Impaired Functional Status Research Articles

The Clinical Presentation and Factors Associated with Disease Severity of Rheumatoid Arthritis in Uganda: A Cross-Sectional Study.

BackgroundRheumatoid arthritis (RA) is a chronic, debilitating disease that leads to joint destruction and disability if left untreated. Few studies on RA have been conducted in Uganda, and there is limited information on disease severity and associated factors. This study sought to characterize the clinical presentation and to determine disease severity and the factors associated with disease severity among participants with RA in Uganda.MethodsBetween August 2018 and February 2019, patients presenting to the rheumatology outpatient clinic in Mulago National Referral Hospital were enrolled into the study using a cross-sectional design. Participants’ demographics and clinical characteristics were collected using a study questionnaire, and laboratory results were extracted from their charts. The patients’ functionality was assessed using the Modified Health Assessment Questionnaire and their disease severity was assessed using the RA Disease Activity Score based on 28-joint count (DAS28).ResultsA total of 170 participants were enrolled, of whom 81.2% were female. Nearly two-thirds (111/170) were classified as having severe disease. Having a functional status score of >0.5 (adjusted odds ratio 1.7, 95% confidence interval 1.4–2.2, p<0.001) was significantly associated with severe disease.ConclusionIn this population, the majority of the patients seen at the rheumatology outpatient clinic had severe disease, suggesting that patients may be presenting late, with limited early detection of the disease. Impaired functional status was associated with increased disease severity and may be used by clinicians to highlight disease severity when it is not possible to assess the RA DAS28.

Sensory Versus Affective Pain Descriptors Predicting Functional Versus Psychosocial Disability

In the lexical assessment of pain, an offshoot of the McGill Pain Questionnaire is the Pain Descriptor System (PDS) which assesses sensory, affective, and overall intensity of pain. To determine if sensory versus affective pain components might be selectively related to different aspects of disability, PDS scores were examined in relation to functional status and psychosocial impairment on the Pain Disability Questionnaire (PDQ). A sample of 629 chronic pain patients rated the degree to which each of 36 PDS words described their pain and also rated 15 items of the PDQ. Three regression models (including Group Lasso) were applied to the data. Results showed that as hypothesized, PDS sensory scores significantly predicted PDQ functional status, accounting for about 13% of the variance; PDS affective scores significantly predicted PDQ psychosocial impairment, accounting for 17% of the variance; PDS total scores significantly predicted PDQ total scores, accounting for approximately 24% of the variance. This supports the overall predictive validity of pain descriptors, while confirming more specific links between components of pain and facets of disability. Clinically, the patient's description of pain sensation may hold valuable clues to physical impairment, whereas the communication of affect/suffering is more likely to connote psychosocial difficulties in functioning. PerspectiveRegression models (including Group Lasso) were applied to data on pain and disability from 629 patients. Findings support the Pain Descriptor System in assessing pain but further suggest that sensory descriptors are predictive of physical impairment from chronic pain, whereas affective descriptors are more predictive of psychologically-related disability.

Postoperative Pneumonia in Geriatric Patients With a Hip Fracture: Incidence, Risk Factors and a Predictive Nomogram.

