Controlling for the wide variability in the physical health status of geriatric populations is important as severity of illness is known to both moderate and suppress relationships examined in psychosocial research. The purpose of the present investigation was to develop a uniform, easily administered quantitative index of illness severity, composed of disease-specific scales, that was independent of psychosocial factors and appropriate for use with a geriatric population. As well, the aim was to collect preliminary data on the reliability and validity of the scale. The development of the Severity of Illness-Geriatric (SOI­G) scale involved the adaptation of a previously developed severity of illness instrument Severity of Renal Disease Scale (SORDS). <p>The present investigation involved five programmatically linked studies. Study 1 involved the determination of the items to be included on SOI-G while Study 2 defined the severity criteria for each item. In Study 3, five geriatric specialists scaled each level of each item on the same underlying threat to life scale. There was a high level of initial agreement between the raters supporting the reliability of the severity values. The final scale consisted of 32 items. <p>In Study 4, archival data was collected on 61 patients admitted to the geriatric unit of a rehabilitation hospital. The SOI-G was compared to the Cumulative Illness Rating Scale-Geriatric (CIRS-G) and a global severity rating. <p>SOI-G inter-rater reliability estimates were low (likely due to rater error) but promising. SOI-G demonstrated support for content validity, face validity, and construct validity but evidence for convergent validity was not established. SOI-G scores were sensitive to differences among patients with respect to discharge outcome. The utility of SOI-G as a moderator variable in psychosocial research with the elderly could not be explored in Study 5 due to a limited sample size. <p>It was concluded that the present investigation demonstrated the potential usefulness of SOI-G in psychosocial research with the elderly but further research is needed before definitive conclusions can be made. The SOI-G offers researchers a tool for controlling disease variability that is not measured by psychological tests but must be accounted for in research designs.

Controlling for the wide variability in the physical health status of geriatric populations is important as severity of illness is known to both moderate and suppress relationships examined in psychosocial research. The purpose of the present investigation was to develop a uniform, easily administered quantitative index of illness severity, composed of disease-specific scales, that was independent of psychosocial factors and appropriate for use with a geriatric population. As well, the aim was to collect preliminary data on the reliability and validity of the scale. The development of the Severity of Illness-Geriatric (SOI­G) scale involved the adaptation of a previously developed severity of illness instrument Severity of Renal Disease Scale (SORDS). <p>The present investigation involved five programmatically linked studies. Study 1 involved the determination of the items to be included on SOI-G while Study 2 defined the severity criteria for each item. In Study 3, five geriatric specialists scaled each level of each item on the same underlying threat to life scale. There was a high level of initial agreement between the raters supporting the reliability of the severity values. The final scale consisted of 32 items. <p>In Study 4, archival data was collected on 61 patients admitted to the geriatric unit of a rehabilitation hospital. The SOI-G was compared to the Cumulative Illness Rating Scale-Geriatric (CIRS-G) and a global severity rating. <p>SOI-G inter-rater reliability estimates were low (likely due to rater error) but promising. SOI-G demonstrated support for content validity, face validity, and construct validity but evidence for convergent validity was not established. SOI-G scores were sensitive to differences among patients with respect to discharge outcome. The utility of SOI-G as a moderator variable in psychosocial research with the elderly could not be explored in Study 5 due to a limited sample size. <p>It was concluded that the present investigation demonstrated the potential usefulness of SOI-G in psychosocial research with the elderly but further research is needed before definitive conclusions can be made. The SOI-G offers researchers a tool for controlling disease variability that is not measured by psychological tests but must be accounted for in research designs.

Personality pathology, especially antisocial personality disorder (ASPD), often occurs in patients with methamphetamine use disorder (MAUD). However, little is known about potential risk factors for this dual diagnosis, and the impact of this comorbidity on both the severity of MAUD and levels of functional impairment. Casting light on such phenomena may aid in early identification of treatment targets, assist in the management of patients in this particular population, and contribute to development of treatment strategies. This crosssectional study described and compared sociodemographic, clinical and childhood trauma correlates in patients with a dual diagnosis of MAUD and ASPD (MAUD+ASPD) and those with MAUD without ASPD (MAUD-ASPD). The contribution of sociodemographic and childhood trauma variables in predicting membership of the MAUD+ASPD group was also investigated. A sample of 62 adult patients with a primary diagnosis of MAUD took part in the study. A sociodemographic questionnaire was completed and well established diagnostic measures of ASPD (The Mini-International Neuropsychiatric Interview; MINI) and MAUD (Structured Clinical Interview; SCID - 5) were used to determine diagnostic status. Illness severity was evaluated with the Yale-Brown Obsessive Compulsive scale (adapted for MAUD) (Y-BOCS-du) and functional impairment was assessed with the Sheehan Disability Scale (SDS). Histories of exposure and severity of childhood trauma (CT) were measured using the CTQ-SF. Of the 62 participants, 14 (23%) had MAUD and had MAUD+ASPD whereas 48 (77%) had MAUD without ASPD (MAUD-ASPD). Bivariate analyses found significant group differences in terms of gender (df =1) = 8.05; p =< 0.01), language (df = 2) = 7.12; p = 0.03), and level of physical neglect (F(1, 60) = 2.33; M = 9.85; SD = 4.23; p = 0.04). The MAUD+ASPD group members were mostly male (N = 9; 64%), English-speaking and with histories of increased physical neglect. Logistic regression suggested that male gender (beta = 1.08; OR = 8.65; p = 0.01) and English language (beta = 1.55; OR = 11.38; p = 0.03) significantly predicted ASPD comorbidity. There were no significant differences in clinical severity or functional impairment between the MAUD+ASPD and MAUD-ASPD groups. In conclusion, this study indicated that male gender and having English as a first language are associated with MAUD+ASPD but other sociodemographic variables, CT histories and clinical severity and impairment were not. Men who use MA are thus more prone to antisocial behaviour, which complicates their substance use condition. Treatment approaches for MAUD may benefit from developing adaptations that cater for challenges specific to comorbid ASPD. Additionally, the finding regarding first language warrants further investigation. Recommendations for future research are suggested.

Yes / Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods: We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results: Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p

No / To build an early warning score (EWS) based exclusively on routinely undertaken laboratory tests that might provide early discrimination of in-hospital death and could be easily implemented on paper. Using a database of combined haematology and biochemistry results for 86,472 discharged adult patients for whom the admission specialty was Medicine, we used decision tree (DT) analysis to generate a laboratory decision tree early warning score (LDT-EWS) for each gender. LDT-EWS was developed for a single set (n=3496) (Q1) and validated in 22 other discrete sets each of three months long (Q2, Q3...Q23) (total n=82,976; range of n=3428 to 4093) by testing its ability to discriminate in-hospital death using the area under the receiver-operating characteristic (AUROC) curve. The data generated slightly different models for male and female patients. The ranges of AUROC values (95% CI) for LDT-EWS with in-hospital death as the outcome for the validation sets Q2-Q23 were: 0.755 (0.727-0.783) (Q16) to 0.801 (0.776-0.826) [all patients combined, n=82,976]; 0.744 (0.704-0.784, Q16) to 0.824 (0.792-0.856, Q2) [39,591 males]; and 0.742 (0.707-0.777, Q10) to 0.826 (0.796-0.856, Q12) [43,385 females]. CONCLUSIONS: This study provides evidence that the results of commonly measured laboratory tests collected soon after hospital admission can be represented in a simple, paper-based EWS (LDT-EWS) to discriminate in-hospital mortality. We hypothesise that, with appropriate modification, it might be possible to extend the use of LDT-EWS throughout the patient's hospital stay.