Moderate Functional Impairment Research Articles

P101. Can AI identify patterns of complex adult spinal deformity with distinct perioperative outcomes?

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) refers to multiple types of spinal deformity. This study used a prospective multicenter database of patients with "complex" surgical ASD to derive a data-driven classification of different deformity patterns, and assessed if such patterns have distinct clinical outcomes. <h3>PURPOSE</h3> Use an AI-based unsupervised approach to identify patterns of ASD. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of a multi-center prospective database. <h3>PATIENT SAMPLE</h3> A total of 286 patients with complex ASD who underwent surgical correction. <h3>OUTCOME MEASURES</h3> Operative decision-making and 30-day adverse events. <h3>METHODS</h3> Complex surgical ASD included severe deformity, surgical complexity or advanced age with a multilevel fusion. An unsupervised cluster analysis that allowed for 10% outliers was used to identify different patterns of deformity. Perioperative outcomes of these clusters were then compared using ANOVA, Kustal-Wallis, and Chi-Squared analyses as indicated, with p-value < 0.05 considered significant. <h3>RESULTS</h3> The Hyper-Kyphosis (Hyper TK, n = 31) group had a mean thoracic kyphosis of 82.6±17.6°, lumbar hyperextension (PI-LL: -20.4±14.7°) and relatively straight coronal curvatures. Hyper-Kyphosis patients were the youngest (mean age 48±20 years) and had the lowest disability (mean ODI 32.9±17.1) and pain scores (median NRS back 6 IQR 3 to 8, median NRS leg 1 IQR 0 to 4). The Severe Coronal (Coronal, n = 91) group had a mean thoracic Cobb of 44.7±17.8° and a mean thoraco-lumbar Cobb of 57.9±16.5° with preserved global sagittal alignment. Coronal patients had moderate disability (mean ODI 33.5±18.8), functional impairment (PCD: 34.4±12.3) and pain scores (median NRS back 7 IQR 5 to 8, median NRS leg 4 IQR 0 to 7). The Severe Sagittal (Sev. Sag. n=79) group had a severe spino-pelvic mismatch (42.9±12.9°) and global sagittal deformity (24.3±7.9°). Sev Sag had higher BMIs (28.9±5.9), high levels of disability (mean ODI 49.3±15.6) and low appearance scores (2.3±0.7). Finally, the Moderate Sagittal (Mod. Sag. n=85) group had moderate deformities without distinctive radiographic characteristics, a mean age of 68.8±7.8°, the highest PROMIS pain interference sub-scores (65.2±5.8), high levels of disability (mean ODI 47.6±15.3) and back pain (NRS back 7 IQR 6 to 9), and poor overall quality of life (mean SRS total 2.8±0.6). Thirty-day adverse events were equivalent. Hyper TK and Coronal patients had the longest constructs, but fusion to the pelvis was most common in Mod Sag (89.4%) and Sev Sag (97.5%) deformities. Coronal patients had more osteotomies per case (median 11 IQR 6.5 to 14), longer OR times, and more 30-day implant-related complications (5.5%). Sev Sag and Hyper TK patients were more likely to require a 3-column osteotomy (43% and 32.3%, respectively). Sev Sag deformities were more likely to require interbody implants (29.1%) and operative wound debridement (7.6%). Hyper TK patients had shorter hospital stays. <h3>CONCLUSIONS</h3> AI methodologies identified 4 distinct patient clusters within a large population of surgically treated ASD patients. Each ASD cluster presented with 1) a unique spinal deformity pattern, 2) reported distinct pathognomonic health deficits, 3) received consistent surgical treatment across 11 centers, and 4) had characteristic perioperative complications and hospital stays. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The Impact of Internalizing Symptoms on Impairment for Children With ADHD: A Strength-Based Perspective

Background/Purpose: This study aims to investigate the influence of internalizing symptoms on functional impairment for children with ADHD, and whether child strengths and parenting strengths have moderating effects on this relationship. Methods: Participants included 209 children with ADHD and their caregivers seeking mental health services between the ages of 5 and 11 years. To examine the moderating effects of parenting and child strengths, ordinary least squares regression models were tested using the PROCESS macro for SPSS (v3.5). Results: Results suggest that levels of internalizing symptoms influence functional impairment in children with ADHD. Child strengths moderate the relationship between internalizing symptoms and functional impairment when internalizing symptoms are medium to high. Conclusion: Findings from this study demonstrate that facilitating child strengths can help moderate functional impairment for children who experience ADHD and internalizing symptoms.

