Functional Status Outcomes Research Articles

Impact of semaglutide on weight and functional outcomes among obese heart failure patients: a propensity scores matching analysis

Background & objectivesObesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide’s impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure.MethodsA retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control).ResultsAmong 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p < 0.001), while the control group showed a non-significant mean change of -0.41 kg/m² (95% CI: -1.08 to 0.26; p = 0.22). The difference in BMI between the two groups was statistically significant (mean difference: 3.42 kg/m², 95% CI: 1.43 to 5.42; p = 0.001). Improvements by at least one NYHA class were observed in 65% of the SEMA group (p < 0.001) compared to 15% of the control group (p = 0.18). The SEMA group also showed a significant increase in 6-minute walk distance (6MWD), with a mean difference of 75 m between the groups at one year (95% CI: 0.53 to 150.02; p = 0.049). NT-proBNP levels significantly decreased in the SEMA group (p < 0.001) compared to the control group (p = 0.78), with a statistically significant difference in NT-proBNP between the groups (p = 0.048). Both improvements in 6MWD and reductions in NT-proBNP were significantly correlated with BMI percentage reductions.ConclusionsSemaglutide was associated with significant weight reduction in obese patients with heart failure, accompanied by improved NYHA classification and 6-minute walk distance. Larger, multi-center trials and prospective, randomized controlled trials are warranted. These studies should focus on assessing long-term outcomes, optimizing dosage, and exploring the potential cardiovascular benefits beyond weight reduction.

Optimizing the Preoperative Preparation of Sarcopenic Older People: The Role of Prehabilitation and Nutritional Supplementation before Knee Arthroplasty.

Age-related loss of skeletal muscle strength and mass is linked to adverse postoperative outcomes in older individuals with sarcopenia. Half of patients suffer from severe associated osteoarthritis requiring orthopedic interventions. Mitigating the onset and progression of sarcopenia before surgery is essential to improve the prognosis and reduce surgical complications. The aim of this research was to innovatively explore whether the preoperative period could be the appropriate timeframe to empower surgical resilience, through prehabilitation and dietary supplementation, in older sarcopenic patients undergoing knee arthroplasty. The current literature concerning the effectiveness of prehabilitation and dietary supplementation before knee arthroplasty in sarcopenic older individuals was reviewed, following the SANRA criteria, between December 2023 and February 2024. The study inclusion criteria were as follows: (1) prehabilitation and/or dietary supplementation interventions; (2) human participants aged 65 years and older; (3) relevant outcome reporting (functional status, postoperative complications, and patient-reported outcomes); and (4) articles written in English The extracted information included study characteristics, demographics, intervention details, outcomes, and the main findings. Merged prehabilitation and dietary supplementation strategies extrapolated from the current literature and involving strength, resistance, balance, and flexibility training, as well as essential amino acids, iron, vitamin D, adenosine triphosphate, and glucosamine sulphate supplementation, could improve the functional capacity, ability to withstand the upcoming surgical stressors, and postoperative outcomes in older people undergoing knee arthroplasty. Addressing complex links between knee osteoarthritis and sarcopenia in older individuals undergoing knee arthroplasty requires a multidimensional approach. Prehabilitation emerges as a crucial preliminary step, allowing the optimization of surgical outcomes. Nutraceutical integration, included in a comprehensive care plan, could have a synergic effect in achieving prehabilitation goals. Those interventions are essential for surgical resilience, in terms of muscle function preservation, recovery acceleration, and overall quality of life enhancement. Intensive collaboration among specialists could advance knowledge and the sharable consensus concerning the critical and evolutive field of perioperative care.

Early Postoperative Patient-Reported Outcomes of Sarcopenia Versus Nonsarcopenia in Patients Undergoing Video-Assisted Thoracoscopic Surgery for Lung Cancer.

