full score method had worse predictive performance than the Screener and the 2-stage scoring method. All characteristics of the three scoring methods for the ASRS were worse when applying DSM-5 criteria. The best-fitting structure was a bi-factor model with a general ADHD factor and three specific factors. ConclusionsADHD was best conceived as a one-dimensional construct. The 2-stage scoring method superseded the Screener with comparable sensitivity and specificity.

Infective endocarditis in adults with congenital heart disease: Contemporary management and related outcomes in Central and South-Eastern European region

BackgroundInfective endocarditis (IE) remains major cause of morbidity and mortality in adult congenital heart disease (ACHD). Limited data exists on ACHD with IE in Central and South-Eastern European (CESEE) countries. The aim of this study is to characterize contemporary management and assess outcomes of ACHD with IE in CESEE region. MethodsData on ACHD patients with IE from 9 tertiary centres in 9 different CESEE countries between 2015 and 2020 was included. Baseline demographics, clinical presentation, indication for surgery, outcomes, hospital and all-cause-1-year mortality were studied. ResultsA total of 295 ACHD patients (mean age 40 ± 14 years) with IE were included. Median time from symptoms onset to establishing diagnosis was 25 (11–59) days. The majority of patients (203, 68.8%) received previous empiric oral antibiotic therapy. The highest incidence of IE was observed on native and left sided valves, 194(65.8%) and 204(69.2%), respectively. More than half had a vegetation size ≥10 mm (164, 55.6%); overall 138 (46.8%) had valve complications and 119 (40.3%) had heart failure. In-hospital mortality was 26 (8.8%). ConclusionThere is clear delay in establishing IE diagnosis amongst ACHD patients in CESEE countries. Adequate diagnosis is hampered by common prescription of empiric antibiotics before establishing formal diagnosis. Hence, patients commonly present with associated complications requiring surgery. Hospital treatment and survival are, nevertheless, comparable to other Western European countries. Improved awareness and education of patients and medical profession regarding IE preventive measures, risks, signs, and symptoms are urgently needed. Empiric antibiotic prescription before blood cultures are taken must be omitted.

Autism-Related Language Preferences of French-Speaking Autistic Adults: An Online Survey.

In recent years, there have been increasing discussions surrounding the appropriate terminology to talk about autism. Initially, this debate revolved around the use of person-first language (e.g., person with autism) versus identity-first language (IFL; e.g., autistic person) but has recently expanded to other autism-related terms (e.g., deficits). However, to date, studies investigating autism-related language preferences have been limited to English-speaking countries, and little is known about preferences in other languages. This study addresses this gap by investigating the language preferences of French-speaking autistic adults. Five hundred and forty-one French-speaking autistic adults (formal diagnosis and self-identified) completed an online survey where they selected terms they preferred to use to talk about: (1) the nomenclature of autism; (2) an autistic person; (3) someone's autistic identity; (4) autism more broadly; (5) the abilities of autistic people; and (6) people without a diagnosis of autism. Participants also revealed more about their language preferences via an open-text response. The most preferred terms were "Autisme," "Personne autiste," "Autiste," "Est Autiste," "Différence neurologique/cérébrale," "Différences," "Difficultés," "Personne neurotypique," "Neurotypique," and "Personne non-autiste." To better understand these preferences, participants' open comments were analyzed, revealing further support for IFL and the social model of disability, and a preference for simple, precise, and validated terms. These results are consistent with autism terminology preferences in English-speaking countries and provide additional insight into the reasons underlying these preferences. Such work has implications for informing the language of researchers, clinicians, and other professionals in the field, as well as the general public.

