Moderate Functional Impairment Research Articles

Social and role functioning in youth at risk of serious mental illness.

Functional impairment is common in serious mental illness (SMI). This study assessed social and role functioning in a sample of youth at risk of SMI who met different stages of risk based on a transdiagnostic clinical staging model described by McGorry and colleagues. The sample consisted of 243 male and female youths aged 12-26 and included: non-help-seeking youth with risk factors (stage 0; n = 41); youth with mild symptoms (stage 1a; n = 52); youth with attenuated psychiatric syndromes (stage 1b; n = 108); and healthy controls (HCs; n = 42). Social and role functioning were assessed with the Global Functioning: Social and Role scales. Participants in stage 1b (attenuated syndromes) had significantly poorer social and role functioning than stage 0 participants and HCs (P < .001) and poorer social functioning than stage 1a (P < .05). Stage 1a participants had significantly poorer social functioning than HCs (P < .01) and significantly poorer role functioning than stage 0 participants (P < .01). Participants in stages 1a and 1b did not significantly differ from each other in role functioning only. This study demonstrates that mild to moderate functional impairments are present in young people experiencing subthreshold psychiatric symptoms and distress in the absence of a diagnosable mental illness. Results partially validate the model in that social although not role functioning declines across the stages.

Divergent Benefits of a Diet Plus Exercise Obesity Intervention by Race (black/white): Preliminary Cognitive and Functional Outcomes in Obese Older Adults (P21-045-19)

ObjectivesObesity affects a growing number of older adults, contributing to poor physical and mental health outcomes; meanwhile, treatments to reduce obesity in older adults are complicated by a relatively limited treatment window and potential loss of lean mass. Furthermore, obesity’s prevalence is unevenly distributed and highest among black and Hispanic older adults, thus contributing to ongoing health disparities. Recent research from our laboratory shows that higher protein intake (≥30 g/meal) enhances functional improvement during intentional weight loss but it is not yet known whether these effects are consistent across race. MethodsIn an ancillary pilot study, change in body weight, physical function (Short Physical Performance Battery), and cognitive function (Trail Making Test, TMT; Symbol Digit Modalities, SMD) was assessed among obese black and white older adults with mild to moderate functional impairment (n = 10) following 3 months of weight loss intervention at one of two protein intake levels (RDA 0.8 vs 1.2 g/kg/d and (≥30 g/meal) and moderate exercise. ResultsSignificant weight loss (P = 0.009) and improvement in physical function (SPPB; P = 0.008) were observed at 3 months. While protein effects were not observed in this subset, trends toward race*time interactions showing greater weight loss among white participants (P = 0.062) and greater function improvement among black participants (P = 0.067) were observed. Additionally, cognitive assessment revealed a race*time interaction on TMT performance (TrailsB-A; P = 0.012), which correlated with changes in body weight and physical function. ConclusionsThese preliminary findings suggest that obesity reduction interventions benefited older adults across multiple health domains and underscore the need for further research to characterize potentially divergent benefits of intentional weight loss within these populations. Funding SourcesThis study was funded by the National Dairy Council and received additional support from the United States (U.S.) Department of Veterans Affairs Rehabilitation Research and Development Service Program and the National Institute of Aging.

Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia

Objective: To describe current practice and investigate factors associated with selection for rehabilitation following acute stroke. Design: Prospective observational cohort study. Setting: Seven public hospitals in Queensland, Australia. Subjects: Consecutive patients surviving acute stroke. Measures: Rehabilitation selection processes are assessment for rehabilitation needs, referral for rehabilitation and receipt of rehabilitation. Functional impairment following stroke is modified Rankin Scale (mRS). Results: We recruited 504 patients, median age 73 years (interquartile range (IQR) = 62–82), between July 2016 and January 2017. Of these, 90% (454/504) were assessed for rehabilitation needs, 76% (381/504) referred for rehabilitation, and 72% (363/504) received any rehabilitation. There was significant variation in all rehabilitation selection processes across sites (P < 0.05). In multivariable analyses, stroke unit care (odds ratio (OR) = 2.7; 95% confidence interval (CI) = 1.1, 6.6) and post stroke functional impairment (severe stroke mRS 4–5: OR = 10.9; 95% CI = 4.9, 24.6) were associated with receiving an assessment for rehabilitation. Receipt of rehabilitation was more likely following assessment (OR = 6.5; 95% CI = 2.9, 14.6) but less likely in patients with dementia (OR = 0.2; 95% CI = 0.1, 0.9), end-stage medical conditions (OR = 0.4; 95% CI = 0.2, 0.8) or ischaemic stroke (OR = 0.4; 95% CI = 0.1, 0.9). The odds of receiving rehabilitation increased with greater impairment: OR = 3.0 (95% CI = 1.5, 4.9) for mRS 2–3 and OR = 12.5 (95% CI = 6.5, 24.3) for mRS 4–5. Among patients with mild-moderate impairment (mRS 2–3), 39/117 (33%) received no rehabilitation. Conclusions: There was significant inter-site variation in rehabilitation selection processes. The major factors influencing rehabilitation access were assessment for rehabilitation needs, co-morbidities and post-stroke functional impairment. Gaps in access to rehabilitation were found in those with mild to moderate functional impairment.

TB sequel: incidence, pathogenesis and risk factors of long-term medical and social sequelae of pulmonary TB \u2013 a study protocol

BackgroundUp to fifty percent of microbiologically cured tuberculosis (TB) patients may be left with permanent, moderate or severe pulmonary function impairment. Very few studies have systematically examined pulmonary outcomes in patients to understand the pathophysiologic basis and long-term socio-economic consequences of this injury. The planned multi-country, multi-centre observational TB cohort study, aims to advance the understanding of the clinical, microbiological, immunological and socio-economic risk factors affecting long-term outcome of pulmonary TB. It will also determine the occurrence of reversible and irreversible socio-economic consequences to patients, their households and the health sector related to pulmonary TB disease and its treatment.MethodsWe will enrol up to 1.600 patients with drug sensitive and multidrug-resistant pulmonary TB who are treated according to the local standard of care by the respective National TB Program. Recruitment is taking place at the time of TB diagnosis at four African study clinics located in The Gambia, Mozambique, South Africa and Tanzania. The primary outcome is the proportion of TB patients with severe lung impairment measured by spirometry at 24 months after TB treatment initiation. Biological samples, including sputum, urine and blood, for studying host- and pathogenic risk factors will be collected longitudinally and examined in a nested case-control fashion. A standardized quality of life questionnaire will be used together with a novel version of WHO’s generic patient cost instrument which has been adapted for the longitudinal study design.DiscussionThis study is an integral part of an overall strategy to fill a knowledge gap needed to improve TB treatment outcomes globally. The main scientific goal is to identify the major pathogenic mechanisms associated with poor TB treatment outcomes, so that such pathways can be interrupted to avert long term TB sequelae. National as well as supra-national stakeholders and decision makers have been integrated early in the study planning process to inform future treatment guidelines and national health policies.Trial registrationClinicalTrials.gov: NCT03251196, August 16, 2017.

Prevalence and correlates of psychiatric comorbidity in chronic pain patients: A hospital-based study