To compare early postoperative patient-reported outcomes between sarcopenic and nonsarcopenic patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer. The data used in this study were acquired from a longitudinal prospective study (CN-PRO-Lung 1) between November 2017 and January 2020. Skeletal muscle index was measured at L3 vertebral level on preoperative computed tomography to identify sarcopenia based on an established threshold. Symptoms severity and status of functional impairments were reported as proportions of patients with clinically relevant moderate-to-severe scores on 0-10 scales, which were measured by using the MD Anderson Symptom Inventory-Lung Cancer at baseline, daily postoperative hospitalization, and weekly after discharge up to 4 weeks. Symptom severity, functional status, and postoperative clinical outcomes were compared between the sarcopenia and nonsarcopenia groups. This study included 125 patients undergoing VATS for lung cancer. Sarcopenia was identified in 34 (27.2%) patients. Sarcopenic patients reported more moderate-to-severe pain (P = 0.002) at discharge and more moderate-to-severe fatigue (P = 0.027) during the 4 weeks after discharge. Besides, sarcopenic patients had a longer recovery time from both pain (P = 0.002) and fatigue (P = 0.007) than nonsarcopenic patients. Meanwhile, no significant between-group difference was found in the postoperative clinical outcomes (all P > 0.05). Sarcopenic patients undergoing VATS for lung cancer may have more pain and fatigue, as well as longer symptoms recovery time than nonsarcopenic patients during the early postoperative period.

2226 Assessing quantitative sonographic changes in the muscle mass of geriatric patients hospitalised using point of care ultrasound

Abstract Introduction One of the most important consequences of hospitalisation in older patients is sarcopenia. This study aims to determine the impact of hospitalisation on the muscle mass, functional status, nutritional status, and short-term clinical outcomes. Methods A prospective study of patients admitted to an Acute Geriatric Ward between 1st November and 30th December 2022. Muscle ultrasound, utilising Point of Care Ultrasound (POCUS) at bedside, was employed to estimate rectus femoris muscle thickness (MT), area (Ar), pennation angle (PA), and fascicle length (FL) at the time of hospital admission, 3 days post-admission, and at hospital discharge. Results 30 patients included, with a median age of 84 years (SD 72–93), 63.3% male, and 70% Clinical Frailty Scale score ≥ 4. Barthel Index and Functional Ambulation Category revealed median values of 72.33 and 3.87 respectively. Global Deterioration Scale median was 2.47. Mini Nutritional Assessment Short-Form (MNA) and total serum protein showed median values of 7.40 and 6.35 respectively. The median length of hospital stay was 5.79 days, with inpatient mortality rate of 10% and 53.3% incidence of delirium. Ultrasound showed a decrease in PA by 36.31%, Ar by 34.30%, and MT by 24.50%, and increase in FL by 10.47%. Sarcopenia classification at admission and discharge revealed an increase in mean index from 5.04 to 7.74. Conclusions In our cohort of patients admitted to an acute geriatric unit, POCUS identified real-time decreases in MT, Ar, and PA at the muscular level before these manifested as functional changes. It demonstrated an inverse relationship between frailty and muscle morphology as living with frailty associated further decreases in muscle mass at discharge. The study also established a direct relationship between MNA, muscle thickness, PA, and fascicles length at discharge. POCUS assessment of muscle mass could indirectly predict outcomes and guide decisions to address muscle mass abnormalities.

Percutaneous versus surgical closure of paravalvular leaks in prosthetic valves: A cross-sectional comparison of clinical outcomes.

Paravalvular leak (PVL) is a serious complication of prosthetic valve replacement. Both surgical and percutaneous closure techniques are used for PVL closure, but optimal strategies and comparative outcomes are uncertain. This study aimed to compare the efficacy and safety of percutaneous versus surgical PVL closure by analyzing changes in leak severity, functional status, echocardiographic parameters, and clinical outcomes. A total of 72 patients were included in this retrospective cross-sectional single-center study comparing percutaneous (n = 25) and surgical (n = 47) PVL closure from 2015 to 2022. Demographics, medical history, echocardiograms, laboratory data, complications, and mortality data were extracted from the records. Changes in leak severity, NYHA class, echocardiographic parameters, and clinical outcomes were compared between the percutaneous and surgical groups. Both percutaneous and surgical PVL closure significantly reduced leak severity and improved NYHA class (both p < 0.01), with no difference between the quantity of changes in each group. The 30-day mortality was 4% after percutaneous and 6.4% after surgical closure (p = 0.65). At 90 days, mortality was 24% percutaneous versus 17% surgical (p = 0.48). The length of stay in the hospital and post-procedural decrease in hemoglobin were considerably lower in the percutaneous group. The rate of complication rates was similar between the groups. Echocardiographic changes were also comparable. Percutaneous and surgical PVL closure had similar efficacy in reducing leaks and improving symptoms, with no significant difference in early outcomes. Both options should be considered viable for PVL repair after heart team evaluation.

