Lower Functional Status Research Articles

Identifying subtypes of HIV/AIDS-related symptoms in China using latent profile analysis and symptom networks

The identification of subgroups of people living with HIV in China based on the severity of symptom clusters and individual symptoms is crucial to determine group-specific symptom management strategies. Participants reported 27 highly prevalent HIV/AIDS-related symptoms. Latent profile analysis based on symptom severity was used to identify person-centered subtypes of HIV/AIDS-related symptoms. Symptom networks were compared among subgroups identified by latent profile analysis. A total of 2927 eligible people living with HIV (PWH) were included in the analysis. Five profiles were identified: “Profile 1: all low symptom severity” (n2 = 2094, 71.54%), “Profile 2: medium symptom severity with syndemic conditions” (n3 = 109, 3.72%), “Profile 3: medium symptom severity with low functional status” (n1 = 165, 5.64%), “Profile 4: medium symptom severity in transitional period” (n4 = 448, 15.31%), and “Profile 5: all high symptom severity” (n5 = 111, 3.79%). Except for Profile 1 and Profile 5, the symptom severity was similar among the other three profiles. Profiles 1 (2.09 ± 0.52) and 4 (2.44 ± 0.66) had the smallest ∑s values, and Profiles 2 (4.38 ± 1.40) and 5 (4.39 ± 1.22) had the largest ∑s values. Our study demonstrates the need for health care professionals to provide PWH with group-specific symptom management interventions based on five profiles to improve their physical and psychological well-being. Future studies should be conducted in different contexts using different symptom checklists to further validate our results.

Pre-Surgery Demographic, Clinical, and Symptom Characteristics Associated with Different Self-Reported Cognitive Processes in Patients with Breast Cancer

Simple SummaryOne in three patients with breast cancer report cancer-related cognitive impairment (CRCI) even before treatment. CRCI can persist and negatively impact patients’ quality of life. We used a self-report measure to assess CRCI. We assessed patients’ ability to plan and solve everyday life problems, concentrate, and have meaningful relationships with others. We evaluated subgroups of patients with different profiles regarding these abilities and whether they had different demographic and clinical characteristics. Our analyses showed that 64.2%, 43.3%, and 40.1% of the patients had clinically meaningful decrements in their abilities to plan and problem-solve, concentrate, and have meaningful relationships with others, respectively, from prior to through to 6 months after surgery. Pre-surgery symptoms (i.e., anxiety, depression, fatigue, sleep disturbance) and other characteristics (e.g., lower functional status, higher comorbidity) were associated with worse CRCI profiles and may be potential targets for personalized interventions.Cancer related cognitive impairment (CRCI) is a common and persistent symptom in breast cancer patients. The Attentional Function Index (AFI) is a self-report measure that assesses CRCI. AFI includes three subscales, namely effective action, attentional lapses, and interpersonal effectiveness, that are based on working memory, inhibitory control, and cognitive flexibility. Previously, we identified three classes of patients with distinct CRCI profiles using the AFI total scores. The purpose of this study was to expand our previous work using latent class growth analysis (LCGA), to identify distinct cognitive profiles for each of the AFI subscales in the same sample (i.e., 397 women who were assessed seven times from prior to through to 6 months following breast cancer surgery). For each subscale, parametric and non-parametric statistics were used to determine differences in demographic, clinical, and pre-surgical psychological and physical symptoms among the subgroups. Three-, four-, and two-classes were identified for the effective action, attentional lapses, and interpersonal effectiveness subscales, respectively. Across all three subscales, lower functional status, higher levels of anxiety, depression, fatigue, and sleep disturbance, and worse decrements in energy were associated with worse cognitive performance. These and other modifiable characteristics may be potential targets for personalized interventions for CRCI.

Identification of Distinct Symptom Profiles in Cancer Patients Using a Pre-Specified Symptom Cluster.

