FI Score Research Articles

Risk stratification and characterisation of subpopulations of frail elderly in the primary care practice using routine healthcare data

Background: A major challenge in primary health care today, is the increase of frail elderly individuals in primary care practices. The current reactive approach leads to a rise of unplanned visits to the emergency room and after hours general practitioners consultations. The aim of the current study is to identify and characterise subpopulations of community dwelling elderly as a lead towards a ‘needs-tailored’ and pro-active care approach. Methods: This is a retrospective cohort study of 9668 patients with a follow up of 1 year median age: 67 years [interquartile range, 64-74]; 5128 women [53%]. The patients were community dwelling elderly, registered in the general practitioner registration network in the western part of The Netherlands. A frailty index FI score, based on the International Classification of Primary Care ICPC and medication use ATC, was calculated for each patient. This was defined as the proportion of deficits from a predefined and validated list of 50 deficits drubbel et al. 2013. Based on this FI score, five subgroups were formed and characterised on coded diagnosis and symptoms, medication use and social vulnerability as coded in the routine data by the general practitioner. Results: The median FI score of the total study population was 0.16 interquartile range 0.1-0.24. The quintile of the population with the highest FI scores median 0.32 [0.28-0.62] contained more woman 64% and a higher median age 75 [60-101]. Further characterisation of the subpopulations showed a difference in overall prevalence of deficits, while the distribution of the most prominent deficits does not greatly differ between subpopulations. Both social vulnerability and polypharmacy were highly prevalent in the subpopulation with the highest FI scores 98.8% vs 6.2% and 27% vs 5.2% respectively. Conclusion: By using primary care routine health data, we can identify subpopulations of frail community dwelling elderly and show differences in the characteristics of these populations. These differences are of importance as a lead towards a more targeted, integrated healthcare approach, which is aimed at the needs of the different subpopulations. Limitations: Misclassification due to missing data is a risk of the current approach using routine healthcare data. Therefore it is of importance for further research to investigate the needs of the identified subpopulations by qualitative research designs.

Construct validation of a Frailty Index, an HIV Index and a Protective Index from a clinical HIV database.

BackgroundStandard care for HIV clinical practice has started focusing on age-related problems, but despite this recent change physicians involved in HIV care do not often screen HIV patients for frailty. Our aim was to construct three indexes from an HIV clinical database (i.e. Frailty Index, (FI), HIV Index, (HIVI), and Protective Index (PI)) and to assess levels of frailty, HIV severity and demographic and protective lifestyle factors among HIV patients.Methods and findingsWe included data from 1612 patients who attended an Italian HIV clinic between September 2016 and December2017 (mean±SD age: 53.1±8 years, 73.9% men).We used 92 routine variables collected by physicians and other health care professionals to construct three indexes: a 72-item FI (biometric, psychiatric, blood test, daily life activities, geriatric syndromes and nutrition data), a 10-item HIVI (immunological, viral and therapeutics) and a 10-item PI (income, education, social engagement, and lifestyle habits data)(the lower the FI and HIVI scores, and the higher the PI scores, the lower the risk for participants).The FI, HIVI and PI scores were 0.19±0.08, 0.48±0.17 and 0.62±0.13, respectively. Men had higher FI (0.19±0.08 vs 0.18±0.08; p = 0.010) and lower HIVI (0.47±0.18 vs 0.50±0.15; p = 0.038) scores than women. FI and HIVI scores both increased 1.9% per year of age (p < 0.001), whereas the PI decreased 0.2% per year (p<0.050). In addition, the FI score increased 1.6% and the PI score decreased 0.5% per year of HIV infection (p < 0.001).ConclusionIt is feasible to assess levels of frailty, HIV severity and protective lifestyle factors in HIV patients using data from a clinical database. Frailty levels are high among HIV patients and even higher among older patients and those with a long duration of HIV. Future studies need to examine the ability of the three indices to predict adverse health outcomes such as hospitalization and mortality.