The Effectiveness of an Exercise Program on Muscle Strength and Range of Motion on Upper Limbs, Functional Ability and Depression at Early Stage of Dementia.

Background: Dementia involves the loss of cognitive abilities and represents a decline from the prior level of function, which impairs functional abilities in day-to-day life. The purpose of the present study is to examine the effectiveness of an exercise program on the muscle strength and range of motion of the upper limbs, the functional status, and the depression of elderly people with early stage dementia. Methods: The sample consisted of 60 elderly people with early stage dementia who were randomly divided into a control and an experimental group of 30 participants each. The experimental group received a 12-week Otago exercise program with 45 min duration of each session. The control group received usual care without doing exercise. The outcome measures of muscle strength and range of motion of the upper limbs, the functional status, and the depression were assessed by valid instruments and tests at the beginning and at the end of the intervention program. Repeated measures one-way ANOVA and Mann-Whitney tests examined the differences between the two groups at the end of the 12-week exercise program. Results: Statistically significant differences were found between the experimental and control groups in the entire outcome measures (functional ability F = 9.35 p < 0.05; muscle strength right hand F = 32.33, p < 0.05 left hand U = 95.50 p < 0.01; e.g., range of motion shoulder extension U = 104.00 p < 0.01), except depression. Conclusions: Both muscle strength and range of motion of the upper limbs, as well as the functional ability, were improved by the exercise program. Further research is needed to investigate the present results, in particular to explore the long-term cognitive, behavioral, and functional status outcomes of exercise in the early stages of dementia.

ДОЛГОСРОЧНАЯ ЭФФЕКТИВНОСТЬ УСИЛЕННОЙ НАРУЖНОЙ КОНТРПУЛЬСАЦИИ У ПАЦИЕНТОВ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ ИШЕМИЧЕСКОГО ГЕНЕЗА

Aim. To study the long-term effect of complex therapy with the addition of enhanced external counterpulsation (EECP) on exercise tolerance, quality of life and systolic heart function in patients with ischemic chronic heart failure (CHF). Material and methods. Patients with ischemic CHF NYHA class II-III (n=20) included in the study. Patients, in addition to optimal medical therapy, were treated with EECP (35 hours, the standard protocol, 1 course every 6 months). The duration of observation was 5 years. Baseline, 12, 24, 36, 48 and 60 months performed assessment of NT-proBNP level, clinical status, exercise tolerance (6-minute walk test – 6MWT), quality of life (Minnesota Living with Heart Failure Questionnaire – MLHFQ), left ventricular ejection fraction (LVEF) according to echocardiography. The composite primary endpoint (CPE) included adverse cardiovascular events, new cases of atrial fibrillation (AF), diabetes mellitus (DM), decreased renal function, and hospitalizations due to CHF. Results. During the observation period (60 months), significant stable positive dynamics were noted in exercise tolerance (6MWT distance increased by 59.3%), clinical status, LVEF, NT-proBNP level, quality of life (MLHFQ). The incidence of myocardial infarction was 5%, revascularization – 15%, new cases of AF – 5%, decreased renal function – 10%, hospitalizations for CHF – 35%. There were no cases of strokes, deaths or new cases of diabetes. The prevalence of CPE was 70% over a 5-year period. Conclusion. A stable positive effect of EECP treatment of patients with ischemic heart failure on functional status and clinical outcomes has been demonstrated.

Standardized phase angle: relationship with functionality, muscle mass and postoperative outcomes in surgical cancer patients.

To evaluate the association of standardized phase angle (SPA) with nutritional status, functional parameters, and postoperative outcomes in surgical cancer patients. This prospective study includes 59 cancer patients from Pelotas (Brazil) admitted for elective cancer surgery. We obtained the phase angle through Bioelectrical Impedance Analysis (BIA) and standardized it according to the population's reference values. We estimated the muscle mass using BIA for later calculation of the Skeletal Muscle Index (SMI) and performed handgrip strength (HGS) and gait speed (GS) tests. We used the Patient-Generated Subjective Global Assessment (PG-SGA) to assess the nutritional status. Postoperative complications and duration of hospital stay were evaluated as the outcomes. The prevalence of malnutrition in the sample was 28.8%, according to ASG-PPP. SPA was statistically lower in patients with malnutrition, with lower HGS and reduced GS. For postoperative outcomes, patients with severe complications and those with prolonged hospitalization also had lower SPA values. The greater the number of functional alterations in patients, the lower the SPA value, mainly when associated with reduced muscle mass assessed by BIA, suggesting that muscle mass reduction plays an important role in the association between functional alterations and phase angle in patients with cancer. According to the parameters used in this study, low SPA value was associated with impaired nutritional and functional status and negative outcomes in the analyzed sample.