Pain, fatigue, sleep disturbance, and depression often co-occur in oncology patients and negatively impact quality of life (QOL). Study purposes were to identify subgroups of patients with distinct symptom profiles based on their experiences with a pre-specified symptom cluster (i.e., pain, fatigue, depression, sleep disturbance) and to identify demographic, clinical, and symptom characteristics and QOL outcomes associated with each distinct profile. Patients with breast, lung, gastrointestinal, and gynecologic cancers (n=1340) were recruited from outpatient clinics during their first or second cycle of chemotherapy. They completed valid and reliable measures of pain, fatigue, sleep disturbance. depression, and QOL prior to their next dose of chemotherapy. Latent class profile analysis was used to identify the patient subgroups. Differences among the profiles were evaluated using parametric and non-parametric tests. Three distinct profiles were identified (i.e., Low (44.0%), Moderate (45.1%), High (10.8%). Compared to Low class, Moderate and High classes were younger and more likely to be female. Compared to the other two classes, High class was less likely to be married/partnered and employed, more likely to have a lower income and childcare responsibilities, had lower functional status, a higher body mass index, and exercised less. For both QOL scales, differences in subscale and total scores followed the same pattern (Low>Moderate>High). Over 55% of patients undergoing chemotherapy had a moderate to high symptom burden associated with these four common co-occurring symptoms. Multimodal interventions are needed to decrease symptom burden and improve QOL outcomes in these patients.

Clinical characteristics of a large cohort of patients with narcolepsy candidate for pitolisant: a cross-sectional study from the Italian PASS Wakix® Cohort

IntroductionNarcolepsy is a chronic and rare hypersomnia of central origin characterized by excessive daytime sleepiness and a complex array of symptoms as well as by several medical comorbidities. With growing pharmacological options, polytherapy may increase the possibility of a patient-centered management of narcolepsy symptoms. The aims of our study are to describe a large cohort of Italian patients with narcolepsy who were candidates for pitolisant treatment and to compare patients’ subgroups based on current drug prescription (drug-naïve patients in whom pitolisant was the first-choice treatment, switching to pitolisant from other monotherapy treatments, and adding on in polytherapy).MethodsWe conducted a cross-sectional survey based on Italian data from the inclusion visits of the Post Authorization Safety Study of pitolisant, a 5-year observational, multicenter, international study.ResultsOne hundred ninety-one patients were enrolled (76.4% with narcolepsy type 1 and 23.6% with narcolepsy type 2). Most patients (63.4%) presented at least one comorbidity, mainly cardiovascular and psychiatric. Pitolisant was prescribed as an add-on treatment in 120/191 patients (62.8%), as switch from other therapies in 42/191 (22.0%), and as a first-line treatment in 29/191 (15.2%). Drug-naive patients presented more severe sleepiness, lower functional status, and a higher incidence of depressive symptoms.ConclusionOur study presents the picture of a large cohort of Italian patients with narcolepsy who were prescribed with pitolisant, suggesting that polytherapy is highly frequent to tailor a patient-centered approach.

Fatigue-related symptom clusters and functional status of older adults in hospice.

Fatigue is frequently co-existing with other symptoms and is highly prevalent among patients with cancer and geriatric population. There was a lack of knowledge that focus on fatigue clusters in older adults with cancer in hospice care. To identify fatigue-related symptom clusters in older adult hospice patients and discover to what extent fatigue-related symptom clusters predict functional status while controlling for depression. This was a cross-sectional study in a sample of 519 older adult hospice patients with cancer, who completed the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression, Boston Short Form Scale, and the Palliative Performance Scale. Data from a multi-center symptom trial were extracted for this secondary analysis using exploratory factor analysis and hierarchical multiple regression analysis. Data from 519 patients (78 ± 7 years) with terminal cancer who received hospice care under home healthcare services revealed that 39% of the participants experienced fatigue-related symptom clusters (lack of energy, feeling drowsy, and lack of appetite). The fatigue cluster was significantly associated positively with depression (r = 0.253, p < 0.01), and negatively with functional status (r = -0.117, p < 0.01) and was a strong predictor of participants' low functional status. Furthermore, depression made a significant contribution to this predictive relationship. Older adult hospice patients with cancer experienced various concurrent symptoms. The fatigue-specific symptom cluster was identified significantly associated with depression and predicted functional status. Fatigue should be routinely monitored in older adults, especially among hospice cancer patients, to help reduce psychological distress and prevent functional decline.

