Charlson Comorbidity Scale Research Articles

Frailty and its Associated Factors Among Rural Community-Dwelling Older Adults: A Cross-Sectional Study.

To investigate the status quo and influencing factors of overall frailty and its 3 domains among rural community-dwelling older adults. This is a cross-sectional study. A convenience sample of 195 older adults from 6 villages in Bashang Area of Zhangjiakou City, Hebei Province, China, were recruited from August to September, 2022. The demographic characteristics, the Chinese version of Tilburg Frailty Indicator, Charlson Comorbidity Scale and Hospital Anxiety and Depression Scale were used to investigate frailty and its influencing factors. Univariate analysis and multiple linear regression analysis were employed. The prevalence of overall frailty among the older adults in Bashang Area was 85.13%. Multiple linear regression analysis showed that age, gender, marital status, regular exercise, comorbidity, and anxiety were the influencing factors of overall frailty. While anxiety was the only shared influencing factor for physical frailty, psychological frailty, and social frailty, age, gender, marital status, financial burden, the comorbidity, and regular exercise were factors which influenced 1 or 2 domains of frailty. The prevalence of overall frailty among the older adults in rural areas, Zhangjiakou City is high. It is influenced by many factors. Medical staff and policy makers should work hand in hand to improve frailty among rural community-dwelling older adults in China.

Higher baseline resting metabolic rate is associated with 1-year frailty decline among older adults residing in an urban area

BackgroundDysregulated energy metabolism is one hypothesized mechanism underlying frailty. Resting energy expenditure, as reflected by resting metabolic rate (RMR), makes up the largest component of total energy expenditure. Prior work relating RMR to frailty has largely been done in cross section with mixed results. We investigated whether and how RMR related to 1-year frailty change while adjusting for body composition.MethodsN = 116 urban, predominantly African-American older adults were recruited between 2011 and 2019. One-year frailty phenotype (0–5) was regressed on baseline RMR, frailty phenotype, demographics and body composition (DEXA) in an ordinal logistic regression model. Multimorbidity (Charlson comorbidity scale, polypharmacy) and cognitive function (Montreal Cognitive Assessment) were separately added to the model to assess for change to the RMR-frailty relationship. The model was then stratified by baseline frailty status (non-frail, pre-frail) to explore differential RMR effects across frailty.ResultsHigher baseline RMR was associated with worse 1-year frailty (odds ratio = 1.006 for each kcal/day, p = 0.001) independent of baseline frailty, demographics, and body composition. Lower fat-free mass (odds ratio = 0.88 per kg mass, p = 0.008) was independently associated with worse 1-year frailty scores. Neither multimorbidity nor cognitive function altered these relationships. The associations between worse 1-year frailty and higher baseline RMR (odds ratio = 1.009, p < 0.001) and lower baseline fat-free mass (odds ratio = 0.81, p = 0.006) were strongest among those who were pre-frail at baseline.DiscussionWe are among the first to relate RMR to 1-year change in frailty scores. Those with higher baseline RMR and lower fat-free mass had worse 1-year frailty scores, but these relationships were strongest among adults who were pre-frail at baseline. These relationships were not explained by chronic disease or impaired cognition. These results provide new evidence suggesting higher resting energy expenditure is associated with accelerate frailty decline.

The Prediction of Survival Outcome and Prognosis Factor in Association with Comorbidity Status in Patients with Colorectal Cancer: A Research-Based Study.

Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients’ life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan–Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients’ disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50–69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan–Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, “Gender” (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56–7.81, p-value = 0.040), “Presence of metastases” (HR: 3.76; 95% CI: 1.89–7.32, p-value = 0.010), “Metastasis site: Liver” (HR: 5.04; 95% CI: 1.71–19.05, p-value = 0.039), “Lymphovascular permeation” (HR: 2.94; 95% CI: 1.99–5.92, p-value = 0.021), and “CEA-level” (HR: 2.43; 95% CI: 1.49–5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient’s comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC.