Blood urea nitrogen to serum albumin ratio as a new indicator of disease severity and prognosis in idiopathic pulmonary artery hypertension

BackgroundEmerging evidence has shown that the blood urea nitrogen to serum albumin ratio (BAR) is associated with the severity and prognosis of heart failure. However, its role in idiopathic pulmonary arterial hypertension (IPAH) remains unclear. This study investigated the associations between BAR and functional status, echocardiographic findings, hemodynamics, and long-term outcomes among patients with IPAH. MethodsThis study included consecutive patients who underwent right heart catheterization (RHC) and were diagnosed with IPAH between January 2013 and January 2018 at Fuwai Hospital. The primary outcome was the worsening of clinical symptoms. Spearman correlation coefficients were used to evaluate the association between the BAR and established markers of IPAH severity. Receiver operating characteristic (ROC) curve analysis was used to determine BAR's optimal cut-off and predictive performance. Kaplan–Meier analysis and Cox proportional hazard models assessed the relationship between BAR and clinical worsening. ResultsA total of 340 patients with IPAH were included in this study. BAR correlated with well-validated variables that reflected the severity of IPAH, such as World Health Organization functional class, 6-min walk distance, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, mixed venous oxygen saturation, and cardiac index. Kaplan–Meier curves indicated that patients with BAR＞3.80 had a significantly higher clinical worsening rate (log-rank test, P < 0.001) than those with BAR≤3.80. Multivariate Cox analysis showed that BAR could independently predict clinical worsening [hazard ratio(HR):2.642, 95 % confidence interval (CI):1.659–4.208, P < 0.001]. In addition, BAR provided additional predictive value for the European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk assessment score. ConclusionsBAR reflects disease severity and is independently associated with the prognosis of patients with IPAH.

Prognostic value of GLIM-defined malnutrition in combination with hand-grip strength or gait speed for the prediction of postoperative outcomes in gastric cancer patients with cachexia

BackgroundCancer cachexia is associated with impaired functional and nutritional status and worse clinical outcomes. Global Leadership Initiative in Malnutrition (GLIM) consensus recommended the application of GLIM criteria to diagnose malnutrition in patients with cachexia. However, few previous study has applied the GLIM criteria in patients with cancer cachexia.MethodsFrom July 2014 to May 2019, patients who were diagnosed with cancer cachexia and underwent radical gastrectomy for gastric cancer were included in this study. Malnutrition was diagnosed using the GLIM criteria. Skeletal muscle index was measured using abdominal computed tomography (CT) images at the third lumbar vertebra (L3) level. Hand-grip strength and 6-meters gait speed were measured before surgery.ResultsA total of 356 patients with cancer cachexia were included in the present study, in which 269 (75.56%) were identified as having malnutrition based on the GLIM criteria. GLIM-defined malnutrition alone did not show significant association with short-term postoperative outcomes, including complications, costs or length of postoperative hospital stays. The combination of low hand-grip strength or low gait speed with GLIM-defined malnutrition led to a significant predictive value for these outcomes. Moreover, low hand-grip strength plus GLIM-defined malnutrition was independently associated with postoperative complications (OR 1.912, 95% CI 1.151–3.178, P = 0.012). GLIM-defined malnutrition was an independent predictive factor for worse OS (HR 2.310, 95% CI 1.421–3.754, P = 0.001) and DFS (HR 1.815, 95% CI 1.186–2.779, P = 0.006) after surgery. The addition of low hand-grip strength or low gait speed to GLIM-defined malnutrition did not increase its predictive value for survival.ConclusionGLIM-defined malnutrition predicted worse long-term survival in gastric cancer patients with cachexia. Gait speed and hand-grip strength added prognostic value to GLIM-defined malnutrition for the prediction of short-term postoperative outcomes, which could be incorporated into preoperative assessment protocols in patients with cancer cachexia.

