Katz Scores Research Articles

Periprosthetic fracture around total knee arthroplasty: What are the advantages of minimal-invasive surgery?

ObjectivesPeriprosthetic femur fractures after total knee arthroplasty in older adults are mostly treated by internal fixation. Members of the GETRAUM (French Orthopedic Trauma Society) sought to compare two surgical techniques – conventional open surgery and minimally invasive surgery – with the aim of analyzing the patients’ functional recovery. We hypothesized that a minimally invasive technique would produce better early functional outcomes with recovery of independence. Materials and MethodsThis retrospective multicenter study of patients treated between 2009 and 2015 consisted of 90 fractures with a follow-up of 1 year. Demographic, preoperative data and the characteristics of fractures, type of fixation and the surgeon's experience level were collected. The endpoints were the Parker Mobility score, Katz ADL, place of residence at the time of fracture and at 6 months and one-year follow-up. All complications and one-year mortality during the follow up were searched. ResultsAt 6 months follow-up, the minimally invasive technique contributed to significantly better functional recovery as measured by the Parker (p < 0.05) and Katz scores (p < 0.05). However, there were no differences in these scores at one-year follow-up. The complication rate was 31% at one year follow-up. Mortality rate was 12 % (11 patients). ConclusionOur hypothesis was confirmed, as there was a difference between techniques that impacted functional recovery and independence, but only in the early postoperative phase. A minimally invasive technique appears to be beneficial in the short term for distal femur fractures after total knee arthroplasty but must be evaluated in a comparative and prospective study to fully confirm its reliability.

PROMOTING PROVIDER ADHERENCE TO THE MEDICATION M OF THE AGE-FRIENDLY 4MS FRAMEWORK

Abstract BACKGROUND The Age Friendly Health Systems (AFHS) initiative promotes use of the 4Ms Framework: We sought to evaluate provider adherence to protocols addressing the medication M of the framework. METHODS The project was conducted among patients &amp;gt; 65years treated in the inpatient (IP), outpatient (OP) and emergency departments (ED) of Grady Memorial Hospital (GMH). We implemented 2 approaches to improve provider prescribing among older adults 1) Using a clinical decision support tool via the electronic health record Epic Systems®, a best practice advisory (BPA) offered individual provider feedback regarding potentially inappropriate medications (PIMs) ordered and offered safer alternative medications. 2)A pharmacist-led daily medication review with provider feedback on PIMs in the Acute Care for Elderly (ACE) Unit. Primary outcome: Percentage of PIMs discontinued. Secondary outcomes: Percentage of BPA vs pharmacist recommendations accepted, discharge PIMs, Length of Stay (LOS), mobility, delirium and Katz scores, 30-day readmission rate. RESULTS: 8270 BPA alerts fired for 3291 patients, mean age 73.7, with 5709 BPAs in IP, 1462 in ED &amp; 1083 in OP settings. Providers responded to alerts by overriding BPA (10.2%), canceling BPA (60.4%), removing alerted PIM (20.6%), ordering alternative medication (3.5%).. With the pharmacist led intervention, ACE Unit providers accepted 47.2% recommendations, discontinued 17.9% PIMs . 19% of ACE and 1.1% of GMU patients were discharged without PIMs. 30-day readmission rate was 19.1% (ACE) vs 27% (GMU) (P = 0.31). Conclusion There was a higher provider acceptance rate with the pharmacist led intervention but no significant difference in PIM discontinuation rate

Comprehensive, continuous, and compulsory monitoring of frailty in elderly.

The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression. To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool. In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared. Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively. Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.

Use of the Heracles straight blade in the treatment of intertrochanteric hip fractures: a prospective study with a 1-year follow-up.