Effect of Interposed Abdominal Compression on Cardiopulmonary Resuscitation Outcomes; a Randomized Clinical Trial.

Introduction:Standard cardiopulmonary resuscitation (STD-CPR) is successful in only 10-15% of cases in emergency department (ED). This study aimed to determine the effect of interposed abdominal compression (IAC) during resuscitation on outcomes of ED cardiac arrests.Methods:In this randomized clinical trial study, non-trauma patients aged 18-85 years, patients with in-hospital cardiac arrest hospitalized in the ED were randomly assigned into two either STD-CPR or IAC-CPR group on a 1:1 basis and using computer-generated random numbers. Participants in the intervention group, received abdominal compression during the diastole phase of STD-CPR. The rate of return of spontaneous circulation (ROSC), heart rate (HR), respiratory rate (RR), arterial blood gas (ABG) indicators, and survival rate were compared between the two groups. Results:Ninety patients were enrolled (45 in each group). There were no differences between the two groups regarding age (p = 0.76), sex (p = 0.39), employment status (p = 0.62) and Charlson comorbidity scale (p = 0.46). Abdominal compression had a positive effect on heart rate (p < 0.001), mean arterial pressure (p = 0.003), arterial blood oxygen pressure (p = 0.001), and arterial blood carbon dioxide pressure (p = 0.001) as well as a negative effect on arterial blood oxygen saturation (p = 0.029) 30 minutes after resuscitation. Out of the 90 CPR cases, 8 (17.7%) cases in intervention group and 8 (17.7%) cases in control group were successful, among which all of the 8 patients in the intervention group and 5 of the patients in the control group had been discharged from hospital without any complications. Conclusion: The results showed that abdominal compression during CPR can improve resuscitation outcomes in patients with cardiac arrest. Therefore, in order to use this technique, further research is recommended.

COVID-19: economic aspects of influenza vaccine prevention

Relevance. A viral pandemic caused by the SARS-CoV-2 coronavirus has led to the development of a new coronavirus disease-2019 (COVID-19). The COVID-19 pandemic has forced the mobilization of all available health system resources. There are separate publications on reducing the risk of developing coronavirus infection in people vaccinated against influenza. Objective: to study the cost-effectiveness of influenza vaccination in the conditions of the» first « wave of COVID-19. Materials and methods. The archival data of 2,452 people from among the sick employees of JSC «Russian Railways» were analyzed. The control group consisted of 2,911 employees who were not infected with COVID-19, comparable by gender, age and territory of residence. Scores on the Charlson comorbidity scale were calculated for all individuals. The pharmacoeconomical cost of the patient’s treatment was predicted using the Markov model. Results. Having a flu shot reduced the likelihood of getting COVID-19 by 1.3 times. In the presence of a diagnosis of coronavirus infection, inpatient treatment for influenza vaccinated patients was required 2 times less often than for unvaccinated patients. Compared to the situation of the absence of vaccinated persons, in the «first wave», the estimated cost savings for the treatment of patients with coronavirus infection amounted to 124 million rubles. When the number of points on the comorbidity scale increased from 1 to 8, the average cost of treatment of patients without previous influenza vaccination increased by 2 times, and in the presence of vaccination, the average cost of treatment increased by 1.7 times. Conclusion. Thus, this study shows that influenza vaccination is cost-effective against COVID-19. The effect is achieved by reducing the likelihood of getting a coronavirus infection in the presence of a flu shot.

