Higher Functional Status Research Articles

A comprehensive assessment for community-based, person-centered care for older adults

BackgroundMany health and social needs can be assessed and met in community settings, where lower-cost, person-centered, preventative and proactive services predominate. This study reports on the development and implementation of a person-centered care model integrating dental, social, and health services for low-income older adults at a community dental clinic co-located within a senior wellness center.MethodsA digital comprehensive geriatric assessment (CGA) and referral system linking medical, dental, and psychosocial needs by real-time CGA-derived metrics for 996 older adults (age ≥ 60) was implemented in 2016–2018 as part of a continuous quality improvement project. This study aims to describe: 1) the development and content of a new CGA; 2) CGA implementation, workflows, triage, referrals; 3) correlations between CGA domains, and adjusted regression models, assessing associations with self-reported recent hospitalizations, emergency department (ED) visits, and clinically-assessed dental urgency.ResultsThe multidisciplinary team from the senior wellness and dental centers planned and implemented a CGA that included standard medical history along with validated instruments for functional status, mental health and social determinants, and added oral health. Care navigators employed the CGA with 996 older adults, and made 1139 referrals (dental = 797, care coordination = 163, social work = 90, mental health = 32). CGA dimensions correlated between oral health, medical status, depressive symptoms, isolation, and reduced quality of life (QoL). Pain, medical symptoms, isolation and depressive symptoms were associated with poorer self-reported health, while general health was most strongly correlated with lower depressive symptoms, and higher functional status and QoL. Isolation was the strongest correlate of lower QoL.Adjusted odds ratios identified social and medical factors associated with recent hospitalization and ED visits. General and oral health were associated with dental urgency. Dental urgency was most strongly associated with general health (AOR = 1.78,95%CI [1.31, 2.43]), dental symptoms (AOR = 2.39,95%CI [1.78, 3.20]), dental pain (AOR = 2.06,95%CI [1.55–2.74]), and difficulty chewing (AOR = 2.80, 95%CI [2.09–3.76]). Dental symptoms were associated with recent ED visits (AOR = 1.61, 95%CI [1.12–2.30]) or hospitalizations (AOR = 1.47, 95%CI [1.04–2.10]).ConclusionCommunity-based inter-professional care is feasible with CGAs that include medical, dental, and social factors. A person-centered care model requires coordination supported by new workflows. Real-time metrics-based triage process provided efficient means for client review and a robust process to surface needs in complex cases.

P1565THE COMBINATION OF MALNUTRITION-INFLAMMATION AND LIMITATIONS IN FUNCTIONAL STATUS IS ASSOCIATED WITH A HIGH RISK OF MORTALITY IN HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY

Abstract Background and Aims The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in haemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients. Method We analysed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (<3.8 g/dL) and high serum C-reactive protein (>3mg/L in Japan; >10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (score ranges from 0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, haemoglobin level, and time on dialysis therapy. Results The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to this reference group, the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups. Conclusion The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS status may plausibly help to direct interventions to improve patients’ experiences and lessen adverse clinical outcomes in the HD setting.