The treatment of intertrochanteric fractures in the elderly remains challenging for orthopedic surgeons, due to aging, comorbidities, and poor bone quality. The Heracles straight blade has proven a lower rate of cut-out and femoral head displacement in biomechanical studies; however, there are currently no published clinical studies using this nail. To analyze the clinical and radiological results of the Heracles nail with the straight cephalic Heracles blade as a device to treat osteoporotic intertrochanteric fractures of the proximal femur. A total of 136 patients with trochanteric hip fractures were operated on by the same surgeon, using the Heracles nail with a straight cephalic blade. However, only 86 patients completed the 1-year follow-up both clinically and radiologically. According to the Association of Osteosynthesis classification, 38 patients (44.1%) had 31-A1, 36 patients (41.6%) had 31-A2, and 12 patients (14.1%) had 31-A3. Functional outcomes were assessed according to the Katz and Barthel scores, finding that 58% of patients recovered their original functional level, According to Barthel score, a mean loss of 11.8 points was found. The mean hospital stay was 8.22 days (mean preoperative stay of 2.71 days). The mean tip-apex distance was 15.2 mm. During the follow-up, 6 complications (6.96%) were detected: 4 cut-out, 1 cut-in, and 1 nail breakage. According to the Katz score, 58% of the patients recovered their previous functional status and 20.58% needed an additional walking aid. The mean loss in the Barthel score was 11.8 points. The Heracles nail using a cephalic straight blade has proven to be a valid treatment of trochanteric fractures, due to the functional recovery of the patients and low level of complications.

One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol.

Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied. The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol. One year after the initiation of an early mobility protocol in 7 intensive care units (ICUs) at an academic medical center, patients with an ICU stay of 7 days or more were enrolled in a 1-year follow-up phone call study. Baseline demographic data included the following: average ICU mobility and highest ICU mobility level achieved (4 levels), highest ICU mobility score (10 levels) at ICU admission, ICU discharge (DC), hospital DC, LOS, and delirium positive days. At 4 time points after DC (1, 3, 6, 12 months), patients were contacted regarding current residence, employment, readmissions, and current level of ADL from the Katz ADL (scored 0-6) and Lawton instrumental ADL scales (scored 0-8). A convenience sample of 106 patients was enrolled with a mean age of 58 ± 15.4 years, ICU LOS of 18 ± 11.5 days, and hospital LOS of 37.5 ± 31 days; 58 (55%) were male; 4 expired before DC. Mobility results included mean mobility level of 1.6 ± 0.8, mean highest mobility level 3.3 ± 0.9; ICU mobility score was 5.9 ± 2.4 at time of ICU DC and 7.3 ± 2.5 at hospital DC. Katz ADL scores improved from 4.8 at 1 month to 5.6 at 12 months (P = .002), and Lawton IADL scores improved from 4.2 to 6.6 (P < .001). Mobility scores were predictors of 1 month Katz (P = .004) and Lawton (P < .001) scores. None of the mobility levels or scores were predictive for readmissions. Most patients were not working before admission, and not all returned to work. Days positive for delirium were predictive of 1 month Katz and Lawton (P = .014, .002) scores. Impact of delirium was gone by 1 year. In this critically ill patient population followed for 1 year, ICU mobility positively impacted return to ADLs and improved ADLs over time but not readmissions. Delirium positive days decreased ADL scores, but the effect diminished over time.

The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults

BackgroundThe type 2 diabetes (T2D) specific dementia-risk score (DSDRS) was developed to evaluate dementia risk in older adults with T2D. T2D-related factors have been shown increase the risk of age-related conditions, which might also increase dementia risk. Here, we investigate the associations of DSDRS with frailty, disability, quality of life (QoL) and cognition in community-dwelling older adults with T2D.MethodsWe included 257 community-dwelling older adults with T2D to evaluate the association between DSDRS and Mini-mental state examination (MMSE), Isaac’s set-test (IST), clock drawing test (CDT), quality of life (SF-36), risk of malnutrition (Mini-Nutritional Assessment or MNA), as well as frailty, Katz’ and Lawton-Brody scores. We also assessed the phenotype and correlates of high-estimated dementia risk by assessing individuals with DSDRS >75th age-specific percentiles.ResultsMean age of participants was 78.0 ± 6.2 years. DSDRS showed a significant correlation with MMSE test, IST, CDT, SF-36, MNA, Lawton-Brody and Katz scores, and an increasing number of frailty components. DSDRS was higher among frail, pre-frail, and subjects with limited ADL and IADL (p < 0.001). Participants with DSDRS >75th age-specific percentiles had lower education, MMSE, IST, SF-36, MNA, Katz, Lawton-Brody, and higher frailty scores. High-estimated 10-year dementia risk was associated with ADL and IADL disability, frailty and risk of malnutrition. When assessing individual components of DSDRS, T2D-related microvascular complications were associated to all outcome measures.ConclusionThe DSDRS is associated with frailty, disability, malnutrition and lower cognitive performance. These findings support that T2D-related factors have significant burden on functional status, QoL, disability and dementia risk.