Risk Factors for Occurrence and Outcome of Acute Graft Versus Host Disease in Allogeneic Hematopoietic Stem Cell Transplant: Analysis of 7 Year Health Care Utilization Project Data

Introduction: Acute Graft versus Host Disease (aGVHD) is a common complication of allogeneic hematopoietic stem cell transplant (allo-HSCT). Despite advances in prevention and treatment methods, it remains significant cause of morbidity and mortality in this group of patients. Most of the studies assessing risk factors and outcome have yielded inconsistent results. In the current study, we have utilized the national database, which provided us with larger sample size to adequately assess the risk factors for occurrence and mortality of aGVHD in allo HSCT patients.Methods: aGVHD risk factors for occurrence and mortality were identified in 46652 patients from year 2008 to 2014 utilizing national inpatient sample (NIS) of health care utilization project (HCUP) data. Occurrence was defined as established diagnosis of aGVHD (identified with ICD-9 code of 279.51) and mortality as death prior to hospital discharge. Predictors were defined as baseline patient characteristics that influence incidence and outcome of aGVHD. We performed regression analysis using these baseline patient characteristics as covariates and calculated odd ratio (OR) with 95% confidence interval (CI) in both univariate and multivariate model to assess the risk for occurrence and outcome of aGVHD. In addition we also assessed the burden of the disease on our healthcare system by identifying the difference in length of stay and hospital charges in patients with and without aGVHD.Results: On multivariate analysis significant risk factors for occurrence of aGVHD were age 0-49 years (OR = 1.70, CI = 1.14-2.53), white race (OR = 1.57, CI = 1.20-2.07), allogeneic cord stem cell transplant (OR = 1.48, CI = 1.07-2.05), conditioning regimen with use of total body irradiation (OR = 1.40, CI = 1.15-1.71), infections including bacterial sepsis (OR = 1.99, CI = 1.67-2.36), viral infections OR = 1.88, CI = 1.53-2.31), fungal infections (OR = 1.54, CI = 1.22-1.98) and c diff colitis (OR = 1.52, CI = 1.21-1.90). Similarly on multivariate analysis significant risk factors for mortality of aGVHD were age >65 years (OR = 3.44, CI = 1.28-9.22), infections including bacterial sepsis (OR = 6.30, CI = 3.83-10.35), viral infections (OR = 1.85, CI = 1.09-3.16), fungal infections (OR = 2.14, CI = 1.25-3.66), presence of comorbidities assessed by charlson comorbidity scale (OR 2.28, CI = 1.34-3.88). These results were replicated on univariate analysis as well with the exception of race (white) for aGVHD occurrence and age (>65 years) for aGVHD mortality, which were only significant on multivariate analysis.The median length of stay (in days) was significantly higher in patients of allo HSCT with aGVHD, 42 (CI= 39-44) as compared to without aGVHD, 26 (CI = 26-27). Similarly the median total charges for hospital stay (in US dollars) were also significantly higher in patients of allo HSCT with aGVHD, 512025 (CI = 462567-561482) as compared to without aGVHD with a median of 298447 (CI = 275865-321029).Conclusion: Our study confirmed several previously established risk factors for aGVHD. In addition we identified certain new factors, which increases risk for occurrence and mortality of aGVHD. Additionally we identified that aGVHD substantially increases the burden on our healthcare system as measured by increase in both length of stay and cost. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Perceived acceptability and preferences for low-intensity early activity interventions of older hospitalized medical patients exposed to bed rest: a cross sectional study