Морфофункциональные исходы при несоблюдении режима антиангиогенной терапии при неоваскулярной форме возрастной макулярной дегенерации у пациентов с низким функциональным статусом

Purpose. To study morphological and functional outcomes in patients with neovascular age-related macular degeneration (nAMD) and low visual acuity violating the treatment regimen. Material and methods. Treatment-naive patients as well as patients receiving anti-VEGF therapy with best-corrected visual acuity (BCVA) less than 0.1 were included. Demographic characteristics, changes in BCVA, central retinal thickness (CRT) and structural changes on optical coherence tomography (OCT) were evaluated baseline and at the of the study period. Results. BCVA changed not statistically significantly at the end of the study period in all groups (р &gt; 0.05). A statistically significant decrease of CRT was found only in the group of treatment-naive patients (р = 0.03). Atrophy of the retinal pigment epithelium and subretinal fibrosis were most common among structural changes in advanced nAMD with low visual acuity. These morphological changes persisted by the end of the observation period, without statistically significant changes in the frequency of occurrence. Conclusion. Low visual acuity in patients with advanced nAMD is associated with severe irreversible structural changes in the macula. The use of anti-VEGF therapy in patients with low functional status and severe changes in the macula appears to be unpromising. Keywords: age-related macular degeneration, antiangiogenic therapy, optical coherence tomography, retinal pigment epithelium atrophy, subretinal fibrosis.

A Scoping Review of the Incidence, Predictors, and Outcomes of Delirium Among Critically Ill Stroke Patients.

BACKGROUND: Delirium is a common, often iatrogenically induced syndrome that may impede the physical, cognitive, and psychological recovery of critically ill adults. The effect delirium has on outcomes of intensive care unit patients having acute neurologic injury remains unclear because previous studies frequently exclude this vulnerable population. The aim of this scoping review was to describe the incidence, predictors, and outcomes of delirium among adults admitted to an intensive care unit experiencing an acute ischemic stroke, intracerebral hemorrhage, or aneurysmal subarachnoid hemorrhage. METHODS: PubMed, CINAHL, Web of Science, EMBASE, and Scopus were searched with the terms (1) stroke, (2) critical care, and (3) delirium. Inclusion criteria were original peer-reviewed research reporting the incidence, outcomes, or predictors of delirium after acute stroke among critically ill adults. Editorials, reviews, posters, conference proceedings, abstracts, and studies in which stroke was not the primary reason for admission were excluded. Title and abstract screening, full-text review, and data extraction were performed by 2 authors, with disagreements adjudicated by a third author. RESULTS: The initial search yielded 1051 results. Eighteen studies met eligibility criteria and were included in the review. Stroke type was not mutually exclusive and included persons given a diagnosis of acute ischemic stroke (11), intracerebral hemorrhage (12), aneurysmal subarachnoid hemorrhage (8), and other (1) strokes. Incidence of delirium among stroke patients ranged from 12% to 75%. Predictors of delirium included older age, preexisting dementia, higher severity of illness, and physical restraint use. Outcomes associated with delirium included higher mortality, longer length of stay, worse cognition and quality of life, and lower functional status. CONCLUSIONS: Current findings are limited by heterogenous populations, assessments, and measurement parameters. Detection and management of delirium among critically ill stroke patients requires an approach with specific considerations to the complexities of acute neurological injury and concomitant critical illness.

Higher stress and symptom severity are associated with worse depressive symptom profiles in patients receiving chemotherapy.

