Comprehensive Assessment Research Articles

Protocol for the process evaluation of the GOAL trial: investigating how comprehensive geriatric assessment (CGA) improves patient-centred goal attainment in older adults with chronic kidney disease in the outpatient setting

IntroductionThe GOAL Cluster Randomised Controlled Trial (NCT04538157) is now underway, investigating the impact of comprehensive geriatric assessment (CGA) for frail older people with chronic kidney disease (CKD). The primary outcome...

Childhood-Onset Fluency Disorder with marked ingressive speech: a prospective case study

This prospective case study aimed to examine the effectiveness of a comprehensive treatment approach employed for a 14-year-old boy, EK, with Childhood-Onset Fluency Disorder (COFD), particularly manifested by excessive pulmonic ingressive speech and phonation as well as profound secondary behaviors that resemble those attested in individuals with Tic Syndrome (TS). A single-case, experimental-longitudinal design was used, with a hypothesis adopting a therapeutic approach, which integrated strategies used to manage several behaviors in TS, would reduce dysfluency and associated secondary behaviors and that gains would be maintained. Perceptual and instrumental data were obtained. The findings offered evidence for the effectiveness of the therapeutic program, which could be attributed to the possible similarities in the underlying pathogenesis of stuttering and TS – glitches in the neurophysiological system that give rise or contribute to the two disorders. The results further back up comprehensive assessment and therapeutic approach facilitating better understanding and management of complex human behaviors like stuttering.

Assessing the Radon Exposure Variability and Lifetime Health Effects across Indoor Microenvironments and Sub-Populations

To assess the health impacts of radon exposure over a lifetime, in the present study, the annual effective dose (AED) and cumulative excess lifetime cancer risk (ELCR-C) were evaluated by considering various indoor microenvironmental exposures based on age-specific time–activity patterns using Monte Carlo simulations. Significant regional variations in indoor radon concentrations across the Republic of Korea were observed, with the highest levels found in schools and single detached houses. Based on the standard annual total of 8760 h spent indoors and outdoors, the AED varied by age group and dwelling type, with the ELCR-C for single detached houses being approximately 1.36 times higher than that for apartments on average. The present study highlights the importance of comprehensive health risk assessments that consider differences across indoor environments and age groups, indicating that limited evaluations of specific sites or areas may distort actual exposure levels.

Muscle-Inspired Formable Wood-Based Phase Change Materials.

Phase change materials (PCMs) are crucial for sustainable thermal management in energy-efficient construction and cold chain logistics, as they can store and release renewable thermal energy. However, traditional PCMs suffer from leakage and a loss of formability above their phase change temperatures, limiting their shape stability and versatility. Inspired by the muscle structure, formable PCMs with a hierarchical structure and solvent-responsive supramolecular networks based on polyvinyl alcohol (PVA)/wood composites are developed. The material, in its hydrated state, demonstrates low stiffness and pliability due to the weak hydrogen bonding between aligned wood fibers and PVA molecules. Through treatment of poly(ethylene glycol) (PEG) into the PVA/wood PEG gel (PEG/PVA/W) with strengthened hydrogen bonds, the resulting wood-based PCMs in the hard and melting states elevate the tensile stress from 10.14 to 80.86MPa and the stiffness from 420MPa to 4.8GPa, making it 530 times stiffer than the PEG/PVA counterpart. Capable of morphing in response to solvent changes, these formable PCMs enable intricate designs for thermal management. Furthermore, supported by a comprehensive life cycle assessment, these shape-adaptable, recyclable, and biodegradable PCMs with lower environmental footprint present a sustainable alternative to conventional plastics and thermal management materials.

Ketoprofen promotes the conjugative transfer of antibiotic resistance among antibiotic resistant bacteria in natural aqueous environments