Analysis of structural and functional central nervous system abnormalities associated with prenatal exposure to ethanol in children of primary school age

The article is presenting results of the third stage of the examination of primary school students for the identification and assessment of the severity of structural and functional abnormalities of the central nervous system (CNS) that arose in connection with perinatal exposure to ethanol — 77 children with previously identified delayed physical development of various degrees and characteristic dysmorphological disorders were examined. The identification of structural abnormalities to the CNS was carried out on the basis of assessing the correspondence of the occipital frontal circumference of the child’s head with the normative values for a specific sex and age, determination of functional abnormalities was carried out on the basis of an assessment of intellectual development based on the results of the Wechsler Intelligence Scale for Children and behavioral characteristics according to the Vineland Adaptive Behavior Scales.The presence of structural abnormalities to the CNS, manifested by a decrease in the occipital frontal circumference 2 or more standard deviations below the mean for the age norm, was revealed in 59 patients (77%). A serious functional disorder of the CNS, manifested by mild and moderate mental retardation, was found in 23 children (30%). Mild or moderate functional impairment of the CNS in the form of delayed cognitive development was found in 21 children (27%).Assessment of behavior and adaptive skills revealed a significant number of children (72%), whose adaptive behaviors were unfavorably different from the norm. The most common ones were: low concentration of attention — in 77%, increased anxiety and fear — in 65%, hyperactivity — in 60%, impulsivity — in 44%, outbursts of anger — in 43%, deceit and theft — in 40%, excessive dependence or codependency — in 38%, deliberate destruction of one’s own or someone else’s property — in 14% of children.Statistically significant inverse correlations of a high level of significance (p≤0.01) between indicators of nonverbal intelligence and maladaptive behavior were obtained. Inverse correlations between structural abnormalities of the CNS and nonverbal intelligence are presented at the tendency level.

Severe functional impairment increases the risk of major morbidity and mortality in older patients after digestive tract surgery: a retrospective cohort study.

The relationship between the severity of impairment in basic activities of daily living (ADLs) function and postoperative outcomes in older surgical patients remains unclear. This study aimed to clarify the association between the severity of preoperative functional impairment and the composite postoperative outcome of major morbidity and mortality in older patients undergoing digestive tract surgery. This was a retrospective cohort study. We collected perioperative data of older patients (age ≥ 65years) who underwent digestive tract surgery in our institution. The severity of functional impairment was assessed using the Barthel Index scale before surgery. The major morbidity and mortality were defined as Clavien-Dindo grade III or greater postoperative complications during hospital stay. The association between the severity of functional impairment and the major morbidity and mortality was assessed using a multivariable logistic regression model. 131 of 1076 patients (12.2%) developed major morbidity and mortality. After controlling for confounding factors, high Barthel Index scores were correlated with decreased risk of major morbidity and mortality (OR 0.986, 95% CI 0.976-0.997, P = 0.011); preoperative severe (OR 2.862, 95% CI 1.172-6.989, P = 0.021), but not mild or moderate (OR 1.019, 95% CI 0.602-1.726, P = 0.943) functional impairment was independently associated with an increased risk of major morbidity and mortality, when compared with independent functional status. Preoperative severe functional impairment in basic ADLs was independently associated with a higher risk of major postoperative morbidity and mortality in older patients undergoing digestive tract surgery.

