Autonomy In Activities Of Daily Research Articles

Focal muscle vibration and action observation: a combined approach for muscle strengthening.

Muscle strength is essential for autonomy in daily activities and performance in sports activities. Yet, conventional strength training is challenging during recovery from pathological conditions. This study investigates a novel combined intervention employing Focal Muscle Vibration (FMV) and Action Observation (AO) to enhance muscle strength. Twenty-seven healthy volunteers (18 females and 9 males, aged 22 to 42 years) were enrolled for an intervention-control study comparing 2 groups: the intervention group received AO treatment with FMV on the right leg, and the control group underwent only FMV on the right leg. This design allowed the comparison of four conditions: FMV+AO (intervention group, right leg), AO alone (intervention group, left leg), FMV alone (control group, right leg), and no-treatment NT (control group, left leg). The treatment, conducted five times a week (Mon-Fri) for two weeks, involved a 20-minute session of FMV on the right quadriceps, coupled, for the intervention group, with the observation of a gym training video. The assessments of Maximum Voluntary Contraction (MVC), and fatigue coefficient (FC) expressed at knee extension bilaterally were measured at the beginning (T0), after the first week (T1), at the end of treatment (T2), and one-week post-intervention for the follow-up (T3). The FMV+AO group demonstrated a significant improvement in MVC over time, reaching statistical significance at T2 and maintaining the gain at T3. In contrast, all the other conditions demonstrated milder MVC increases without statistical significance. FC did not differ significantly in any condition. The combination of FMV and AO optimized muscle strengthening, offering insights for targeted treatments in various settings.

COVID-19-Associated Cerebellitis: A Case Report and Rehabilitation Outcome.

The COVID-19 pandemic has brought attention to neurological complications, including cerebellitis, characterized by inflammation of the cerebellum. Despite its rare occurrence, cerebellitis has been associated with COVID-19 infection, albeit the pathogenic mechanisms remain unclear. We present the case of a 22-year-old male with acute onset ataxia and dysarthria during a SARS-CoV-2 infection. Diagnostic evaluations ruled out other causes, confirming cerebellitis. Treatment included steroid therapy, vitamin supplementation, physiotherapy, and intravenous immunoglobulins. Rehabilitation focused on enhancing balance, coordination, and daily activities. The patient showed significant improvement in functional abilities, with increased autonomy in daily activities and improved ambulation. Despite persistent mild symptoms, the multidisciplinary rehabilitation approach led to remarkable progress. This case underscores the importance of recognizing and managing neurological complications, such as cerebellitis, in COVID-19 patients. A comprehensive approach combining medical treatment and rehabilitation is essential for optimizing outcomes. Further research is needed to elucidate the pathogenesis and optimal management strategies for such complications.

Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center.

The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development. This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I-II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7months. We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully. The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.

Anodal transcranial direct current stimulation associated with aerobic exercise on the functional and physical capacity of patients with heart failure with reduced ejection fraction: ELETRIC study protocol