The emergence and spread of antibiotic resistance in the environment pose a serious threat to global public health. It is acknowledged that non-antibiotic stresses, including disinfectants, pharmaceuticals and organic pollutants, play a crucial role in horizontal transmission of antibiotic resistance genes (ARGs). Despite the widespread presence of non-steroidal anti-inflammatory drugs (NSAIDs), notably in surface water, their contributions to the transfer of ARGs have not been systematically explored. Furthermore, previous studies have primarily concentrated on model strains to investigate whether contaminants promote the conjugative transfer of ARGs, leaving the mechanisms of ARG transmission among antibiotic resistant bacteria in natural aqueous environments under the selective pressures of non-antibiotic contaminants remains unclear. In this study, the Escherichia coli (E. coli) K12 carrying RP4 plasmid was used as the donor strain, indigenous strain Aeromonas veronii containing rifampicin resistance genes in Taihu Lake, and E. coli HB101 were used as receptor strains to establish inter-genus and intra-genus conjugative transfer systems, examining the conjugative transfer frequency under the stress of ketoprofen. The results indicated that ketoprofen accelerated the environmental spread of ARGs through several mechanisms. Ketoprofen promoted cell-to-cell contact by increasing cell surface hydrophobicity and reducing cell surface charge, thereby mitigating cell-to-cell repulsion. Furthermore, ketoprofen induced increased levels of reactive oxygen species (ROS) production, activated the DNA damage-induced response (SOS), and enhanced cell membrane permeability, facilitating ARG transmission in intra-genus and inter-genus systems. The upregulation of outer membrane proteins, oxidative stress, SOS response, mating pair formation (Mpf) system, and DNA transfer and replication (Dtr) system related genes, as well as the inhibition of global regulatory genes, all contributed to higher transfer efficiency under ketoprofen treatment. These findings served as an early warning for a comprehensive assessment of the roles of NSAIDs in the spread of antibiotic resistance in natural aqueous environments.

Exploring the user experience, quality, and provision of urban greenspace: A mixed-method approach

Urban greenspace plays a crucial role in city design, offering residents various benefits for their health and wellbeing. With increasing urbanisation and human population growth, urban greenspace is becoming an even more significant resource. By implementing a mixed-method approach, we conducted a comprehensive assessment of urban greenspace based on public usage and perceptions, and quality, availability and accessibility in Derby, UK. Our methodology included an online questionnaire to investigate greenspace usage and perceptions, an in-situ assessment to assess greenspace quality, and Geographical Information Systems analysis to quantify greenspace provision based on Natural England’s (2023) Accessible Greenspace Standards (AGS). We found that greenspace usage and perception vary according to demographic and socioeconomic aspects, with younger people and students showing lower engagement with greenspace. Positive engagement correlates with factors such as proximity, car access, employment, and education. We also found that moderately high levels of greenspace quality (69.47/100) are available in the city, with the most notable insufficiencies related to quietness/peacefulness, aesthetics, and naturalness. Finally, none of the AGS criteria are met at a city-wide scale given the lack of large greenspace sites (particularly over 100 ha) and inequalities in spatial distribution. Our study highlights the value of the use of different methodologies to assess greenspace-related factors and emphasises the significance of public engagement in evaluating greenspace quality. Additionally, we identified factors adversely affecting greenspace use, including parking fees and issues with facilities, amenities, and safety. We therefore recommend interventions to address these challenges and enhance greenspace experience and accessibility in the city.

Feathers and faith: Sacred groves of semi-arid landscapes hold distinct avian richness and composition in Udaipur district, Rajasthan, India

Sacred groves have long been recognised for their critical role in biodiversity conservation, but research on their importance in avian conservation is limited. We conducted a comprehensive assessment of bird diversity, richness, and abundance within sacred groves and their surrounding areas in the semi-arid landscape of Udaipur, Rajasthan, India. We made 120 point counts (60 sacred groves and 60 random points) to record birds from March 2023 to July 2023. Our results revealed a greater number of bird species (n = 114) within sacred groves than random points (n = 100), including several species of global conservation concern. The species diversity remained consistent, while variations in species richness and abundance was observed. Moreover, we found that the overall composition of birds’ feeding guilds was similar in both groups. We observed noteworthy differences in the abundance of frugivores, granivores, insectivores, and omnivores. Species and guild-level abundance exhibited an even distribution. Species richness in both type of sites predominantly attributed to species turnover. Feeding guilds and bird species had varying associations to environmental variables. Our findings recommend the immediate protection of these sacred areas for bird conservation.

Анализ основных критериев обеспечения продовольственной безопасности региона (на материалах Рязанской области

The article analyzes the main criteria for ensuring food security in the Ryazan region. The information basis of the study was the electronic databases of Rosstat, Ryazanstat, Resolutions and Orders of the Government of the Russian Federation and the Ryazan region related to food security issues. A system of indicators given in the "Doctrine of Food Security of the Russian Federation" is used for a comprehensive assessment of food security in the region. The indicators are determined in dynamics over 5 years. The most significant problems of the region in the studied issue have been identified: a low level of food independence for the group of fruits and vegetables; a significant lag from the recommended consumption rates of the most physiologically complete food products: meat, dairy products, vegetables, fruits and berries; a low level of economic accessibility of food. The objectives of the Ryazan Region State Program "Development of the agro-industrial complex" to solve these problems are highlighted.

