Development and Validation of the Emergency Department Geriatric Readmission Assessment at Yale (ED GRAY): Part 1, Fundamental Measurement.

Objective: Our primary objective was to develop a reliable, valid, and efficient screening tool that measures recovery disability among geriatric patients for the Department of Emergency Medicine (ED) Geriatric Readmission Assessments (GRAY). Methods: We conducted a retrospective medical chart review and prospective data analysis of geriatric patients admitted to hospital from the emergency department that were discharged, admitted, or died at a single academic urban university-affiliated hospital to identify items for ED GRAY. Rasch analysis was then used to reduce items and construct an interval/ratio scale of physical and cognitive disabilities. Patients consisted of a cohort of consenting, non-critically ill, English-speaking adults older than 65 years and receiving care in the ED to reduce the number of items. Results: Rasch analyses resulted in infit and outfit statistics that eliminated redundant items or items that did not fit a unidimensional disability construct. From the 158 original items, sixteen items comprise the ED GRAY global health questionnaire, representing five sub-constructs: physical disability, cognitive disability, stress, depression, and isolation. All infit and outfit statistics for the global recovery disability score ranging from 1 (least healthy) to 5 (most healthy) were consistent with forming a unidimensional scale. Conclusions: Our study resulted in an objective measurement tool of physical and cognitive disability using Rasch analyses. This screening tool allows healthcare providers the ability to screen older ED patients on a continuum of risk, with high-risk patients being most likely to benefit from in-depth evaluation—e.g., comprehensive geriatric assessment—followed by intervention (when necessary).

Advance in Diagnosis of Post-traumatic Stress Disorder following Intellectual Disability(review) / 中国康复理论与实践

@#Post-traumatic stress disorder (PTSD) is the most serious post-disaster physical and mental barrier, and intellectual disabilities are more sensitive to the negative effects caused by trauma than the healthy population. The debate existing extensively makes the diagnosis of PTSD in patients with intellectual disability difficult to be understood. There is a need to use uniform diagnostic criteria, howere, it still remains a problem for less experienced clinicians.