"Katz activities of daily living disability in older cancer survivors by age, stage, and cancer type".

The purpose of this study was to describe ADL impairments using the Katz ADL Index by cancer type, stage, and age in older cancer survivors. Cross-sectional data from cohorts 9-14 (year 2006-2013) of the Surveillance, Epidemiology and End Results national cancer registry and Medicare Health Outcomes Survey linkage were used to describe ADL performance using the Katz ADL Index. Mean Katz scores and frequency of ADL disability were reported across cancer types for all eight cancers (colon, lung, breast, prostate, bladder, kidney, non-Hodgkin's lymphoma, uterine) and by stage and age for the four large cancers (colon, lung, breast, prostate). In this sample of 6,973 cancer survivors, ADL deficits were the greatest in uterine cancer survivors (μ = 4.72, SD = 1.44). When considering age, Katz scores were most impaired in breast (μ = 3.90, SD = 1.93) and prostate survivors (μ = 4.35, SD = 1.84) age > 85 years. When considering stage, Katz scores were most impaired in stage four survivors of prostate (μ = 4.14, SD = 1.82) or breast (μ = 4.43, SD = 2.05) cancer. Across all cancer types and age groups, with the exception of stage 4 prostate cancer, ADL deficits were consistently impaired in the same order, from most impaired to least: continence, transfers, bathing, dressing, toileting, and, lastly, feeding. Screening for ADL impairments is needed for older cancer survivors as Katz ADL disability differs by cancer type, stage, and age with greater impairment with advanced age and stage. Interventions to address ADL limitations should be considered for older cancer survivors.

Relationship Between Dysphagia and Sarcopenia with Comprehensive Geriatric Evaluation.

Oropharyngeal dysphagia has features of geriatric syndromes and is strongly associated with sarcopenia. In this cross-sectional study, we aimed to evaluate the association between dysphagia and sarcopenia, in a practical way, accompanied by comprehensive geriatric assessment. Dysphagia and sarcopenia were defined by the EAT-10 and SARC-F questionnaires, respectively. Cognition and mood, was evaluated by the Mini-mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Physical performance was assessed by the Timed up and Go Test (TUG) and muscle strength was determined by Hand Grip Strength (HGS). Functionality was stated by Katz and Lawton Indexes. Serum levels of hemoglobin, triglyceride, albumin, and total cholesterol were recorded. A total of 512 (151 male/361 female) patients age 60 and older were included in the study. Prevalences of dysphagia and sarcopenia were 23% and 40.6%, respectively. In multivariate analysis sarcopenia (OR:2.596, p = 0.008), depressive symptoms (OR:1.115, p < 0.001), and lower KATZ scores (OR:0.810, p = 0.036) were independently related with dysphagia. Dysphagic patients with sarcopenia had lower scores on the Katz and Lawton scales (p < 0.001, rpb = 0.380 and p < 0.001, rpb = 0.447 respectively) and TUG performances were worse (p = 0.009, rpb = - 0.254). Serum hemoglobin and albumin levels were significantly low in dysphagic patients with sarcopenia (p < 0.001, rpb = 0.345, p = 0.008, rpb = 0.243). Dysphagia is independently associated with sarcopenia, depressive symptoms, and functionality. Dysphagia coexist with sarcopenia is associated with worse clinical consequences than without sarcopenia.

P4751Underdosing fragile patients - Are we helping or harming?