BackgroundThe hallmark symptom of heart failure (HF) is severe exercise intolerance. Fortunately, accumulated evidence suggests that exercise programs improve physical performance, enhance autonomy in daily activities and quality of life, and reduce cardiovascular and other hospitalizations. Recently, experimental studies have explored the application of non-invasive brain stimulation techniques, especially transcranial direct current stimulation (tDCS), aiming to improve physical performance due to its ability to modulate brain functioning. The primary objective of the present study is to evaluate the effects of anodal tDCS associated with aerobic exercise on the functional capacity of patients with HF with reduced ejection fraction (HFrEF). Secondary objectives are to compare the effects of tDCS associated with aerobic exercise vs. sham-tDCS associated with aerobic exercise on cardiopulmonary exercise capacity; inflammatory cytokines; and quality of life.MethodsThis is a two-arm, prospectively registered, randomized trial with concealed allocation, double-blind, and intention-to-treat analysis. Forty-four patients with HFrEF will be recruited. The experimental group will undertake 25–30 min aerobic exercise training associated with tDCS, for 4 weeks. The control group will undergo the same aerobic exercise training, but with sham-tDCS. The primary outcome will be functional performance by the 6-min walk test. Secondary outcomes will include cardiopulmonary exercise capacity, inflammatory cytokines, and quality of life. Outcomes will be collected by a researcher blinded to group allocation at baseline (T0) and after 4 weeks of intervention (T1).DiscussionAlthough previous studies have investigated the combined effect of tDCS on T3 area and physical performance and have suggested that tDCS could have reduced ratings of perceived exertion by affecting the activity of the insular cortex, and therefore increase exercise tolerance, this study is the first to evaluate the effects of the addition of anodal tDCS to aerobic exercise training for improving physical and functional performance, decreasing the perceived exertion, altering the quantification of inflammatory cytokines, and improving the subclinical values of the cardiopulmonary test in patients with HFrEF, which could result in an important advance in cardiac rehabilitation for patients with chronic HF.Trial registrationBrazilian Registry of Clinical Trials (ReBEC) RBR-10w787j6. Registered on 25 April 2023. https://ensaiosclinicos.gov.br/pesquisador

Supportive Care in Older Lymphoma Patients to Reduce Toxicity and Preserve Quality of Life.

The treatment paradigm in older patients with malignant hemopathies is the choice between an effective conservative treatment that preserves quality of life and an intensive, potentially curative treatment with more toxicities. For each patient, it is important to determine the risk/benefit ratio. The patient should be involved in the discussion, sufficiently informed and able to express himself and his expectations in terms of quality of life. However, this informed consent is conditioned by the ability of the patient to understand the risks and benefits of the treatment. Decline in quality of life is an important parameter for older patients with cancer and many prospective trials have now confirmed the impact of different side effects of treatment, such as recurrent hospitalization, loss of autonomy in daily activities, loss of contact with grandchildren and loss of cognitive functions. Interventions oriented to vulnerabilities detected in the older patients (by comprehensive geriatric assessment) and an optimal approach, including preventive measures to reduce treatment-related toxicity and mortality, are directly correlated to improvement in quality of life.

PROGNOSTIC IMPACT OF FRAILTY ON FUNCTIONAL AUTONOMY IN OLDER ADULTS WITH HYPERTENSION

Objective: To date, few studies have evaluated frailty in older adults with hypertension and the most appropriate tool to quantify frailty in this population has yet to be identified. The present study aimed to investigate the prognostic impact of frailty on decline of functional autonomy in a sample of hypertensive older adults. Design and method: We performed a longitudinal observational study including patients aged 75 or older evaluated at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent a multidimensional geriatric assessment including frailty evaluation using three frailty scales (Fried Frailty Phenotype, Clinical Frailty Scale [CFS], Frailty Index) and two physical performance measures (gait speed and Short Physical Performance Battery [SPPB]). The primary outcome was reduction of autonomy in daily activities according to the Barthel Index (functional decline). The predictive performance of different frailty measures was evaluated based on ROC curve analysis, sensitivity, specificity and accuracy. Results: Among 99 hypertensive older adults (mean age 81, 59% women, median follow-up 13 months), functional decline occurred in 39% of patients. Participants with functional decline had a higher prevalence of cognitive impairment and frailty according to all the frailty scales used and a worse physical performance. Frailty Index and CFS showed the best predictive performance (AUC 0.715 and 0.708, respectively), followed by physical performance measures (AUC 0.691). All frailty measures showed good specificity (66-79%) and moderate sensitivity (54-70%). Gait speed showed the highest accuracy (71%) and achieved 57% sensitivity and 79% specificity, resulting in better predictive performance than the SPPB. Conclusions: The CFS and gait speed - easily applicable even in non-geriatric settings – may represent useful instrument to detect frailty and predict functional decline in hypertensive older adults.