Comprehensive assessment of postoperative recurrence and survival in patients with cervical cancer

BackgroundThe prediction of postoperative recurrence and survival in cervical cancer patients has been a major clinical challenge. The combination of clinical parameters, inflammatory markers, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), and MRI-derived radiomics is expected to support the prediction of recurrence-free survival (RFS), disease-free survival (DFS), tumor-specific survival (CSS), and overall survival (OS) of cervical cancer patients after surgery. MethodsA retrospective analysis of 181 cervical cancer patients with continuous follow-up was completed. The parameters of IVIM-DWI and radiomics were measured, analyzed, and screened. The LASSO regularization was used to calculate the radiomics score (Rad-score). Multivariate Cox regression analysis was used to construct nomogram models for predicting postoperative RFS, DFS, CSS, and OS in cervical cancer patients, with internal and external validation. ResultsClinical stage, parametrial infiltration, internal irradiation, D-value, and Rad-score were independent prognostic factors for RFS; Squamous cell carcinoma antigen, internal irradiation, D-value, f-value and Rad-score were independent prognostic factors for DFS; Maximum tumor diameter, lymph node metastasis, platelets, D-value and Rad-score were independent prognostic factors for CSS; Lymph node metastasis, systemic inflammation response index, D-value and Rad-score were independent prognostic factors for OS. The AUCs of each model predicting RFS, DFS, CSS, and OS at 1, 3, and 5 years were 0.985, 0.929, 0.910 and 0.833, 0.818, 0.816 and 0.832, 0.863, 0.891 and 0.804, 0.812, 0.870, respectively. ConclusionsNomograms based on clinical and imaging parameters showed high clinical value in predicting postoperative RFS, DFS, CSS, and OS of cervical cancer patients and can be used as prognostic markers.

Efficient Governance for Indian States using Big Data

Big data integration with e-governance offers revolutionary potential to improve the effectiveness and responsiveness of state government operations in India. In addition to highlighting important research gaps and outlining complete solutions, this article investigates the role of big data technologies in modernizing e-governance frameworks. Our approach includes a comprehensive assessment of the literature as well as the creation of theoretical frameworks for sentiment analysis, data integration, predictive analytics, and real-time data processing. We suggest cutting-edge uses for these frameworks in disaster management, law enforcement, traffic management, healthcare, and environmental monitoring. The findings of this study have implications for better governance, better decision-making, and better public services. The application of these frameworks in pilot projects in different states, comparative analyses to find best practices, and ongoing technological adaptation to changing governance requirements are some of the future paths that these projects will pursue. The research highlights the importance of implementing big data to achieve an efficient, transparent, and flexible government in India.

Establishment of an antiplatelet aggregation efficacy-oriented effect-constituent index for quality evaluation of Curcumae Rhizoma from different species (Curcuma phaeocaulis Val, Curcuma kwangsiensis S. G. Lee et C. F. Liang and Curcuma wenyujin Y. H. Chen et C. Ling)

Curcumae rhizoma (CR) is the dried rhizoma of Curcuma phaeocaulis Val (CP), Curcuma kwangsiensis S. G. Lee et C. F. Liang (CK) and Curcuma wenyujin Y. H. Chen et C. Ling (CW), used widely to treat blood stagnation in China. Currently, quality control indicators for CR are limited to chemical composition analysis. It is unclear whether the current quality standard of the multicomponent content of CR can reflect clinical effects, due to the lack of the evaluation of biological effects. A method of evaluating quality was developed called the effect-constituent index (ECI). By meticulously measuring and calibrating the key active components, the ECI offers a comprehensive assessment of the CR's biological effects, establishing a crucial link to clinical efficacy and safety. An analytical protocol employing high-performance liquid chromatography (HPLC) was devised to ascertain the presence and measure ten principal constituents within CR sourced from various species and the content of total volatile oil was also measured. An In vitro antiplatelet aggregation assay was developed to measure the antiplatelet aggregation biopotencies of thirty batches of CR and ten main components. Then, the calibration weights for each constituent in the ECI were determined based on the antiplatelet aggregation biopotency values of eight components with notable efficacy. The ECI calculation involved summing the products obtained by multiplying the content (Ci) of each component by its corresponding biopotency weight (Wi). Correlation analysis unveiled a the most robust correlation (R = 0.8579, p < 0.001) between ECI and antiplatelet aggregation biopotency of CR, when compared to individual components or volatile oil content. The devised ECI, synthesizing chemical and biological data pertinent to clinical effectiveness, facilitates a nuanced assessment of CR quality across various species in its efficacy in treating blood stagnation. This method addresses the challenge of guaranteeing effectiveness through chemical analysis alone. This study offers substantiation for the applicability of the ECI as a tool for assessing the quality of traditional Chinese medicine (TCM).