Relevant Predictors in the Association Between Patients' Functional Status and Scar Outcomes After Total Hip Arthroplasty.

We aimed to investigate the relevant predictors in the association between the functional status and the consequences of the persistence of scars in patients with traumatic versus non-traumatic coxarthrosis after total hip arthroplasty (THA). A total of 203 patients undergoing THA after traumatic or non-traumatic coxarthrosis were asked to complete the Mekeres' Psychosocial Internalization Scale (MPIS), in which they self-evaluated on a Likert scale (between one and five) by selecting the rating that corresponded to their personal opinion and the activities of daily living (ADL) format six months postoperative. The statistical data were processed using the IBM SPSS Statistics software version 22.0 (IBM Corp., Armonk, NY). A combined assessment of the internalization of scars using MPIS and ADL forms after THA allowed for the identification of relevant predictors of the quality of life six months post-surgery in patients with traumatic or non-traumatic coxarthrosis. Depending on the coxarthrosis etiology (traumatic or non-traumatic), the results were further processed by a univariate ANOVA, considering the independent variables represented by symptoms, the number of surgical procedures, and the postoperative evolution, which are acting on the outcomes of physical functioning (the dependent variable) in the postoperative phase. In the case of the traumatic group, our results suggest that the number of surgical interventions, the ability to internalize scars, and autonomy in terms of body care are predictors of the quality of life. In patients with non-traumatic coxarthrosis, an important role in predicting quality of life is played by the administered treatment and the ability to maintain their autonomy regarding self-hygiene six months post-surgery. The predictive regression equation suggests that the quality of life in patients with traumatic coxarthrosis can be predicted by the number of surgical interventions, the administered treatment, the ability to internalize scars, and the autonomy regarding body care activities. On the other hand, for patients with non-traumatic coxarthrosis, an important role in predicting the quality of life is played by the treatment and the ability to maintain autonomy in terms of body hygiene activities.

Measures of functional status in older patients treated with palbociclib for advanced breast cancer

IntroductionLimited data are available on the effects of treatment for advanced breast cancer (ABC) in older patients because this population has limited enrollment in clinical trials. Data generated from the prospective, noninterventional POLARIS study of patients with hormone receptor-positive/human epidermal growth factor receptor 2–negative ABC may help bridge the gap in our understanding of the tolerability and outcomes in this vulnerable population. Materials and MethodsWe evaluated measures of geriatric impairments and activities of daily living in patients with ABC aged ≥70 years in POLARIS to evaluate the change within six months of palbociclib initiation. Geriatric impairments and activities of daily living (functional) status were assessed using the Geriatric 8 (G8) and Activities of Daily Living (ADL) screening tools. The G8, ADL, and Eastern Cooperative Oncology Group performance status (ECOG PS) scores were assessed at baseline and month six through end of treatment with palbociclib. ECOG PS scores were also stratified by G8 and ADL score severity subgroups (G8: ≤14 = impaired subgroup; >14 = not at all impaired subgroup; ADL: <18 = dependent subgroup, 18 = independent subgroup). ResultsAt data cutoff in November 2020, of 1282 POLARIS patients of all ages, 287 (22.4%) were ≥ 70 years old and completed ≥6 months of palbociclib therapy. At baseline, 117 (45%; n = 260) of these patients had an ECOG PS score of 0, 143 (55%; n = 260) had ECOG PS score > 0, 248 (86%) had G8 scores (mean [SD] 13.6 [2.14]), and 256 (89%) had ADL scores (17.7 [1.03]) among the available 287 patients. At six months, 102 (40%; n = 255) had an ECOG PS score of 0, 153 (60%; n = 255) had ECOG PS score > 0, 198 (69%) had G8 scores (13.6 [1.99]), and 211 (74%) had ADL scores (17.6 [1.22]) among the 287 available patients. There was no mean change (standard deviation) from baseline to 6 months in mean ECOG PS scores (0.0 [0.61], P = 0.24), G8 scores (0.0 [2.17], P = 0.89), or ADL scores (0.0 [1.00], P = 0.62). DiscussionIn this subgroup analysis of older patients with ABC from POLARIS, functional status and impairment outcomes were preserved in older patients receiving palbociclib. G8, ADL, and ECOG PS scores were generally maintained during the first six months of palbociclib therapy.ClinicalTrials.govidentification number.NCT03280303

Predictors of Usual and Peak Gait Speed in Community-Dwelling Older Adults With Mild-to-Moderate Alzheimer's Dementia.