P1456PREVALENCE OF HEPATITIS B CORE ANTIBODY AND OCCULT INFECTION AMONG HAEMODIALYSIS PATIENTS

Abstract Background and Aims Haemodialysis (HD) patients are highly susceptible to blood borne virus infections and prevention strategies include surveillance, segregation, vaccination and strict implementation of standard precautions. As per new guidelines it is mandatory for all HD patients to be tested for hepatitis B core antibody at the beginning of renal replacement therapy. In the present study we sought to determine the prevalence of core antibody positivity and occult HBV infection as evidenced by viraemia in hepatitis B surface antigen (HBsAg) negative patients on maintenance haemodialysis. Method All HD patients (aged≥ 18 years) who were dialyzing in 2019 were included in this cross-sectional study. Retrospective data based on one-off screening for hepatitis B core antibody total (anti-HBc) for all HBsAg negative patients (study population) carried out between May and Oct 2019 was used for analysis. Information was gathered on HBsAg, anti-HBc antibody, surface antibody (anti-HBs) and Hepatitis B virus (HBV) DNA. All anti-HBc antibody positive patients were tested for HBV DNA using quantitative PCR assay. Patients were classified as immune (anti-HBs >10 IU/L) and non-immune (anti-HBs ≤10 IU/L) based on surface antibody levels. Demographic data were compared using Chi square test for categorical variables and Independent T test/Mann Whitney U test for continuous variables between the patients with and without HBV core antibody. Baseline characteristics were compared between the immune and non-immune groups using Chi square test and Independent T test/Mann Whitney U test as appropriate. Results A total of 3704 HBsAg negative HD patients (mean age 63.5±11.3 years, 56.1% male, 57.7% Chinese, 65.4% diabetic and mean vintage of 5.8±5.4 years) were included in the study after exclusion of 147 patients (3.8%) who had chronic HBV infection from the entire HD cohort of 3851 patients. 895 (24.2%) showed evidence of past HBV infection (anti-HBc positive but HBsAg negative) with only 3 (0.1%) patients having detectable HBV DNA. The HBV core antibody positive patients were predominantly elderly, Chinese, males and with high medical dependency compared to the patients without HBV core antibodies (p<0.001). There were no statistically significant differences in diabetic status and dialysis vintage between the patients with and without HBV core antibody. 3202 (86.4%) patients were immune following vaccination (anti-HBs >10 IU/L). The non-immune patients (13.5%) were more likely to be diabetic, with high medical dependency and lower vintage compared to immune patients (p<0.001). Age, race and gender did not differ significantly between the immune and non-immune patients. Conclusion The prevalence of hepatitis B core antibody positivity was 24.2% in our large racially diverse haemodialysis cohort but the presence of occult HBV was low (0.1%). Elderly Chinese males with high comorbidity and poor functional status were more likely to have evidence of past HBV infection. Occult HBV infection has implications in policy development for the prevention of HBV infection in dialysis centres.

Functional status and survival in patients ≥85 years of age who have keratinocyte carcinoma: A retrospective cohort study

Functional status assessment may help estimate which patients ≥85years of age will benefit from surgical treatment for keratinocyte carcinoma (KC), but predictive value for short-term survival in this population has not been determined. We sought to assess the predictive value of functional status for short-term survival in patients ≥85years of age who have KC. This was a retrospective cohort review of 238 patients ≥85years of age who presented forthemanagement of KC between 2010 and 2015. Functional status was assessed with the KarnofskyPerformance Scale (KPS) and Katz Activities of Daily Living (ADL) index. Overall survival was determined. Lower functional status scores of KPS ≤40 and Katz ADL ≤4 were associated with 37% and 53% survival at 2years, respectively. Retrospective design and single-center study. In this study, KPS and Katz ADL predicted short-term survival. Patients with low functional status scores had significantly decreased survival at 2years, with double the death rate of patients with high functional status. Functional status should be considered during shared decision-making for elderly individuals who are seeking treatment for KC.

Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model.

IntroductionEarly access to cancer palliative care is recommended. Descriptions of structures and processes of outpatient palliative care clinics operated within smaller hospitals are scarce. This paper presents the development and operation of a fully integrated cancer and palliative care outpatient clinic at a local hospital in a rural region of Mid-Norway offering palliative care concurrent with cancer treatment. A standardized care pathway was applied.MethodsPalliative care is in Norway part of the public healthcare system. Official recommendations recent years point out action points to improve delivery of palliative care. An integrated cancer and palliative care outpatient clinic at a local hospital and an innovative care delivery model was developed and operated in this setting. Patients were recruited for a descriptive study of the patient population. Clinical data were collected by clinical staff and 13 symptom intensities were reported by the patients.ResultsCancer and palliative care were provided by one team of healthcare professionals trained in both fields. There was a close collaboration with the other departments at the hospital, with its affiliated tertiary hospital, and with community health and care services to provide timely referral, enhanced continuity, and improved coordination of care. Eighty-eight patients were included. Mean age was 65.6 years, the most common cancer diagnoses were digestive organs (22.7%), male genital organs (20.5%) or breast (25.0%), 75.0% had metastatic or locally advanced cancer, 59.1% were treated with non-curative intention and 93.1% had Karnofsky Performance Status ≥ 80%. Median scores of individual symptoms ranged from 0 to 3 (numerical rating scale, 0–10) and 61.0% reported at least one clinically significant symptom rating (≥ 4).ConclusionThis delivery model of integrated outpatient cancer and palliative care is particularly relevant in rural regions allowing cancer patients access to palliative care earlier in the disease trajectory and closer to home