Prevalence of depressive disorders and associated demographic characteristics in Shandong: An epidemiological investigation

BackgroundDepression is characterized by debilitating symptoms and high recurrence rates, and there are relatively few large-scale epidemiological surveys of depressive disorders conducted in Shandong since 2005. Data from the largest Epidemiological Survey of Mental Disorders conducted in 2015 in Shandong were collected to investigate the prevalence of depressive disorders and associated demographic characteristics in general adult population. MethodsA multi-stage stratified cluster sampling method was adopted to select residents and a two-stage screening and assessment process was used to define the prevalence and characteristics of depressive disorders. Respondents were initially screened using the General Health Questionnaire followed by a structured clinical interview using the DSM-IV criteria. ResultsAmong 27,489 respondents who completed the survey, 1277 respondents met the diagnostic criteria for depressive disorders. The adjusted prevalence in the last month was 4.86%, among which the prevalence of major depressive disorder, dysthymia, and unspecified depressive disorder were 2.32%, 1.78%, and 0.75%, respectively. 40.35% of depression patients had moderate or severe functional impairment and only 10.65% of patients had visited a psychiatric service. Univariate and multivariate analyses revealed that age, gender, occupation, education, marital status, and urban/rural living were associated with the prevalence. LimitationsThe key limitation is that this is a cross-sectional survey therefore cannot draw any causal relationship between risk factors and disease progression. ConclusionsFindings from this largest epidemiological study reveal current prevalence of depressive disorders and associated demographic factors and offers opportunities for policy makers and health-care professionals to improve mental health provision in Shandong.

Evaluation of kidney function among people living with HIV initiating antiretroviral therapy in Zambia.

As the response to the HIV epidemic in sub-Saharan Africa continues to mature, a growing number of people living with HIV (PLHIV) are aging and risk for non-communicable diseases increases. Routine laboratory tests of serum creatinine have been conducted to assess HIV treatment (ART) suitability. Here we utilize those measures to assess kidney function impairment among those initiating ART. Identification of non-communicable disease (NCD) risks among those in HIV care creates opportunity to improve public health through care referral and/or NCD/HIV care integration. We estimated glomerular filtration rates (eGFR) using routinely collected serum creatinine measures among a cohort of PLHIV with an HIV care visit at one of 113 Centre for Infectious Disease Research Zambia (CIDRZ) supported sites between January 1, 2011 and December 31, 2017, across seven of the ten provinces in Zambia. We used mixed-effect Poisson regression to assess predictors of eGFR <60ml/min/1.73m2 allowing random effects at the individual and facility level. Additionally, we assessed agreement between four eGFR formulae with unadjusted CKD-EPI as a standard using Scott/Fleiss method across five categories of kidney function. A total of 72,933 observations among 68,534 individuals met the inclusion criteria for analysis. Of the 68,534, the majority were female 41,042 (59.8%), the median age was 34 (interquartile range [IQR]: 28-40), and median CD4 cell count was 292 (IQR: 162-435). The proportion of individuals with an eGFR <60ml/min/1.73m2 was 6.9% (95% CI: 6.7-7.1%) according to the unadjusted CKD-EPI equation. There was variation in agreement across eGFR formulas considered compared to unadjusted CKD-EPI (χ2 p-value <0.001). Estimated GFR less than 60ml/min/1.73m2, per the unadjusted CKD-EPI equation, was significantly associated with age, sex, body mass index, and blood pressure. Using routine serum creatinine measures, we identified a significant proportion of individuals with eGFR indicating moderate or great kidney function impairment among PLHIV initiating ART in Zambia. It is possible that differentiated service delivery models could be developed to address this subset of those in HIV care with increased risk of chronic kidney disease.

Outcome of idiopathic pulmonary fibrosis with pregnancy

Background Idiopathic pulmonary fibrosis (IPF) is a chronic pulmonary disease with an unknown etiology. It is uncommon in women of childbearing age. Limited data are available regarding the outcome of IPF with pregnancy. Objectives To evaluate both maternal and neonatal outcomes among pregnant women with IPF in comparison with pregnant asthmatic patients. Analysis of potential factors associated with unfavorable outcomes was done. Patients and methods This prospective case–control study recruited 20 pregnant women with IPF and 43 asthmatic pregnant controls. Demographics and disease-related parameters were recorded. Functional and radiological evaluations were performed. Watchful peripartum follow-up and precise management in a multidisciplinary team were done. Maternal and neonatal outcomes were evaluated with an analysis of prognostic factors for unfavorable outcomes. Results The mean age (SD) of study patients was 31.2 (6.4) years. Seven (35%) cases showed moderate functional impairment, and nine (45%) cases showed severe impairment. All cases required oxygen therapy by the third trimester. Five (25%) cases required ICU admission during the peripartum period. A total of 15 (75%) cases needed domiciliary oxygen upon discharge from the hospital (unfavorable maternal outcome) with no maternal mortality recorded. Overall, 11 (55%) cases were associated with neonatal complications (unfavorable neonatal outcome). The degree of functional impairment showed a significant association with neonatal outcome (P=0.02). Both maternal and neonatal outcomes were significantly better in the control group than in cases (P&lt;0.001). Conclusion Pregnancy course in patients with IPF can be associated with adverse effects on maternal and neonatal outcomes and disease progression. However, collaborative management can minimize maternal mortality.