ObjectivesTo evaluate the incidence and risk factors of postoperative pneumonia (POP) in geriatric patients with a hip fracture after surgery, to design a predictive nomogram, and to validate the accuracy of the nomogram.DesignRetrospective study.SettingA tertiary hospital affiliated to a medical university.Patients/ParticipantsWe retrospectively studied 1285 surgical-treated geriatric patients with a hip fracture from April 2010 to April 2018.InterventionSurgical treatment was performed on the patients of this study. The procedure methods were classified as: total hip arthroplasty, hemiarthroplasty, percutaneous fixation, intramedullary nail fixation, and plate/screw fixation.Main Outcome MeasurementThe primary interest of end point of this study is the development of POP during the postoperative period. The postoperative period in this study was defined as the time from 24 hours after surgery to discharge. The diagnostic criteria for pneumonia were set according to the guidelines built by the Infectious Diseases Society of America and the American Thoracic Society (Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia, 2005). Potential variables for developing POP were identified using logistic regression analyses initially and were further selected via the method of LASSO. Then the independent risk factors were identified by multivariable regression analyses. A predictive nomogram was built based on the multiple regression model, and the calibration abilities of the nomogram was measured by Harrel C-index, calibration plot and Hosmer–Lemeshow test, respectively. Decision curve analysis was carried out to assess the net benefit due to threshold probability and an on-line questionnaire survey was conducted among the clinicians to assess the applicability of the nomogram coherently.ResultsOf the 1285 patients, 70 (5.4%) developed POP. COPD, number of comorbidities, ASA classification >2, preoperative dependent functional status and cognitive impairment were identified as independent risk factors of POP. The nomogram built based on the results showed good accordance between the predicted probabilities and the observed frequency. The decision curve analysis confirmed the clinical utility of the nomogram when the threshold probabilities were between 5% and 65% due to the net benefit, while the results of on-line questionnaire among 200 clinicians showed that 91.5% of the participants had a mental threshold of intervention between 5-50%.Conclusion(1). COPD, number of comorbidities, ASA classification >2, preoperative dependent functional status and cognitive impairment are independent risk factors for POP. (2). The nomogram built in this study has a good accordance between the predictive risk and the observational incidence. The results of decision curve and questionnaire among clinicians show well applicability of the nomogram.

Frail young adult cancer survivors experience poor health-related quality of life.

Young adult cancer survivors experience frailty and decreased muscle mass at rates equivalent to much older noncancer populations, which indicate accelerated aging. Although frailty and low muscle mass can be identified in survivors, their implications for health-related quality of life are not well understood. Through a cross-sectional analysis of young adult cancer survivors, frailty was assessed with the Fried frailty phenotype and skeletal muscle mass in relation to functional and quality of life outcomes measured by the Medical Outcomes Survey Short-Form 36 (SF-36). z tests compared survivors with US population means, and multivariable linear regression models estimated mean SF-36 scores by frailty and muscle mass with adjustments made for comorbidities, sex, and time from treatment. Sixty survivors (median age, 21years; range, 18-29) participated in the study. Twenty-five (42%) had low muscle mass, and 25 were either frail or prefrail. Compared with US population means, survivors reported worse health and functional impairments across SF-36 domains that were more common among survivors with (pre)frailty or low muscle mass. In multivariable linear modeling, (pre)frail survivors (vs nonfrail) exhibited lower mean scores for general health (-9.1; P=.05), physical function (-14.9; P<.01), and overall physical health (-5.6; P=.02) independent of comorbid conditions. Measures of frailty and skeletal muscle mass identify subgroups of young adult cancer survivors with significantly impaired health, functional status, and quality of life independent of medical comorbidities. Identifying survivors with frailty or low muscle mass may provide opportunities for interventions to prevent functional and health declines or to reverse this process. Young adult cancer survivors age more quickly than peers without cancer, which is evidenced by a syndrome of decreased resilience known as frailty. The relationship between frailty (and one of its common components, decreased muscle mass) and quality of life among young adult cancer survivors was examined. Measuring decreased muscle mass and frailty identifies young survivors with poor quality of life, including worse general health, fatigue, physical function, and overall physical health, compared with nonfrail survivors. Interventions to address components of frailty (low muscle mass and weakness) may improve function and quality of life among young adult cancer survivors.

Association of Oncologist-Patient Communication With Functional Status and Physical Performance in Older Adults

