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Das ATP Challenger Pullach ist ein Tennisturnier in Pullach im Isartal, das zum ersten Mal ausgetragen wird. Es ist Teil der ATP Challenger Tour und wird im Freien auf Sand gespielt. Die Isar Open waren ein Tennisturnier, das erstmals vom 6. bis August in Pullach stattfand. Das Turnier war ein Teil der ATP Challenger Tour. Aus den Isar Open werden die Schwaben Open. Nach nur einem Jahr auf der Anlage des TC Großhesselohe wird das ATP-Challenger-Turnier. Die von der Eventagentur IsarOne GmbH veranstaltete IsarOpen ist ein ATP Challenger Tennisturnier der höchsten Kategorie mit € Preisgeld + Hospitality. Zum Auftakt der Schwaben Open beginnen wir mit einer herzlichen Einladung zu unserem Ladies [ ];. Vom bis fand das diesjährige Isar Open Tennis Turnier in München statt. Die GEMCO Veranstaltungsmedien GmbH war dabei zuständig für den. Isar Open werden zu Schwaben Open Unser ATP Challenger Turnier zieht zum TC Augsburg Siebentisch e.V. um. 🧦.
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Andere Beiträge. In seine Zuständigkeit fällt die Turnierorganisation und technische Koordination. Sämtliche Verträge mit. Webseite Facebook Instagram. You also have Wie Genial Ist Das Denn option to opt-out of these cookies. Welches Rücktrittsrecht habe ich als Investor?Design: an observational cohort study using receiver—operator curve analysis to compare baseline ISAR to an adverse clinical outcome at 90 days where an adverse outcome was any of death, institutionalisation, hospital readmission, increased dependency in activities of daily living decrease of 2 or more points on the Barthel ADL Index , reduced mental well-being increase of 2 or more points on the point General Health Questionnaire or reduced quality of life reduction in the EuroQol-5D and high health and social services costs over 90 days estimated from routine electronic service records.
Conclusions: adverse outcomes are common in older people discharged from acute medical units in the UK; the poor predictive ability of the ISAR in older people discharged from acute medical units makes it unsuitable as a sole tool in clinical decision-making.
Most UK acute hospitals operate a system whereby medical patients admitted for non-elective care are assessed on an acute medical unit AMU [ 1 ].
AMUs have an important role in triage—identifying those patients that require in-patient care and those who might be safely managed in the community setting.
These observations have led to the development of services based on acute medical units to deal with frail older patients [ 3 ]. For such services to be cost-effective, it is important to focus the intervention on a cohort of patients at risk of adverse outcomes that are likely to benefit.
A review [ 4 ] of tools to do this showed that only the Identification of Seniors at Risk ISAR [ 5 ] see Supplementary data available in Age and Ageing online, Appendix S1 had evidence that it predicted a wide range of adverse health outcomes including death, institutionalisation, readmission, resource use and decline in physical or cognitive function.
The ISAR includes six simple dichotomous questions, making it simple and acceptable for patients and staff alike.
For the ISAR to be used in the UK, it is important to demonstrate adequate predictive ability in UK settings, but this has not yet been done, and this was the purpose of this study.
Recruitment was over 23 months from January Nottingham January —April , Leicester December —November , and was performed by research staff embedded in the acute medical units during week-day office hours.
Participants were recruited after a decision to discharge had been made by the medical team, and before they left hospital.
Initially, patients were excluded if they lacked mental capacity to give informed consent and if there was no family consultee available.
An amendment was subsequently approved in March by the research ethics committee to permit such potential participants to be recruited subject to agreement by the responsible physician.
Other exclusion criteria were if staff advised against approaching the patient, or if neither the patient nor carer could communicate in English sufficiently to complete baseline assessments.
The ISAR score was completed by the researcher on recruitment. Other baseline variables included:. Clinical outcomes were ascertained at 90 days.
After checking hospital and GP records for deaths and moves of addresses, outcomes were determined using postal questionnaires, with further checks of hospital and GP records, telephone prompts and home visits for those not returning questionnaires within 2 weeks.
A composite adverse outcome was defined as any of the following during the follow-up:. Social service resource use was also obtained from service databases contacts and services.
Complete health and social service resource use data were obtained only from the Nottingham cohort, because regulatory permission to access these data was granted only for this site.
Within this cohort, general practice data were obtained for the subset of participants where general practitioners gave permission for their data to be extracted.
Personal costs were not measured. The resource use data were combined into one database to allow derivation of an overall cost for each participant.
Costs were determined by applying standard NHS [ 20 ] and social care [ 21 ] reference costs in pounds sterling to the resource use data.
