scholarly journals Measuring Quality of Service in a Robotized Comprehensive Geriatric Assessment Scenario

2020 ◽  
Vol 10 (18) ◽  
pp. 6618
Author(s):  
Adrián Romero-Garcés ◽  
Jesús Martínez-Cruz ◽  
Juan F. Inglés-Romero ◽  
Cristina Vicente-Chicote ◽  
Rebeca Marfil ◽  
...  
Keyword(s):  
Quality Of Service ◽  
Functional Properties ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
User Preferences ◽  
Care Plans ◽  
Whole Process ◽  
Frail Elderly People ◽  
Individualised Care

Comprehensive Geriatric Assessment (CGA) is an integrated clinical process to evaluate frail elderly people in order to create therapy plans that improve their quality and quantity of life. The whole process includes the completion of standardized questionnaires or specific movements, which are performed by the patient and do not necessarily require the presence of a medical expert. With the aim of automatizing these parts of the CGA, we have designed and developed CLARC (smart CLinic Assistant Robot for CGA), a mobile robot able to help the physician to capture and manage data during the CGA procedures, mainly by autonomously conducting a set of predefined evaluation tests. Using CLARC to conduct geriatric tests will reduce the time medical professionals have to spend on purely mechanical tasks, giving them more time to develop individualised care plans for their patients. In fact, ideally, CLARC will perform these tests on its own. In parallel with the effort to correctly address the functional aspects, i.e., the development of the robot tasks, the design of CLARC must also deal with non-functional properties such as the degree of interaction or the performance. We argue that satisfying user preferences can be a good way to improve the acceptance of the robot by the patients. This paper describes the integration into the software architecture of the CLARC robot of the modules that allow these properties to be monitored at run-time, providing information on the quality of its service. Experimental evaluation illustrates that the defined quality of service metrics correctly capture the evolution of the aspects of the robot’s activity and its interaction with the patient covered by the non-functional properties that have been considered.

scholarly journals Comprehensive Geriatric Assessment in Consecutive Newly-Diagnosed Elderly Multiple Myeloma Patients in China: A Multicentered, Prospective, Non-Interventional Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5493-5493
Author(s):  
Yuan Yao ◽  
Dehui Zou ◽  
Aijun Liao ◽  
Xiaoxia Chu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Geriatric Assessment ◽  
Real World ◽  
Comprehensive Geriatric Assessment ◽  
Newly Diagnosed ◽  
Frail Patients

Background: Multiple Myeloma (MM) is a disease of the elderly, whose prognoses are highly heterogeneous. Hence International Myeloma Working Group (IMWG) proposed geriatric assessment (GA) in 2015, including daily activity and comorbidity status, to better discriminate between fit and frail patients (Palumbo et al, 2015). However, IMWG recruited patients from clinical trials instead of real world practices. Therefore we studied GA in elderly MM patients consecutively in China, along with other perspectives which are known to be problematic in elderly population that were previously left unnoticed, such as nutrition status, risk of cognitive impairment, risk of depression, and quality of life. Aim: Our study centers on the feasibility to perform a more comprehensive geriatric assessment (cGA) in elderly MM patients, current cGA status in elderly MM patients in China, and the cGA difference between Chinese patients and patients in the IMWG study. Method: From August 2017 to April 2019, we continuously recruited 336 newly diagnosed elderly (age ≥ 65) MM patients from 21 centers in China. cGA was performed at diagnosis, after treatment cycle 1, after cycle 4, and 1 year after treatment. cGA includes physical conditions (ECOG), activities of daily living (ADL), instrumental ADL (IADL), mini-nutritional assessment (MNA-SF), geriatric depression scale (GDS), mini-mental state examination (MMSE), quality of life (SF-36) and Charlson comorbidity index (CCI). Staging was assessed at baseline (International Staging System (ISS) & Revised ISS) and hematological responses were evaluated along with each cGA timepoint. Results: We pool-analyzed data of 336 newly-diagnosed elderly MM patients. The median age was 70 (range 65-88) and 25.5% of patients were older than 75 years. 336 (100%) patients were able to complete cGA, and median assessment time was 40 minutes (range 20-70). Upon diagnosis, only 34% and 37.5% of patients had full ADL and IADL respectively. 38.5% of patients had moderate to high risk of depression (GDS ≥ 6). 13.2% of patients were malnourished (MNA-SF ≤ 7), while 46.3% of patients were at risk of malnutrition (8 ≤ MNA-SF ≤ 11). 41% of patients had at least one comorbidity (CCI ≥ 1). 45.7% of patients had moderate to intermediate risk of cognitive impairment (MMSE ≤ 26). Grouping by IMWG-GA index, our study identified 59.9% patients in frail group (vs 39% in IMWG study), 15.8% in intermediate (vs 31% in IMWG) and 24.3% in fit (vs 30% in IMWG). 69% of patients received proteasome inhibitor-containing regimens and 20.7% of patients received lenalidomide-containing regimens. Best hematological responses in fit and intermediate groups were better than responses in frail group (≥ PR rate: 88.5% in fit, 94.4% in intermediate vs 77.5% in frail). Median follow up time was 10 months. To date, 215 (64%) patients have finished the cGA after cycle 1; 164 (48.8%) patients have finished the cGA after cycle 4; 91 (27.1%) patients has finished all 4 planned cGA and improvements in cGA were observed in the majority of these patients. Conclusion: Our study showed significant CGA heterogeneity in elderly MM patients. Even in the IMWG-GA "fit" group, nutrition, depression and cognitive impairment remain problems. Frail patients took up a larger proportion in Chinese elderly MM patients compared to IMWG study. Our study strongly justifies the necessity for cGA in elderly patients with MM, more so in the real world MM patients than in the clinical trials. Disclosures No relevant conflicts of interest to declare.

