Journal ArticleDOI
Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale
Mark D. Miller,Cynthia F. Paradis,Patricia R. Houck,Sati Mazumdar,Jacqueline A. Stack,A. Hind Rifai,Benoit H. Mulsant,Charles F. Reynolds +7 more
TLDR
The current data suggest that the CIRS(G) can be successfully applied in medically and psychiatrically impaired elderly subjects, with good interrater reliability and face validity (credibility).Abstract:
Reliable quantitative ratings of chronic medical illness burden have proved to be difficult in geropsychiatric practice and research. Thus, the purpose of the study was to demonstrate the feasibility and reliability of a modified version of the Cumulative Illness Rating Scale (CIRS; Linn et al., 1968) in providing quantitative ratings of chronic illness burden. The modified CIRS was operationalized with a manual of guidelines geared toward the geriatric patient and for clarity was designated the CIRS(G). A total of 141 elderly outpatient subjects (two medical clinic groups of 20 each, 45 recurrent depressed subjects, 21 spousally bereaved subjects, and 35 healthy controls) received comprehensive physical examinations, reviews of symptoms, and laboratory testing. These data were then used by nurse practitioners, physician's assistants, and geriatric psychiatrists to compute CIRS(G) ratings of chronic illness burden. As hypothesized, analysis of variance demonstrated significant differences among groups with respect to total medical illness burden, which was highest among medical clinic patients and lowest in control subjects. Good interrater reliability (i.e., intraclass correlations of 0.78 and 0.88 in a subsample of 10 outpatients and a separate group of 10 inpatients, respectively) was achieved for CIRS(G) total scores. Among medical clinic patients, a significant correlation was found, as expected, between CIRS(G) chronic illness burden and capability as quantified by the Older Americans Activities of Daily Living Scale; and between CIRS(G) scores and physicians' global estimates of medical burden. Finally, with repeated measures of illness burden approximately 1 year from symptom baseline, significant rises were detected, as expected. The current data suggest that the CIRS(G) can be successfully applied in medically and psychiatrically impaired elderly subjects, with good interrater reliability and face validity (credibility).read more
Citations
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Journal ArticleDOI
Acute and Longer- Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report
A. John Rush,Madhukar H. Trivedi,Stephen R. Wisniewski,Andrew A. Nierenberg,Jonathan W. Stewart,Diane Warden,George Niederehe,Michael E. Thase,Philip W. Lavori,Barry D. Lebowitz,Patrick J. McGrath,Jerrold F. Rosenbaum,Harold A. Sackeim,David J. Kupfer,James F. Luther,Maurizio Fava +15 more
TL;DR: The acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial are described and compared.
Journal ArticleDOI
Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice
Madhukar H. Trivedi,A. John Rush,Stephen R. Wisniewski,Andrew A. Nierenberg,Diane Warden,Louise Ritz,Grayson Norquist,Robert H Howland,Barry D. Lebowitz,Patrick J. McGrath,Kathy Shores-Wilson,Melanie M. Biggs,Goundappa K. Balasubramani,Maurizio Fava +13 more
TL;DR: The response and remission rates in this highly generalizable sample with substantial axis I and axis III comorbidity closely resemble those seen in 8-week efficacy trials.
Journal ArticleDOI
How to measure comorbidity: a critical review of available methods
TL;DR: The Charlson Index, the CIRS, the ICED and the Kaplan Index are valid and reliable methods to measure comorbidity that can be used in clinical research.
Journal ArticleDOI
Can comorbidity be measured by questionnaire rather than medical record review
TL;DR: The authors found that a questionnaire version of the Charlson index is reproducible, valid, and offers practical advantages over medical record-based assessments.
Journal ArticleDOI
Comorbidity and functional status are independent in older cancer patients.
TL;DR: Both the Charlson and CIRS-G scales are reliable tools for use in trials of older cancer patients and can be tested in further studies as predictors of outcomes such as toxicity of treatment, changes in functional status, or survival.
References
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TL;DR: The new Fifth Edition has been significantly reorganized to enhance geriatric assessment skills, general medical management, management of specific diseases, surgical management, gender issues in clinical geriatrics, and more.