The functional status and physical performance of older adults with cancer are underassessed and undertreated despite the high prevalence of impaired functional status and physical performance in this population and their associations with chemotherapy-induced toxic effects and mortality. To examine the association between providing oncologists with a geriatric assessment (GA) summary with recommendations and having oncologist-patient conversations about functional and physical performance. Data for this secondary analysis were collected from October 29, 2014, to April 28, 2017, for a national cluster randomized clinical trial conducted by the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program evaluating the effect of a GA intervention on patient satisfaction with communication about aging-related concerns. There were 17 practice clusters in the intervention group and 14 in the usual care group. All 541 participants underwent a GA including standardized functional and physical performance measures and had 1 clinical encounter audio-recorded, transcribed, and blindly coded to categorize conversations by GA domain. Participants were aged 70 years or older, with a stage III or IV solid tumor or lymphoma with palliative treatment intent, and impairment in 1 or more GA domain. Statistical analysis was performed from August 18, 2020, to January 10, 2022. Oncologist practices randomized to the intervention received a GA summary and validated recommendations for each patient prior to the audio-recorded clinical encounter. The primary analysis of this clinical trial assessed the effect of the intervention on patient satisfaction with oncologist communication about aging-related concerns. This secondary analysis assessed the post hoc hypothesis that the intervention would be associated with an increase in the proportion of patients having conversations with their oncologists and receiving oncologist recommendations specific to functional and physical performance concerns. A total of 541 patients (276 men [51%]; mean [SD] age, 77.5 [5.2] years [range, 70-96 years]) were analyzed at baseline. Excluding 13 patients without audio recordings, 86% of patients (95% CI, 78%-91%) in the intervention group vs 59% of patients (95% CI, 47%-69%; P < .001) receiving usual care had conversations about functional or physical performance. Conversations were more frequently initiated by oncologists in the intervention group (84%; 95% CI, 77%-90%) than oncologists in the usual care group (58%; 95% CI, 45%-70%; P < .001). Oncologists in the intervention group were more likely to address patients' concerns (43%; 95% CI, 33%-53%) than oncologists in the usual care group (17%; 95% CI, 10%-26%; P < .001). In this secondary analysis of a cluster randomized clinical trial, providing oncologists with a GA summary was associated with an increase in the number of oncologist-patient conversations about functional and physical performance-related concerns with recommendations to address these concerns. These findings support the use of the GA summary and recommendations as important tools in caring for older adults with advanced cancer and functional or physical impairments. ClinicalTrials.gov Identifier: NCT02107443.

Physiotherapy management of acute transverse myelitis in a pediatric patient in a Nigerian hospital: a case report

BackgroundTransverse myelitis is a rare neurological disorder of the spinal cord, caused by inflammation and damage of the myelin sheath of the neurons of the spinal cord across one or more spinal segments. This causes a disruption in the passage of nervous signals leading to motor, sensory, and autonomic dysfunction. This affects the physical and psychological health, as well as the functional status of the patient. This case report presents the physiotherapy evaluation and management of acute transverse myelitis in a pediatric patient.Case presentationA 17-year-old Nigerian male diagnosed with acute transverse myelitis was referred to the physiotherapy team for expert management. The patient presented with severe muscle spasms and frequent jerking movements, shocking sensations, hypertonicity, and spasticity (modified Ashworth scale: 1+ on the right, > 2 on the right), and muscle strength of the lower limbs (Oxford muscle grading: 3/5 on the left, 1/5 on the left) with impaired functional status (Functional Independence Measure: 70/126).The patient tolerated and participated in the physiotherapy interventions (cryotherapy, soft tissue mobilization, splinting) and exercises (free active, resistance and functional exercises) in the ward and outpatient clinic, as well as subsequent home programmes (free active, resistance and functional exercises). The patient also received other medical and pharmacological interventions in the ward. After 23 days of therapy, the patient improved in all clinical outcomes, including muscle spasm and hypertonicity, spasticity (modified Ashworth scale: 0 bilaterally), sensation, and muscle strength (Oxford muscle grading: 5/5 bilaterally). The patient’s overall functional status also improved (Functional Independence Measure: 117/126).ConclusionsPhysiotherapy improved the symptoms of acute transverse myelitis in this patient. Randomized controlled trials are required to replicate these findings.

BONE DEFECT MANAGEMENT AND AUGMENTATION OF DISTAL FEMORAL FRACTURES WITH POLYMETHYLMETHACRYLATE BONE CEMENT

Fragility distal femoral fractures are often associated to deficient bone stock and bone defect. Frail patients, who are characterized by their coexisting comorbidities, low functional status and frequent cognitive impairment, benefit from early intervention and mobilization. The use of polymethylmethacrylate bone cement in the case of distal femoral fractures with decreased screw purchase and bone defect is a valid option in frail non-ambulatory patients. Given an accurate patient selection, the immediate postoperative mobilization provided by the one-shot surgery presented in this paper procures substantial advantages.

Racial Inequities Across Rural Strata in Acute Stroke Care and In-Hospital Mortality: National Trends Over 6 Years.