BackgroundHospitalized older patients spend most of their time in bed, putting them at risk of experiencing orthostatic intolerance. Returning persons to their usual upright activity level is the most effective way to prevent orthostatic intolerance but some older patients have limited activity tolerance, supporting the need for low-intensity activity interventions. Consistent with current emphasis on patient engagement in intervention design and evaluation, this study explored older hospitalized patients’ perceived acceptability of, and preference for, two low-intensity early activity interventions (bed-to-sitting and sitting-to-walking), and characteristics (gender, illness severity, comorbidity, illnesses and medications with orthostatic effects, and baseline functional capacity) associated with perceived acceptability and preference.MethodsA convenience sample was recruited from in-patient medical units of two hospitals in Ontario, Canada and included 60 cognitively intact adults aged 65+ who were admitted for a medical condition within the past 72 h, spent ≥ 24 consecutive hours on a stretcher or in bed, presented with ≥ 2 chronic diseases, understood English, and were able to ambulate before admission. A cross-sectional observational design was used. Participants were presented written and oral descriptions and a 2-min video of each intervention. The sequence of the interventions’ presention was randomized. Following the presentation, a research nurse administered measures of perceived acceptability and preference, and collected health and demographic data. Perceived acceptability and preference for the interventions were measured using the Treatment Acceptability and Preferences Scale. Illness severity was measured using the Modified Early Warning Score. Comorbidity was assessed with the Age Adjusted Charlson Comorbidity Scale and the Cumulative Illness Rating Scale – for Geriatrics. Baseline functional capacity was measured using the Duke Activity Status Index.ResultsParticipants’ perceived acceptability of both interventions clustered above the scale midpoint. Most preferred the sitting-to-walking intervention (n = 26; 43.3%). While none of the patient characteristics were associated with intervention acceptability, illness severity (odds ratio = 1.9, p = 0.04) and medications with orthostatic effects (odds ratio = 9.9, p = 0.03) were significantly associated with intervention preference.ConclusionsThe interventions examined in this study were found to be acceptable to older adults, supporting future research examining their feasibility and effectiveness.

Epidemiology and prognosis of healthcare-associated infective endocarditis

Objective To describe the characteristics of healthcare-associated infective endocarditis (HAIE) and to investigate the risk factors of infective endocarditis (IE) case fatality. Methods All consecutive cases of definite IE diagnosed from 1992 to 2012 were collected and categorized into HAIE and community acquired IE (CAIE). The epidemiological and clinical features of HAIE and CAIE were compared. Risk factors for in-hospital case fatality were analyzed by Logistic regression. Results One hundred and fifty-four patients with IE were enrolled; 126 (81.8%) were CAIE and 28 (18.2%) were HAIE. Compared with CAIE patients, HAIE patients were in poorer condition (Charlson comorbidity scale≥2: 35.7% vs 15.1%; χ2=6.382, P=0.012), more frequently associated with a history of prosthetic valve replacement (35.7% vs 7.1%; χ2=17.291, P<0.01), more rheumatic heart disease (35.7% vs 10.3%; χ2=11.631, P=0.002), more recieved immunosuppressive or glucocorticoid therapy (21.4% vs 4.0%; χ2=10.530, P=0.005) and more acute heart failure (17.9% vs 4.8%; χ2=5.923, P=0.029). Viridans group streptococci infection predominated in CAIE (χ2=5.489, P=0.019), while staphylococci and enterococci infections (50.1%) were frequent in HAIE. Other bacterial pathogen infections were more common in HAIE (χ2=5.870, P=0.026). Ten patients died before discharge and the case fatality rate in-hospital was 6.5% (10/154). Case fatality rate in HAIE (17.9%) was significantly higher than CAIE (4.0%; χ2=7.278, P=0.018). Surgery treatment, albumin level, stroke and HAIE were independent risk factors for IE-related deaths. Odds ratios (OR) were 0.081 (95%CI: 0.008-0.873), 0.754 (95%CI: 0.587-0.967), 33.777 (95%CI: 2.751-414.743) and 11.952 (95%CI: 1.045-136.709), respectively. Conclusion HAIE is common and distinctive from CAIE in epidemiology and prognosis, which increases patient fatality. Key words: Endocarditis, bacterial; Community-acquired infections; Healthcare-associated infective endocarditis; Epidemiology; Risk factors

The Community In-Reach and Care Transition (CIRACT) clinical and cost-effectiveness study: study protocol for a randomised controlled trial.