Background: There is a paucity of information on psychiatric comorbidity in chronic pain patients in developing countries like India. The present study was undertaken in this context. Aim: The aim of this study is to assess the psychiatric comorbidity in chronic pain patients. Materials and Methods: Fifty adult chronic pain patients without organic cause of more than 6 months duration attending outpatient departments were included in the study with their informed consent. Psychiatric comorbidity was assessed by the Schedules for Clinical Assessment in Neuropsychiatry. Results: Majority (80%) of patients was between 18 and 50 years of age, came from nuclear families (88%), and was married (82%). Majority (76%) of patients had pain <2 years; 56% had moderate pain severity and 54% had moderate functional impairment due to pain. In chronic pain patients, 78% had psychiatric comorbidity; the most common disorder was depression (36%) followed by generalized anxiety disorder (18%), somatoform disorder (16%), and panic disorder (8%) patients indicating that patients with chronic pain are more likely to have mood disorder than other psychiatric disorders. A significant association was seen between psychiatric comorbidity and pain severity but not with sociodemographic characteristics. Psychiatric comorbidity was associated with severity of pain. Head and neck and back pain patients reported high prevalence of depression (39.5% and 36%), while chest pain and limb pain patients had high prevalence of generalized anxiety disorder (45.5% and 33.3%). There was high prevalence of nonspecific symptoms such as localized tension pain (90%) and worry (82%) in chronic pain patients. Conclusion: The high prevalence of psychiatric comorbidity in patients suffering from chronic pain disorders emphasize the need to screen these patients for psychiatric disorders, particularly depression and anxiety. Diagnosis and treatment of comorbid psychiatric disorders will greatly improve the management of chronic pain patients.

Adequacy of treatment for child and adolescent mental disorders in Australia: A national study.

Worldwide, little information is available about the extent to which children with mental disorders in the general population receive treatment from health professionals that meets minimal clinical practice guidelines. This study identifies the percentage of 6-17 year olds with mental disorders in the 2013-2014 Australian national survey of mental health who had sufficient contact with health professionals during the 18 months after the survey to have received treatment meeting criteria for minimally adequate treatment (MAT). It also identifies factors associated with children having this level of contact with health professionals. Mental disorders were identified using the Diagnostic Interview Schedule for Children Version IV completed by parents. Health professional attendances and psychotropic medications dispensed were identified from linked national Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records. Only 11.6% (95% confidence interval [CI] [9.1, 14.8]) of children with disorders ( n = 517) had sufficient contact to achieve study criteria for MAT. Furthermore, among children with mental disorders who had severe functional impairment and whose parents perceived that their child needed help ( n = 146), 20.2% (95% CI [14.3, 27.9]) had contact sufficient for MAT, 46.0% (95% CI [37.8, 54.4]) had contact that did not achieve MAT criteria and 33.8% (95% CI [26.1, 42.3]) had no contact with health professionals. In multivariable regression, children with moderate or severe functional impairment were more likely to have had sufficient contact to meet MAT criteria. During the 18 months after being identified with a mental disorder, only a small percentage of children have enough contact with health professionals to allow provision of MAT. This may be contributing to the unchanging high prevalence of childhood mental disorders.

Valued Activities Among Individuals With and Without Functional Impairments: Findings from the National Health and Aging Trends study (NHATS)

ABSTRACTUsing the National Health and Aging Trends Study (NHATS), we examined baseline activity and functional status. Respondents were classified as High (n = 1,662), Moderate (n = 1,973), or Low (n = 989) Function and rated importance of and actual participation in four activities. Transportation and health were also examined. Individuals classified as low function were less likely to engage in valued activities and more likely to report that poor health and transportation limited participation, compared to individuals with no or moderate functional impairments. Data suggest the importance of developing interventions which bridge the gap between activity preferences and participation for older adults with functional limitations.

Thresholds for severity, remission and recovery using the functioning assessment short test (FAST) in bipolar disorder