An innovative model of psychological service delivery in primary healthcare: the Single-Session Intervention

BackgroundIn Canada, the demand for mental health care exceeds the provision of services. This exploratory study aimed to assess the feasibility and impact of a new service delivery model for psychological consultations in primary care settings: the Single-Session Intervention (SSI), inspired by Advanced Access (AA) principles for appointment scheduling. The specific objectives were to examine whether the SSI increases accessibility to psychological consultations, to measure the effects of the intervention on different self-reported measures, and to assess users’ consultation experiences.MethodsParticipants were recruited in a University Family Medicine Group in Quebec (Canada), and the SSI was delivered by the on-site psychologist. No referral or formal diagnosis was needed to attend, and participants could promptly obtain an appointment. Participants rated the intensity of their problem, their level of psychological distress and their well-being, before and after the SSI. They also rated their satisfaction with their consultation experience. There was a follow-up 4 to 6 weeks later.ResultsOf the N = 69 participants who received SSI, 91% were able to obtain an appointment in less than 7 working days. The number of patients who were able to benefit from a psychological consultation was about 7 times higher after the implementation of SSI compared to previous years, when a traditional model of service delivery was in place. After SSI, participants felt that the intensity of their problem and psychological distress were lower, and that their well-being was increased, as indicated by significant pre-post test clinical measures (p < 0.0001). The observed effects seemed to be sustained at follow-up. Moreover, 51% of participants said that one session was sufficient to help them with their problem. Participants rated SSI as a highly satisfying and helpful consultation experience (92,9% overall satisfaction).ConclusionsSSI, offered in a timely manner, could be an innovative and cost-effective intervention to provide mental health services on a large scale in primary healthcare. Further research is needed to replicate the results, but these preliminary data seem to indicate that psychological distress may be quickly addressed by SSI, thereby preventing further deteriorations in patients’ mental health.Trial Registration2019–393, 26 March 2019.

Gamification in Biomedical Science Education: The Successful Implementation of Resimion, a Scenario-Based Learning Tool.

Introduction: Scenario-based learning and gamification have many advantages in comparison to traditional didactic teaching methods, including development of many higher-level skills such as analysis and evaluation. It is hoped that these simulations provide a real-world experience in a format accessible to students. Integration of these tools into teaching excelled during the COVID-19 pandemic, an event that completely changed education and initiated the greatest advancement in digital learning to date. We discuss our experiences using Resimion, a novel scenario-based learning tool that was adapted to biomedical science, both for teaching and assessment. Methods: Our cohort included 769 students studying BSc(Hons) Biomedical Science at the University of the West of England from 2020 to 2023. Data was obtained from assessments within four different modules, two at FHEQ level 5 and two at level 6. Students were grouped based on reasonable adjustment (RA) status, including physical issues, specific learning differences and neurodiversity, with differences between student groups and assessment types analysed by ANOVA. Results: Data clearly demonstrate good engagement from students utilising Resimion software, representing 18,436 student interactions in total, across both assessed and non-assessed activities. RAs of any type did not alter submission rates (p = 0.53) or student outcome in any of the assessment types analysed. However, submission rates for Resimion assessments were notably higher than for other assessment types (p = 0.002). Whist outcomes were not significantly different, students with RAs did take significantly longer to complete the Haematology and Transfusion assessments (p = 0.0012). Specifically, neurodiverse students and those with specific learning differences used on average 81% of their allocated time, students with other RAs used 76%, whereas students without RAs used just 56% (p ≤ 0.0001), highlighting the appropriate adjustment of extra time provided for these students. It was further observed that 1.3% of Resimion activities undertaken by students utilised the in-built inclusivity features in the software. Both students with known RAs, and those without, utilised these features, therefore also aiding students without a formal diagnosis. Conclusion: The scenario-based learning tool Resimion was successfully integrated into the teaching of biomedical science and provided an engaging platform for students, with comparable results to other traditional assessment types.

Respiratory gas kinetics in patients with congestive heart failure during recovery from peak exercise