Gait speed significantly affects functional status and health outcomes in older adults. This cross-sectional study evaluated cognitive and physical fitness contributors to usual and peak gait speed in persons with Alzheimer's dementia. Multiple hierarchal linear regression was used to obtain squared semipartial correlation coefficients (sr2) and effect sizes (Cohen's ƒ2). Participants (n = 90; 56% male) averaged 77.1 ± 6.6years of age and 21.8 ± 3.4 on Mini-Mental State Examination. Demographic/clinical, physical fitness, and cognition variables explained 45% and 39% of variance in usual and peak gait speed, respectively. Muscle strength was the only significant contributor to both usual (sr2 = .175; Cohen's ƒ2 = 0.31; p < .001) and peak gait speed (sr2 = .11; Cohen's ƒ2 = 0.18; p < .001). Women who were "slow" walkers (usual gait speed <1.0m/s) had significantly lower cardiorespiratory fitness and executive functioning compared with "fast" walkers. In conclusion, improving muscle strength may modify gait and downstream health outcomes in Alzheimer's dementia.

Association between baseline characteristics of carpal tunnel syndrome and its relation to psychometric properties of the Boston carpal tunnel questionnaire

Objectives: Carpal tunnel syndrome (CTS) generally causes functional disabilities and consequently develops socioeconomic burdens for individuals and our community in the long run. The negative consequences are more recorded in developing nations. Therefore, early addressing the disorder is essential to eliminate the negative impacts on any health-care system. Methods: This descriptive cross-sectional study was conducted on patients with CTS attending the professorial surgical clinics at Teaching Hospital Jaffna. The demographic and clinical presentation while a self-reported Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess the severity of symptoms and functional status of the wrist and hand. Results: This study involved 63 respondents whose mean age and body mass index were 55.4 ± 12.4 years and 25.6 ± 3.1, respectively. The larger proportion was female (74.6%) and the majority’s civil status was married (90.5%). Menial and skilled jobs were 46.6% and 31.7%, respectively, whereas the remaining were professionals. The right-hand dominance was 93.7%, although 57.1% had the right hand affected. There was a significant association (r = 0.739 and P = 0.0001) between the clinical tests and the severity of symptoms score. Conclusion: This study outcomes of CTSs severity and functional status with the BCTQ recommend that this tool and its scales indicate the association between CTSs baseline characteristics and impairments resulting from CTS in the clinical context.

Concomitant Ipsilateral Knee Pain Is Associated With Worse Preoperative Functional Status and Short-Term Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome

Purpose(1) To determine the effect of concomitant IKP (ipsilateral knee pain) on short-term outcomes after hip arthroscopic treatment of FAIS (femoroacetabular impingement syndrome), and (2) to determine whether IKP would improve with surgery. MethodsData between September 2021 and May 2022 was reviewed. Patients diagnosed with FAIS and underwent hip arthroscopy with minimum of 1-year follow-up were included. Exclusion criteria were prior ipsilateral hip or knee surgery, hip Tönnis grade > 1, knee Kellgren-Lawrence grade > 2, hip conditions (avascular necrosis, Legg-Calve-Perthes disease, pigmented villonodular synovitis, osteoid osteoma, synovial chondromatosis and developmental dysplasia of the hip), and spine diseases. A knee MRI was performed on all patients preoperatively. Preoperative and short-term (1 year) patient-reported outcome (PRO) scores were collected for Hip Sports Activity Scale (HSAS), weekly sports participation, modified Harris Hip Score (mHHS), international Hip Outcome Tool, 12-component form (iHOT-12), visual analog pain scale (VAS) of the hip and ipsilateral knee. The percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) of mHHS and iHOT-12 were calculated. Multivariate regression analysis was performed to determine the effect of IKP severity on postoperative outcomes. Subgroup analysis was performed between patients with and without IKP alleviation. ResultsAmong the 107 patients included, 47 presented preoperative IKP. Compared to patients without IKP, the IKP cohort had comparable knee structural abnormalities (all with P > 0.05). Still, it showed inferior preoperative mHHS (P = .003), iHOT-12 (P = .016), hip VAS (P = .001), and weekly sports participation (P = .039). Postoperatively, the IKP cohort had lower mHHS (P = .046), iHOT-12 (P = .037), and hip VAS (P = .003), and were less likely to achieve PASS of mHHS (P = .021) and iHOT-12 (P = .049). Patients with higher knee VAS were less likely to achieve PASS of mHHS (OR = 0.61; P = .023). Within the IKP group, knee VAS improved from 2.3 to 1.0 (P < .001). Those with alleviated IKP showed superior postoperative iHOT-12 (P = .038) compared to those with persistent IKP. ConclusionConcomitant IKP at baseline negatively affected preoperative status and short-term PROs after arthroscopic treatment of FAIS. Patients with IKP were less likely to meet clinical thresholds. Most patients achieved IKP alleviation postoperatively, which was associated with superior clinical outcomes. Level of evidenceIII, retrospective cohort study.