BackgroundDespite its importance, no distinction between none, mild, moderate and severe functional impairment is available. Categorization of functional impairment could help to better assess randomized controlled trials (RCT) and to study the correlates of functional impairment according to severity. The Functional Assessment Short Test (FAST) is one of the most widely used measures of functional impairment in bipolar disorder and related conditions, but to date no severity cut-offs have been determined for their use in clinical research and practice. MethodFAST and Global Functioning Assessment (GAF) ratings from 65 euthymic outpatients with bipolar disorder at the Hospital Clínic in Barcelona were analyzed. A linear regression was computed using the FAST as the independent variable and the GAF as the dependent variable. Cut-offs scores for the FAST were estimated taking into account the GAF scores as a reference. ResultsLinear regression analysis with GAF scores as the dependent variable yielded the following equation: GAF score = 91,41–1,031 * FAST score. The cut-off scores for the FAST scale derived from this equation were as follows: scores from 0 to 11 included patients with no impairment. Scores from 12 to 20, represented the category of mild impairment. Moderate impairment comprised scores from 21 to 40. Finally, scores above 40 represent severe functional impairment. Further, the 4 × 4 cross-tabulation resulted in a significant association of FAST and GAF severity gradation: (Chi2 = 95,095; df = 9; p < 0,001). Chance-corrected agreement was κ = 0,65 (p < 0.001). LimitationsIn the absence of a better alternative, the GAF, a broad clinical measure, was used as gold standard for establishing FAST categories according to severity. ConclusionThe categorization of functional impairment in four categories based on empirical data shows that 12, 20 and 40 represent clinically meaningful cut-offs of the FAST for mild, moderate, and severe functional impairment and for functional recovery, remission, and improvement. The proposed categories are suitable to be further implemented in clinical studies and RCTs.

The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine.

Recently, objective functional tests have generated interest since they can supplement an objective dimension to clinical assessment. The five-repetition sit-to-stand (5R-STS) test is a quick and objective tool that tests movements frequently used in everyday life. The aim of this prospective study was to evaluate the validity and reliability of the 5R-STS test in patients with degenerative pathologies of the lumbar spine. Patients and healthy volunteers completed the standardized 5R-STS, Roland-Morris Disability Questionnaire (RMDQ), Oswestry Disability Index (ODI), visual analog scale (VAS) for back and leg pain, and EQ-5D for health-related quality of life (HRQOL). To assess convergent validity, the 5R-STS test times were correlated with these questionnaires. Overall, 157 patients and 80 volunteers were enrolled. Direct correlation with RMDQ (r = 0.49), ODI (r = 0.44), and VAS for back pain (r = 0.31) and indirect correlation with the EQ-5D index (r = -0.41) were observed (p < 0.001). The 5R-STS test showed no correlation with VAS for leg pain and EQ-5D VAS (p > 0.05). In 119 individuals, the 5R-STS test demonstrated excellent test-retest reliability with an intraclass correlation coefficient of 0.98. The upper limit of normal, distinguishing patients with and without objective functional impairment, was identified as 10.35 seconds. A severity stratification classified patients with test times of 10.5-15.2, 15.3-22.0, or greater than 22.0 seconds as having mild, moderate, or severe functional impairment, respectively. The 5R-STS test is a simple and effective tool to describe objective functional impairment. A patient able to perform the test in 10.4 seconds can be considered to have no relevant objective functional impairment. Clinical trial registration no.: NCT03303300 (clinicaltrials.gov).

Efficacy and safety of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and moderate renal function impairment: A systematic review and meta-analysis

AimsA systematic review and meta-analysis was conducted to evaluate the clinical efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes (T2D) and moderate renal function impairment. MethodsEmbase, Medline, and Cochrane Central were searched, and randomized controlled trials comparing SGLT2 inhibitors to placebos and other drugs for T2D were collected. ResultsSeven RCTs with a total of 3307 participants were included, and the overall bias was low. In the patients with T2D and moderate renal function impairment (30 ml/min/1.73 m2 ≤ estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2) compared with the placebo, SGLT2 inhibitors improved HbA1c significantly (WMD, −0.23%; 95% CI: −0.38 to −0.08), presented a lower incidence of hypoglycemia (30.1% vs. 34.6%; RR, 0.85; 95% CI: 0.76 to 0.96), led to the reduction of eGFR (WMD, −1.74 ml/min/1.73 m2; 95% CI: −3.45 to −0.03), resulted in an obvious reduction in body weight (WMD, −1.45 kg; 95% CI: −2.01 to −0.89), and presented a similar risk of urinary tract infection and genital infection. ConclusionsSGLT2 inhibitors are safe, but mildly reduce the HbA1c level. The clinical significance of SGLT2 inhibitors in the target population was limited.