BackgroundOlder people represent a significant proportion of patients admitted to hospital. Their care compared to younger patients is more challenging, length of stay is longer, risk of hospital-acquired problems higher and the risk of being re-admitted within 28 days greater. This study aims to compare a Community In-Reach and Care Transition (CIRACT) service with Traditional Hospital Based rehabilitation (THB-Rehab) provided to the older person. The CIRACT service differs from the THB-rehab service in that they are able to provide more intensive hospital rehabilitation, visiting patients daily, and are able to continue with the patient’s rehabilitation following discharge allowing a seamless, integrated discharge working alongside community providers. A pilot comparing the two services showed that the CIRACT service demonstrated reduced length of stay and reduced re-admission rates when analysed over a four-month period.Methods/DesignThis trial will evaluate the clinical and cost-effectiveness of the CIRACT service, conducted as a randomised controlled trial (RCT) with an integral qualitative mechanism and action study designed to provide the explanatory and theoretical components on how the CIRACT service compares to current practice. The RCT element consists of 240 patients over 70 years of age, being randomised to either the THB therapy group or the CIRACT service following an unplanned hospital admission. The primary outcome will be hospital length of stay from admission to discharge from the general medical elderly care ward. Additional outcome measures including the Barthel Index, Charlson Co-morbidity Scale, EuroQoL-5D and the modified Client Service Receipt Inventory will be assessed at the time of recruitment and repeated at 91 days post-discharge. The qualitative mechanism and action study will involve a systematic programme of organisational profiling, observations of work processes, interviews with key informants and care providers and tracking of participants. In addition, a within-trial economic evaluation will be undertaken comparing the CIRACT and THB-rehab services to determine cost-effectiveness.DiscussionThe outcome of the study will inform clinical decision-making, with respect to allocation of resources linked to hospital discharge planning and re-admissions, in a resource intensive and growing group of patients.Trial registrationRegistered with the ISRCTN registry (ISCRCTN94393315) on 25 April 2013 (version 3.1, 11 September 2014).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0551-2) contains supplementary material, which is available to authorized users.

Prevalence of malnutrition in a mid-long term stay unit

Malnutrition is a common health problem, especially in hospitalized patients, where it's associated with longer hospital stays and higher rates of morbidity and mortality. Furthermore, current scientific advances and life expectancy increase, have produced a progressive increase of mid- to long-term stay units (UMLE). To determinate the prevalence of malnutrition on admission to a mid- to long-term stay unit, using MNA and VGS and to analyze the possible factors/clinical features associated with malnutrition and its consequences. Descriptive and transversal study conducted with 201 patients admitted consecutively for 12 months in an Universitary Hospital mid- to long-term stay unit (Valencia). Clinical, anthropometric, biochemical and nutritional history data were registered, as well as Charlson comorbidity scale, Pfeiffer cognitive scale, Barthel functional scale and presence of edema, ascitis and pressure ulcers. Nutritional status was evaluated in the first 24-72 hours of admission using MNA and VGS. Dysphagia was evaluated using EAT-10 and MECV-V questionnaires. The overall rate of malnutrition was 76,6%, being severe protein energy malnutrition the most common type (20,4%). Malnourished patients were older (p=0,002), presented greater dependence (p.

Development and Preliminary Testing Of The Post-Transplant Multimorbidity Index (PTMI)