Digital Phenotyping for Monitoring and Disease Trajectory Prediction of Patients With Cancer: Protocol for a Prospective Observational Cohort Study.

Timely recognition of cancer progression and treatment complications is important for treatment guidance. Digital phenotyping is a promising method for precise and remote monitoring of patients in their natural environments by using passively generated data from sensors of personal wearable devices. Further studies are needed to better understand the potential clinical benefits of digital phenotyping approaches to optimize care of patients with cancer. We aim to evaluate whether passively generated data from smartphone sensors are feasible for remote monitoring of patients with cancer to predict their disease trajectories and patient-centered health outcomes. We will recruit 200 patients undergoing treatment for cancer. Patients will be followed up for 6 months. Passively generated data by sensors of personal smartphone devices (eg, accelerometer, gyroscope, GPS) will be continuously collected using the developed LAIMA smartphone app during follow-up. We will evaluate (1) mobility data by using an accelerometer (mean time of active period, mean time of exertional physical activity, distance covered per day, duration of inactive period), GPS (places of interest visited daily, hospital visits), and gyroscope sensors and (2) sociability indices (frequency of duration of phone calls, frequency and length of text messages, and internet browsing time). Every 2 weeks, patients will be asked to complete questionnaires pertaining to quality of life (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30]), depression symptoms (Patient Health Questionnaire-9 [PHQ-9]), and anxiety symptoms (General Anxiety Disorder-7 [GAD-7]) that will be deployed via the LAIMA app. Clinic visits will take place at 1-3 months and 3-6 months of the study. Patients will be evaluated for disease progression, cancer and treatment complications, and functional status (Eastern Cooperative Oncology Group) by the study oncologist and will complete the questionnaire for evaluating quality of life (EORTC QLQ-C30), depression symptoms (PHQ-9), and anxiety symptoms (GAD-7). We will examine the associations among digital, clinical, and patient-reported health outcomes to develop prediction models with clinically meaningful outcomes. As of July 2023, we have reached the planned recruitment target, and patients are undergoing follow-up. Data collection is expected to be completed by September 2023. The final results should be available within 6 months after study completion. This study will provide in-depth insight into temporally and spatially precise trajectories of patients with cancer that will provide a novel digital health approach and will inform the design of future interventional clinical trials in oncology. Our findings will allow a better understanding of the potential clinical value of passively generated smartphone sensor data (digital phenotyping) for continuous and real-time monitoring of patients with cancer for treatment side effects, cancer complications, functional status, and patient-reported outcomes as well as prediction of disease progression or trajectories. PRR1-10.2196/49096.

Patient randomised controlled trial of technology enabled strategies to promote treatment adherence in liver transplantation: rationale and design of the TEST trial

Background and aimsLiver transplantation is a life-saving procedure for end-stage liver disease. However, post-transplant medication regimens are complex and non-adherence is common. Post-transplant medication non-adherence is associated with graft rejection,...

Genetic liability to frailty in relation to functional outcome after ischemic stroke.