In a sample of oncology patients, identify subgroups of patients with distinct depressive symptom profiles and evaluate for differences in demographic and clinical characteristics, levels of stress and resilience, and the severity of common co-occurring symptoms. Patients (n=1327) had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Demographic and clinical characteristics, stress, resilience, and co-occurring symptoms were evaluated at enrollment. Depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression (CES-D) scale a total of six times over two cycles of chemotherapy. Latent profile analysis (LPA) was used to identify subgroups of patients (i.e., latent classes) with distinct depressive symptom profiles using the six CES-D scores. Based on the findings from the LPA, 47.3% of the patients were classified as "None"; 33.6% as "Subsyndromal"; 13.8% as "Moderate"; and 5.3% as "High". Compared to None class, patients in the Subsyndromal, Moderate, and High classes had a lower functional status, a higher comorbidity burden, and a self-reported diagnosis of depression or back pain. Those patients with higher levels of depressive symptoms reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms. Inter-individual variability in depressive symptoms was associated with demographic and clinical characteristics, multiple types of stress and levels of resilience, as well as with the increased severity of multiple co-occurring symptoms. The risk factors associated with worse depressive symptom profiles can assist clinicians to identify high risk patients and initiate more timely supportive care interventions.

RAPT Scores Predict Inpatient Versus Outpatient Status and Readmission Rates After IPO Changes for Total Joint Arthroplasty: An Analysis of 12,348 Cases

BackgroundChanges to Medicare’s Inpatient Only List (IPO) and factors associated with the COVID pandemic have led to more total joint arthroplasty (TJA) patients to be designated as outpatient (OP). This potentially complicates postoperative care for patients with lower functional status and poor social support. These factors make the decision between OP versus inpatient (IP) designation particularly challenging for healthcare teams. The Risk Assessment and Prediction Tool (RAPT) was designed to indicate patient risk for needing posthospital discharge to facility and considers social and functional factors. The purpose of this study is to 1) evaluate the correlation of RAPT as a clinical tool to aid decision-making regarding OP versus IP for Total Hip and Knee Arthroplasty (THA and TKA), 2) assess the impact of recent changes to the IPO and the COVID pandemic on OP TJA readmission rates, and 3) determine whether 90-day readmissions are correlated with RAPT scores after OP TJA. MethodsWe identified all elective TKA and THA patients from 2015 through 2021 in our electronic health record at our large, urban, academic health system. Fracture patients were excluded. For those patients with available RAPT scores, we determined OP and IP designations, with IP defined as those with length-of-stay 2 midnights or more. We performed subanalysis of OP between same-day and next-day discharge. RAPT scores and readmission rates were compared at time points related to changes in the IPO: before TKA removal in 2018 (period A), from 2018 until THA removal in 2020 (Period B), and after January 1, 2020, inclusive of impact from the COVID pandemic (Period C). ResultsReviewed were 11,819 elective TKAs and 10,212 elective THAs. RAPT scores were available for 6,759 TKA patients and 5,589 THA patients. For both TKA and THA, RAPT scores between IP, same-day, and next-day discharged OP were significantly different across all time periods (P < .001). The percentage of OP designation increased across all time periods for TKA and THA. Over these same time periods, mean RAPT scores decreased significantly for both OP TKA and OP THA (P < .01). Concurrent with these changes were significant increases in OP THA 90-day readmission rates across Periods A and B (P = .010) as well as A and C (P = .006). Readmitted OP TKA had significantly lower RAPT scores than OP TKA without readmission during Period B (P < .001). Readmitted OP THA had significantly lower RAPT scores than those without readmission for all periods (P < .05). To facilitate clinical utility, median RAPT scores were also analyzed, and showed that RAPT scores for OP THA patients with readmission were 1 to 2 points lower for all time periods. ConclusionRAPT scores correlate with IP versus OP status for both TKA and THA and vary significantly with same-day versus next-day discharge. OP TJA RAPT scores may also help predict readmission, and counsel some patients away from OP surgery. Average RAPT scores of 10, 9, and 8 appeared to be separators for same day, next day, and inpatient stay. Changes to the IPO and COVID pandemic correlate with decrease in RAPT scores for both TKA and THA patients within all designations. In addition, a shift toward lower RAPT for OP TJA correlates with increased 90-day readmission rates for OP TJA. Taken together, these results suggest that patients with poorer function and worse social support systems are increasingly being driven toward OP surgery by these changes, which may play a role in increasing readmission rates. Social support and functional factors should be considered for OP elective TKA and THA. Further, any OP TJA value-based payment system must account for these variables.