Simple descriptive statistics were used to describe the characteristics of the study population and their clinical outcomes. Differences in participant characteristics at recruitment according to the conventional ISAR cut-off point of 2 were explored using t -tests and Mann—Whitney U tests for continuous variables and Chi-squared tests for categorical variables.
The diagnostic value of the ISAR tool for the composite adverse clinical outcome was analysed using a ROC to compare the sensitivity and specificity of different ISAR cut-off values to detect adverse outcomes.
The positive and negative predictive values for different ISAR cut-off values were also calculated. Ninety-five percent confidence intervals were calculated to describe the precision of the sensitivity, specificity, positive predictive value and negative predictive value estimates.
ROC analyses were performed for each component of the composite adverse outcome. The area under the curve AUC was interpreted, where 0.
Unit costs were applied to resource use data. Death and residential status were ascertained for all participants, and re-admission was ascertained for participants.
See the study flow diagram Figure 1. Participants with an ISAR score of 2 or more were older, more likely to be female, more likely to be widowed, more likely to be cognitively impaired, more dependent in activities of daily living, had higher scores on the GHQ, lower EQ-5D quality of life scores, were more likely to be malnourished or at risk of malnourishment and more likely to be classified as frail.
Median IQR presented for continuous and scaled variables. Frequency and percentage presented for categorical variables. Receiver-operating characteristics analysis of the ISAR tool for detecting adverse outcomes.
Data from acute and subacute hospitals, ambulance services, intermediate care services, mental health services and social services were obtained for all participants in the Nottingham cohort.
The participants were registered with general practices, of whom 48 gave permission for their data to be extracted.
However, despite significances between the baseline health status of patients with ISAR scores above and below the cut-off level, the ability of the ISAR to predict adverse outcomes was poor, and its ability to predict health and social care costs was fair.
A large proportion of potential participants were not recruited, partly due to methodological issues related to the ability of potential participants who lacked mental capacity to give informed consent.
As a result, patients with the worst outcomes were likely to have been excluded. However, exclusion of those who were probably at high risk incapable, no consultee would have increased sensitivity and reduced specificity, but the exclusion of low-risk people who came and went quickly would have had the reverse effect.
This might have affected the overall discriminatory value. Thus, we believe that the estimates of the ISAR to predict such adverse outcomes are broadly correct.
The cost analyses were carried out in a smaller cohort than originally intended due to the inability to acquire resource use data from both centres and for all participants, but despite this a significant difference in costs between ISAR groups was seen.
The fact that the ISAR has only poor predictive ability does not mean that it has no clinical value. Clearly, the ISAR is not suitable as a single tool in clinical decision-making such as to identify people suitable for specialist services—used alone it will miss many at high risk and misclassify as high risk many who are at low risk.
However, given that the clinical issues related to the care of vulnerable older people are characterised by complexity, it is unlikely that any single simple tool will ever be found that has excellent or good predictive properties.
Thus, the ISAR could be used as a standardised adjunct to clinical decision-making and recording, or as an indicator of case mix for service monitoring purposes, and in the stratification and selection process for patients in clinical trials.
Given the limitation of such tools, further work is required to devise a simple, clinically acceptable process to identify high-risk patients. Such a process may require clinical judgment alongside simple standardised tools such as the ISAR.
Tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them.
The ISAR tool was poor at predicting adverse outcomes and fair for health and social care costs. The ISAR in older people discharged from acute medical units is unsuitable as a sole tool in clinical decision-making.
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Thus, the ISAR could be used as a standardised adjunct to clinical decision-making and recording, or as an indicator of case mix for service monitoring purposes, and in the stratification and selection process for patients in clinical trials.
Given the limitation of such tools, further work is required to devise a simple, clinically acceptable process to identify high-risk patients.
Such a process may require clinical judgment alongside simple standardised tools such as the ISAR. Tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them.
The ISAR tool was poor at predicting adverse outcomes and fair for health and social care costs. The ISAR in older people discharged from acute medical units is unsuitable as a sole tool in clinical decision-making.
All authors have contributed to the preparation of the manuscript. All authors have completed the Unified Competing Interest form at www.
The authors would like to acknowledge the help of Loraine Buck for helping recruit GP practices to participate in the study, Georgios Gkountouras for helping assign unit costs to secondary care and Melanie Titze for applying unit costs to the medication audit data.
Google Scholar. Google Preview. Outcome: placement at discharge variables associated with discharge destination other than usual place of living.
Barthel index pre-ER. Need of oxygen supply. Outcome: placement at 1 month variables associated with placement other than usual place of living. Cognitive impairment.
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Abstract Background: tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them.
Setting: two acute medical units in the East Midlands, UK. Open in new tab Download slide. Figure 1. Table 1. Participant baseline characteristics by the ISAR score.