Identifying Malnutrition Risk in the Elderly: A Single- and Multi-Parameter Approach

Malnutrition is a significant concern affecting the elderly, necessitating a complex assessment. This study aims to deepen the understanding of factors associated with the assessment of malnutrition in the elderly by comparing single- and multi-parameter approaches. In this cross-sectional study, 154 individuals underwent a comprehensive geriatric assessment (CGA). Malnutrition risk was determined using the mini nutritional assessment (MNA). Additional factors assessed included sarcopenia, polypharmacy, depression, appetite, handgrip strength, and gait speed. Phase angle (PA) and body composition were measured using bioelectrical impedance analysis (BIA). The MNA identified a malnutrition risk in 36.8% of individuals. The geriatric depression scale (GDS) and PA demonstrated moderate effectiveness in assessing malnutrition risk, with AUC values of 0.69 (95% CI: 0.60–0.78) and 0.62 (95% CI: 0.54–0.72), respectively. A logistic regression model incorporating handgrip strength, skeletal muscle mass, sarcopenia, osteoporosis, depression, specific antidepressant use, mobility, appetite, and smoking achieved superior performance in predicting malnutrition risk, with an AUC of 0.84 (95% CI: 0.77–0.91). In conclusion, this study demonstrates that integrating multiple parameters into a composite model provides a more accurate and comprehensive assessment of malnutrition risk in elderly adults.

Regional earthquake-induced landslide assessments for use in seismic risk analyses of distributed gas infrastructure systems

Earthquake-induced landslides are associated with significant risks to human lives and infrastructure. Spatially distributed infrastructure systems, such as pipelines, power lines, and transportation networks, are at particular risk to seismic landslides due to their large spatial extent. To conduct a comprehensive seismic landslide risk assessment for these systems, there is the need to evaluate the seismic landslide characteristics (i.e., location, size, displacement, direction) on a broad, regional scale. This paper presents a framework for seismic landslide analysis that provides this information for subsequent risk assessments. The approach computes seismic landslide displacements using a sliding block approach while accounting for the uncertainties in the input variables and displacement models using a logic tree. The computed displacements are then aggregated based on geomorphic landforms to define landslide zones. For each landslide zone, the statistical distributions of landslide features, such as landslide size, displacement level, and direction of movement, are defined. These attributes are presented in a format that can be integrated with fragility models for distributed infrastructure systems to quantify risk on a regional scale. The application of the approach is demonstrated through assessments for gas pipeline networks across the state of California in the United States.

Effects of higher dietary acid load: a narrative review with special emphasis in children.

Metabolic effects of high diet acid load (DAL) have been studied for years in adults, although only recently in children. Contemporary diets, especially those of Western societies, owe their acidogenic effect to high animal-origin protein content and low contribution of base-forming elements, such as fruits and vegetables. This imbalance, where dietary acid precursors exceed the body's buffering capacity, results in an acid-retaining state known by terms such as "eubicarbonatemic metabolic acidosis," "low-grade metabolic acidosis," "subclinical acidosis," or "acid stress". Its consequences have been linked to chronic systemic inflammation, contributing to various noncommunicable diseases traditionally considered more common in adulthood, but now have been recognized to originate at much earlier ages. In children, effects of high DAL are not limited to growth impairment caused by alterations of bone and muscle metabolism, but also represent a risk factor for conditions such as obesity, insulin resistance, diabetes, hypertension, urolithiasis, and chronic kidney disease (CKD). The possibility that high DAL may be a cause of chronic acid-retaining states in children with growth impairment should alert pediatricians and pediatric nephrologists, since its causes have been attributed traditionally to inborn errors of metabolism and renal pathologies such as CKD and renal tubular acidosis. The interplay between DAL, overall diet quality, and its cascading effects on children's health necessitates comprehensive nutritional assessments and interventions. This narrative review explores the clinical relevance of diet-induced acid retention in children and highlights the potential for prevention through dietary modifications, particularly by increasing fruit and vegetable intake alongside appropriate protein consumption.

Using Deep Learning Techniques as an Attempt to Create the Most Cost-Effective Screening Tool for Cognitive Decline.