Functional performance of children with Myelomeningocele submitted to intrauterine repair and conventional surgery

Introduction: Myelomeningocele (MMC) is an embryonic malformation that occurs in the first four weeks of gestation due to a failure in the closure of the neural tube. They have multifactorial etiology such as genetic and environmental factors that affect folic acid metabolism. Several anomalies may be associated with MMC, with the occurrence of hydrocephalus and Arnold Chiari type II malformation being most present. Surgical repair should ideally occur within the first 24 hours after birth to prevent or decrease the risk of infection, preservation of all viable nerve tissue, anatomical reconstitution. However, surgical repair of MMC intrauterine has shown substantial benefit in all babies submitted to this intervention. Objective: To compare the functional performance of children with MMC who underwent intrauterine surgical repair and those who did traditional surgery at birth. Methods: Cross-sectional study carried out at the UCB School-Clinic, where children treated with MMC were evaluated, analyzing their motor status and functional performance using the Pediatric Evaluation of Disability Inventory (PEDI) for a quantitative record of functional capacity and autonomy in daily activities, in the areas of self-care, mobility and social function. Results: There was a statistically significant relevance on the mobility function (p=0.01) for children who underwent intrauterine repair when compared to children who underwent traditional surgery. Conclusion: There is a strong relationship of better functionality of children who underwent intrauterine surgery when compared to children who underwent traditional surgery.

425 THE IMPACT OF NURSING EDUCATION ON THE QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE DURING CARDIAC REHABILITATION: A SYSTEMATIC REVIEW

Abstract Introduction Heart failure (HF) occurs in 26 million people worldwide and is one of the most common causes of hospitalization, hospital readmission and death. To overcome this, ESC guidelines recommend the cardiologic rehabilitation pathway, which places the patient with HF at the center of his or her care pathway with the aim of improving quality of life through the implementation of a personalized multidisciplinary program. In the cardiology rehabilitation pathway, the nurse plays a key role of education and support, encouraging the patient to change. The aim of the review is to explore the quality of life of the elderly patient with HF and the educational role of nursing in the cardiac rehabilitation setting. Materials and Methods A systematic search was conducted using PUBMED, CINAHL until June 2022, according to REA methodology. The quality of the study was assessed by three reviewers using the DIXONWOOD checklist. Results and discussion: Analysis of the results suggests that multiple aspects need to be considered to improve the management and quality of life of patients with HF. Among these, the literature cites the implementation of a network of nurse case managers, standardization of operative protocols, mental and physical pain management, and cardiac rehabilitation units after hospital discharge. It also shows how physical activity, according to the ERIC-HF program, can improve the ability to perform ADL activities (Kang Y. et all, 2020). An additional study found that home cardiac rehabilitation intervention results in clinically significant improvement in disease-related quality of life in patients with HF. Cost-utility analyses support that home cardiac rehabilitation programs are cost-effective treatments for patients with HF and that nurses play a key role in educating and managing their condition (Rod s. et all, 2019). They should encourage patients with heart failure to practice cardiac rehabilitation for a longer period to improve their quality of life. One study shows that rehabilitation intervention for caregivers of patients with HF is helpful in supporting their role and improving their confidence (Wingham J. et all, 2019). Conclusions Cardiac rehabilitation in which nurses are present proves to be crucial in both psychological (Suzanne H et al, 2018) and exercise-enhancing projects to improve long-term health conditions, as shown by Kentaro, K., this approach produces benefits on patients with HF and their caregivers. It induces in the patient greater autonomy in daily activities, medication adherence and self-care of the disease, delaying its progression. At the same time, for caregivers there is a reduction in caregiver burden resulting in economic, emotional and social improvement. For the National Health Service, there is a reduction in length of stay in intensive care and emergency departments and consequently, a decrease in costs.

Applying to a nursing home is a way to maintain control of life-Experiences from Swedish nursing home applicants.