Abstract Background An individualized approach should be taken regarding the utilization of direct oral anticoagulants (DOAC) in frail and elderly populations with atrial fibrillation (AF). We hypothesized that among an elderly and frail population, where the risk of bleeding, both real and perceived, is very high, the proportion of patients with a dose regimen different from the formal indication would be particularly high due to potential underdosing. Methods We conducted a retrospective, observational study enrolling 327 patients with AF admitted to an Internal Medicine ward during a 1-year period and discharged with a DOAC prescription. We divided the population in 2 groups: patients prescribed a reduced dose without formal dose reduction criteria (underdosed, n=170) and the rest of the population (n=157), which included adequately dosed patients, both with normal dose (n=99) and correctly reduced dose (n=43) and overdosed patients (n=15). A 1-year follow-up was completed for all patients, assessing the following outcomes: all-cause mortality, stroke, systemic embolism and major bleeding. Results Patients were elderly (81.9±7.68) and frail (Katz index 3.35±2.36). Apixaban was the most commonly prescribed NOAC (38.8%), followed by rivaroxaban (36.4%) and dabigatran (24.8%). Among underdosed patients, apixaban was prescribed in 45.3% of patients, dabigatran in 29.4% and rivaroxaban 25.3%. Although only 18.3% of patients had clinical criteria for dose reduction, 65.4% were discharged with reduced dose and thus 52% were underdosed. Regarding 1-year outcomes, mortality (40.8% vs 25.5%, RR=1.6, p=0.003) and the combined stroke, systemic embolism and major bleeding event rate (10.1% vs 3.2%, RR=3.16, p=0.015) were higher for underdosed patients. Among underdosed patients, comparing with the rest of the population, the increased ischemic events rate (ischemic stroke and systemic embolism) did not reached statistical significance (3.7% vs. 1.9%, p=0.5), but it did for hemorrhagic events (major bleeding and hemorrhagic stroke) (6.1% vs 0.6%, p=0.01) On multivariate analysis, even after considering adjustment for age, Katz and CHAD2VAS2C scores, renal function and DOAC prescribed, DOAC underdosing was associated with a higher risk of both ischemic and hemorrhagic events (HR = 3.51, 95% CI 1.08–11.38). However, it lost its independent negative effect regarding mortality (HR 1.32, 95% CI 0.87–1.99). Survival and event rate in underdosed Conclusions There is a significant proportion of frail and elderly patients with AF that are underdosed. This subset has a significant survival disadvantage, eventually reflecting prescription bias. However, underdosed patients have also a higher event rate of both ischemic and hemorrhagic events, suggesting that underdosing fragile patients is not an effective strategy and that instead it may be hazardous.

MON-157 SELF-ASSESSMENT OF DEPRESSION AND ANXIETY: CORRELATION WITH BIOLOGICAL MARKERS IN HEMODIALYSIS PATIENTS

Patients in hemodialysis have higher prevalence of mood disorders compared to the general population. These may cause an increase in morbi-mortality, poor adherence to treatment, immunological and nutritional deregulation and decline in quality of life. The objective of this study was to correlate psychological scores and biological variables obtained in the last 3 months in patients with CKD-V. Cross-sectional study monocentric, in a dialysis center, in southern Brazil. The study included 30 patients, who were submitted to a socio-demographic interview and an application of validated questionnaires in the Portuguese language on Quality of life (SF-36), Beck Depression Inventory (BDI) and Beck Anxiety inventory (BAI). The independence index for daily life activity and functionality were evaluated by the Multidisciplinary team through the Katz and Karnofsky scores. The project was approved by Ethic and Research Committee (CEP/HED). Anonymity was respected and the ICF was signed. The oral questionnaires were applied by one of the members of the multidisciplinary team during the dialysis session. Male gender: 50%; mean age: 65 y.o. the average time in HD: 36 months (4-192 mo); Hypertension (60%) and diabetes (27%) were the most common comorbidities; Laboratory data (means): Albumin: 3.9; Hematocrit: 32.6 %; PTH: 320; Ca: 9.3; P: 5,7; K: 5,4. Adequacy of dialysis: KtV 1.51, URR 69.3%.interdialytic weight gain 2,900 g; Poor adherence to therapy (1 mssing session/trimester:) 16%; hospital recoveries (last 3 months) in 40% (mostly due to access problem); need for temporary access (AVF failure) was 23%; married:40%; lived alone only 2 (6%); higher level education: 20% (n = 6); living at their own homes: 93%; away from their professional activities: 70% (21/30). Health self-assessment and Dialysis self-assessment categories "good/optimal" were the answers for 57% and 77% of patients, respectively. Anxiety was reported by 33% (n = 10) and depression by 37% (n =11). These conditions coexisted in 40% (n = 6). Karnofski scores ranged from 30-90, the majority of patients were considered "partially-dependent" (n = 20). A Katz Index of Independence in Activities of Daily Living score 5-6 was present in 70% (full function or mild dependence). Low serum iron was associated with depression (ANOVA, p=0.001) but not with anxiety. Self-assessment in optimal health/good, high schooling, normal blood glucose levels had a good correlation with absence of depression (chi-square, p = 0.04; 0.04 and 0.03). We did not observe correlation between arterial blood pressure (higher or lower values) and anxiety or depression in this sample. BDI and BAI scores are effective diagnostic tools for depression and anxiety and had a good correlation with some clinical outcomes and biological variables among patients with terminal CKD undergoing hemodialysis.