Low function and frequent readmission in nursing home patients with persistent resistant gram-negative bacterial colonization

Background: Persistent colonization with resistant gram-negative bacteria (R-GNB) increases risk of clinical infection and intra-facility transmission among nursing home (NH) patients. Limited data exist on the roles of age and function on duration of R-GNB colonization. Methods: Secondary data analysis was performed from a cohort study of patients admitted to 6 Michigan NHs between November 2013 and May 2018. Swabs obtained upon enrollment, day 14, day 30, then monthly until NH discharge from 6 anatomical sites were cultured for GNB. R-GNB were defined as resistant to ciprofloxacin, ceftazidime, or imipenem. Positive R-GNB culture from a single visit followed by negative cultures for the same organism from ≥2 subsequent visits were defined as transient R-GNB colonization. All other patients with positive R-GNB cultures from multiple visits were considered persistently colonized. Demographic data, antibiotic use, device use, and physical self-maintenance scales (PSMSs) were obtained upon enrollment. Characteristics were compared between patients with transient versus persistent R-GNB and uncolonized patients using multinomial logistic regression. Results: We recruited 896 patients (median age, 75 years; 41% male; 46% nonwhite) and followed them for 2,437 total visits. Of 896 patients, 407 (45.4%) were colonized with ≥1 R-GNB during their stay. Of 171 patients with ≥ 2 follow-up visits after R-GNB detection, 94 (55%) remained persistently colonized with the same R-GNB (Table 1). Escherichia coli (30%) and Proteus mirabilis (22%) were the most frequently identified R-GNB. The most common anatomical colonization sites were perirectal (368 [24.3%] of 1,147) groin (340 [14.3%] of 2,046), and hands (115 [4.8%] of 2283). Compared to uncolonized patients, patients with persistent (1.09; 95% CI, 1.00–1.19, P = .048) and transient R-GNB colonization (1.13; 95% CI, 1.04–1.23; P = .003) had lower PSMS (Tables 2 and 3). Compared to uncolonized and transiently colonized patients, patients with persistent R-GNB colonization had prolonged lengths of NH stay (1.01; 95% CI, 1.00–1.01; P = .003). Conclusions: R-GNB colonization in vulnerable NH patients is common (407 [45.5%] of 896 and often persistent (94 [55%] of 171 patients with sufficient follow-up to assess persistence). Patients with persistent R-GNB had lower functional status, longer LOS, and higher readmission rates than those without. R-GNB decolonization should be investigated as a strategy to potentially improve outcomes among NH patients.Funding: NoneDisclosures: None

Abdominal pain in Finnish young adults with juvenile idiopathic arthritis

Objectives Abdominal pain (AP) is a common feature in the general population. However, in patients with juvenile idiopathic arthritis (JIA) AP has scantily been studied. Among other reasons, gastrointestinal symptoms may present as side effects due to the medical treatment of JIA. The aim of the study was to explore the frequency of AP and its relationship to disease components and health-related quality of life (HRQoL) among young adults with JIA. Methods This study included a cohort of 97 Finnish patients belonging to the population-based Nordic JIA cohort at their 17-year follow-up study visit. Mean age of the patients was 23 years. AP, functional status, fatigue, HRQoL, disease characteristics of JIA, and comorbidities were evaluated. AP was classified into three categories according to frequency: (1) never, (2) seldom (one to three times a month) and (3) frequent (at least once a week). Results About 48 (50%) young adults with JIA reported AP. Seldom AP was reported by 37 (38%), and frequent AP by 11 (11%) patients. AP was significantly associated with fatigue, female gender, functional status and arthritis-related pain. Patients having frequent AP reported lower HRQoL. AP was associated with the use of methotrexate and sulfasalazine, but not with nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusion AP is an important complaint in young adults with JIA and is associated with fatigue, female gender, methotrexate and sulfasalazine use. Patients with JIA reporting frequent AP with lower functional status and higher arthritis-related pain values have lower HRQoL.

Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project)

ObjectiveTo determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia.DesignEvaluator blinded, randomised controlled...