Swedish social policy enables ageing in place with support from home-based care services despite high age and/or declining health. This study aims to describe the daily life experiences behind the decision to apply for a nursing home placement in older adults ageing in place. A qualitative design was chosen, and 11 semi-structured interviews were conducted and analysed using inductive qualitative content analysis. The participants described a feeling of dependence in which they had to ignore their personal privacy when receiving home-based care. They reached a turning point when ageing in place was, for several reasons, no longer considered an acceptable option. This influenced their choice to apply to a nursing home where they expected that they could maintain control over their lives. The results indicate that when enhancing ageing in place it is important to enable older adults to receive support to maintain autonomy in daily activities and to have the opportunity to age in the right place.

Factors influencing employability of elderly working persons (literature review)

However, raising the official retirement age requires considering various factors that directly or indirectly affect the working capacity of elderly citizens who continue their labour activity, primarily depending on the physical and mental state of their health and the socio-economic conditions of their life in general. the purpose of the analytical review is to summarize the data of foreign and domestic studies aimed at identifying various factors that positively or negatively affect the working capacity of working older people. We searched for publications in the Scopus, Web of Science, PubMed, The Cochrane Library, SciELO, EMBASE, Global Health, CyberLeninka, RSCI databases to find studies published from 2011 to 2021. Descriptors were used that included terms related to disability, ageing, and older people. Quantitative observational studies were included to examine the effect of various factors on working capacity in old age. Studies aimed at analyzing the clinical course of diseases associated with ageing and/or articles and publications in editorials, interviews, projects, clinical notes, review reports were excluded. Seven hundred forty-four articles were received, 24 of which were included in the analysis. Variables that showed a negative correlation with the ability to work in the elderly included: bad habits, working hours, and physical requirements for professional activity. Life satisfaction, adequate income, physical activity, volunteering and mental workload were considered factors that positively affect the working capacity of older people. Conclusion. Aggregated data from previous studies have shown protective mechanisms against depression, disability and loss of performance, maintenance of physical and mental well-being, good cognitive function and autonomy in daily activities in the elderly.

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

AimsTo evaluate neurocognitive performance, daily activity and quality of life (QoL), other than usual oncologic outcomes, among patients with brain metastasis ≥5 (MBM) from solid tumors treated with Stereotactic Brain Irradiation (SBI) or Whole Brain Irradiation (WBI). MethodsThis multicentric randomized controlled trial will involve the enrollment of 100 patients (50 for each arm) with MBM ≥ 5, age ≥ 18 years, Karnofsky Performance Status (KPS) ≥ 70, life expectancy > 3 months, known primary tumor, with controlled or controllable extracranial disease, baseline Montreal Cognitive Assessment (MoCA) score ≥ 20/30, Barthel Activities of Daily Living score ≥ 90/100, to be submitted to SBI by LINAC with monoisocentric technique and non-coplanar arcs (experimental arm) or to WBI (control arm). The primary endpoints are neurocognitive performance, QoL and autonomy in daily-life activities variations, the first one assessed by MoCa Score and Hopkins Verbal Learning Test-Revised, the second one through the EORTC QLQ-C15-PAL and QLQ-BN-20 questionnaires, the third one through the Barthel Index, respectively. The secondary endpoints are time to intracranial failure, overall survival, retreatment rate, acute and late toxicities, changing of KPS. It will be considered significant a statistical difference of at least 30% between the two arms (statistical power of 80% with a significance level of 95%). DiscussionSeveral studies debate what is the decisive factor accountable for the development of neurocognitive decay among patients undergoing brain irradiation for MBM: radiation effect on clinically healthy brain tissue or intracranial tumor burden? The answer to this question may come from the recent technological advancement that allows, in a context of a significant time saving, improved patient comfort and minimizing radiation dose to off-target brain, a selective treatment of MBM simultaneously, otherwise attackable only by WBI. The achievement of a local control rate comparable to that obtained with WBI remains the fundamental prerequisite. Trial registrationNCT number: NCT04891471.