Evaluations of exercise intolerance with cardiopulmonary exercise tests in an 18-year-old adolescent with pituitary stalk interruption syndrome: a case report

BackgroundPituitary stalk interruption syndrome (PSIS) is a rare disease associated with different level of anterior pituitary hormone deficiency resulting with a variety of clinical manifestations which could limit exercise capacity. Cardiopulmonary exercise test (CPET) is valuable in differential diagnosis of exercise intolerance and exercise prescription.Case presentationAn 18-year-old male adolescent was diagnosed with PSIS at 4 years old, had undergone growth hormone supplement until puberty, and was referred to rehabilitation department due to exercise intolerance. We arranged pulmonary function test (PFT) and CPET to clarify the cause of limited capacity. The test result provided evidence of moderate functional impairment (54% of predicted maximal oxygen uptake) mainly affected by physical unfitness without significant cardiovascular or pulmonary limitations.ConclusionCPET serves as a valuable tool for diagnostic purpose. Aerobic and resistance exercise training for the patient should be conducted promptly for better prognosis but under safe circumstances, with criteria which could be provided by CPET results.

Long-term functional outcomes after traumatic spine fractures

BackgroundTraumatic spine fractures can result in chronic pain, disability, and prolonged rehabilitation. The purpose of this study is to determine the long-term effects of traumatic spine fractures on patients’ functional outcomes after nonoperative and operative management. MethodsPatients with traumatic spine fractures over a 5-year period were identified and stratified by management strategy (nonoperative and operative) and compared. Functional outcomes were measured using the Boston Activity Measure for PostAcute Care to assess basic mobility and daily activity. Multiple linear regression was used to identify predictors of functional outcome after traumatic spine fractures. ResultsIn total, 488 patients were identified: 271 nonoperative and 217 operative. Follow-up was obtained in 168 (34%) patients: 95 nonoperative and 73 operative. Mean follow-up was 5.7 years (range 3–8 years). Mean Activity Measure for PostAcute Care scores in patients managed nonoperatively for basic mobility (68 vs 64, P = .09) and daily activity (69 vs 66, P = .26) were clinically similar to those managed operatively. Multiple linear regression identified increasing age as a predictor of decreased basic mobility (β = –0.50, P < .0001, β = –0.17, P = .022) and daily activity (β = –0.58, P < .0001, β = –0.35, P = .003) in nonoperative and operative groups, respectively. In nonoperative patients, thoracic spine fracture was predictive of both decreased basic mobility (β = –5.88, P = .041) and daily activity (β = –8.62, P = .043). In operative patients, lower extremity fractures (β = –8.86, P = .012), discharge location (β = –6.91, P = .003), and time to operative fixation (β = –0.77, P = .040) were associated with decreased basic mobility. ConclusionAll patients with traumatic spine fractures displayed mild to moderate functional impairment. Age, thoracic fractures, lower extremity fractures, discharge location, and time to operative fixation were associated with poor functional outcomes.

The Urinary Glucose Excretion by Sodium–Glucose Cotransporter 2 Inhibitor in Patients With Different Levels of Renal Function: A Systematic Review and Meta-Analysis