Neurobehavioral Deficits After Subarachnoid Hemorrhage in Mice: Sensitivity Analysis and Development of a New Composite Score.

BackgroundBecause of the failure of numerous clinical trials, various recommendations have been made to improve the usefulness of preclinical studies. Specifically, the STAIR (Stroke Therapy Academic Industry Roundtable) recommendations highlighted functional outcome as a critical measure. Recent reviews of experimental subarachnoid hemorrhage (SAH) studies have brought to light the numerous neurobehavioral scoring systems that are used in preclinical SAH studies. To gain insight into the utility of these scoring systems, as well as to identify a scoring system that best captures the deficits caused by SAH in mice, we designed the current study.Methods and ResultsAdult male C57BL/6J mice were used. One cohort of mice was randomly allocated to either sham or SAH and had functional testing performed on days 1 to 3 post‐SAH using the modified Bederson Score, Katz Score, Garcia Neuroscore, and Parra Neuroscore, as well as 21 individual subtests. A new composite neuroscore was developed using the 8 most diagnostically accurate subtests. To validate the use of the developed composite neuroscore, another cohort of mice was randomly assigned to either the sham or SAH group and neurobehavior was evaluated on days 1 to 3, 5, and 7 after injury. Receiver operating characteristic curves were used to analyze the diagnostic accuracy of each scoring system, as well as the subtests. Of the 4 published scoring systems, the Parra Neuroscore was diagnostically accurate for SAH injury in mice versus the modified Bederson and Katz Scores, but not the Garcia Neuroscore. However, the newly developed composite neuroscore was found to be statistically more diagnostically accurate than even the Parra Neuroscore.ConclusionsThe findings of this study promote use of the newly developed composite neuroscore for experimental SAH studies in mice.

Cementless, Fluted, Long-Stem Hemiarthroplasty for Vancouver B2 and B3 Periprosthetic Fractures Around Hip Hemiarthroplasty

BackgroundThe purpose of this study was to assess the effectiveness of a cementless, modular, fluted, long-stem hemiarthroplasty for the treatment of Vancouver type B2 and B3 periprosthetic femoral fracture around hip hemiarthroplasty. MethodsThis was a retrospective case-control study comparing 46 patients revised to hemiarthroplasty (HA group) and 31 revised to total hip arthroplasty (THA group). Functional outcome was evaluated by the Merle d’Aubigné score, and the Katz scale based on activities of daily living. Comorbidity was assessed by the Charlson index, and cognitive function by a mini-mental test score. Radiological evaluation was also performed. ResultsMean postoperative follow-up was 3.3 (range, 2-4) years in the HA group and 3.9 (range, 2-5) in the THA group. The need for transfusion and hospital stay were significantly higher in the THA group. Postoperatively, both groups had a significant decrease in mean hip function (P = .001) although the mean Merle (P = .121) and Katz (P = .214) scores were similar at final follow-up. Likewise, there were no significant differences between groups in pain or loss of life independence. All fractures were united but one in the HA group. There were no dislocations in the HA group, and 3 in the THA group. ConclusionThe management of Vancouver B2 and B3 periprosthetic femoral fracture around hemiarthroplasties with a long-stem revision cementless bipolar hemiarthroplasty, supplemented with wire cerclages and cancellous allograft, was an effective option in terms of fracture healing and stability of the implant with a low rate of complications. Nevertheless, a significant functional impairment was also observed in either group.