Striving for autonomy in everyday diabetes self-management—qualitative exploration via grounded theory approach

ObjectivesThe rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social...

The Clinical Significance of Procalcitonin Elevation in Patients over 75 Years Old Admitted for COVID-19 Pneumonia.

Aim To investigate the clinical significance of procalcitonin (PCT) elevation on hospital admission for coronavirus disease-19 (COVID-19) and its association with mortality in oldest old patients (age > 75 years). Methods The clinical records of 1074 patients with chest high-resolution computed-tomography (HRCT) positive for interstitial pneumonia and symptoms compatible for COVID-19, hospitalized in medical wards during the first pandemic wave in a single academic center in Northern Italy, were retrospectively analyzed. All patients had serum PCT testing performed within six hours from admission. Information on COVID-19-related symptoms, comorbidities, drugs, autonomy in daily activities, respiratory exchanges, other routine lab tests, and outcomes were collected. Clinical characteristics were compared across different admission PCT levels and ages. The association of admission PCT with mortality was tested separately in participants aged > 75 and ≤75 years old by stepwise multivariate Cox regression model with forward selection. Results With increasing classes of PCT levels (<0.05, 0.05-0.49, 0.5-1.99, and ≥2 ng/ml), there was a significant trend (P < 0.0001) towards older age, male gender, wider extension of lung involvement on HRCT, worse respiratory exchanges, and several other laboratory abnormalities. Each incremental PCT class was associated with increased risk of hospital death at multivariate models in subjects older than 75 (hazard ratio for PCT ≥ 2 vs. <0.05 ng/ml: 30.629, 95% confidence interval 4.176-224.645, P = 0.001), but not in subjects aged 75 or younger. Conclusions In patients admitted for COVID-19, PCT elevation was associated with several clinical, radiological, and laboratory characteristics of disease severity. However, PCT elevation was strongly associated with hospital mortality only in oldest old subjects (age > 75).

Adult phenotype in Koolen-de Vries/KANSL1 haploinsufficiency syndrome

BackgroundKoolen-de Vries syndrome (KdVS) is a multisystem neurodevelopmental disorder caused by 17q21.31 deletions or mutations in KANSL1. It was mainly described in children.MethodsA retrospective study on 9 subjects aged 19–45...

Reverse shoulder arthroplasty for treatment of proximal humerus complex fractures in elderly: A single institution experience

Treatment of complex proximal humerus fractures (PHFs) in the elderly should provide early mobilization to maintain autonomy and self-care possibility, avoiding further surgery for complications. Nowadays, there is not a gold standard for treatment. Aim of our study was to review our experience with the use of Reverse Total Shoulder Arthroplasty (RTSA) for the treatment of these fractures in the elderly, evaluating complications and functional results. Ninety-one patients older than 65 were treated with RTSA at our Institute between June 2005 and December 2017: there were 14 males and 77 females, with a mean age of 76 years (range 65-87 years). There were 58 fractures (20 Neer 3, 38 Neer 4) and 33 fracture-dislocations (7 Neer 3, 26 Neer 4). Complications were recorded, and functional outcomes were evaluated using the DASH score and Constant score (CS). Twenty-three complications occurred: 8 cases of scapular notching, 5 neurologic palsies, 4 dislocations, 3 intraoperative diaphyseal fractures, and subclavian artery damage, deep infection, and radiolucent line in one each. No aseptic loosening or breakage was observed. Further surgeries were necessary in 3 cases only, whereas all patients retained their implant at last follow-up. Functional results were satisfactory: mean abduction was 93°, mean flexion was 110°, mean active internal-rotation reached 35°, mean active external-rotation was 25°, mean CS was 54 points and mean DASH score was 45 points. Surgical treatment of complex PHFs should be a "one-shot surgery," especially in the elderly, since further surgeries could compromise patient outcomes and survival. Additional surgery due to complications is less frequent after RTSA than other techniques. A stable reconstruction permitting early mobilization is fundamental in the elderly. Usually, a prolonged immobilization is recommended after ORIF, TSA, and hemiarthroplasty to provide a stable fixation, whereas RTSA allows early mobilization. In elderly with inadequate bone stock and needing early recovery of autonomy in daily activities, RTSA effectively treats complex PHFs. The incidence of complications requiring revision surgery is low and functional results are satisfactory and predictable.