There are glaring racial and rural-urban inequities in stroke outcomes. The objective of this study was to determine whether there were recent changes to trends in racial inequities in stroke treatment and in-hospital mortality, and whether racial inequities differed across rural strata. Retrospective analysis of Black and White patients >18 years old admitted to US acute care hospitals with a primary discharge diagnosis of stroke (unweighted N=652 836) from the National Inpatient Sample from 2012 to 2017. Rural residence was classified by county as urban, town, or rural. The primary outcomes were intravenous thrombolysis and endovascular therapy use among patients with acute ischemic stroke, and in-hospital mortality for all stroke patients. Logistic regression models were run for each outcome adjusting for age, comorbidities, primary payer, and ZIP code median income. The sample was 53% female, 81% White, and 19% Black. Black patients from rural areas had the lowest odds of receiving intravenous thrombolysis (adjusted odds ratio [aOR], 0.43 [95% CI, 0.37-0.50]) and endovascular therapy (aOR, 0.60 [0.46-0.78]), compared with White urban patients. Black rural patients were the least likely to be discharged home after a stroke compared with White/urban patients (aOR, 0.79 [0.75-0.83]), this was true for Black patients across the urban-rural spectrum when compared with Whites. Black patients from urban areas had lower mortality than White patients from urban areas (aOR, 0.87 [0.84-0.91]), while White patients from rural areas (aOR, 1.14 [1.10-1.19]) had the highest mortality of all groups. Black patients living in rural areas represent a particularly high-risk group for poor access to advanced stroke care and impaired poststroke functional status. Rural White patients have the highest in-hospital mortality. Clinical and policy interventions are needed to improve access and reduce inequities in stroke care and outcomes.

The Aftermath of Tapering Tocilizumab After Achieving Treatment Target in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study.

BackgroundAlthough recent guidelines recommend that tapering of biologic disease-modifying anti-rheumatic drugs (bDMARDs) can be considered in patients with rheumatoid arthritis (RA), there has been little evidence supporting the strategy during the non-tumor necrosis factor inhibitor treatment. This study aims to investigate the effectiveness and safety of tapering tocilizumab (TCZ) dose in patients with RA who attain low disease activity (LDA) after TCZ therapy in a nationwide cohort.MethodsData were collected from a nationwide cohort of patients with RA receiving biologic disease-modifying anti-rheumatic drugs in South Korea (KOBIO-RA). This study included 350 patients who were treated with TCZ and achieved Clinical Disease Activity Index-low disease activity (CDAI)-LDA (CDAI ≤ 10) after 1 year of treatment. We performed longitudinal analysis considering clinical data measured at all 1-year intervals for the included patients using the generalized estimating equation. A total of 575 intervals were classified into two groups according to their dose quotient (DQ) of TCZ (tapering group vs. standard-dose group). The main outcome was maintaining CDAI-LDA in the following 1-year interval.ResultsTapering TCZ dose strategy was used in 282 (49.0%) intervals with a mean (SD) DQ of 66.0 (15.5) %. Loss of CDAI-LDA occurred in 91 (15.1%) intervals. Multivariable GEE showed that the tapering group was associated with more frequent failure to sustain CDAI-LDA (adjusted OR [95% CI]: 0.57 [0.33–0.99]), which subsequently led to impaired functional status. The likelihood of achieving DAS28-deep remission (DAS28-ESR <1.98) was also significantly lower in the tapering group (adjusted OR 0.68 [0.46–0.99]). CDAI remission was achieved in only 69 (12.0%) of the total intervals, with no significant difference in the proportion of intervals achieving the target between the two groups. Incidence of adverse events was comparable in both groups except for hypercholesterolemia, which was lower in the tapering group.ConclusionsTapering TCZ dose after achieving LDA increases the risk of losing LDA without a significant merit in safety.