Chronic morbidity and reported disability among older persons from the India Human Development Survey

BackgroundThe burden of disability and chronic morbidity among the elderly has been increasing substantially in India in recent years. Yet, the use of nationally representative data to investigate the relationship between chronic morbidity and reported disability in the country has been minimal. The objective of this study is twofold: i) to quantify the association between chronic morbidities and overall disabilities in the activities of daily living (ADLs) among elderly people in India, and ii) to understand how various chronic morbidities influence individual ADLs, specifically, walking, toileting and dressing.MethodsWe used data from the India Human Development Survey-II (IHDS-II) as a basis for this study. We computed the Katz Index of independence in ADL to examine the burden of disability among the elderly. Ordered logistic regression was carried out to examine the effect of chronic morbidities on: i) the disability index (where 0 = no disability; 1 = disability in 1 or 2 ADLs; and 2 = disability in 3 ADLs), and ii) disabilities in three ADLs in the population over-60 years of age in India.ResultsThe percentage of people scoring lower Katz index (indicating severe and mild disability) in at least one of the three ADLs is very high in India (17.91% for males and 26.21% for females). Irrespective of the type of ADL, the Katz score is lower in elderly females than in elderly males. Elderly people who are illiterate and belong to the poorest wealth quintile report lower Katz scores in ADL. Both bivariate and multivariate analyses confirm that all three types of chronic morbidities are positively and significantly associated with a disability condition in the ADLs. Yet, the effects of morbidities vary greatly according to the type of disability. For instance, while diabetes affect walking (OR: 2.56; 95% CI: 2.29–2.86), and toileting (OR: 2.63; 95% CI: 2.26–3.07), high blood pressure mainly affects walking (OR: 2.29, 95% CI: 2.09–2.5) and dressing disabilities (OR: 2.13, 95% CI: 1.84–2.46).ConclusionsChronic morbidity is a decisive factor in old age disability. It is crucial to reduce chronic morbidity in a timely way to minimise the enormous associated burden of disability.

Analysis on nursing effect and HSS score and complications of total knee arthroplasty

Objective To study the effects of total knee arthroplasty and its effects on HSS score and complications. Methods A total of 100 patients who underwent total knee arthroplasty admitted to this hospital from March 2013 to March 2015 were selected.According to the random number table method, they were divided into the research group and the control group, 50 cases of each group.The research group was treated with targeted operation room nursing.The control group was given the routine nursing.The postoperative VAS score, HSS score, Katz score, incision healing and postoperative complications were observed.At the same time, the time required for knee flexion greater than or equal to 90 degrees and the length of hospital stay were observed.The optimal rate of clinical recovery and nursing effect of the two groups were comprehensively evaluated. Results There was no significant difference in VAS score at 6 hours after surgery, and the difference was not statistically significant(P>0.05). However, the VAS score at 24 hours after surgery was significantly lower in the research group than that in the control group, and the difference was statistically significant(P 0.05). The efficiency and Katz scores of the research group were significantly higher than those of the control group, and the differences were statistically significant(P<0.05). In addition, the incidence of postoperative complications in the research group was lower than that of the control group.And the difference was statistically significant(P<0.05). Conclusions In total knee arthroplasty, targeted nursing intervention can significantly improve the postoperative HSS score, shorten the length of hospital stay and effectively avoid complications.It is worthy of clinical reference and application. Key words: Total knee arthroplasty; Intraoperative nursing coordination; HSS score; Complications

Incrementally updating Katz centrality in dynamic graphs

A variety of large datasets, such as social networks or biological data, can be represented as graphs. A common query in graph analysis is to identify the most important vertices in a graph. Centrality metrics are used to obtain numerical scores for each vertex in the graph. The scores are then translated to rankings identifying relative importance of vertices. In this work, we focus on Katz centrality, a linear algebra-based metric. In many real applications, since data are constantly being produced and changed, it is necessary to have a dynamic algorithm to update centrality scores with minimal computation when the graph changes. We present an algorithm for updating Katz centrality scores in a dynamic graph that incrementally updates the centrality scores as the underlying graph changes. Our proposed method exploits properties of iterative solvers to obtain updated Katz scores in dynamic graphs. Our dynamic algorithm improves performance and achieves speedups of over two orders of magnitude compared to a standard static algorithm while maintaining high quality of results.