MP33: Predictors of delirium in older patient at the emergency department: a prospective multicentre derivation study

The objective of this study was to identify the predictors of incident delirium in this high-risk population. This study was a planned sub-analysis of the INDEED multicentre cohort study. We recruited patients aged ≥ 65, independent/semi-independent, with an emergency department (ED) length of stay ≥ 8h and admitted to any hospital ward. Patients were followed up during their ED stay up to 24h after ward admission. Sociodemographic characteristics, comorbidities, functional status (OARS), illness severity, level of frailty, cognitive status (TICS-m) and ED/patient environment evaluation were collected during initial interview. Patients were screened for delirium twice a day using the Confusion Assessment Method. Multivariate logistic regression was performed to identify the predictors of delirium. Incident delirium was detected in 68 patients of the 612 patients included (11%). Initially, seven candidate predictors were included in a regression model, of which four were retained using a stepwise selection procedure. Presence of cognitive impairment at baseline (OR 3.6, p < 0.001), absence of mobilization during the whole ED length of stay (OR 3.3, p = 0.002), longer ED length of stay (OR 1.02, p = 0.006) were associated with a higher risk of incident delirium while higher functional status was associated with a lower risk (OR 0.8, p < 0.001). More work is needed to determine which tool(s) are most appropriate for the ED use to increase delirium screening compliance among health professionals working in this department. It is really the first step to be able to suggest interventions to decrease delirium incidence.

Giant prolactinoma, germline BRCA1 mutation, and depression: a case report

BackgroundGiant prolactinomas are very rare pituitary tumors that may exhibit an aggressive behavior and present with a life-threatening condition.Case presentationA 25-year-old white woman was admitted to our hospital with a headache, psychomotor retardation, reduced vision, and loss of autonomy in daily activities. Her past medical history was significant for having oligomenorrhea and a depressive syndrome since her mother’s death. She also had a breast cancer gene 1 (BRCA1) mutation and a family history of breast cancer. She had marked hyperprolactinemia (7615 ng/dL), central hypocortisolism, growth hormone deficiency, and a giant pituitary tumor (52 × 30 × 33 mm) which was shown in magnetic resonance imaging with obstructive hydrocephalus, requiring emergency surgery. Treatment with cabergoline led to a 99.8% reduction in serum prolactin levels and significant tumor shrinkage. Her depressive symptoms progressively improved and psychiatric drugs were withdrawn after 3 months of cabergoline treatment. Currently, she is being followed in Endocrinology, Neurosurgery, and Neurophthalmology out-patient clinics and in a breast cancer unit. Careful monitoring, support, and follow-up will be essential throughout this patient’s life.ConclusionsThis case is a rare presentation of a giant prolactinoma in a young woman, who presented a life-threatening event. She also had an unexpected association between diseases or symptoms that may have contributed to the delay in diagnosis. Given the concomitant presence of a giant prolactinoma, a BRCA1 mutation, and depressive symptoms, a possible association was hypothesized. The breast cancer risk in a BRCA1 mutation carrier and the possible interference of hyperprolactinemia and life events were also discussed. However this hypothesis requires further investigation.

Daily Routine and Autonomy: Identifying Independence and Desire for Autonomy in Daily Activities Among Adolescents With Autism Spectrum Disorder

Abstract Date Presented 4/19/2018 Adolescents with autism spectrum disorder show poor independence in daily activities compared with their peers. Daily Routine and Autonomy is an innovative self-report questionnaire that assesses their independence abilities and desire for autonomy. This study examined its reliability and validity. Primary Author and Speaker: Liron Lamash Contributing Authors: Naomi Josman

Oral oxycodone/naloxone for pain control in cirrhosis: Observational study in patients with symptomatic metastatic hepatocellular carcinoma.