Why do family dementia caregivers reject caregiver support services? Analyzing types of rejection and associated health-impairments in a cluster-randomized controlled intervention trial

BackgroundAlthough there are a number of support services accessible for most family dementia caregivers, many caregivers reject available and affordable support. Previous research suggests that rejections of support services may result from insufficient fit of available services with caregivers’ unmet needs and a lack of acknowledgement of caregivers’ unmet needs and associated support services. The present study investigates (a) the number, proportion and types of caregivers’ rejection on recommended tailored support, (b) socio-demographic and clinical determinants of caregiver’s rejection of both people with dementia (PwD) and caregivers, and (c) caregivers’ health-related variables related to caregivers’ rejection.MethodsCaregivers’ rejection of tailored support services was identified based on a standardized, computerized unmet needs assessment conducted by dementia-specific qualified nurses. The present analysis is based on data of n = 226 dyads of caregivers and their community-dwelling PwD who participated in a general practitioner (GP)-based, cluster-randomized intervention trial. The trial was approved by the Ethical Committee of the Chamber of Physicians of Mecklenburg-Western Pomerania, registry number BB 20/11. Data analyses were conducted using Stata/IC 13.1. We conducted Welch’s t-test, Pearson’s product-moment correlation, and conditional negative binomial regression models with random effects for GP to account for over-dispersed count data.ResultsIn sum, n = 505 unmet needs were identified and the same number of tailored recommendations were identified for n = 171 family dementia caregivers from the intervention group at baseline. For n = 55 family dementia caregivers not a single unmet need and recommendation were identified. A total of 17.6% (n = 89) of the recommendations were rejected by caregivers. Rejection rates of caregivers differed by type of recommendation. Whereas caregivers’ rejection rate on recommendations concerning mental health (3.6%), physical health (2.5%), and social, legal, and financial affairs (0%) were low, caregivers’ rejection rates concerning social integration (especially caregiver supporting groups) was high (71.7%). Thus, the rejections of family dementia caregivers are mainly linked to the delegation to caregiver supporting groups. Caregivers’ rejections were mainly related to personal factors of caregivers (n = 66), service-related factors (n = 6), relational factors (n = 1), and other factors (n = 17).Furthermore, our results showed that the number of caregivers’ rejections was associated with a higher functional status of the PwD and are mainly associated with the rejection of caregiver supporting groups. Thus, caregivers visit supporting groups more often when the PwD shows low abilities in activities of daily living. Importantly, this is independent of the status of cognition and depression of the PwD as well as the physical and mental health of the family dementia caregivers.ConclusionsOur results underline the importance of understanding factors that determine caregivers’ rejection of support services. These need to be specifically addressed in tailored solutions for caregivers’ support services.Trial registrationClinicalTrials.gov Identifier: NCT01401582 (date: July 25, 2011, prospective registered).

ФУНКЦИОНАЛЬНЫЙ СТАТУС ЯКУТСКОГО ЯЗЫКА В РЕСПУБЛИКЕ САХА (ЯКУТИЯ)

Relying on the results of a sociolinguistic analysis of the actual functional status of the Yakut language in bilingual communicative space and using the data of previous surveys, the author shows that urbanization processes, promoting the growth of titular population in the capital of the republic, contribute to raising the functional status of the Yakut language basically in non-regulated spheres of the social and cultural system. The persistently high functional status of the Russian language and certain extra-linguistic factors determine the less frequent usage of the Yakut language against the background of the official bilingualism.

Severity of Preoperative Myelopathy Symptoms Affects Patient-reported Outcomes, Satisfaction, and Return to Work After Anterior Cervical Discectomy and Fusion for Degenerative Cervical Myelopathy.