scholarly journals Nutrition in Cancer Therapy in the Elderly—An Epigenetic Connection?

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3366
Author(s):  
Janusz Blasiak ◽  
Jan Chojnacki ◽  
Elzbieta Pawlowska ◽  
Joanna Szczepanska ◽  
Cezary Chojnacki
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Cancer Therapy ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
The Elderly ◽  
Assessment Tools ◽  
Continuous Increase ◽  
Epigenetic Profile

The continuous increase in life expectancy results in a steady increase of cancer risk, which consequently increases the population of older adults with cancer. Older adults have their age-related nutritional needs and often suffer from comorbidities that may affect cancer therapy. They frequently are malnourished and present advanced-stage cancer. Therefore, this group of patients requires a special multidisciplinary approach to optimize their therapy and increase quality of life impaired by aging, cancer, and the side effects of therapy. Evaluation strategies, taking advantage of comprehensive geriatric assessment tools, including the comprehensive geriatric assessment (CGA), can help individualize treatment. As epigenetics, an emerging element of the regulation of gene expression, is involved in both aging and cancer and the epigenetic profile can be modulated by the diet, it seems to be a candidate to assist with planning a nutritional intervention in elderly populations with cancer. In this review, we present problems associated with the diet and nutrition in the elderly undergoing active cancer therapy and provide some information on epigenetic aspects of aging and cancer transformation. Nutritional interventions modulating the epigenetic profile, including caloric restriction and basal diet with modifications (elimination diet, supplementary diet) are discussed as the ways to improve the efficacy of cancer therapy and maintain the quality of life of older adults with cancer.

Comprehensive geriatric assessment and management for Canadian elders with Cancer: The 5C study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12011-12011
Author(s):  
Martine Puts ◽  
Naser Alqurini ◽  
Fay Strohschein ◽  
Johanne Monette ◽  
Doreen Wan-Chow-Wah ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Data Collection ◽  
Cancer Treatment ◽  
Functional Status ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Primary Outcome ◽  
Group Performance

12011 Background: Comprehensive Geriatric Assessment (CGA) is recommended by ASCO for older adults with cancer undergoing chemotherapy to identify issues that can interfere with treatment delivery and optimize functional status and quality of life. However, few randomized controlled trials have been completed so far. Our objective is to evaluate the effectiveness of CGA on improving quality of life for older adults receiving cancer treatment. Methods: Eligible patients were aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, speaking English/French, and with an Eastern Collaborative Oncology Group Performance Status 0–2. The CGA was done by a nurse and geriatrician followed by monthly phone calls by the study nurse for 6 months. Patients were randomly assigned (1:1) to receive either the intervention (CGA plus follow-up by geriatric trained team in addition to usual oncology care) or usual care alone. All participants received a monthly healthy aging booklet for attention control. Randomization was stratified by center and treatment intent (curative/adjuvant versus palliative). Our primary outcome was health-related quality of life (HRQOL) assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health scale (items 29 and 30). Secondary outcomes include functional status (Instrumental Activities of Daily Living). Outcome data collection was completed monthly for the first 6 months, then at 9 and 12 months. For the primary outcome we used a pattern mixture model using an intent-to-treat approach (at 0, 3, and 6 months). The last data collection took place March 8 2021. Results: From May 2017 to March 2020, 351 participants from 8 hospitals across Canada were enrolled. All patients were seen on or after day 1 of treatment for the intervention per patient request. Patient characteristics at baseline were similar in both arms. The average age was 75.7 (SD = 4.8), 60.4% was male and 54.3% had treatment with palliative intent. Change in HRQOL scores did not differ by arm (p =.80). Neither group exceeded the MCID of 10 points. There was also no difference in IADL between the groups (p = 0.82). Conclusion: CGA was not effective in improving quality of life for older adults receiving cancer treatment in this study. CGA may need to be performed prior to treatment initiation to achieve benefits. Clinical trial information: NCT03154671.