This study aimed to use deep learning (DL) to develop a cost-effective and accessible screening tool to improve the detection of cognitive decline, a precursor of Alzheimer's disease (AD). This study integrating a comprehensive battery of neuropsychological tests adjusted for individual demographic variables such as age, sex, and education level. A total of 2,863 subjects with subjective cognitive complaints who underwent a comprehensive neuropsychological assessment were included. A random forest classifier was used to discern the most predictive test combinations to distinguish between dementia and nondementia cases. The model was trained and validated on this dataset, focusing on feature importance to determine the cognitive tests that were most indicative of decline. Subjects had a mean age of 72.68 years and an average education level of 7.62 years. The DL model achieved an accuracy of 82.42% and an area under the curve of 0.816, effectively classifying dementia. Feature importance analysis identified significant tests across cognitive domains: attention was gauged by the Trail Making Test Part B, language by the Boston Naming Test, memory by the Rey Complex Figure Test delayed recall, visuospatial skills by the Rey Complex Figure Test copy score, and frontal function by the Stroop Test Word reading time. This study showed the potential of DL to improve AD diagnostics, suggesting that a wide range of cognitive assessments could yield a more accurate diagnosis than traditional methods. This research establishes a foundation for future broader studies, which could substantiate the approach and further refine the screening tool.

Indexed aortic valve area using multimodality imaging for assessing the severity of bicuspid aortic stenosis

BackgroundThe impact of various imaging modalities on discordance/concordance between indexed aortic valve area (iAVA) and catheterization-derived mean transaortic pressure gradient (mPGcath) is unclear in patients with bicuspid aortic valve (BAV). This study aimed to compare iAVA measurements obtained using four different methodologies in BAV and tricuspid aortic valve (TAV) patients, using mPGcath as a reference standard. MethodsWe retrospectively reviewed patients who underwent comprehensive assessment of AS, including two-dimensional (2D) transthoracic echocardiography (TTE), three-dimensional (3D) transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and catheterization, at our institution between 2019 and 2022. iAVA was measured using the continuity eq. (CE) with left ventricular outflow tract area obtained by 2D TTE, 3D TEE, and MDCT, as well as planimetric 3D TEE. Results and ConclusionsAmong 564 patients (64 with BAV and 500 with TAV), 64 propensity-matched pairs of patients with BAV and TAV were analyzed. iAVACE(2DTTE) led to overestimation of AS severity (BAV, 23.4%; TAV, 28.1%) and iAVACE(MDCT) led to underestimation of AS severity (BAV, 29.3%; TAV, 16.7%), whereas iAVACE(3DTEE) and iAVAPlani(3DTEE) resulted in a reduction in the discordance of AS grading. A moderate correlation was observed between mPGcath and iAVACE(3DTEE) (BAV, r = −0.63; TAV, r = −0.68), with iAVACE(3DTEE) corresponding to the current guidelines' cutoff value (BAV, 0.58 cm2/m2; TAV, 0.60 cm2/m2). Discordance/concordance between iAVA and mPGcath in evaluating AS severity varies depending on the methodology and imaging modality used. The use of iAVACE(3DTEE) is valuable for reconciling the discordant AS grading in BAV patients as well as TAV.

Crossing horizons: unraveling perspectives on enhancing medical students’ success through at-risk factor exploration

BackgroundMedical universities often face the ongoing challenge of identifying and supporting at-risk students to enhance retention rates and academic success. This study explores a comprehensive analysis of perceived at-risk factors impeding academic and career aspirations and compares the perspectives of students and faculty in a medical school.MethodsWe focused on first and second-year medical (MBBS) students and teaching faculty in an international medical college offering a twinning program in India and Malaysia. Our investigation involved a comprehensive assessment of 25 at-risk factors through Likert-type questionnaires distributed to 250 MBBS students and 50 teaching faculty.ResultsOur findings revealed distinct disparities in perceptions between faculty and students regarding mean scores of classroom engagement (p = 0.017), procrastination (p = 0.001), unrealistic goals (p = 0.026), emotional/behavioral problems (p = 0.008), limited key social skills (p = 0.023), and a non-supportive home environment (p = 0.001). These differences underscore the need for increased communication and understanding between faculty and students to address these risk factors effectively. In contrast, no significant disparities were observed among faculty and students’ perceptions concerning mean scores of various potential at-risk factors, including academic unpreparedness, cultural/language barriers, individual guidance/mentoring, limited communication skills, racism/sexism, self-confidence, self-respect, self-concept, motivation, underprepared for current academic challenges, self-discipline, negative social network, negative peer culture, transportation time, college financial cost, college evaluation culture bias, broken college relationships, teaching methodology, and learning disabilities. However, varying degrees of influence were perceived by faculty and students, suggesting the importance of individualized support.ConclusionThis study contributes to the academic community by shedding light on the multifaceted nature of at-risk factors influencing student success. It underscores the need for proactive measures and tailored interventions to enhance student retention in higher education and academic achievement, fostering a sustainable foundation for lifelong learning and growth.