A Prospective Observational Pilot Study of Young Women Undergoing Initial Breast Cancer Treatment and Their Biopsychosocial Profile

Background: Breast cancer in young women can be a major challenge for those affected. To offer support, the establishment of a biopsychosocial profile may be beneficial. Methods: For this prospective observational pilot study, we collected data of 19 women with a mean age of 42.8 ± 5.4 years (30.0-49.0 year) before (T0) and after (T1) initial breast cancer treatment. The handgrip strength (HGS), 6-minute walk test (6MWT), and bioimpedance analysis for the detection of phase angle (PhA) and bioimpedance vector analysis (BIVA) were used. Assessments included the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy-Breast (FACT-B), and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Results: Women (age &lt;50 years) with breast cancer showed impaired functional status (HGS, 6MWT, and PhA), abnormal physiologic findings (BIVA), decreased health-related quality of life (HRQoL), and cancer-related fatigue (CRF) after breast cancer diagnosis prior to the onset of cancer treatment with significant deterioration following cancer treatment. This was accompanied by a potentially higher risk of mortality and impaired function due to the prevalence of values below a critical threshold (PhA: T0 = 11%, T1 = 42%; HGS: T0 = 21%, T1 = 32%). In addition, there was evidence of anxiety (47%) and depression (32%) at T0. Conclusion: Routine assessment of biomarkers of physical function, mental health, HRQoL, and CRF may lead to individual risk stratification and multidisciplinary intervention in young patients with breast cancer, which could help to personalize and optimize survivorship care plans.

Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore.

Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore. Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months. A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status. PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.

The association of polypharmacy with functional status impairments, frailty, and health-related quality of life in older adults with gastrointestinal malignancy - Results from the Cancer and Aging Resilience Evaluation (CARE) registry

ObjectivesPolypharmacy is a common problem among older adults that can complicate cancer care and outcomes. Our objective was to examine the prevalence of polypharmacy and its potential association with functional status impairments, frailty, and health-related quality of life (HRQoL) in older adults with gastrointestinal (GI) malignancy. MethodsThe Cancer and Aging Resilience Evaluation (CARE) registry is an ongoing prospective cohort study that uses a patient-reported geriatric assessment (GA) in older adults with cancer. For this cross-sectional analysis, we focused on older adults with GI malignancy that completed the GA prior to starting systemic cancer therapy. Polypharmacy was defined as patients reporting the use of ≥9 daily medications at their first visit to the medical oncology clinic. Using multivariable analyses, we examined the association of polypharmacy with functional status limitations, frailty, and HRQoL. Results357 patients were included in our analysis, with a mean age of 70.1 years. 24.1% of patients reported taking ≥9 medications. In multivariable analyses adjusted for age, sex, race, cancer type, cancer stage, and medical comorbid conditions, patients taking ≥9 medications were more likely to report limitations in activities of daily living (adjusted odds ratio [aOR] 3.29, 95% confidence interval [CI] 1.72–6.29) and instrumental activities of daily living (aOR 2.86, 95% CI 1.59–5.14), have a higher prevalence of frailty (aOR 3.06, 95% CI 1.73–5.41), and report lower physical HRQoL (aOR 2.82, 95% CI 1.70–4.69) and mental HRQoL (aOR 1.73, 95% CI 1.03–2.91). ConclusionsOlder adults with GI malignancy taking ≥9 medications prior to cancer therapy were more likely to report functional status limitations, frailty, and reduced HRQoL, independent of the presence of medical comorbid conditions.

Functional Status of Patients on Maintenance Haemodialysis and Burden of Their Caregivers: An Example from a Tertiary Referenz Hospital in Cameroon

Background: Patients on maintenance hemodialysis (MHD) often depend on caregivers due functional status impairment (FSI). We evaluated the functional status of patients on MHD and the burden on their caregivers in Douala. Material and methods: A fourth month cross-sectional study including consenting adult patients on MHD in Douala general hospital and their caregivers. Functional status of patients was assessed using the overall functional status scale. A FSI score between 1-5/13 was considered moderate, and severe when above 5/13. Caregiver burden was assessed with the Zarit caregiver burden scale; a score between 21 to 40 was considered light to moderate burden, and severe if &gt;41. Logistic regression was used to look for associated factors to FSI and caregivers burden (p &lt;0.05). Results: In 184 patients, the mean age 47.29 (13.75) years. FSI was moderate in 60.33% (111/184) and severe in 8.69% (16/184). Caregiver burden was light to moderate in 48.91% (90/184), severe in 38.59% (71/184). Factors associated with FSI were: older patients, low patient and caregiver income, diabetes, longer duration on dialysis and being accompanied by his child. Factors associated with caregiver burden were: male gender, patient’s age ≥ 70 years, low patient’s income, inability to do shopping and laundry, age of caregiver ≥ 50 years, and caregiver being a student. Patient functional dependence increased the caregiver’s burden by 3.87 times (p=0.001). Conclusion: FSI and caregiver’s burden were relatively high with many associated factors. The caregiver burden increased with the degree of patient dependence.