EFFECTIVENESS OF A COMPREHENSIVE GERIATRIC ASSESSMENT TO IMPROVE THE LIFE QUALITY OF THE ELDERLY AND TO EASE THE CAREGIVERS BURDEN

2021 ◽  
pp. 79-90
Author(s):  
Evgenia A. Gurianova ◽  
Enje E. Rechapova ◽  
Ekaterina S. Sidyakina
Keyword(s):  
Elderly People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Life Quality ◽  
Modern Society ◽  
The Elderly ◽  
Diagnostic Process ◽  
Modern World ◽  
Rehabilitation Programs

In the modern world, the number of elderly people with various diseases is growing, they need an appropriate care. Care implementation requires special knowledge, mental and economic expenditures. Ensuring a decent old age for the elderly is one of the problems of modern society. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process for assessing the physical, psychological, functional and socio-economic problems of elderly people in order to develop a comprehensive individual plan for their treatment and rehabilitation. Comprehensive geriatric assessment benefits the elderly population, but the effectiveness of comprehensive geriatric assessment to improve the life quality of the elderly remains unclear. The article provides an overview of studies devoted to studying the effectiveness of using comprehensive geriatric assessment. The article discusses the influence of a comprehensive geriatric assessment on determining the life quality of the elderly, the duration of their stay in the hospital, and relieving the caregivers' burden. In addition, the influence of a comprehensive geriatric assessment on the ability to determine life expectancy, to conduct early diagnosis of major geriatric syndromes, the risk of morbidity and mortality in elderly patients is being considered. It is important that on the basis of a comprehensive geriatric assessment, appropriate rehabilitation programs can be drawn up, and technologies for rehabilitation can be determined.

Quality of Service and Extra-Functional Properties for Web Services

2013 ◽  
pp. 35-64
Author(s):  
Guadalupe Ortiz ◽  
Behzad Bordbar
Keyword(s):  
Quality Of Service ◽  
Web Services ◽  
Functional Properties ◽  
Model Transformation ◽  
Model Driven Architecture ◽  
Aspect Oriented Programming ◽  
Maintenance Costs ◽  
Model Driven

The presented approach draws on two main software techniques: Model-Driven Architecture, and aspect-oriented programming. The method involves modeling of the Quality of Service and Extra-functional properties in a platform-independent fashion. Then applying model transformation, the platform-independent models are transformed into platform-specific models, and finally into code. The code for Quality of Service and Extra-functional properties are integrated into the system relying on aspect-oriented techniques in a decoupled manner. The presented approach is evaluated with the help of a case study to establish that the approach results in increasing the system’s modularity and thus reducing implementation and maintenance costs.

Negotiation of Service Level Agreements

2012 ◽  
pp. 442-469
Author(s):  
Peer Hasselmeyer ◽  
Bastian Koller ◽  
Philipp Wieder
Keyword(s):  
Quality Of Service ◽  
Functional Properties ◽  
Service Level Agreement ◽  
Service Level ◽  
Service Level Agreements ◽  
Common Features ◽  
Current State ◽  
Quality Of Service Parameters ◽  
Future Work

Non-functional properties are an essential constituent of service level agreements as they describe those quality-of-service parameters that are not related to the actual function of a service. Thus, non-functional properties let providers create distinguishing service offers and let consumers discriminate between various offers that provide the same function. The negotiation of non-functional properties is how service level agreements are commonly established. This chapter introduces various forms, models, specifications, and realizations of service level agreement negotiation to provide a broad background of the current state-of-the-art. Although different in various details, the described systems share a number of common features. Based on them, a holistic architecture is defined combining previous work into one coherent framework. The architecture is applicable to different negotiation models and protocols, and covers all functions of the negotiation phase. Based on this architecture, particular challenges and areas of future work are motivated. These mostly revolve around increasing the acceptance of service level agreement negotiation and enhancing interoperability.

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