Retrospective review of prospectively-collected registry data. To compare the patient-reported outcomes, satisfaction, and return to work among a large cohort of patients stratified by preoperative myelopathy severity undergoing Anterior Cervical Discectomy and Fusion (ACDF) for Degenerative Cervical Myelopathy. Recent clinical practice guidelines noted a lack of studies stratifying their sample based on preoperative disease severity. The benefits of early surgical intervention for patients with mild myelopathy remain uncertain. A prospectively-maintained registry was retrospectively reviewed for all patients who underwent primary ACDF for Degenerative Cervical Myelopathy. Patients were stratified based on severity of preoperative myelopathy symptoms according to the Japanese Orthopaedic Association (JOA) scale: mild (>13), moderate (9-13), or severe (<9). Patients were prospectively followed for at least 2 years. In total, 219 patients were included: 74 mild, 94 moderate, and 51 severe cases. The mild group had significantly better Neurogenic Symptoms (NS), Neck Disability Index (NDI), SF-36 Physical (PCS), and Mental Component Summary at baseline (P < 0.05). Neck and arm pain scores were similar at all time points. At 2 years, the severe group still had significantly worse patient-reported outcomes and lower rates of satisfaction, expectation fulfilment and return to work. However, they had significantly greater improvement in JOA, Neurogenic Symptoms, NDI, PCS, and Mental Component Summary, and a larger proportion attained minimal clinically important difference (MCID) for NDI and PCS. All three groups had similar proportions attaining MCID for JOA. Patients with severe myelopathy experienced a greater improvement after ACDF. Although fewer patients attained MCID, early surgical intervention for patients with mild myelopathy should also be considered, as this may allow patients to maintain their higher functional status. They also had high rates of postoperative satisfaction and return to work. The clinical trajectory outlined in this study may provide valuable prognostic information for patients. 3.

Functional Status Measured at Hospital Discharge is Strongly Associated With Out-of-hospital Mortality and Re-admission in Non-cardiac Vascular Surgery Patients Surviving Admission

Introduction: Evaluation of the functional dependency of vascular surgery patients has proved to correlate with short-term mortality but lacks data in the long-term. The aim of this study was to determine the correlation between the functional status at discharge and the out-of-hospital mortality. Methods: We performed an observational cohort study including non-cardiac vascular surgery patients (open and endovascular) surviving hospital admission of 18 years or older in a tertiary care medical center. The exposure of interest was functional status determined by a licensed therapist at hospital discharge and rated based on qualitative categories adapted from the Functional Independence Measure. The primary outcome was all cause 90-day mortality after hospital discharge. Adjusted odds ratios were estimated by multivariable logistic regression models. Results: This cohort included 2318 patients (male 51%; mean age 61±17.7). After evaluation by a physiotherapist, 425 patients scored the lowest functional status, 631 scored moderately low, 681 patients moderately high and 581 patients scored the highest functional status. The unadjusted association of lowest functional status with 90-day mortality showed a 6.04-fold increase of odds (95% confidence interval(CI), 3.16-11.52) compared to patients with the highest functional status. After adjustement for age, gender, race, Deyo-Charlson index, patient type (surgical vs. medical), length of stay and vascular surgery type the association of lowest functional status with 90-day mortality was increased 3.41-fold (95% confidence interval(CI), 1.70-6.84) compared to patients with the highest functional status. When excluding patients who underwent venous interventions the adjusted odds ratio was 6.76 (95%CI, 2.53-18.12) for the 90-day mortality post-discharge. The odds for re-admission within 30-days was 1.5 fold increased in patients who scored the lowest functional status. Conclusion: In vascular surgery patients surviving admission, functional status is strongly associated with out-of-hospital mortality and readmission rate. This is especially apparent in patient who underwent an arterial vascular procedure. Ultimately, functional status could become a prevention target to improve the post-operative survival of vascular surgery patients by optimizing the functional status in the preoperative and postoperative setting. Disclosure: Nothing to disclose