Validation into Arabic versions of Dementia Rating Scales, Dementia Caregivers Scales, and Dementia Research Instruments

IntroductionThis study aimed to examine the validity and internal consistency of Arabic versions of the eight-item Alzheimer's Dementia, Alzheimer Questionnaire, and Clinical Dementia Rating scales and to assess the Arabic version of Katz Activities of Daily Living, and Neuropsychiatric Inventory. MethodsOne hundred fifty participants were recruited from different settings; they underwent clinical interviews and filled the aforementioned scales. ResultsIn our sample, 56.8% of the sample suffered from dementia. The Arabic eight-item Alzheimer's Dementia had excellent psychometric properties, and the Arabic Alzheimer Questionnaire showed near-perfect properties with sensitivity and specificity reaching 100%. In addition, the Arabic Clinical Dementia Rating (A-CDR)–sum of boxes was superior to the regular A-CDR score in detecting dementia cases among the study sample. The A-CDR showed similar characteristics as the original version. The Katz scores demonstrated a strong negative correlation with eight-item Alzheimer's Dementia scores. ConclusionBased on this study, health professionals now have reliable and validated tools to be used in clinical and research settings among Arabic-speaking populations.

Osteosynthesis of periprosthetic type A and B femoral fractures using an unlocked plate with integrated cerclage cable and trochanteric hook: A multicenter retrospective study of 45 patients with mean follow-up of 20 months

IntroductionFemoral periprosthetic fracture (FPF) is a frequent complication in dependent elderly persons, with a limited life expectancy. Their management is difficult and the choice between osteosynthesis and prosthesis is still matter of discussion. To date, there is no study on unlocked plate with integrated cerclage cable and trochanteric hook for this indication. The objectives of this study were to analyze fracture healing, complication rate and functional outcome. Our hypothesis is that this technique allows a high rate of consolidation and a return to the previous state in terms of autonomy and place of residence. Materials and methodsWe conducted a retrospective multicenter study between 2010 and 2015. The inclusion criteria were: patients with type A and B FPF according to the classification of Vancouver who received osteosynthesis hook plate. The evaluation focused on the consolidation period, complications and pre and postoperative Parker and Katz scores. Death, nonunion, dislocation, infection and failure of fixation were considered major complications. ResultsForty-five patients met the inclusion criteria and were evaluated at mean 20 months (6–72). All fractures consolidated at a mean 7 weeks (6–10), except one that has not undergone further surgery in the absence of functional impairment. Parker score decreased from 6.4 to 4.9 (p=0.03) and Katz score from 4.8 to 4.3 (p=0.045). Five patients died within the year of the operation. Five patients living at home preoperatively were admitted to an institution, the others returned to their retirement home or nursing home. ConclusionThis plate allows for a quick and effective management of patients with FPF. The low rate of complications and the very good consolidation rate lead us to use the same plate even for class B2 or B3 fractures in some patients with precarious health condition who cannot tolerate major revision surgery: Elderly, ASA score >3, loss of autonomy, Katz score <4.