BackgroundComorbid health conditions, both those present before transplant and those acquired as late effects of allogeneic hematopoietic stem cell transplantation (alloHSCT) and the treatment of chronic graft-versus-host disease (cGVHD), represent an important covariate. While the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) (Sorror et al. Cancer, 2008; 112(9):1992-2001) has been developed to predict non-relapse mortality and overall survival in allo-HSCT recipients, many of the chronic comorbid conditions that develop in the allogeneic post-transplant setting are not represented in the HCT-CI, and its predictive validity has had limited study in long-term transplant survivors. The objectives of this study were to: (i) establish a new measure of multimorbidity for the post-transplant setting (Post-Transplant Multimorbidity Index [PTMI]), and (ii) explore its content validity. MethodsBased on a review of the literature and the most commonly used comorbidity measures, the PTMI was developed to reflect a broad and inclusive list of comorbid conditions that may arise in the post-transplant setting. Preliminary definitions to establish the presence of each of these conditions were developed. To enhance longitudinal comparisons, the conditions and definitions from the HCT-CI were nested within the PTMI. The conditions and definitions were iteratively refined (SM and DW) through application in a cohort of 30 post-transplant patients. Subsequently, the PTMI, HCT-CI, Charlson Comorbidity Scale (CCS), and the Functional Comorbidity Index (FCI) were comparatively evaluated in a cohort of 50 alloHSCT survivors referred for comprehensive cGVHD consultation. The evaluation cohort was a mean age of 42 (range 23-68) years and a median of 33.5 (range 13-208) months post-transplant. All but two (late acute GVHD n=1; no cGVHD n=1) had active cGVHD that had been present for a median of 27 (range 3-197) months. A majority had severe cGVHD (NIH global severity score 1 n=4; 2 n=8; 3 n=36) and 90% were currently receiving systemic immunosuppression. ResultsApplying the PTMI, HCT-CI, CCS and FCI to our evaluation cohort yielded a mean of 5 (SD±2.5), 1.5 (SD±1.23), 1.39 (SD±0.78), and 2.18 (SD±1.16) co-occurring conditions, respectively. On average the HCT-CI, CCS, and FCI missed the identification of one or more comorbidities 71%, 75%, and 43% of the time. Conditions that were prevalent in the cohort but missed by the other comorbidity measures included osteoporosis, avascular necrosis, hypertriglyceridemia, hypothyroidism, BMI<22, and secondary solid malignancy (excluding nonmelanoma skin cancer) after transplant. Using the PTMI, the two most prevalent comorbid conditions were osteoporosis (64%) and underweight/sarcopenia (BMI<22) (46%), whereas the FCI identified osteoporosis and depression as most prevalent, and the HCT-CI psychiatric disturbance and peptic ulcer, and the CCS history of malignancy and peptic ulcer disease, as the two most prevalent comorbidities, respectively. ConclusionsOur results offer preliminary evidence that the PTMI improves the identification of chronic comorbid conditions in long-term transplant survivors with cGVHD, and demonstrate that the choice of a measure is an important methodologic issue in the design of epidemiologic studies of comorbidity in post-transplant survivors with cGVHD. Prospective studies evaluating the measurement properties of the PTMI are ongoing in post-transplant survivors with and without active chronic GVHD. With continued testing and refinement, we anticipate that this new measure will have utility for risk-adjustment and stratification in both observational studies and clinical trials in the post-transplant setting. Disclosures:No relevant conflicts of interest to declare.

Inter-observer agreement of charlson scale and CIRS-G in a sample of elder patients with prostate cancer

Introduction: Prostate cancer and comorbidities are a common condition in old people and its evaluation has an important role in the choice of the best treatment. Charlson scale and Cumulative Illness Geriatric Rating Scale (CIRS-G) are two instruments that have been used to measure comorbidity. Objectives: To analyse the inter-observer agreement of the Charlson scale and CIRS-G in a sample of older patients admitted to a cancer hospital in Rio de Janeiro, Brazil, for prostate cancer treatment. Methods: This is a descriptive study using data from a cohort study with men, 60 or more , recruited before the start of treatment for prostate cancer in hospitals in Rio de Janeiro. Two nurses from the Oncology Service of one of the participating hospitals effected, separately, the analysis of medical records of the recruited patients. Charlson comorbidity scale and CIRS-G were applied.Variables considered in the study were patient’s age, comorbidities identified, scores obtained on each scale and classification of patients according to each one. Inter-observer agreement was evaluated through simple percent agreement and Cohen’s kappa coefficient . Results: The study sample consisted of 60 patients, whose ages ranged between 60 and 80 years (mean age 65.05 years). For Charlson’s scale, simple percent agreement was 71.6% and the kappa coefficient was 0.255. For Nurse A, 71.7% of the patients had no comorbid conditions, whereas for Nurse B, this value was 80%. Nurse A identified 15 (25%) patients with mild comorbidity and Nurse B identified 11 (18.3%). According to Nurse A, two individuals had moderate comorbidity whereas Nurse B identified only one. For both nurses no patient had severe comorbidity when evaluated with Charlson’s scale. Regarding CIRS-G, simple percent agreement was 50.0%, with a kappa coefficient of 0.304. According toNurseA, 8.3% of the patients had no comorbidities as assessed by this scale and for Nurse B this value was 11.7%. Both nurses classified 15 (25%) patients as having mild comorbidity. As for moderate comorbidity, Nurse A rated 19 (31.7%) patients while Nurse B rated 23 (38.3%). For Nurse A, 21 (35%) patients had severe comorbidity, while for Nurse B they were 15 (25%). The total CIRS-G score for Nurse A, ranged between 0 and 11 points (mean 3.9) and for nurse B, it varied between 0 and 8 points (mean 3.2). The severity index varied between 0 and 2.6 for the two nurses, although Nurse A mean value corresponded to 1.53 and Nurse B mean value was 1.33. Conclusion: Simple percent agreement was higher for the Charlson scale than for CIRSG, but when taking into account the effect of chance, CIRS-G presented the higher kappa coefficient. CIRS-G was the instrument that detected severe comorbidity in the study’s patients, since this condition was not observed with Charlson’s scale. In this study sample, CIRS-G performed better than Charlson’s scale for the assessment of comorbidities in older prostate cancer patients.