BackgroundCardiopulmonary Exercise Testing (CPX) is essential for the assessment of exercise capacity for patients with Chronic Heart Failure (CHF). Respiratory gas and hemodynamic parameters such as Ventilatory Efficiency (VE/VCO2 slope), peak oxygen uptake (peak VO2), and heart rate recovery are established diagnostic and prognostic markers for clinical populations. Previous studies have suggested the clinical value of metrics related to respiratory gas collected during recovery from peak exercise, particularly recovery time to 50% (T1/2) of peak VO2. The current study explores these metrics in detail during recovery from peak exercise in CHF. MethodsPatients with CHF who were referred for CPX and healthy individuals without formal diagnoses were assessed for inclusion. All subjects performed CPX on cycle ergometers to volitional exhaustion and were monitored for at least five minutes of recovery. CPX data were analyzed for overshoot of respiratory exchange ratio (RER=VCO2/VO2), ventilatory equivalent for oxygen (VE/VO2), end-tidal partial pressure of oxygen (PETO2), and T1/2 of peak VO2 and VCO2. ResultsThirty-two patients with CHF and 30 controls were included. Peak VO2 differed significantly between patients and controls (13.5 ± 3.8 vs. 32.5 ± 9.8 mL/Kg*min−1, p < 0.001). Mean Left Ventricular Ejection Fraction (LVEF) was 35.9 ± 9.8% for patients with CHF compared to 61.1 ± 8.2% in the control group. The T1/2 of VO2, VCO2 and VE was significantly higher in patients (111.3 ± 51.0, 132.0 ± 38.8 and 155.6 ± 45.5s) than in controls (58.08 ± 13.2, 74.3 ± 21.1, 96.7 ± 36.8s; p < 0.001) while the overshoot of PETO2, VE/VO2 and RER was significantly lower in patients (7.2 ± 3.3, 41.9 ± 29.1 and 25.0 ± 13.6%) than in controls (10.1 ± 4.6, 62.1 ± 17.7 and 38.7 ± 15.1%; all p < 0.01). Most of the recovery metrics were significantly correlated with peak VO2 in CHF patients, but not with LVEF. ConclusionsPatients with CHF have a significantly blunted recovery from peak exercise. This is reflected in delays of VO2, VCO2, VE, PETO2, RER and VE/VO2, reflecting a greater energy required to return to baseline. Abnormal respiratory gas kinetics in CHF was negatively correlated with peak VO2 but not baseline LVEF.

Low-titer antiphospholipid antibodies is associated with increased risk of late preterm stillbirth

Antiphospholipid (aPL) antibodies are present in up to 42% of patients with pregnancy loss. Patients with low-titer aPL antibodies who do not meet Sapporo criteria for antiphospholipid syndrome (APLS) often receive conflicting counseling in regards to pregnancy loss and perinatal outcomes by both hematologists and perinatologists. We performed a retrospective cohort study of pregnant patients who had aPL testing and compared pregnancy outcomes between subjects with low-titer aPL and those with negative aPL. Low-titer aPL was defined as positive anticardiolipin or anti-B2 glycoprotein IgG or IgM < 40 GPL or MPL or < 99th percentile. The primary outcome consisted of early pregnancy loss (< 13 weeks), spontaneous abortion (≥13, < 20 weeks), and fetal demise/stillbirth (≥20 weeks). Bivariable and multivariable analyses were performed. There were 2,898 patients with a pregnancy episode and aPL testing. Compared to those with negative aPL, low-titer aPL individuals were more likely to be younger, identify as Black or African-American, have hematologic or autoimmune disorders, have a history of substance use disorder or psychiatric disorder. Notably, there was increased use of aspirin but no difference in anticoagulation use in this group. (Table 1). After multivariable analysis, patients with low-titer aPL were not at higher risk for early pregnancy loss or spontaneous abortion when compared to those with negative aPL. However, they were at higher risk for stillbirth between 28-37 weeks compared with their negative aPL counterparts with an OR 1.81 (1.01-3.23), once adjusted for high risk comorbidities. (Table 2). Patients with low-titer aPL had higher rates of expected autoimmune and hematologic disorders compared to those with negative aPL. While there was no increased risk of spontaneous abortion, these patients were more likely to have a late preterm fetal demise, even when adjusted for medical and social comorbidities and aspirin use. While these patients do not carry a formal APLS diagnosis, they have a higher risk of stillbirth than patients with negative aPL.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Um caso de ocorrência em massa de Sandalodesmus araujoi () em um município de São Paulo, Brasil e descrição da fêmea até então desconhecida (Polydesmida, Chelodesmidae)