Pain management in cirrhosis is a clinical challenge. Most analgesics are metabolized in the liver and cirrhosis may deeply alter their concentration, favouring the appearance of side effects. We aimed to assess the efficacy and safety of oral prolonged-release association of oxycodone/naloxone tablets (OXN) in the treatment of moderate/severe cancer pain in cirrhotic patients with metastatic hepatocellular carcinoma (HCC). We enrolled n=32 HCC patients with moderate/severe cancer pain unresponsive to paracetamol alone or associated with codeine or tramadol. All patients received an initial OXN dose of 5mg bid to be gradually increased in case of insufficient analgesia. At baseline and follow-up visits, we evaluated: pain intensity (using the Numerical Rating Scale, NRS), patients' autonomy in daily activities (Barthel Functioning Index); bowel dysfunction (Bowel Function Index, BFI), signs of hepatic encephalopathy (HE) and other opioid-induced side effects. No clinically significant adverse effects were reported (median follow-up 122days). No significant worsening of the BFI score was noted and no cases of HE were detected. Two patients (6.3%) discontinued treatment before T14 because of mild nausea and dizziness. The remaining n=30 patients were assessed for efficacy. Treatment led to a significant reduction in the mean of pain scores both at T14 (-37.1±16.3%, P<.001) and at T28 (-55.6±21.5%, P<.001); Barthel scores showed gradual and significant increase from T0 (81.6±13.0) to T14 (86.5±11.4, P=.001) and to T28 (88.3±13.6, P=.009). OXN may be considered a safe and effective option in the fragile population of cirrhotic patients.

Automatic prediction of autonomy in activities of daily living of older adults

15.s.875.00 Purpose: world population is aging and the number of seniors in need of care is expected to surpass the number of young people capable of providing it. It is then quintessential to develop instruments to support doctors at the task of diagnosing and monitoring the health status of seniors 1-3. Methods to assess autonomy and functional abilities of seniors currently rely on rating scales 4. The subjective character of these scales and their dependence on human observations tend to jeopardize the timely diagnosis of deteriorations in cognitive health. We propose a probabilistic model (PM) to objectively classify a person's performance in executive functions into three classes of cognitive status: Alzheimer's disease (AD), mild cognitive impairment (MCI) and healthy control (HC); and into different levels of autonomy: good, intermediate or poor. Material & Methods: the proposed PM relies on Naive Bayes model for classification and takes as input automatically extracted parameters about a person's performance at activities of daily living (event monitoring system, EMS, Fig. 1). To evaluate our approach participants aged 65 or older were recruited within the Dem@care project protocol, at the Memory Center of the Nice university hospital: n=49; 12 AD (5 male), 23 MCI (13) and 14 HC (5). They were asked to carry out a set of instrumental activities of daily living (IADL, e.g., medication preparation; talking on the telephone) in an observation room equipped with everyday objects. Results & Discussion: EMS recognized targeted IADLs with a high precision (e.g., 'prepare medication': 93%, 'talk on the telephone': 89%). The proposed PM achieved average classification accuracy of 73.5 % for cognitive status classes and of 83.7% for autonomy classes. Moreover, the proposed PM displayed a higher accuracy when inputted with EMS data than with human annotations of daily activities. This finding is explained by the stability of EMS recognition which permits to relate subtle deviations from activity norms to characteristic traits of target classes. Conclusion: The proposed framework provides clinicians with diagnostic relevant information to support autonomy assessment in ecological scenarios by decreasing observer biases and facilitating a more timely diagnosis of frailty patterns in senior. Further work will extend the proposed framework to other clinical sites and seek for novel cues about autonomy decline in seniors.