Empleo de la escala de calidad de vida para el ictus (ECVI-38) para cuantificar y medir las consecuencias de un ictus. Relación con variables demográficas y clínicas

ObjectiveTo describe the sociodemographic data, clinical and health-related quality of life (HRQOL) profile according to the ECVI-38 scale and its relation to the different sociodemographic and clinical characteristics. Material and methodA descriptive, observational study was conducted. Participants: Patients who had suffered stroke in the last year, had been admitted to a Neurological Rehabilitation Unit and had fulfilled some inclusion criteria. Measurements: Sociodemographic, clinical variables were gathered as well as the Charlson comorbidity scale, grade of functional dependence using the modified Rankin and Barthel index. Treatments performed were fibrinolysis, physiotherapy, occupational therapy, speech therapy, psychiatric evaluation. The CVRS was measured through the ECVI-38 survey. ResultsA total of 95 surveys (72 from the University Miguel Servet Hospital and 23 from San Juan de Dios Hospital) were collected from 60 men and 35 women. Average age was 64.33 years (age range: 24-90 years). Common activities of the daily living (CADL), basic activities of the daily living (BADL), sociofamilial functions (SF) and physical condition (PC) were the four dimensions that were most affected in the study patients, with statistically significant results. ConclusionsThe stroke patients in our study observed a mild affectation in their quality of life (ECVI-38-Total: 35.59%). Age, functional status and grade of dependence are the parameters that are best related to quality of life.

Efficacy and Safety of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients with Comorbid Diseases

Endoscopic submucosal dissection (ESD), a new and potentially curative method for treating gastrointestinal neoplasms, may have longer procedure time and the risk of complications when compared to conventional endoscopic mucosal resection. This study evaluated the efficacy and safety of ESD in patients with comorbid diseases. The outcomes of 337 patients who underwent ESD for early gastric cancer at Samsung Medical Center from April 2003 to December 2006 were analyzed retrospectively. The Charlson comorbidity scale was used to divide the patients into low-risk (no risk factor) and high-risk (at least one risk factor) groups. The outcomes and complications were compared between the high- and low-risk groups. The low- and high-risk groups comprised 240 and 97 patients with mean ages of 61.1 and 64.7 years, respectively (p=0.002). Tumor location, tumor size, depth of invasion, procedure duration, and rates of en bloc resection, complete resection, complication, and recurrence did not differ significantly between the two groups (p>0.05). ESD may be a safe and effective treatment for early gastric cancer in patients with comorbid diseases.