Abstract Somatic characters are shared by many Chelodesmidae groups, and generic placement and species identifications traditionally have been based on gonopodal morphology. Female genitalic characters have been largely neglected and are rarely photographed or illustrated. This is rather unfortunate as the morphology of female genitalia presents important characters and may be decisive for developing a more robust family classification. We describe the heretofore unknown female of Sandalodesmus araujoi (Schubart, 1946), previously known only from the male holotype collected in São Paulo, Brazil in December 1943; discuss the utility of female genitalic characters for species delineation in Sandalodesmus; and report the first case of a mass occurrence in the Chelodesmidae. While an attempt at a formal diagnosis of Sandalodesmus females based on genitalic characters is premature, the vulvar morphology of the three taxa examined in this study suggests that female genitalia are species-specific. Some characters (i.e., asymmetric valves, presence of digitiform projections and reduction of setae on the internal basal portion of the valves) are constant between the species, suggesting utility for generic-level delineation. Mass occurrences of millipedes are typically unpredictable and likely related to variations in environmental conditions and/or anthropogenic modifications of natural habitats. Although the mass occurrence of S. araujoi reported herein was only observed once, the event coincides with the mating period of millipedes during the rainy season in Brazil. On the other hand, the region where the species was found has been the target of intense urban development, including replacement of natural habitats with residential areas, which may have influenced its population dynamics.

New estimate suggests most autistic adults in England lack a formal diagnosis

New estimate suggests most autistic adults in England lack a formal diagnosis

Understanding the experiences and needs in autism education: A semi-structured interview among Chinese American parents of autistic children.

The diversity of the autistic population seeking professional services and education in the United States has increased. As the diagnosis of autism increases among the Chinese American immigrant population, there is also an increasing need to learn about this population and provide appropriate intervention and education for this group. However, current education and intervention provided for autistic individuals tend to be culturally blind. Gaps were found in our understanding of the cultural context and its relationship with the education mechanisms among Chinese American autistic families. The current study intends to investigate how Chinese American parents perceive the education materials and intervention strategies received by their autistic children as well as their experiences and needs in the education process. Semi-structured interviews were conducted among 10 Chinese American parents (one father and nine mothers) online. They all had children who had a formal diagnosis of autism spectrum disorder and received some intervention or education. Thematic analysis was used to analyse the results. The study suggested that most Chinese American parents were satisfied with the current education materials and intervention strategies provided to their autistic children. Due to cultural-related stigma, parents differ in their perceptions of children's autism diagnosis and characteristics as well as their expectations of children's culturally sensitive education. A theoretical model was created to provide culture-centered interpretation of the interconnected relationship between their pre- and post-immigration contexts and parenting attitudes. Culture plays a critical role in understanding Chinese American parents' experiences, needs, and expectations of culturally sensitive education for their autistic children. Interconnected relationships were found between contexts and parenting attitudes, which were largely influenced by cultural-related stigma. Suggestions and implications were provided for institutions and professionals working with Chinese American families and children. It is critical for them to learn about the experiences, needs, and attitudes of Chinese American parents to provide Chinese American autistic children with more appropriate and culturally sensitive education.

COMPARATIVE ANALYSIS OF THREE MACHINE LEARNING MODELS FOR EARLY PREDICTION OF SKELETAL CLASS-III MALOCCLUSION FROM PROFILE PHOTOS

The pre-adolescent growth period is the best time for the skeletal Class-III malocclusion treatment. Diagnosis and treatment during this period continue to be a complex orthodontic problem. Class-III malocclusion is complicated to treat with braces frequently requiring surgical intervention after a pubertal growth spurt. In addition, delayed recognition of the problem will yield significant functional, aesthetic, and psychological concerns. This study presents the first fully automated machine learning method to accurately diagnose Class-III malocclusion applied across mobile images, to the best of our knowledge. For this purpose, we comparatively evaluated three machine learning approaches: a deep learning algorithm, a machine learning algorithm, and a rule-based algorithm. We collected a novel profile image data set for this analysis along with their formal diagnosis from 435 orthodontics patients. The most successful method among the three was the machine learning method, with an accuracy of %76.