Distinct Stress Profiles Among Oncology Patients Undergoing Chemotherapy

ContextCancer and its treatment are inherently stressful and stress impacts important patient outcomes. Patients vary considerably in their response to stress. Understanding this variability requires a patient-centered multidimensional approach. ObjectivesThe objectives of this study were to identify and characterize patient subgroups with distinct multidimensional stress profiles (stress appraisal, exposure, and adaptation) during cancer treatment. MethodsAmong 957 patients undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer, latent profile analysis was performed to identify patient subgroups using concurrent evaluations of global (Perceived Stress Scale) and cancer-specific (Impact of Events Scale–Revised) stress, lifetime stress exposure (Life Stressor Checklist–Revised), and resilience (Connor-Davidson Resilience Scale-10). ResultsThree latent classes were identified: “Normative” (54.3%; intermediate global stress and resilience, lower cancer-related stress, lowest life stress); “Stressed” (39.9%; highest global and cancer-specific stress scores, lowest resilience, most life stress); and “Resilient” (5.7%; lowest global stress, cancer-specific stress comparable to Normative class, highest resilience, intermediate life stress). Characteristics that distinguished the Stressed from the Normative class included the following: younger age, female gender, lower socioeconomic status, unmarried/partnered, living alone, poorer functional status, and higher comorbidity burden. Compared to Stressed patients, Resilient patients were more likely to be partnered, to not live alone, and had a higher functional status. No demographic or clinical characteristics differentiated Normative from Resilient patients. Exposure to specific life stressors differed significantly among the classes. ConclusionA subset of patients warrants intensive psychosocial intervention to reduce stress and improve adaptation to cancer. Intervention efforts may be informed by further study of Resilient patients.

ISSUES IN HOME CARE AND CAREGIVING ARE MEDICAL FOSTER HOMES SERVING VETERANS WHO HAVE SIMILAR FUNCTIONAL IMPAIRMENT AS TYPICAL NURSING HOME RESIDENTS?

The Veterans Health Administration’s (VHA’s) Medical Foster Home (MFH) program was developed as a community-based alternative to institutional care. This study compares the clinical and functional characteristics of Veterans in the VHA MFH program to residents in nursing homes to understand whether MFHs substitute for nursing home care or serve a population with different care needs. All data were derived from Minimum Data Set (MDS) 3.0 assessments. Nurses collected MDS assessments from Veterans (n=92) in 4 MFHs between April 2014-December 2015. Data for nursing home residents were from a national nursing home dataset of residents with an annual MDS assessment in 2014 (n=818,287). We found that MFH Veterans were more likely to be male, have higher functional status, and perform more activities of daily living (ADLs) independently relative to nursing home residents (p<0.01 for all comparisons). Yet, a similar proportion of MFH Veterans and nursing home residents required total assistance in 9 of the 11 measured ADLs. Cognitive impairment, neurological comorbidity, and psychiatric comorbidity were similar in both cohorts; however, MFH Veterans were more likely to have traumatic brain injury (p<0.01), higher Patient Health Questionnaire (PHQ)-9 depression scores (p=0.04) and less likely to have anxiety (p=0.05). Our results suggest there are two distinct MFH populations, one with lower-care needs and another with Veterans completely dependent in performing ADLs. Given these findings, MFHs may be an ideal setting for both low-care nursing home residents with less functional impairment as well as residents with higher care needs who desire community-based long-term care.

RISK FACTORS FOR DISENROLLMENT AMONG HOME HOSPICE PATIENTS WITH DEMENTIA

Hospice delivers care to a substantial and growing number of individuals with primary and comorbid dementia diagnoses. Dementia diagnosis and racial/ethnic minority status are risk factors for hospice disenrollment. However, little research examines racial/ethnic disparities and other risk factors for hospice disenrollment among hospice patients with dementia. This paper uses multinomial logistic regression to explore sociodemographic and functional status risk factors for hospice disenrollment among 3,949 home hospice recipients with primary or comorbid dementia. Results indicate that patients with a primary dementia diagnosis, racial/ethnic minority groups, and those higher functional status have elevated risk of disenrollment due to hospitalization, disqualification, and electively leaving hospice care. Additional research is needed to understand why primary dementia diagnosis and underrepresented racial/ethnic status are associated with multiple kinds of hospice disenrollment so that hospice practice can be tailored to respond to the needs of these individuals.

Return to Baseline Functional Status in Older Women Undergoing Surgery for Pelvic Organ Prolapse.