Oncology outpatients with worse depression and sleep disturbance profiles are at increased risk for a higher symptom burden and poorer quality of life outcomes

Objective/Background - Depression and sleep disturbance are significant problems during chemotherapy. Study purposes were to identify subgroups of patients with distinct joint depression AND sleep disturbance profiles and evaluate for differences in demographic and clinical characteristics, severity of symptoms, and quality of life (QOL) outcomes among these subgroups. Patients/methodsOncology outpatients (n = 1331) completed measures of depression and sleep disturbance six times over two chemotherapy cycles. Latent profile analysis, that modeled the two symptoms together, was done to identify the distinct joint depression and sleep disturbance profiles. ResultsFive distinct profiles were identified (i.e., no depression or sleep disturbance (None, 21.4%); no depression and moderate sleep disturbance (32.3%); subsyndromal depression and very high sleep disturbance (20.4%); moderate depression and moderate sleep disturbance (17.7%); and high depression and very high sleep disturbance (8.2%)). Compared to the None class, the other four classes were more likely to be female; less likely to be employed; had a higher comorbidity burden; and had a lower functional status. Patients in the two very high sleep disturbance classes had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and fatigue as well as lower levels of energy, cognitive function, and poorer QOL. ConclusionsOver 45% of the patients had subsyndromal to high levels of depression AND moderate or very high levels of sleep disturbance. Characteristics associated with the higher risk profiles can be used to screen patients at increased risk for both symptoms.

Management of breast cancer in older patients.

Japanese women have the highest life expectancy in the world and breast cancer is the most prevalent cancer among them. However, little data are available to support the evidence-based clinical management due to the fact that older adults are commonly excluded from most clinical trials. In Japan the rate of other cause of death in older patient was about a half, then we should consider whether or not breast cancer may affect the patient's life expectancy to avoid either overtreatment or undertreatment. Although management principles in older patients may be similar with those of younger age, these differences would be caused by relatively short life expectancy, some comorbidity, drug interactions and low functional status. Then, their treatment needs to be individualized. To this end, employing a comprehensive geriatric assessment may be advantageous, which enables to evaluate patient vulnerability from several different aspects, to predict adverse events of chemotherapy and to identify geriatric problems in advance so that extra support and modified treatment can be provided. Before treatment we should assess the patient's goals and values regarding the management of the cancer, especially on balancing survival benefit with immediate quality of life impairment due to anti-cancer therapy. In Japan Clinical Oncology Group (JCOG) , a randomized controlled trial for older patients with advanced stage HER2-positive breast cancer is ongoing as an inferiority design including geriatric assessment (JCOG1607, HARB TEA study). Best practice, current management and how to approach decision making in older patients with breast cancer are summarized.

Distinct Cognitive Function Profiles Are Associated With a Higher Presurgery Symptom Burden in Patients With Breast Cancer.

Cancer-related cognitive impairment (CRCI) is a common symptom in patients with breast cancer. In our previous study of 397 women with breast cancer, we identified 3 groups of patients with distinct CRCI profiles (ie, high, moderate, and low-moderate attentional function). Compared with the other 2 classes, the low-moderate class was younger, had more comorbidities, and with lower functional status. In this study, we expand on this work and evaluate for differences among these latent classes in the severity of psychological (depression and anxiety) and physical (fatigue, decrements in energy, sleep disturbance, and pain) symptoms before surgery. Cancer-related cognitive impairment was assessed using the Attentional Functional Index from before through 6 months after surgery. Lower Attentional Functional Index scores indicate higher levels of CRCI. Psychological and physical symptoms were assessed with valid instruments. Parametric and nonparametric tests were used to evaluate for differences in symptom severity scores among the latent classes. Approximately 60% of patients experienced CRCI (ie, moderate and low-moderate classes). Significant differences were found among the 3 classes in the severity of trait and state anxiety, depressive symptoms, fatigue, and sleep disturbance (ie, high < moderate < low-moderate). In addition, compared with the other 2 classes, the low-moderate class reported higher pain interference scores. These findings suggest that women with clinically meaningful levels of persistent CRCI have a relatively high symptom burden before surgery. Clinicians need to routinely perform preoperative assessments of CRCI and associated symptoms and initiate therapeutic interventions.