Associations of Multidomain Lifestyle Intervention with Frailty: Secondary Analysis of a Randomized Controlled Trial

BackgroundThe objective of this study was to investigate whether a long-term multidomain lifestyle intervention was associated with the severity and incidence of frailty in older adults. MethodsA 3-year randomized controlled trial was conducted among 1637 French community dwellers age ≥70: 821 controls and 816 who received a multidomain lifestyle intervention (cognitive training, nutrition counseling, and advice on physical activity). The intervention involved 12 2-hour sessions (in the first 2 months) followed by a 1-hour session each month until the study end. Controls received the usual care but did not receive any personalized lifestyle intervention. A frailty index (FI; range = 0-1, higher is worse) composed of 32 items was calculated at baseline, 6 months, 1 year, 2 years, and 3 years and constituted our main endpoint. FI ≥ 0.25 defined frailty. The 4 outcomes were severity of frailty (continuous FI score), incident frailty, incidence of persistent frailty (frailty at 2 consecutive time points), and reversibility of frailty (from frailty to nonfrailty). ResultsMixed-effect linear regression did not find a significant effect of the multidomain intervention on FI score. Frailty incidence occurred in 241 of 1146 subjects (138 controls and 103 in the multidomain group), whereas incidence of persistent frailty occurred in 75 of 1042 subjects (48 controls and 27 in the multidomain group). Cox models adjusted for baseline FI scores showed that compared with controls, subjects in the multidomain group had a decreased risk of developing both frailty (hazard ratio 0.72; 95% confidence interval, 0.55-0.93) and persistent frailty (hazard ratio 0.53; 95% confidence interval, 0.33-0.85). ConclusionsThis multidomain lifestyle intervention was associated with a reduced risk of developing frailty but did not affect the severity of frailty in community-dwelling older adults.

Sphincteroplasty and perineoplasty with skin advancement flap in management of traumatic cloacal defect

BackgroundTraumatic cloacal defect (TCD) is the condition that occurs in 0.3% of women who have experienced the third/fourth-degree perineal laceration during traumatic Natural Vaginal Delivery (NVD). This condition has many undesirable effects in their lives. Surgery is the best way to repair this deformity and will improve the quality of life in these patients. DesignIn this study, we prospectively studied 19 patients who were referred to the hospital with symptoms of TCD within years 2011 and 2015 with the mean of 2.6-yrs follow-up. They all underwent sphincteroplasty and perineoplasty with skin advancement flap. ResultsOf all 19 patients, incontinence to solid faeces in 16 patients (84%), incontinence to liquid stool in 15 patients (78%) and incontinence to flatus in 4 patients (21%) were completely resolved. The FI score was decreased from the mean of 12.7 to 2.6. Sexual function was significantly improved in all of them and dyspareunia was completely disappeared in 9 patients (50%). The quality of life score was increased from the mean of 45 to 95. Post-operation complications were occurred in 3 of patients (wound infection in 2-cases and recto-vaginal fistula in another). ConclusionOur findings show that sphincteroplasty and perineoplasty with skin advancement flap is an effective surgical technique to repair the perineal body due to its benefits and few complications. In this study, there was significant improvement in quality of life of almost all patients after this reconstructive surgery. Consulting with a colorectal surgeon is recommended for these cases.

A deep convolutional neural network for bleeding detection in Wireless Capsule Endoscopy images.

Wireless Capsule Endoscopy (WCE) is a standard non-invasive modality for small bowel examination. Recently, the development of computer-aided diagnosis (CAD) systems for gastrointestinal (GI) bleeding detection in WCE image videos has become an active research area with the goal of relieving the workload of physicians. Existing methods based primarily on handcrafted features usually give insufficient accuracy for bleeding detection, due to their limited capability of feature representation. In this paper, we present a new automatic bleeding detection strategy based on a deep convolutional neural network and evaluate our method on an expanded dataset of 10,000 WCE images. Experimental results with an increase of around 2 percentage points in the Fi score demonstrate that our method outperforms the state-of-the-art approaches in WCE bleeding detection. The achieved Fi score is of up to 0.9955.