The aim of the study was to determine the rate of return to baseline functional status 3 months after surgery for pelvic organ prolapse (POP) in women 65 years or older. This is a multicenter prospective cohort study of women older than 65 years undergoing POP surgery. Functional status was determined by the Activities Assessment Scale at the preoperative visit and 3 months after surgery. We compared a variety of clinical variables and preoperative functional status scores for women who worsened, improved, or returned to baseline functional status after surgery using univariable and multivariable analysis. A total of 192 women were enrolled in the study. Of 176 women who completed both sets of questionnaires, 59% improved, 35% returned, and 6% worsened from their baseline functional status. Variables significantly associated with postoperative functional status score were depression (P < 0.002) and preoperative functional status score (P < 0.001). The group that improved from baseline had the lowest (worst) preoperative functional status score (78.7 ± 16.4), whereas the group that worsened after surgery had the highest (best) preoperative functional status score (98.6 ± 2.2). After adjusting for age and depression, higher preoperative functional status score was predictive of failure to return to baseline functional status. Most older women undergoing surgery for POP, including those with low preoperative functional status, return to or improve from their baseline functional status within 3 months of surgery. Women with higher functional status before surgery are less likely to report improvement in physical functioning after surgery.

Assessment of the Functional State of Green Plantings and the Accumulation of Heavy Metals by Vegetation in Urban Green Areas for Various Purposes

This article is devoted to the ecological problem of effective urban landscaping and increasing the role of green plantings in stabilizing the environment. The paper summarizes the material on the complex bioecological assessment of functionally different urban green areas of Vladivostok. There are six types of urban plantings: ordinary plantings, squares, intraquarter gardening, old city public gardens, city parks, and intraurban recreational forests. The questions of the specificity of their species composition, conditions of growth, and the intensity of influencing anthropogenic press are considered. An almost fourfold increase of environmental stress in the following series is noted: city parks → intra-quarter gardening → intraurban recreational forests → old city public gardens → line plantings → squares. Most attention is paid to a comparative analysis of tree–shrub species and plantation accumulation of heavy metals: the main markers of technogenic pollution of the urban environment. The correlation regularities in the accumulation of heavy metals by plants in the conditions of Vladivostok urban ecosystems were found and a geochemical association of the main metal pollutants was established: Fe4.1 Zn2.0 Pb1.9 Cu1,4 Ni1.3. It is shown that the intensity of heavy-metal transformation by green plantings increases 3 times in a ranked series: intraurban recreational forest → city parks → old city public gardens → intra-quarter gardening → squares → line plantings. On the basis of the research and earlier results, a complex assessment of the functional condition of city green plantings is performed. For a practical solution, the author offers the functional status index (IFS) of plantings as an integral indicator of the ecological condition of vegetation and soils of green plantings and their capability for heavy-metal transformation in the conditions of the urbanized environment. The high functional status of ordinary plantings and squares, caused mainly by the active accumulation of heavy metals by soils and plants, is noted. This index is one and a half times lower for old city gardens and intraurban recreational forests. In conclusion, the author recommends using the results in the organization of a rational system of urban landscaping and differentiated measures of care for plantations of various functional purposes.

LPTO-09. INTRATHECAL TOPOTECAN FOR LEPTOMENINGEAL METASTASIS IN SOLID TUMORS: THE MD ANDERSON EXPERIENCE

BACKGROUND: Leptomeningeal metastasis (LM) is a devastating complication of cancer resulting in progressive neurologic decline. Although intrathecal (IT) methotrexate and cytarabine are commonly used for solid tumor LM, we routinely use IT topotecan due to previously demonstrated similar efficacy and modest side effect profile. We report updated data on our experience. METHODS: We reviewed clinical records of patients with solid tumor LM treated with IT topotecan at MD Anderson Cancer Center from 2008–2018. Patient characteristics and course were summarized by descriptive statistics. Overall survival (OS) was estimated with Kaplan-Meier, and the association of KPS with OS evaluated with log-rank test. RESULTS: 138 patients were treated with IT topotecan. The median age was 54 years (range, 22–76), 81% were female. Breast cancer (62%) was the most common primary, then lung (21%), melanoma (4%). Median time from primary diagnosis to LM was 3.4 (range, 0.07–25.2) years. LM was diagnosed by CSF cytology alone in 8 (6%), MRI alone in 21 (15%), CSF+MRI in 108 (78%). Patients most commonly presented with headache (39%) or sensory changes (18%), and had a median KPS of 80 (range, 60–100). 66% had prior/concurrent brain metastasis. 71 patients (52%) received WBRT following LM diagnosis. 41% had adverse effects, most commonly nausea/vomiting (22%) and headache (20%). The majority were grade 1 (63%); 7 were grade 4 (2 Ommaya malfunctions and 5 infections). Patients received a median of 9 (range, 1–79) doses, most stopped due to CNS progression (42%). Median OS was 6.5 months (95% CI 4.7, 7.8). OS was 3.8 mos with KPS ≤70, vs. 7.5 mos with KPS >70 (p< 0.001). CONCLUSIONS: IT topotecan has a modest side effect profile. Patients with higher functional status at diagnosis had significantly better survival. This study supports the continued use of IT topotecan as a well-tolerated option for LM.