Autism Spectrum Disorder May Be Highly Prevalent in People with Functional Neurological Disorders

Recent observations suggest that autism spectrum disorder (ASD) co-occurs in people with a functional neurological disorder (FND), but little systematic data are available on the relationship between FND and autism. The study aimed to assess the self-reported autistic traits via a standardized questionnaire and the prevalence of previously diagnosed ASD among people with FND and their 1st-degree relatives. We performed a survey of members of the patient organization FNDHope, using a self-completed questionnaire for screening for autistic traits and ASD: the adult autism subthreshold spectrum (AdAS spectrum). There were 344 respondents diagnosed with FND with a mean age of 39.8 ± 11.6 years (female sex 90%). Eight per cent of respondents volunteered a previous diagnosis of ASD, and 24% reported a 1st-degree relative with a formal diagnosis of ASD, mostly their children. We found that 69% of respondents had scores in the AdAS spectrum indicating a clinically significant ASD and 21% indicating autistic traits. Further studies are needed to provide more evidence regarding the prevalence of ASD in people with FND and how this may influence the aetiology, treatment selection and prognosis.

Predictors of treatment non-response for depression in a sample of female adolescents with risk-taking and self-injurious behavior – A one year follow-up

ObjectiveDepressive disorders (DD) are highly prevalent among adolescents. While up to 60 % do not respond to treatment, evidence on predictors of treatment non-response in this age group is mixed, impeding meaningful clinical implications. Drawing on a consecutive clinical cohort of adolescents with risk taking and self-injurious behavior, the present study aimed to identify predictors of treatment non-response for female DD in a naturalistic one year follow-up. MethodsThe sample comprised female adolescents with verified DD (n = 152). Patients underwent assessments at baseline (T0) and follow-up (T1). Sociodemographic factors (e.g., age), clinical measures (e.g., symptom severity, trauma), and treatment variables (e.g. number of psychotherapy sessions), were analyzed as potential predictors of treatment non-response in unadjusted analyses and analyses adjusting for treatment intensity and age at baseline. Treatment response was defined based on not fulfilling formal diagnosis for DD at follow-up (52.3 %; n = 80) or the 50 % decrease in self-reported depressive symptoms (21.1 %; n = 32) from T0 to T1. ResultsGreater depressive and overall symptom severity, greater frequency of self-injuries, history of suicide attempts and history of childhood trauma at T0 were robustly associated with treatment non-response based on diagnostic interviews. Only a lower number of siblings was robustly associated with treatment non-response based on self-reports. LimitationsFindings may not generalize to other treatment settings. ConclusionCollectively, our results highlight overall symptom severity as significant predictor of treatment non-response in female adolescents with depression. Methodological differences (interviews versus self-reports) and potential implications from these findings for clinical practice are discussed.

Cerebral visual impairment and educational support in the United Kingdom: Understanding thresholds for providing support

Cerebral visual impairment (CVI) is the most common cause of visual impairment in children in the United Kingdom. The mainstay of management is providing strategies and environment adaptations to allow the child to use their vision for learning and independence. It is therefore important to understand educational access policies to facilitate timely and appropriate referral to qualified teachers for learners with visual impairment (QTVI) by ophthalmologists. QTVIs were recruited from VIEW (Visual Impairment England and Wales) and the Scottish Sensory Centre (QTVI organisations) via email, newsletter and social media. Respondents were directed to an online electronic questionnaire. 116 responses were received; this represents around 18% response rate. All services accepted referrals for children with cerebral visual impairment (CVI). The majority of services (97%) did not have a strict visual acuity threshold for children with CVI. There is an inconsistent approach in the diagnosis of CVI across the United Kingdom, with some QTVI expressing concern that this had prevented children with visual dysfunction from accessing help. QTVI indicated they would welcome more referrals for Cerebral VI, at an earlier age, and that a formalised referral pathway would be beneficial. Children with CVI are accepted for support by QTVI/sensory services regardless of visual acuity. Some services welcomed referrals for children undergoing assessment where CVI had yet to be confirmed. However, the formal diagnosis of CVI by an ophthalmologist as a pre-requisite to access services in other areas emphasises the need to improve clinicians’ confidence in the diagnosis of CVI. Ophthalmologists are encouraged to engage with local QTVI/sensory teams to facilitate exchange of information and appropriate and timely referral of children in need.