Symptoms Used In Heart Failure Research And Reviewed By Patients And Clinicians

<h3>Introduction</h3> Patients with heart failure (HF) commonly experience multiple symptoms. Increasing symptom burden can lead to HF decompensation and frequent use of healthcare resource including rehospitalization. Even though the American Heart Association (AHA) lists seven symptoms as common HF-related symptoms, many HF studies have used additional symptoms to measure patient outcomes. Our goal was to identify symptoms associated with heart failure from contemporary literature and obtain patient and clinician perspective on their importance. <h3>Aim</h3> . To determine frequent symptoms used in research to improve HF outcomes. <h3>Methods</h3> We searched PubMed, Embase and google scholar databases through entering combinations of search terms: "heart failure" [mesh] OR "heart failure" in the title and abstract AND symptom in the title" for articles published between 2016 and 2020. Of 495 matches, we excluded articles that did not mention HF in the title, did not mention individual symptoms in the abstract, or were focused on validation of instruments, symptom perception, or relationship of scores of instruments and outcomes. We selected 132 final articles and identified symptoms that were frequently described as part of HF research or evaluated as outcome measures. We then asked 15 patients with HF to review the list of symptoms and select the ones most bothersome in connection with their experience of the disease. Lastly, we had six clinicians review the symptoms identified by the patients and weigh in on their importance from clinician perspective. <h3>Results</h3> Among 43 symptoms identified in the 132 articles, we selected 13 that were mentioned in more than four articles (see Figure). Fifteen patients with HF ranked the 13 symptoms by how bothersome they were. The top seven symptoms ranked by patients were dyspnea, depression, fatigue, sleep disturbance, edema, pain and cognitive alterations. Depression, sleep disturbance and pain were three symptoms that are not routinely assessed. These three symptoms have also been shown as risk factors for negative outcomes such as poor quality of life, lower functional status, and unplanned healthcare use. <h3>Conclusions</h3> We present symptoms ranked by patients with HF according to burden. Depression, sleep disturbance and pain were important symptoms that in particular may require better assessment, monitoring and treatment.

Frailty Is Associated With Worse Outcomes In Geriatric Pelvic Fractures.

Frail, geriatric patients with pelvic fractures can present differently than non-frail patients. Using the Clinical Frailty Scale(CFS), a retrospective analysis was conducted to determine the relationship between patients' CFS and outcomes after pelvic fractures. We hypothesized that frail, geriatric trauma patients defined as a CFS>4 with pelvic fractures have worse outcomes than non-frail patients with a CFS≤4 despite similar injuries. All geriatric patients with pelvic fractures and documented CFS were included. Seventy patients were included, with 59% (n = 41) frail. The groups were compared with no difference in mortality. The frail group was older and were most likely discharged to a skilled nursing facility (65.8%). Non-frail were most likely discharged to acute rehab (52%). Frail had lower functional status at discharge (median: 14.5v.16, P = .015). Frail patients had worse overall outcomes in this analysis of geriatric pelvic fracture patients. Special attention should focus on this vulnerable population to ensure optimal treatment and outcomes.

Pediatric intracranial pressure surveillance and quantitative outcomes in kids: (PIPSQK) Study

Objectives Intracranial pressure (ICP) monitoring in pediatric traumatic brain injury (TBI) patients remains controversial. This study aimed to characterize the association between ICP monitoring and mortality for pediatric severe TBI, hypothesizing that ICP monitoring would not be associated with improved survival. Methods Pediatric patients (≤14 years) presenting to Pennsylvania trauma centers from 2003 to 2018 who met severe brain injury criteria (Glasgow Coma Score &lt;9 and Head Abbreviated Injury Scale 4–5) and presented with a blunt mechanism of injury were included. Patients presenting dead on arrival and transfer patients were excluded. Patients were categorized according to ICP monitor placement (ICP+ and ICP−). To assess the effects of ICP monitors on mortality, a multivariate logistic regression model adjusting for demographics and injury patterns was performed. Results A total of 802 pediatric patients met the inclusion criteria. Of those, 28.7% were in ICP+ group ( n = 230) and overall mortality was 33.9% ( n = 272). Despite a higher Injury Severity Score in ICP+ compared to ICP− (33 v. 27, p &lt; 0.001), the mortality rate was lower (22% v. 39%, p &lt; 0.001). The ICP+ group had lower functional statuses at discharge (8 v. 18, p &lt; 0.001). The multivariate logistic regression revealed that presence of an ICP monitor significantly decreased odds of mortality (adjusted odds ratio:0.57, p = 0.027). Conclusion While ICP monitor placement remains controversial in pediatric trauma, there appears to be an association between ICP monitor placement and decreased mortality, despite the ICP monitor group having lower functional status at discharge.