The pre- and postoperative course of functional status in patients undergoing esophageal cancer surgery

IntroductionTo optimally target physiotherapy treatment, knowledge of the pre- and postoperative course of functional status in patients undergoing esophagectomy is required. The aim of this prospective longitudinal study was to investigate the course of functional status in patients with esophageal cancer before and after esophagectomy. Materials and methodsFunctional status outcome measures of patients with esophageal cancer who underwent surgery between March 2012 and June 2016 were prospectively measured at 3 months and at 1 day before surgery and at 1 week and at 3 months after surgery. Analysis of repeated measurements with the mixed model approach was used to study changes over time. ResultsHundred fifty-five patients were measured at 3 months and at 1 day before surgery, of which 109 (70.3%) at 1 week and 60 (38.7%) at 3 months after surgery. Mean (SD) age at surgery was 63.5 years (9.3), and 122 patients (78.7%) were male. The incidence of postoperative complications was 83 (53.5%). Three months postoperatively, functional status measures returned to baseline levels, except from handgrip strength (beta [95% CI] −6.2 [-11.3 to −1.1]; P = 0.02) and fatigue (4.7 [0.7to 8.7]; P = 0.02). No differences were observed in the course of functional status between patients with and without postoperative complications. ConclusionFunctional status of patients undergoing esophagectomy returned to baseline values three months after surgery, despite the high incidence of postoperative complications. This requires rethinking the concept of prehabilitation, where clearly not all patients benefit from high functional status to prevent postoperative complications.

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up

To identify predictors of achieving clinically significant sport function in athletic patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Data were analyzed for all patients who treated for FAIS between 2012 to 2016 and reported being athletes, including recreational and competitive athletes. All patients had a minimum of 2-year follow-up with patient-reported athletic function in the form of the Hip Outcome Score-Sport Specific (HOS-SS), visual analog score-pain, and patient satisfaction. Achieving clinically significant sports function was defined as either reaching the minimally clinical important difference (MCID) or the patient acceptable symptomatic state (PASS) for HOS-SS at 2-year follow-up. An exploratory factor analysis was used to determine specific domains for the predictor variables and to reduce the redundancy in these variables. A logistic regression analysis was used to identify significant predictors of achieving clinically significant sports function [corrected]. Of 780 qualifying patients, 626 completed the 2-year minimum follow-up (80%), with a mean age and body mass index of 31.6 ± 11.9years and 24.6 ± 8.6, respectively. A total of 500 patients (86.5%) achieved high functional status, with 77.9% achieving MCID HOS-SS and 68.7% achieving PASS HOS-SS. Logistic regression analysis identified increased the α angle (odds ratio [OR] 0.976; P= .027), preoperative pain duration (OR 0.729; P= .011), and body mass index (BMI) (OR 0.919; P= .018), as well as the presence of femoral chondral defects (OR 0.769; P= .013), as negative predictors for achieving MCID. Negative predictors for achieving PASS HOS-SS included the presence of a preoperative limp (OR 0.384; P= .013), anxiety or depression (OR 0.561; P= .041), and increased BMI (OR 0.945; P= .018) and preoperative pain duration (OR 0.987; P<.001). Several predictors of achieving clinically significant sport function performance exist, including a history of anxiety or depression, BMI, preoperative α angle, limp, femoral chondral damage, *and preoperative symptom duration. Our results suggest there are both modifiable and nonmodifiable preoperative factors that have the potential to predict achieving high athletic function after hip arthroscopy for FAIS. IV, Case Series.