SUBJECTIVE COGNITIVE DECLINE AS A PREDICTOR OF INCIDENT HOMEBOUND STATUS AMONG OLDER ADULTS

Abstract In the US, over 2 million older adults are homebound, meaning they never or rarely leave their home. Being homebound increases risk for negative outcomes, including depression and mortality. Dementia diagnosis is a risk factor for becoming homebound, but over half of those with dementia do not receive a formal diagnosis. Subjective cognitive decline (SCD)—self-reported increase in memory loss over a given timeframe—is an early indicator of dementia that can be easily determined during routine medical encounters. SCD screening could be a valuable tool for identifying older adults at risk of becoming homebound—a critical first step towards supporting these individuals and their caregivers—but its predictive value is not yet known. We examined a nationally representative sample of 4,914 (weighted n=34,381,060) community-living older adults who responded to the 2016 and 2017 National Health and Aging Trends Study (NHATS). We modelled incident homebound status as a function of SCD using weighted, multivariable logistic regression while adjusting for older adult sociodemographic characteristics, health status, and caregiving support. In adjusted models, those who reported SCD experienced 43% greater odds of becoming newly homebound from 2016-2017 (aOR: 1.43; p=0.03). This relationship persisted among individuals without a formal dementia diagnosis (n=4,735); among these individuals, those who reported SCD experienced 50% greater odds of becoming newly homebound (aOR: 1.50; p=0.02). Findings suggest the potential value of SCD screening as an efficient method of identifying older adults who may benefit from resources that reduce the risk and/or mitigate the negative effects of becoming homebound.

COGNITIVE STATUS AND HEALTH CARE UTILIZATION IN AN EMERGENCY DEPARTMENT: EARLY RESULTS OF A LONGITUDINAL PILOT STUDY

Abstract Many people living with Alzheimer’s disease and related dementias (ADRD) never receive a formal disease diagnosis. This compromises wellbeing and increases health services utilization and care costs. Wider screening and assessment for ADRD may increase access to supportive care, improve allocation of medical care, and foster interventions that prevent or delay disease progression. A sample of Medicare-enrolled individuals 65+ (n=60) consecutively presenting to the Oregon Health &amp; Science University (OHSU) emergency department (ED) in Portland, Oregon consented to the study and were administered the TICS, a validated tool for telephone-based assessments of cognition, post-discharge from the ED. Study participants were asked about their physical health via the modified Cumulative Illness Rating Scale (M-CIRS), and their cognitive health via the PROMIS Cognitive Measure Questions on Mental Clarity. Care utilization patterns were measured via review of participants’ electronic health records (EHR) for three years prior to study enrollment focusing on total hospitalizations, ED visits, and primary care (PC) visits.Medicare-enrolled adults 65+ recently discharged from the ED were a feasible population to perform a cognitive assessment. The study enrollment rate was 24.2% (n=60). Enrollment was limited to patients with their PC affiliated with the OHSU health system, which excluded the majority (792, 73.8%) of ED patients Medicare-enrolled, 65+ from our study (1,072). This study provides preliminary evidence to support focusing on older ED patients to administer cognitive assessments, linking outcomes to the EHR, and ultimately providing a platform for future research on impacts of under-diagnosed ADRD on population-level health outcomes and care utilization.

APA GUIDELINES FOR THE EVALUATION OF DEMENTIA AND AGE-RELATED COGNITIVE CHANGE: OVERVIEW AND CLINICAL APPLICATION

Abstract Dementia is a leading cause of cognitive and functional decline and the number of people living with dementia or involved in caring for another person with dementia continues to rise. There is a growing need for health professionals who are well trained in dementia assessment and intervention. In 2021, the American Psychological Association and its Committee on Aging (CONA) published a revision of the APA Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change with the goal of promoting proficiency and expertise in this growing practice area. This symposium presents an overview of the APA Guidelines and their clinical application in various practice situations and settings. The first presentation (Mast) provides an overview of the guidelines and highlights areas of significant revision, including greater attention to multicultural competence, person-centered principles, and assessment of family caregivers. The second presentation (Steffen) presents the application of the APA Guidelines to working with older adults before formal assessment and diagnosis has been initiated. The third presentation (Allen) describes use of the APA Guidelines in the post-evaluation period and integrates GSA’s revised KAER Toolkit for Primary Care Teams. The final presentation (Bush) presents ethical considerations before, during, and after dementia assessment.