The Relationship between Functional Status and Social, Emotional and Family Loneliness among Older Adults in Pontian

Life at mature age is perceived to be very challenging and mostly influenced by the ageing process and negative changes that increase the risk of functional abilities. The most enormous thing to achieve is to live independently with less help from others to achieve an optimum quality of life. Methods: This is a community-based cross-sectional survey conducted among 414 community-dwelling older adults in Pontian District aiming to identify the functional status and examine the relationship between functional status and three types of loneliness. The Pfeffer Functional Activities Questionnaire was used to measure the level of functional status. Loneliness was measured with the short form of the Social and Emotional Loneliness Scale for Adults. The Statistical Package for Social Science Ver.26 for Windows was used to analyse all of the data.The results of this study show that the mean (+SD) age is 71.4 (+2.0). The majority of respondents perceived good health status and no deterioration in functional status. 8.2% of respondents experienced deterioration in functional status. Of these, 32.6% of respondents experienced social loneliness, 39.9% experienced emotional loneliness, and 9.2% experienced family loneliness. The results also revealed a significant relationship between functional status and social loneliness (p = 0.02). In conclusion, the majority of respondents are independent enough to perform functional activities, and less than half of them have experienced social, emotional, or family loneliness. Social loneliness was linked to a decline in functional ability in older adults. This research could aid in the care of older adults who live independently and freely in the community.

Nurses as Agents of Safety: Identifying unique contributors to falls in hospitalized Adult Hematology Patients: A Retrospective Study

Falls continue to be a major safety concern in acute care settings and are the second cause of unintentional injury deaths globally [1].The World Health Organization defines a fall as an event that results in a person coming to a rest inadvertently on the ground or floor or other lower level. Prevention of a fall is a safety measure, which is significantly affected by nursing care according to the National Database of Nursing Quality Indicators (NDNQI) [2].This retrospective review of one hundred medical records was conducted to assess if there are unique contributors to falls in hospitalized adult hematology patients. The study sample was drawn from the parent study that examined the impact of video-based educational intervention on the occurrence of falls among hematology patients hospitalized for the management of cancer treatment and complications. Patients with cancer are at an increased risk of sustaining a fall related injury due to impaired functional status, low blood counts, treatment related fatigue, frailty, and poor nutritional status [3,4]. Simple logistic regression between continuous variables and dependent variable, and cross-tabulation between categorical variables and the dependent variable was used to analyze study results.The study revealed that there was a significant relationship between fall incident and fall risk assessment scores on admission; X2 (1) = 6.153, p = .013, Cramer’s V = .256.

Prognostic Value of the B12/CRP Index in Older Systemically Treatable Cancer Patients.

Simple SummaryDecisions on cancer treatment for older patients take into account not only comorbidities but also physical and cognitive resources. Comprehensive geriatric assessment (CGA) in older patients assesses geriatric frailties but does not include standardized biological tests. The B12/CRP index (BCI) was first intended as a prognosis tool to predict 90-day mortality after advanced cancer diagnosis. This study shows the prognostic link between BCI value and overall cancer survival time in older people, and the association between BCI value and geriatric frailty before cancer treatment in this population.Background: While comprehensive geriatric assessment (CGA) in older patients treated for cancer assesses several related domains, it does not include standardized biological tests. The present study aimed to: (1) assess the prognosis value of the B12/CRP index (BCI) in a population of systemically treatable older patients with cancer and (2) analyze the association between BCI value and pre-existing geriatric frailty. Method: We conducted a retrospective observational study between January 2016 and June 2020 at Marseille University Hospital. All consecutive cancer patients aged 70 years and over before initiating systemic therapy were included. Results: Of the 863 patients included, 60.5% were men and 42.5% had metastatic stage cancer. Mean age was 81 years. The low-BCI group (≤10,000) had a significantly longer survival time than the mid-BCI (10,000 < BCI ≤ 40,000) and high-BCI (BCI > 40,000) groups (HR = 0.327, CI95% [0.26–0.42], p-value = 0.0001). Mid- and high-BCI (BCI > 40,000) values were associated with impaired functional status and malnutrition. Conclusion: A BCI > 10,000 would appear to be a good biological prognostic factor for poor survival times and pre-existing geriatric impairment in older cancer patients before they initiate systemic treatment.