ObjectivePrevious evidence suggested that sodium–glucose cotransporter 2 inhibitor (SGLT2i)-mediated urinary glucose excretion (UGE) appeared to be reduced with a decrease in glomerular filtration rate. Thus, we conducted a systematic review and meta‐analysis to compare SGLT2i-mediated UGE among individuals with different levels of renal function.MethodsWe conducted systematic searches in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov from inception to May 2021. Clinical studies of SGLT2i with reports of UGE changes in predefined different levels of renal function were included. The results were expressed as pooled effect sizes with 95% confidence interval (CI). A random-effects model was used to calculate the pooled effect sizes.ResultsIn total, eight eligible studies were included. Significant differences were observed in the post-treatment UGE level among subgroups stratified by renal function (P <0.001 for subgroup difference), which were gradually decreased along with the severity of impaired renal function. Consistently, changes in UGE before and after SGLT2i treatment were also decreased along with the severity of impaired renal function [67.52 g/day (95%CI: 55.58 to 79.47 g/day) for individuals with normal renal function, 52.41 g/day (95%CI: 38.83 to 65.99 g/day) for individuals with mild renal function impairment, 35.11 g/day (95%CI: 19.79 to 50.43 g/day) for individuals with moderate renal function impairment, and 13.53 g/day (95%CI: 7.20 to 19.86 g/day) for individuals with severe renal function impairment; P <0.001 for subgroup differences].ConclusionsSGLT2i-mediated UGE was renal function dependent, which was decreased with the extent of renal function impairment.

Predicting discharge from long-term forensic treatment: patients characteristics, protective factors, needs and treatment-related factors study in the Czechia

ABSTRACT One of the challenges in forensic psychiatry is determining when an inpatient is ready to be discharged and return to the community. The comprehension of factors that predict extended treatment or discharge is relatively limited. We assessed the treatment progress of a cohort of forensic inpatients (N=80) divided into two groups: discharged patients and patients who remain detained. We derived socio-demographic and clinical variables from each patient’s medical records and scores on the HoNOS-Secure, GAF, and SAPROF scales. The dataset was subjected to logistic regression and Chi-square analysis to determine the relevant factors. We gained insights into illness as a strong predictor of discharge, which is also associated with the patient’s general compliance with the facility program and participation in occupational therapy. The majority of our sample has moderate or severe functional impairment according to GAF. The instruments used can capture dynamic factors related to discharge or continuing hospitalization, namely the SAPROF total or external factors score, the HoNOS-Secure subscale, and significant items from the HCR-20 clinical and risk subscales.

Management of Canine Y-T Humeral Fractures Using Titanium Polyaxial Locking Plates in 17 Dogs

ABSTRACTThe objective of this study was to document the short- and medium-to-long-term outcomes and complication rates of Y-T humeral condylar fractures fixed using titanium polyaxial locking plate (T-PLP). A retrospective review was performed of the medical records and radiographs of dogs with a Y-T humeral condylar fracture treated with T-PLP at a single veterinary referral center (2012–2018). Seventeen cases met the inclusion criteria. Medium- to long-term follow-up (.6 mo) information was derived using the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Recorded complications were catastrophic (1/17) and minor (2/17). Gait at 10–12 wk following surgery was subjectively assessed as good or excellent for 13 cases. Radiographic bone union was achieved in 7/12 cases at 4–6 wk. LOAD scores obtained a mean of 15 mo (range 6–29 mo) following surgery and indicated no or mild impairment in 15/16 and moderate functional impairment in 1. The application of T-PLP for the treatment of Y-T humeral condylar fractures resulted in adequate stabilization allowing successful fracture healing and medium- to long-term outcomes comparable to previous reports. According to results of LOAD testing, the medium- to long-term follow-up suggests that clients were aware of mild to moderate functional impairment in all cases.

Introdução ao transtorno de déficit de atenção/hiperatividade: caracterização, avaliação e intervenção

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning and personal development, being a set of cognitive and behavioral symptoms, with onset in childhood, manifestation in different settings, and severity can be specified in mild, moderate, or severe symptoms or functional impairment. The diagnostic process that involves the evaluation, seeks to understand the patient’s cognitive functioning, raise diagnostic hypotheses and point out which skills are impaired and/or preserved, thus being able to indicate difficulties or potentialities of cognitive functioning and which are the best referrals for the patient, ADHD have complex forms of presentation and symptomatology, are diverse in nature and have different content and focus, depending on thepatient’s age, which is why interdisciplinary and multidisciplinary treatment is so important in these cases, it is up to the professionals who will follow up to observe whether these strategies are appropriate and how they can create new ways of accomplishing tasks or solving problems that become functional and assertive for the patient. Treatment should target not only symptoms of inattention, hyperactivity, and impulsivity, but also academic difficulties, impairments in family and social relationships, and psychiatric comorbidities. These approaches are often most effective when used together, depending on the individual needs of the child and family.