Quality of life in patients with midgut NET following peptide receptor radionuclide therapy.

There is convincing evidence that peptide receptor radionuclide therapy (PRRT) using 177Lu-DOTATATE compared to octreotide therapy has a positive effect on overall survival and progression-free survival in midgut neuroendocrine tumors (NET). The current study analyzed health-related quality of life (QoL) in patients undergoing PRRT with a special focus on differences in functional performance. In our study, 70 patients (39 men or 31 female) suffering from midgut NET were included, with a mean age of 64.2years. Functional performance was assessed by the index of the Eastern Cooperative of Oncology Group (ECOG). Thirty-three patients (47%) showed ECOG 0, 31 patients (44%) ECOG 1, and six patients (9%) ECOG 2. Health-related QoL was assessed by the EORTC QLQ-C30 questionnaire filled in at baseline and 3months after each PRRT cycle. The median cumulative administered activity was 27.4GBq. Global health status significantly improved compared to baseline status after 1st (p = 0.05), 2nd (p = 0.004), and 3rd (p = 0.04) treatment cycle. Analyzing specific aspects of QoL, emotional functioning significantly improved after 1st and 2nd treatment cycle (both p < 0.001) as well as after 3rd cycle (p = 0.001). With regard to cognitive functioning, there was a significant improvement after 1st and 2nd treatment cycle (p = 0.003 and p = 0.05 respectively). With regard to alleviation of somatic symptoms, a significant reduction in pain and diarrhea was observed after the 2nd cycle (p = 0.038) and 3rd cycle (p = 0.036). Furthermore, changes in QoL in relation to functional performance status as assessed by ECOG were analyzed. There were no significant differences with regard to QoL alterations between patients with high (ECOG 0 or 1) and moderate performance status. Our study confirmed an equally positive effect of PRRT on quality of life in midgut NET patients with high or moderate functional status in terms of increasing global health, functional status, and alleviating symptoms.

Association Between Body Mass Index and Results of Rehabilitation in Patients After Stroke: A 3-Month Observational Follow-Up Study.

BackgroundWe assessed the relationship between body mass index and results of rehabilitation in stroke patients.Material/MethodsThe study was carried out at the Clinical Rehabilitation Ward with Early Neurological Rehabilitation Unit at the Clinical Hospital. The examinations were performed 3 times. Based on inclusion and exclusion criteria, 128 subjects were qualified for the first examination, the second examination involved 114 subjects, and 100 stroke patients participated in the third examination. Body mass was examined with an accuracy of 0.1 kg, using a Tanita MC–780 MA body composition analyser. Body mass index (BMI) was calculated for all of the subjects. Effects of rehabilitation were assessed with the Barthel index and Ashworth scale.ResultsHigher functional status in daily life, measured with the Barthel scale, was found in patients with normal body mass, compared to the overweight and obese subjects (examination I, II, and II). Exam I showed that before rehabilitation the overweight patients obtained significantly higher results in assessment of upper limbs, based on the Ashworth scale (mean=0.35±0.54) compared to the obese patients (mean=0.03±0.32) and those with normal body weight (mean=0.24±0.75).ConclusionsFollowing hospital-based rehabilitation, patients with normal body mass achieved greater functional efficiency. The findings also show a trend towards normalization of BMI. The positive effect of rehabilitation was sustained for 3 months (Exam III), which may contribute to decreased risk of cardiovascular diseases and complications such as stroke.

ФІЗИЧНА ПІДГОТОВКА − ОДНА З ВАГОМИХ СКЛАДОВИХ ПРОФЕСІЙНОЇ ПІДГОТОВКИ СУЧАСНОГО ВОЇНА

In the article the processes of improving the system of physical training, modern approaches to create positive dynamics in the development of stable military NSU mental processes and decrease stress levels, which in turn helps to maintain a high functional status and physical fitness in combat.Based on numerous studies on the efficiency level of fitness professional soldiers of the National Guard of Ukraine, it was found that the main problems that affect the level of preparedness include: training method of construction with the possibility of monitoring the physical and mental faculties servicemen systematic practice classes with maximum realistic conditions using simulators, the level of completeness of sports facilities and the level of skill of specialists.