Key public health challenges of the Chinese elderly in a new situation

The results of the seventh national census in 2020 show that China is facing a severe new situation with a rapid increase in the number of the elderly, a huge base of oldest old population, a rapid rise in the elderly dependency ratio, empty-nest families gradually becoming the main form of elderly families, and a further intensification of aging in the future. The elderly has prominent health problems such as decline in physical health, impairment of functional status, malnutrition and mental health, which bring a series of challenges to public health system, geriatric friendly society and geriatric health standards in China. Facing the new situation, we should find out the health status and service needs of the elderly as soon as we can, and regularly monitor and evaluate the progress of response strategies, formulate laws, regulations and policies related to the elderly at the national level, establish a well-defined, innovative and coordinated health care service and long-term care service system for the elderly, promote the wide participation of the whole society to build age-friendly environments. Oriented to the health characteristics and needs of the elderly, we should carry out trials of health protection and intervention for the elderly, strengthen scientific research and technological innovation to serve the elderly multilayered health needs, take multiple measures to improve the guarantee capacity and level of health services for the elderly, and finally actively exploring the "Chinese experience" of Chinese public health system in dealing with population aging.

Implementation and Effectiveness of a Veterans Affairs-Based Comprehensive Lung Cancer Survivorship Program.

Few programs exist to address persistent impairment in functional status, quality of life, and mental health in lung cancer survivors. We aimed to determine whether a 12-wk multimodal survivorship program imparts clinical benefit. Any patient at the Durham Veterans Affairs Medical Center with lung cancer and a Karnofsky score of ≥60 could participate. Chronic obstructive pulmonary disease medications were optimized at the enrollment visit. Participants with a Hospital Anxiety and Depression Scale (HADS) score of >8 were offered pharmacotherapy and mental health referral. Participants did home-based exercise with a goal of 1 hr/d, 5 d/wk. They were called weekly to assess exercise progress and review depression/anxiety symptoms. Participants were offered pharmacotherapy for smoking cessation. Twenty-three (50%) of the first 46 enrollees completed the full 12-wk program. Paired changes from enrollment to completion (mean ± SD) were observed in 6-min walk test (73.6 ± 96.9 m, P = .002), BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise) index (-1.45 ± 1.64 points, P < .001), Duke Activity Status Index (3.84 ± 7.12 points, P = .02), Fried Frailty Index (-0.588 ± 0.939 points, P = .02), modified Medical Research Council dyspnea scale (-0.619 ± 1.284 points, P = .04), Functional Assessment of Cancer Therapy-Lung Emotional subscale score (1.52 ± 2.96 points, P = .03), HADS total score (-2.63 ± 4.34 points, P = .02), and HADS Anxiety subscale score (-1.47 ± 2.29 points, P = .01). A comprehensive Lung Cancer Survivorship Program provides clinically meaningful improvements in functional status, quality of life, and mental health.

Abstract 14073: Deterioration of Functional Status and Timing of Intervention in Patients With Aortic Stenosis: Results From the PROGRESSA Study