Correlation Scale, Functional Tests and Comorbidities with Episodes in Cerebrovascular Accident

Introduction: In assessing patients with a stroke sequel, tonic and postural changes are generally evaluated, but other important information, such as functional capacity, risk of falls, and gait, should also be taken into account. Objective: To correlate the impairment level determined by Brunnstrom's scale, the results of functional tests and analyze the characteristics of the sample as being affected by comorbidities, time and number of strokes occurred. Methods: Cross-sectional evaluation of 50 patients (convenience) at a center of public rehabilitation, using Brunnstrom's scale (1-6, better limb ability closer to 6), Time Up and Go (TUG) (significant mobility deficit and in risk of falls above 20 seconds), Upright Motor Control Test (UMCT) (1-3, bellow 3 are household walkers), Step Test (ST) (disparity between member refers to slower individuals), registration of comorbidity and the time since the stroke happened and the number of episodes. Results: Grade "4" rated for upper and lower limbs by Brunnstrom's Scale, achieving over 20 seconds in TUG, level 2 in UMCT, and commitment of paretic member related to non-paretic on the ST (p&lt;0.01). There was no influence of the time or number of strokes suffered. The main associations found were hypertension, diabetes, and dyslipidemia. Conclusion: The Brunnstrom's scale appointed moderate level function impairment for upper and lower limbs. Wherein association with functional tests determines slower and vulnerable individuals, with disability in changing the load support between members, neuromuscular control and balance deficit, fall risk and compromised walking ability.

High Rate of Elder Abuse in the Time of COVID-19-A Cross Sectional Study of Geriatric and Neurology Clinic Patients.

The ongoing COVID-19 pandemic is believed to have caused a sharp increase in the incidence of elder abuse (EA), including as a result of isolation, social distance combined with increased interpersonal stressors. Thus, the aim of this study is to determine the impact of the COVID-19 pandemic on the elder abuse rates and the characteristics of risk factors. A total of 347 patients hospitalized in the Department of Neurology and Department of Geriatrics at University Hospital No. 1 in Bydgoszcz were selected as subjects for the analysis. The tools used in the study are: Authors-Designed Questionnaire, the Vulnerability to Abuse Screening Scale, the Geriatric Depression Scale and the Activities of Daily Living Scale. Descriptive statistics, chi-squared tests, Spearman’s rank correlation test, and logistic regression analyses were used. In the studied population, nearly 45% of the elderly were victims of violence. This represents an increase of more than 6 percent compared to the pre-pandemic. The most common type of EA was psychological abuse (72.3%). In the final models, the risk factors include, among others, low income (OR = 3.60, 95% CI = 1.93–6.72), chronic diseases (OR = 2.06, 95% CI = 1.28–3.31), poor relationship with the family (OR = 3.26, 95% CI = 1.96–5.43), and moderate and severe depression (OR = 18.29, 95% CI = 10.24–32.69; OR = 18.49, 95% CI = 3.91–87.30, respectively). Moreover, moderate functional impairment 5.52 times more often and severe functional impairment 21.07 times more likely to predispose to EA. People who suffered from COVID-19 are 1.59 times more likely to be victims of EA (95% CI = 1.03–2.46). In this study, we saw significant increases in EA rates during the COVID-19 pandemic.

Initial Renal Function (eGFR) Is a Prognostic Marker of Severe Acute Pancreatitis: A Cohort-Analysis of 1,224 Prospectively Collected Cases.