An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

Background/Aims: Old age and institutionalization in care homes are associated with increased use of risk medications affecting the central nervous system (CNS). This study evaluated medication utilization and appropriateness; and assessed frailty among residents of Malaysian aged care homes. Methods: The subjects of this study included 202 elderly (≥65 years) residents of 17 aged care homes in suburban peninsular Malaysia. Frailty was measured using the Groningen Frailty Indicator (GFI) score and independence in daily living was measured as KATZ activity of daily living score. Medication appropriateness was assessed using the Medication Appropriateness Index (MAI) and 2015 Beers' criteria for Potentially Inappropriate Medication (PIM). Results: CNS medications constituted about 16% of the total, with an average of 0.8 ± 1.1 medications per resident, which reduced to 0.5 ± 0.8 medications after 3 months. Frailty (154/202) and polypharmacy (90/202) were highly prevalent in study subjects. Subjects on CNS medications had significantly higher GFI score (7.1 vs. 5.9; p = 0.031), polypharmacy (57.8 vs. 35.3%; p = 0.002), number of PIMs (0.9 vs. 0.2; p = 0.001), and mean summed MAI score (3.6 vs. 2.6; p = 0.015) than subjects not on CNS medications. Medication number was also significantly correlated with GFI (r = 0.194; p = 0.006) and KATZ (r = 0.141; p = 0.046) scores. Conclusion: Frailty and polypharmacy were highly prevalent among aged care home subjects taking CNS medications. These findings support the notion that periodic regular medication review should improve the overall use of medications in elderly patients.

Functional assessment of elderly population: a community-based cross-sectional study

Background: Aging is a common, strong, and permanent process, which is affected by biological, social, psychological, and environmental factors. Objective: To assess the level of dependency among the study participants using Katz scale for basic activities of daily living and Lawton’s scale for instrumental activities of daily living. Materials and Methods: A cross-sectional, community-based study was conducted in Harekala village, Karnataka, India. Adults aged 60 years and older were included in the study as the participants. Systematic random sampling was followed to reach the calculated sample size of 221. Households were the sampling unit. Data were collected using a predesigned, pretested questionnaire to elicit information on sociodemographic profile. The basic activities were evaluated using the Katz Index, while the instrumental activities were recorded using the Lawton’s scale. Independent t-test was used to compare the mean Katz score/Lawton’s score of those with morbidity with those without morbidity. Result: Of the 221 participants, 121 were aged older than 70 years. A total of 120 were male and 101 were female subjects. About 56.1% of the participants were hypertensive, and about 20.4% revealed other cardiovascular diseases. As per Lawton’s scale, it was observed that the majority of the participants required assistance or were totally dependent in managing money (10.4%) and doing housework (14.5%). About 40.3% of them needed assistance in feeding, and about 26.7% participants were unable to do toileting activity by themselves. Statistically significant difference was observed between the mean Katz scores of those subjects with cardiovascular disease and those without cardiovascular disease. Similarly, statistically significant difference was observed between the mean Lawton scores of subjects with cardiovascular disease and those without cardiovascular disease. Conclusion: Prevention of functional decline of the elderly people needs priority and such prevention may be possible by the way of detecting the functional decline at an early stage.

Potentially inappropriate prescribing according to the STOPP/START criteria for older adults.

The aim of this study was to demonstrate the prevalence and possible predictors of potentially inappropriate medications (PIMs) and potentially prescription omissions (PPOs) according to the Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria in geriatric patients. A total of 374 patients (140 male, 234 female) aged ≥65years were included. Comprehensive demographic and clinical data including age, gender, current diagnoses/medications, comorbid diseases and medical problems were noted. There were 154 (41.2%) patients with at least one PIM. Most common PIMs were proton pump inhibitors for peptic ulcer disease (9.6%), calcium-channel blockers (6.4%) and anticholinergic/antispasmodic drugs (5.9%) in chronic constipation. There were 274 (73.3%) patients with at least one PPO. Most common PPOs were calcium-vitamin D supplement in osteoporosis (OP) (39.6%), statin (22.5%) and antiplatelet therapies (16.0%) in diabetes mellitus (DM) with cardiovascular risk factors. PIM was independently associated with female gender (OR=2.21, p=0.003), number of medications (OR=1.35, p<0.001), Katz scores of daily life activities (OR=0.87, p=0.013) and OP (OR=0.29, p<0.001). PPO was independently associated with age (OR=1.06, p=0.009), Geriatric Depression Scale score (OR=1.20, p=0.007), DM (OR=6.50, p<0.001), chronic obstructive pulmonary disease (COPD) (OR=5.29, p=0.010), number of medications (OR=0.88, p=0.019), and incontinence (OR=0.39, p=0.043). High prevalence of PIMs and PPOs were found in geriatric patients. Number of medications, female gender, and dependency were associated with PIM. Age, higher scores of Geriatric Depression Scale, DM, and COPD were related with PPOs.