Introduction: The assessment of changes in functional status during follow-up is critical to determine the timing of intervention in patients with aortic stenosis (AS). Fast progression of AS (annualized progression of peak jet velocity [V peak ] ≥30 cm/s) is among the risk markers recommended in the guidelines to trigger early intervention in asymptomatic severe AS. We investigated the association between the progression of AS hemodynamic severity and the change in functional status during follow-up of patients with asymptomatic mild to moderate AS. Methods: 285 patients with AS prospectively recruited in the PROGRESSA study (NCT01679431) were included in this analysis. Functional status was evaluated using the New York Heart Association (NYHA) classification. Results: Baseline NYHA class was similar (class I, II, III: 57%, 41%, 2% versus 58%, 41%, 1%; p=0.75) between patients with moderate (V peak progression ≥12 cm/s/year; median of cohort) versus those with slow AS progression rate. During a mean follow-up of 3.9±2.4 years, patients with moderate AS progression rate had larger increase in NYHA class compared to those with slow progression (+0.13±0.48 versus +0.01±0.21 class/year; p=0.008). From baseline to 2 years, a significant worsening of NYHA class occurred but only in the moderate AS progression group ( Figure ). In multivariable analysis, AS progression rate remained significantly associated with the change in NYHA class (p=0.04).A total of 156 clinical events (110 AVR and 46 deaths) occurred during a mean follow-up of 1.1±1.5 years after the last echocardiographic visit. Patients with ≥1 class increase in NYHA (n=70) had significantly higher risk of events (adjusted hazard ratio: 1.75 [95% CI: 1.12-2.75]; p=0.01). Conclusions: In this prospective cohort of patients with mild to moderate AS at baseline, the decline in functional status occurs early in the course of the disease and is in large part determined by the progression rate of AS hemodynamic severity.

Value of BDNF and GDNF extracellular regulatory molecules in fetal umbilical cord blood. Clinical study

Introduction. In modern obstetrics, there are a significant number of diagnostic methods to detect fetal distress, including intrapartum. At the same time, the mechanisms of fetal adaptation to various stressors remain poorly understood. The aim of our study was to provide a clinical assessment of brain and glial neurotrophic factors (NTF) in umbilical cord blood when the fetus is exposed to stressors. Materials and methods. The study included 96 cases, which were divided into five groups depending on the data of retrospective analysis of the history of childbirth, the condition of the newborn. After delivery samples were taken, the level of BDNF (brain-derived neurotrophic factor), GDNF (glial cell-derived neurotrophic factor). Results. The mean NTF level of BDNF in group 1 was 970.3 (60.9) ng/mL, in group 2 was 1499.8 (72.12) ng/mL, in group 3 was 1243.5 (67.49) ng/mL, in group 4 was 1245.5(80.8) ng/mL, in group 5 was 573.5(43.9) ng/mL (p&lt;0.001). Mean GDNF NTF level in group 1 was 35 pg/mL, in group 2 was 41.3 pg/mL, in group 3 was 311.00 pg/mL, in group 4 was 80.00 pg/mL, and in group 5 was 35.6 pg/mL, (p&gt;&lt;0.001). The incidence of fetal functional impairment in labor was not established in group 1, group 2 was 18.8%, group 3 was 29.2%, group 4 was 35.3%, and group 5 was 77.8% (p=0.001). The incidence of impaired fetal functional status in labor was not established in groups 1 and 2, in group 3, 4.2%, in group 4, 17.6%, and in group 5, 77.8% (p&gt;&lt;0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.&gt;&lt;0.001). Mean GDNF NTF level in group 1 was 35 pg/mL, in group 2 was 41.3 pg/mL, in group 3 was 311.00 pg/mL, in group 4 was 80.00 pg/mL, and in group 5 was 35.6 pg/mL, (p&lt;0.001). The incidence of fetal functional impairment in labor was not established in group 1, group 2 was 18.8%, group 3 was 29.2%, group 4 was 35.3%, and group 5 was 77.8% (p=0.001). The incidence of impaired fetal functional status in labor was not established in groups 1 and 2, in group 3, 4.2%, in group 4, 17.6%, and in group 5, 77.8% (p&gt;&lt;0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.&gt;&lt;0.001). The incidence of fetal functional impairment in labor was not established in group 1, group 2 was 18.8%, group 3 was 29.2%, group 4 was 35.3%, and group 5 was 77.8% (p=0.001). The incidence of impaired fetal functional status in labor was not established in groups 1 and 2, in group 3, 4.2%, in group 4, 17.6%, and in group 5, 77.8% (p&lt;0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.&gt;&lt;0.001). Discussion. Clinical study data indicate the existence of a close relationship between the level of neurotrophic factors and the realization of fetal compensatory-adaptive capabilities in the presence of fetal hypoxia development factors in labor. Conclusion. The participation of BDNF and GDNF molecules in the regulation of fetal homeostasis under intrapartum exposure to stressors has been established. High levels of BDNF and GDNF provide fetal protection as part of an endogenous system of compensatory mechanisms in the regulation of fetal homeostasis.