Background: Acute pancreatitis (AP) is a life-threatening disease. We aimed to explore the prognostic relevance of renal function based on estimated glomerular filtration rate (eGFR).Methods: A prospective registry of AP patients was established by the Hungarian Pancreatic Study Group. Data of 1,224 consecutive patients were collected between 2012 and 2017. Patients were divided into 3 groups according to their eGFR measured within 24 h of hospitalization: normal renal function: >90 mL/min, mild to moderate renal functional impairment: 30–90 mL/min and severe renal dysfunction: <30 mL/min. Associations of eGFR with outcome (survival, length of hospitalization, AP severity, blood glucose), inflammatory markers (erythrocyte sedimentation rate, white blood cell count), anemia and organ failure (heart, kidney, liver) were analyzed.Results: Death, longer hospitalization and severe AP, but not the cause of AP, were significantly associated with lower eGFR. The inflammatory markers (CRP, WBC count) but not anemia (Hb, Htk) were closely associated with severe renal dysfunction. Renal function was associated with heart and renal failure but not with other complications of AP such as respiratory failure, local pancreatic complications, diabetes or peptic ulcer. eGFR was not associated with liver damage (ALAT, γ-GT) or liver function (serum bilirubin) although biliary complications, alcohol and metabolic syndrome were the most common etiologies of AP.Conclusions: Our study suggests a useful prognostic value of initial eGFR in AP patients. Even mild eGFR reduction predicted mortality, severity of AP and the length of hospitalization. Thus, precise evaluation of renal function should be considered for assessing AP severity and outcome.

Efficacy and safety of pharmacotherapy for Alzheimer\u2019s disease and for behavioural and psychological symptoms of dementia in older patients with moderate and severe functional impairments: a systematic review of controlled trials

BackgroundMany patients with Alzheimer’s disease (AD) are physically frail or have substantial functional impairments. There is growing evidence that such patients are at higher risk for medication-induced adverse events. Furthermore, frailty seems to be more predictive of poor clinical outcomes than chronological age alone. To our knowledge, no systematic review of clinical trials examining drug therapy of AD or behavioural and psychological symptoms of dementia (BPSD) has specifically focused on the topic of physical frailty. Our objective was to evaluate the efficacy and safety of pharmacotherapy in AD patients with frailty or significant functional impairments.MethodsWe performed a systematic literature search in MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) of drug therapy of AD and BPSD in patients with significant functional impairments according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Cochrane research criteria. Significant functionally impaired patient populations were identified using the recommendations of the Medication and Quality of Life in frail older persons (MedQoL) Research Group. Screening, selection of studies, data extraction and risk of bias assessment were performed independently by two reviewers. Outcomes including functional status, cognitive function, changes in BPSD symptoms, clinical global impression and quality of life were analysed. For assessing harm, we assessed adverse events, drop-outs as a proxy for treatment tolerability and death. Results were analysed according to Cochrane standards and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsOf 45,045 search results, 38,447 abstracts and 187 full texts were screened, and finally, 10 RCTs were included in the systematic review. Selected articles evaluated pharmacotherapy with acetylcholinesterase-inhibitors (AChEI), anticonvulsants, antidepressants and antipsychotics. Studies of AChEIs suggested that patients with significant functional impairments had slight but significant improvements in cognition and that AChEIs were generally well tolerated. Studies of antidepressants did not show significant improvements in depressive symptoms. Antipsychotics and anticonvulsants showed small effects on some BPSD items but also higher rates of adverse events. However, due to the very small number of identified trials, the quality of evidence for all outcomes was low to very low.Overall, the small number of eligible studies demonstrates that significantly functional impaired older patients have not been adequately taken into consideration in most clinical trials investigating drug therapy of AD and BPSD.ConclusionDue to lack of evidence, it is not possible to give specific recommendations for drug therapy of AD and BSPD in frail older patients or older patients with significant functional impairments. Therefore, clinical trials focussing on frail older adults are urgently required. A standardized approach to physical frailty in future clinical studies is highly desirable.

Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital \u2013 cross-sectional results of the intersec-CM study

BackgroundCognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of people with cognitive impairments during hospital stays. The aim of the present research is to describe and analyze the treatment needs of people with cognitive impairments in acute hospital care.MethodsThe analyses use baseline data of the ongoing multisite, longitudinal, randomized controlled intervention trial intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management), which recruited 402 participants at baseline. We assessed sociodemographic aspects, cognitive status, functional status, frailty, comorbidities, level of impairment, formal diagnosis of dementia, geriatric diagnoses, delirium, depression, pharmacological treatment, utilization of health care services and health care related needs.ResultsThe sample under examination had been on average mildly cognitively impaired (MMSE M = 22.3) and had a mild to moderate functional impairment (Barthel Index M = 50.4; HABAM M = 19.1). The Edmonton Frail Scale showed a mean of 7.4 and half of the patients (52.3%) had been assigned a care level. About 46.9% had a geriatric diagnosis, 3.0% had a diagnosis of dementia. According to DSM-V 19.2% of the patients had at least one main symptom of depression. The mean number of regularly taken drugs per patient was 8.2. Utilization of health care services prior to the hospital stay was rather low. On average, the sample showed 4.38 care related needs in general, of which 0.60 needs were unaddressed at the time of assessment.ConclusionsDescriptive analyses highlight an in-depth insight into impairments and different care needs of people with cognitive impairments. The results emphasize the need for gender-specific analyses as well as an increased attention to the heterogeneity of needs of people with cognitive impairments related to specific wards, settings and regions where they are admitted. Our results indicate also that people with cognitive impairments represent a high proportion of older patients in acute hospital care.Trial registrationThe intersec-CM trial is registered at ClinicalTrials.gov (NCT03359408).

Short-term health-related quality of life, physical function and psychological consequences of severe COVID-19

BackgroundSurvivors of severe COVID-19 are at risk of impaired health-related quality of life (HRQoL) and persistent physical and psychological disability after ICU and hospital discharge. The subsequent social burden is a major concern. We aimed to assess the short-term HRQoL, physical function and prevalence of post-traumatic stress symptoms of invasively mechanically ventilated COVID-19 patients treated in our ICU.MethodsProspective, observational cohort study in a follow-up clinic. Patients completed a 6-min walking test (6MWT) to assess their cardio-pulmonary function around 2 months (early follow-up) from hospital discharge, the EQ-5D-5L questionnaire for quality of life assessment around 2 months and at 6 months from hospital discharge and an anonymous web-based Impact of Event Scale-Revised (IES-R) questionnaire for Post-Traumatic Stress symptoms at 2 months.Results47 patients attended our follow-up program, mean age 59 ± 10 years, median pre-morbid Clinical Frailty Scale (CFS) 2 [2–3]. The median distance walked in 6 min was 470 [406–516] m, 83 [67–99]% of the predicted value. Overall 1 out 3 patients and 4/18 (22%) among those with a good functional baseline prior to COVID-19 (CFS of 1 or 2) had lower (84%) than predicted 6MWT. EQ-5D-5L quality of life VAS was 80 [70–90] out of 100 at early follow-up with a slight improvement to 85 [77.5–90] at 6 months. Mobility, self-care and usual activities improved between the two timepoints, while pain/discomfort and depression/anxiety did not improve or got worse. The IES-R total score was greater than the threshold for concern of 1.6 in 27/41(66%) respondents.ConclusionsPatients recovering from severe COVID-19 requiring invasive mechanical ventilation surviving hospital discharge present with early mild to moderate functional impairment, mildly reduced quality of life from hospital discharge with an overall improvement of mobility, self-care and the ability of performing usual activities, while a worsening of pain and depression/anxiety symptoms at 6 months and a large proportion of symptoms of post-traumatic distress soon after hospital discharge.

Moral Injury and Burnout in Health Care Professionals During the COVID-19 Pandemic.

The coronavirus pandemic (COVID-19) is predicted to increase burnout in health professionals (HPs), but little is known about moral injury (MI) in this context. We administered the Moral Injury Symptoms Scale for Health Professionals (MISS-HP) and the abbreviated Maslach Burnout Inventory via online survey to a global sample of 1831 HPs in April and October 2020. Mean MISS-HP increased from 27.4 (SD, 11.6) in April to 36.4 (SD, 13.8) in October (p < 0.001), with an accompanying increase in personal accomplishment (April: 4.7; SD, 3.1; October: 9.3; SD, 3.1; p < 0.001) and no change in other burnout subscales. In April, 26.7% of respondents reported at least moderate functional impairment from MI, increasing to 45.7% in October (p < 0.001). Predictors of MISS-HP included younger age and being a nurse. Odds of functional impairment were higher in respondents who were widowed, divorced, never married, or had direct experience caring for patients with COVID-19. COVID-19 has increased MI but not burnout in HPs; younger or unmarried individuals, nurses, and frontline workers may benefit from targeted outreach to reduce downstream effects of MI, depression, and/or posttraumatic stress disorder.