Pentahomoserine functionalized graphene oxide decorated polyamide thin film for enhanced separation of green tea polyphenols

The isolation of valuable compounds from the byproducts of food processing industries presents a significant contemporary challenge. Thin film nanocomposite (TFN) membranes have been identified as potential media for separating bioactive compounds. In this work, pentahomoserine functionalized graphene oxide (FGO) based TFN membranes were prepared for the effective separation of tea polyphenols epigallocatechin (EGC) and epigallocatechin gallate (EGCG). The nanocomposite selective polyamide (PA) layer was prepared through the dispersion of FGO in an aqueous monomer solution. The prepared membranes possess high average surface roughness with improved hydrophilicity and thermal stability. Additionally, FGO membranes contain more hydroxyl or carboxyl groups with cross-linked PA layer through interfacial polymerization (IP) process. Moreover, FGO membranes featured increased hydroxyl or carboxyl groups, facilitating cross-linking with the PA layer via intermolecular forces. The effects of amine functionality on the membrane characteristics such as surface morphology, roughness and hydrophilicity were also investigated. Remarkably, the membranes demonstrated rejection efficiency of 96.3% towards polyphenols. Furthermore, comprehensive assessments of reusability performance of the membrane highlighted their potential for industrial applications. This study provides valuable insights into the fabrication of highly efficient TFN membranes for biomolecule separation across diverse technological domains.

Quantifying future water resource vulnerability in a high-mountain third pole river basin under climate change

Understanding the water resource vulnerability (WRV) in global mountain regions under climate change is crucial for water resources management and socio-economic development. However, the WRV in the high-mountain Third Pole region (with quite a few transboundary river basins) remains largely unclear. Here, we have applied a comprehensive assessment framework of WRV to a Third Pole high-mountain river basin (Nujiang-Salween River, NSR) and its dependent downstream. The framework consisted of sensitivity, exposure, adaptability, hazard, and water stress indices, considering climate change, socio-economics, government effectiveness, natural disasters, and water supply capacity of the target river basin. Our results indicate that the downstream area (with intensive human activities) often exhibited significantly higher WRV than the mountain region; while the WRV shows an M-shaped change with increasing elevation, with the highest vulnerability occurring in a relatively low elevation range (e.g., 500–1500 m for the NSR basin). In the near future, we find that the spatial pattern of WRV in the basin is alternately influenced by adaptation, water scarcity, and exposure; whereas climate change serves as the main driver affecting the WRV in the far future. These findings enhance our understanding of the WRV in high-mountain transboundary basins of the Third Pole under global change.

Impact of comprehensive geriatric assessment on treatment strategies and complications in older adults with colorectal cancer considering surgery.

This study aimed to assess the effectiveness of Comprehensive Geriatric Assessment (CGA) in customizing care for elderly cancer patients, specifically focusing on colorectal cancer. The research compared treatment strategies and outcomes in older adults considered for surgery before and after the initiation of a Geriatric Oncology Service (GOS). Conducting a comparative study, two cohorts of consecutive colorectal cancer patients aged 75 or older were examined: the control group (n = 156) and the GOS group (n = 158). Upon the treating surgeon's GOS consultation request, a geriatrician and an oncologist performed CGA, guiding treatment decisions and perioperative interventions. Postoperative complications were compared using propensity score matching (PSM). In the GOS group, 91% (n = 116) underwent CGA consultations, influencing decisions to forego surgery in 12 patients. After PSM for surgical cases (controls n = 146, GOS n = 146), each group comprised 128 patients. Perioperative physical therapy and pharmacist referrals were more frequent in the GOS group. The GOS group exhibited a significantly lower incidence of postoperative complications (22%) compared to the control group (33%) (p = 0.0496). Patients undergoing colorectal surgery post-GOS implementation experienced a notable reduction in postoperative complications, highlighting the positive impact of personalized geriatric assessment on surgical outcomes in the elderly.