Development of an aerial counting system in oil palm plantations

This paper proposes the development of a counting aerial system capable of capturing, process and analyzing images of an oil palm plantation to register the number of cultivated palms. It begins with a study of the available UAV technologies to define the most appropriate model according to the project needs. As result, a DJI Phantom 2 Vision+ is used to capture pictures that are processed by a photogrammetry software to create orthomosaics from the areas of interest, which are handled by the developed software to calculate the number of palms contained in them. The implemented algorithm uses a sliding window technique in image pyramids to generate candidate windows, an LBP descriptor to model the texture of the picture, a logistic regression model to classify the windows and a non-maximum suppression algorithm to refine the decision. The system was tested in different images than the ones used for training and for establishing the set point. As result, the system showed a 95.34% detection rate with a 97.83% precision in mature palms and a 79.26% detection rate with a 97.53% precision in young palms giving an FI score of 0.97 for mature palms and 0.87 for the small ones. The results are satisfactory getting the census and high-quality images from which is possible to get more information from the area of interest. All this, achieved through a low-cost system capable of work even in cloudy conditions.

PTU-169 Comparison between sphincteroplasty and sacral nerve stimulation for treat-ment of anal incontinence patients with sphincter injuries

<h3>Introduction</h3> This study aimed to compare outcomes of patients with anal sphincter defects treated by sacral nerve stimulation (SNS) or sphincteroplasty (SP). <h3>Method</h3> After IRB approval, patients treated for FI with a sphincter defect were identified from a prospective database; treatment groups were matched and stratified by SNS or SP. Primary outcome was change in Wexner FI Score (FIS). Demographic variables, past medical history and complication rates were also reviewed. Sphincter defects were assessed by endoanal ultrasound and ranged from 45°–180°. Continuous variables were compared with independent t-tests or Mann-Whitney U tests based on evidence of Gaussian distribution. Categorical variables were compared with Chi-squared analyses. Paired within group analyses were performed with paired t-tests and Wilcoxon signed-rank test. In order to perform a paired assessment of the role of each intervention in affecting the FIS, an Analysis of Covariance (ANCOVA) was performed. <h3>Results</h3> 26 female patients were included, 13 each underwent sphincteroplasty or SNS. The groups were similar with regards to age (62.2 vs 57.2 years, p = 0.16), BMI (26.2 vs 26.5, p = 0.33), initial FIS (15.9 vs 16.8, p = 0.39) and follow-up (14 vs 10 months, p = 0.72). The groups were similar for &gt;1 vaginal delivery or rates of urinary incontinence (p = 1.00 and p = 0.62, respectively). Early postoperative complications included 1 patient in each group with wound infection. Within group analyses revealed a significant improvement of FIS in SNS patients (15.9 to 8.4; p = 0.003) but not observed in the SP group (16.9 to 12.9; p = 0.078). Between groups, a trend towards lower FIS was seen in the SNS group as compared to SP but was not significant (8.4 vs 12.9; p = 0.06). ANCOVA analysis did reveal either procedure as superior in reducing FIS. <h3>Conclusion</h3> This study demonstrates that within each group SNS is effective at reducing FI in patients with a sphincter defect. Larger sample sizes will be required to better compare the difference in scores and assess for superiority between procedures. <h3>Disclosure of interest</h3> None Declared.

Minimal clinically important change of functional decline in community dwelling older persons: Prospective cohort study

Results.– The average FI-scorewas 0.27. A higher FI-scorewas associatedwith higher age andmore severe ID. FI-scores of peoplewith ID were much higher than in the general 50+ population (average FI-score 0.13). Key conclusions.– Comparison with the results of previous studies among non-disabled populations shows that our population has a higher mean FI score; on average, frailty starts at a much younger age. Future research is needed to confirm whether frail older people with ID have a higher risk of adverse health outcomes and to establish howearly frailty can beprevented. Data on adverse health outcomes will be presented at the congress.

The association of cerebral small vessel disease and frailty in patients with vascular cognitive impairment

Results.– The average FI-scorewas 0.27. A higher FI-scorewas associatedwith higher age andmore severe ID. FI-scores of peoplewith ID were much higher than in the general 50+ population (average FI-score 0.13). Key conclusions.– Comparison with the results of previous studies among non-disabled populations shows that our population has a higher mean FI score; on average, frailty starts at a much younger age. Future research is needed to confirm whether frail older people with ID have a higher risk of adverse health outcomes and to establish howearly frailty can beprevented. Data on adverse health outcomes will be presented at the congress.