Effect of Missed Items on the Reliability of the Kessler Foundation Neglect Assessment Process

ObjectiveTo determine the maximum permissible number of missed items on the 10-item Catherine Bergego Scale administered after the Kessler Foundation Neglect Assessment Process (KF-NAP). Secondary objectives were to determine the frequency, characteristics, and most commonly cited reasons reported for missed items. DesignRetrospective diagnostic accuracy study. SettingSixteen inpatient rehabilitation facilities in the United States. ParticipantsA consecutive clinical sample of 4256 patients (N=4256) with stroke or other neurologic deficits who were assessed for spatial neglect with the KF-NAP. InterventionsNot applicable. Main Outcome MeasuresCatherine Bergego Scale via KF-NAP. ResultsThe majority (69.7%) of patients had at least 1 missed item on their KF-NAP. Among those with missed items, it was most common to have 2 missed items (51.4%), and few had more than 3 missed items (11.3%). The most commonly missed items were Collisions (37.2%), Cleaning After Meals (36.1%), Meals (34.0%), and Navigation (19.7%). The most commonly reported reasons for missed items included time constraints, cognitive or communication deficits, and behavior or refusal of the therapy session. These reasons were reported for nearly all item types. Item-specific reasons were also commonly reported, such as a lack of a needed resource for task completion or low functional status of the patient. Prorated scoring of measures with up to 3 missed items maintained an acceptable level of concordance with complete measures (Lin's Concordance Correlation Coefficient=0.96, 95% CI, 0.9478-0.9626) for the combination of 3 missed items with lowest concordance. ConclusionsClinicians should make every effort to capture all items on the KF-NAP. However, missed items occur in the majority of cases because of patient factors and barriers inherent to the inpatient hospital setting. When missed items are necessary, clinicians can confidently interpret a prorated score when 7 or more items are scored.

Minimally Adequate Treatment for Depression and Anxiety Associated With Mortality in Primary Care Older Adults.

To assess the association between receipt of minimally adequate treatment (MAT) and mortality in a sample of community primary care older adults with depression and anxiety. The present study was conducted among a sample of 358 older adults ( ≥ 65 years old) with depression or an anxiety disorder recruited in primary care practices between 2011 and 2013. Participants agreed to link their health survey and administrative data for the 3 years preceding and following the baseline interview. Depression and anxiety disorders were based on self-reported symptoms aligned with DSM-5 criteria and physician diagnoses (International Classification of Diseases [ICD], 9th and 10th revisions). MAT was defined according to Canadian guidelines and include receipt of pharmacotherapy and ≥ 4 medical visits within 3 months or a number of psychotherapy sessions (individual, group, or family) over 12 months (depression: ≥8; anxiety disorders: ≥5 to 7). All-cause 3-year mortality was ascertained from the vital statistics death registry in Québec. Propensity score weighted regression analysis was conducted to assess the association between receipt of MAT and mortality adjusting for individual, clinical, and health system study factors. Receipt of MAT was associated with a reduced risk of mortality (hazard ratio [HR]: 0.27; 95% confidence interval [95% CI], 0.12 to 0.62). Individual and clinical factors associated with increased mortality included older age, male sex, being single, low functional status, and increased physical disorders and cognitive functioning. Lifestyle factors associated with reduced and increased mortality included alcohol consumption and smoking, respectively. Health system factors such as perceived adequate number of visits to speak to the doctor about emotional problems and continuity of care were associated with reduced mortality. The current study highlights the important role of primary care physicians in detecting and providing MAT for older adults with depression and anxiety, as this may have an effect on longevity.