Open in new tab. Table 2. Adverse outcome. Receiver-operating characteristic analysis. Google Scholar Crossref. Search ADS. Umbrella review of tools to assess risk of poor outcome in older people attending acute medical units Medical Crises in Older People Discussion paper series.
Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool.
Prediction of hospital utilization among elderly patients during the 6 months after an emergency department visit.
Google Scholar PubMed. Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments.
Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments.
Emergency department intervention for high-risk elders: identification strategy and randomised controlled trial to reduce hospitalisation and institutionalisation.
Evaluation of two competing methods for calculating Charlson's comorbidity index when analyzing short-term mortality using administrative data. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.
Mini mental state: a practical method for grading the cognitive state of patients for the clinician. Analysis of cost data in randomized trials: an application of the non-parametric bootstrap.
For commercial re-use, please contact journals. Issue Section:. Download all slides. Supplementary data. Supplementary Data - zip file.
Comments 1. The Identification of Seniors At Risk ISAR in the emergency room to detect older adults with exacerbated chronic diseases susceptible of direct admission to intermediate care.
To the Editor: Edmans et al. The ISAR, a short test accounting for geriatric clinical and functional changes related to an acute process, was originally validated to predict home discharge in older adults referred to emergency room ER 2,3.
Similarly to Edmans et al. We evaluate if ISAR predicted final discharge destination of older adults with exacerbated chronic diseases transferred directly from ER to an intermediate care IC unit.
This might refine the selection of patients included in this pathway, implemented as an alternative to conventional acute hospitalization to avoid unnecessary acute admissions4.
A multidisciplinary team expert nurse and geriatrician , based on a comprehensive geriatric assessment, selected ER candidate patients.
IC transfer inclusion criteria were: defined reactivated chronic diseases not requiring complex diagnostic testing, hemodynamic stability and clear discharge orientation4.
Baseline "exposure" variables included: demographics, baseline clinical status admission diagnosis, associated cognitive impairment, delirium, pressure ulcers and need of oxygen supply , functional status Barthel Index , comorbidity Charlson Index and the ISAR scale points, best-worst score.
Returning to the usual place of residence home or nursing home Vs other placements acute hospital, long-term care or death at discharge from IC and 1 month after were set as the outcomes.
In univariate models t-test or chi-square , variables associated with higher risk of not returning home at discharge and 1 month after were worse functional status before ER referral and a higher ISAR, together with the need of oxygen for the first outcome and cognitive impairment for the second one.
In multivariable logistic regression models, each point increase of the ISAR more than doubled the risk of placement other than home at discharge and after 1 month Table.
In conclusion, our results suggest that ISAR could be useful in ER to identify older adults with reactivated chronic diseases susceptible of transfer to IC as an alternative to conventional hospitalization.
Edmans J et al. Age and Ageing ; 0: The relief can be heard clearly on the phone: Frederik Holthaus, owner of the Isar department store in Geretsried, is allowed to unlock his department store on Egerlandstrasse again.
Next Monday, May 4th, the time has come. Prime Minister Markus Söder then corrected the conditions. Holthaus had requested this and a road map for trade in a letter to the Prime Minister.
Söder has also announced a timetable. The Wolfratshauser plans to open the Isar department store next Monday at regular times - namely the ground floor and part of the first floor.
Original article from April 24, Geretsried - For days, Frederik Holthaus has been doing nothing else: The businessman is trying to find a way to open his department store on Egerlandstrasse in Geretsried, which was closed due to the corona pandemic, as soon as possible.
Because his department store has more than square meters of retail space, it is not allowed to reopen from next Monday, April 27, according to the guidelines of the Bavarian state government.
The managing director of the Isar department store is very upset about this, as he says in an interview with our newspaper. The majority of retail in Bavaria has been idle for five weeks.
For Holthaus this meant that he had to send his 24 employees on short-time work. He can only sell a small part of his range via the online marketplace "Dahoamkaufen.
This problem is made somewhat smaller by the Corona emergency aid and loans from the KfW development bank. Together with the Bavarian Trade Association HBE , the entrepreneur wanted to clarify whether he could separate and open an square meter section of his 1, square meter department store.
But that is not allowed - not understandable for Holthaus. For reasons of infection law, it is not understandable why a separated area offers less protection than the total sales area.
Instead, you are left in the dark. But now it's about starting a normal life carefully and carefully. Also interesting:. The district is wearing protective masks.
Divorce in the open air. Source: merkur. Coronavirus: Angela Merkel speaks out after the tightened corona measures come into force T Merkel surprises everyone: Corona press conference LIVE - the head of the chancellery already gives a foretaste T Earthquake in Turkey: 3-year-olds recovered from the rubble after 65 hours - rescuers burst into tears T
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