CRP Modulates fis Transcription by Alternate Formation of Activating and Repressing Nucleoprotein Complexes

The DNA architectural proteins FIS and CRP are global regulators of transcription in Escherichia coli involved in the adjustment of cellular metabolism to varying growth conditions. We have previously demonstrated that FIS modulates the expression of the crp gene by functioning as its transcriptional repressor. Here we show that in turn, CRP is required to maintain the growth phase pattern of fis expression. We demonstrate the existence of a divergent promoter in the fis regulatory region, which reduces transcription of the fis promoter. In the absence of FIS, CRP activates fis transcription, thereby displacing the polymerase from the divergent promoter, whereas together FIS and CRP synergistically repress fis gene expression. These results provide evidence for a direct cross-talk between global regulators of cellular transcription during the growth phase. This cross-talk is manifested in alternate formation of functional nucleoprotein complexes exerting either activating or repressing effects on transcription.

8 Assessing cancer treatment morbidity using the LENT SOMA scales in cervical carcinoma

Methods: 145 patients, who had received radiotherapy for cervical carcinoma more than three years ago, were invited for an assessment to answer questionnaires with a research nurse and offered a medical consultation. The questionnaires were devised from the published scores for LENT SOMA to obtain subjective scores of late effects at each organ site affected by the pelvic radiotherapy fields. This work was the result of collaboration with the departments of clinical oncology, psychological medicine and medical statistics. The questionnaires evolved over a period of 18 months with the fourth draft deemed satisfactory. Questions were used to obtain the objective evidence of treatment effect along with clinical examination and review of the medical notes to assess and record management and analytic evidence based on imaging results. Quality of life was assessed using the EORTC Core30 questionnaire (with permission) and scored according to the algorithm provided by the EORTC QOL study group (Aarondsen et a1,1993). The Hospital Anxiety and Depression Scale questionnaire was also used. Results: 100 patients attended for interview and assessment. Scores for each organ site - 6 sites uterus/cervix, ovary/reproductive, rectum/bowel, bladder/urethra, ureter/kidney and vagina were obtained. Total scores were calculated for subjective and objective criteria using an average score as recommended by the working groups that devised the LS scales. In addition, the maximum scores for each organ site were obtained. The objective LS scores for rectum/bowel correlated significantly with the FI scores, rho =0.79,p<0.0005 but there was less correlation with subjective scores, rho=0.32, p=<0.001. The objective LS score for bladder/urethra was significantly correlated with the FI score, rho =0.71 ,p<0.0005 but the subjective score was weakly correlated, rho=0.43,p<0.0005 (see figure). The total LS objective score was correlated with the total FI score, rho=0.62, p<0.0005. The total LS objective score and maximum FI score was correlated, rho=0.57, p<0.0005. The maximum scores and mean scores for each of the subsites was compared with the FI scores. Using the mean scores gave a slightly greater range and may allow greater discrimination than when using the maximum LENT SOMA score for a subsite. The total EORTC score was not well correlated with the LS objective criteria rho = -0.32, p=0.001, though there was better correlation with the subjective LS scores rho= -0.55, p<0.0005. Similarly, there was better correlation with the HAD anxiety score with the LS subjective criteria rho=0.52,p<0.0005 and HAD depression rho=0.48,p<0.0005, but the objective LS criteria were less well correlated for the HAD anxiety score, rho=0.33,p=0.001 and HAD depression, rho=0.27, p=0.007. Conclusions: The objective LENT SOMA scores were well correlated with the maximum FI score for organ sites, but less so with a total LS score. The data suggest that it may be better to look at the scores for each subsite rather than a total LS score. The subjective LS scores were less well correlated with the FI scores and this Js not surprising as the FI scoring is based on objective scoring and not taking the patients' views into account. The subjective LS scores were correlated with the EORTC and HADS scores but the objective LENT SOMA score was poorly correlated with the quality of life measurements.