The D&amp;T Report

The D&amp;T Report

Clinical Efficacy of Endoscopic Submucosal Dissection in Patients with Comorbid Diseases

Background/Aim: Endoscopic submucosal dissection(ESD) is a new method for the curative treatment of gastrointestinal neoplasm. Increased operation time and complication risks with ESD compared with EMR remain problematic. The aim of the present study is to evaluate the efficacy and safety of ESD in patients with comorbid diseases. Methods: From April 2003 through December 2006, 306 patients treated by ESD for early gastric cancer at Samsung Medical Center were retrospectively analyzed. They were categorized as low risk group (score 0) and high risk group (score 1-4) according to Charlson comorbidity scale which has been used to estimate the risk of death from comorbid diseases in oncologic condition. Location, size, depth of invasion, procedure time, complete en bloc resection rate, complication, recurrence of high risk group were compared with those of low risk group. Results: Seventy seven patients had high risk diseases listed in Charlson's comorbidity scale and 229 patients had none or low risk diseases. The mean age of high risk group was 65.8 yr whereas that of low risk group was 60.9 yr (p < 0.001). There were no significant differences in the location, size, depth of invasion, procedure time between the two groups (p > 0.05). There were no significant difference in the complete en bloc resection rate, complication and recurrence rate between the two groups (p > 0.05). Conclusion: ESD could be a safe and effective treatment for early gastric cancer in patients with comorbid diseases.

Opposing Trends of Religious Attendance and Religiosity in Predicting Elders’ Functional Recovery after an Acute Myocardial Infarction

This study examined the role of religion and spirituality in older adults’ functional recovery following an AMI. Participants were interviewed within 2 weeks of the AMI about their religious beliefs. Functional recovery was evaluated using the Short Physical Performance Battery (SPPB) at one month and seven months. We found that those who reported attending religious services more frequently had better functional recovery. In contrast, those who considered themselves more spiritual had worse functional recovery. These findings remained after controlling for age, gender, co-morbidity (Charlson Co-Morbidity Scale), depression (CES-D), social support (MOS Social Support Survey), and grip strength in Linear Mixed Models. The implications of the findings are discussed.

Are age and comorbidity independent prognostic factors in the treatment of metastatic NSCLC? A review of prospectively randomized national cancer institute of Canada Clinical Trials Group (NCIC CTG) trials

7117 Background: This study analyzed all patients enrolled in two large prospectively randomized trials of systemic chemotherapy to determine whether age and/or co-morbidity are independent predictors of outcome. Methods: Baseline information was recorded, including ongoing medical problems and current medications. This information was extracted and scored using the validated Charlson co-morbidity scale. Scores were then correlated with other clinical data, which included age, gender, race, performance status, histology, stage, weight, LDH, chemotherapy (type, total dose, dose intensity), response and survival. Results: A total of 1,255 patients (481 in BR10 and 774 in BR18) were included in this analysis, the median age was 61.2 years (range 34.2 to 88.7), 827 were less than 65yrs, and 428 65yrs or older. 391 had other medical conditions besides the primary disease of lung cancer, 310 with a Charlson co-morbidity score of 1, and 81 with a cumulative score of 2 or higher. There were more male patients with co-morbidity (35% vs. 21%, p &lt; 0.0001); fewer patients with histologic subtype of adeno with co-morbidity (26% vs. 35%, p = 0.001); and more older patients with co-morbidity (42% vs. 26%, p &lt; 0.001). There was no difference in overall survival in the elderly (≥65) as compared to the younger patients (&lt;65). In contrast, patients with co-morbidity were associated with a shorter survival (p = 0.01). A cumulative Charlson score of 1 was associated with a hazard ratio of 1.28 (95% CI 1.09–1.5; p =0.003), and a cumulative score of 2+ was associated with a hazard ratio of 1.09 (95% C.I. 0.83 -1.44, p = 0.52). Conclusions: From these two large randomized NCIC CTG trials, one observes that age over 65 is not associated with a worse outcome. However, the presence of co-morbidity does appear to be a negative prognostic factor and co-morbity is more common in older patients. No significant financial relationships to disclose.