Frailty appears to be associated with unfavorable prognosis after stroke in observational studies, but the causality remains largely unknown. The aim of this study is to investigate the potential causal effect of frailty on functional outcome at 3 months after ischemic stroke using the Mendelian randomization (MR) framework. Genetic instruments for frailty index were identified in a genome-wide association study meta-analysis including 175,226 individuals of European descent. Corresponding genetic association estimates for functional outcome after ischemic stroke at 90 days were taken from the Genetic of Ischemic Stroke Functional Outcome (GISCOME) network of 6021 patients. We performed inverse-variance weighted MR as the main analyses, followed by several alternate methods and sensitivity analyses. In univariable MR, we found evidence that genetically predicted higher frailty index (odds ratio (OR) = 5.12; 95% confidence interval (CI) = 1.31-20.09; p = 0.019) was associated with worse functional outcome (modified Rankin Scale score ⩾3) after ischemic stroke. In further multivariable MR adjusting for potential confounding traits including body mass index, C-reactive protein, inflammatory bowel disease, and smoking initiation, the overall patterns between genetic liability to frailty and poor functional outcome status remained. Sensitivity analyses with complementary methods and with model unadjusted for baseline stroke severity (OR = 4.19; 95% CI = 1.26-13.90; p = 0.019) yielded broadly concordant results. The present MR study suggested a possible causal effect of frailty on poor functional outcome after ischemic stroke. Frailty might represent a potential target for intervention to improve recovery after ischemic stroke.

Functional Status Changes in Patients Receiving Palliative Care Consult During COVID-19 Pandemic.

Hospitalized patients with functional impairment have higher symptom burden and mortality. Little is known about how increased patient volume and acuity during the coronavirus disease 2019 (COVID-19) pandemic affected access to palliative care among patients with functional impairment. To examine changes in functional status and hospital outcomes among patients receiving inpatient palliative care consultation before, during and after the COVID-19 pandemic. We conducted a retrospective, multisite cohort study of all adult patients (≥ 18 years) admitted to four hospitals in New York City, USA, who received inpatient palliative care consultation between March 1, 2019 and February 28, 2022 with documented functional status at the time of consultation measured by Karnofsky Performance Status scale. Among 13,180 eligible patients identified, patients' functional status at the time of consultation decreased as palliative care consult volume increased with the onset of the pandemic. Compared to pre-pandemic, there was a statistically significant trend of lower functional status (P < 0.001) and higher in-hospital mortality (P < 0.001) among patients with noncancer and non-COVID-19 diagnoses two years after the pandemic. In contrast, patients with cancer had a statistically significant trend of higher functional status (P < 0.001) and no significant changes in in-hospital mortality over time. As the healthcare system was stressed with high demand and limited resources, palliative care consultation prioritized highest acuity patients by shifting towards those with lower functional status and higher in-hospital mortality. This shift disproportionately affected noncancer patients. Innovative approaches to ensure upstream palliative care consultation during increased resource constraints are needed.

Loss of independence after traumatic injury: A patient-centered study

BackgroundPatient-reported outcomes of postdischarge functional status can provide insight into patient recovery experiences not typically reflected in trauma registries. Injuries may be characterized by a long-term loss of independence. We sought to examine factors predictive of patient-reported, postdischarge loss of independence in trauma patients. MethodsTrauma patients admitted to 1 of 3 level I trauma centers were contacted by phone between 6 to 12 months after hospital discharge to complete the Revised Trauma Quality of Life survey. Loss of independence was defined as a new need for assistance with at least one activity of daily living or transition to living in an institutional setting. Patients with severe traumatic brain injury or spinal cord injury were excluded. Multivariable logistic regression analyses were performed to identify predictors of loss of independence. Results801 patients were included. The median age was 65 (interquartile range: 46–76) years, 46.1% were female, and the median Injury Severity Score was 9 (interquartile range: 9–13). Two hundred seventy-one patients (33.8%) experienced a loss of independence, most commonly requiring assistance walking up stairs. The main predictors of loss of independence were persistent daily pain (odds ratio: 3.83, 95% confidence interval: [2.90–5.04], P < .001), length of hospital stay (odds ratio: 1.04, 95% confidence interval: [1.01–1.09], P = .021) and income below the national median (odds ratio: 1.46, 95% confidence interval: [1.12–1.91], P = .006). Perceived social support (odds ratio: 0.75, 95% confidence interval: [0.66–0.85], P < .001) was protective against loss of independence. ConclusionInjury is associated with a relatively high rate of long-term loss of independence. Ensuring adequate social support systems for patients postdischarge may help them regain functional independence after injury.