Distinct Patterns of Conjoint Symptom Distress and Functional Impairment in the Last Year of Life Predict Terminally Ill Cancer Patients' Survival

Context/ObjectivesOur study addressed important knowledge gaps about trajectories of distinct conjoint symptom-functional states, that is, patterns for different levels of combined symptom distress and functional impairment, over cancer patients' last year and their ability to predict survival. MethodsWe identified distinct symptom-functional states and explored their changes over 317 terminally ill cancer patients' last year by a transition model using hidden Markov modeling. These distinct symptom-functional states' ability to predict current survival probability, measured in the previous assessment, was evaluated by multivariate Cox regression models. ResultsWe identified five worsening, conjoint symptom-functional states: 1) mild symptom distress with high functioning, 2) moderate symptom distress with mild functional impairment, 3) severe symptom distress with moderate functional impairment, 4) moderate symptom distress with severe functional impairment, and 5) profound symptom distress and functional impairment. Trajectories of these five states differed substantially by direction (downward vs. upward) and speed. Participants in States 1–4 had substantially lower risk of subsequent death than those in State 5 (adjusted hazard ratios [95% CI] ranged from 0.048 [0.028–0.081] to 0.434 [0.316–0.579]). The risk of subsequent death differed significantly between patients in any two distinct symptom-functional states, except between those in States 3 and 4. ConclusionOur identification of five distinct symptom-functional states and their unique transition patterns and prediction of mortality provides all stakeholders with guides for end-of-life care. Goals of end-of-life care should change toward palliative care and effective symptom management for patients with at least moderate symptom distress and substantial functional impairment.

Efficacy and tolerability of abatacept treatment: results of 12 months observation.

This article reports 1-year clinical outcomes of patients with rheumatoid arthritis (RA) receiving abatacept (ABA) therapy. Patients (n=91) with high RA activity (DAS28 = 5.1 ± 1.0) and an inadequate response on synthetic DMARDs (mainly methotrexate, 70.3%) and biologics (mainly TNF-α inhibitors, 93%) were included in the study. The majority of patients were middle-aged (49 ± 13.5) womens, RF (72.5%) and ACPA (77%) positive, with moderate functional impairment - HAQ = 1.4 (0.9-2). ABA were administered IV, 10 mg/kg according to the standard scheme. The evaluation of the effectiveness of the therapy was carried out according to the EULAR / ACR 2011 criteria using SDAI, CDAI, HAQ and the intention to treat approach. ABA led to a significant (p &lt;0.05) decrease activity of RA. Clinical improvement according to EULAR criteria after 6 months of treatment was registered in 70.9%, after 12 months 63%. Almost a third of patients (28.7%) achieved a good response after 3 months of therapy, 39,2% - after 6 months and 39% - after 12 months. The retention rate of ABA therapy after 6 months was 77%, after 12 months - 60%. There were no significant differences between &quot;bio-naive&quot;, 1 Bio and ≥2 Bio groups in achieving EULAR response. A good response was achieved in 38%, 38% and 43%, respectively, but the lowest number of non-responders was registered in ≥2 Bio - 38%, 36% and 43%. ABA significantly improved functional status of patients, after 12 months a marked and moderate improvement in the HAQ was achieved in 39% and 21% of patients, respectively. Adverse events (AE) were registered in 22 patients. The most frequent AE were upper respiratory tract infections - 11 (12%) patients. Abatacept was effective in the overall population, and in all subgroups of patients. It has shown significant improvement of clinical and functional status in patients who had an inadequate response to previous therapy. ABA has a good safety profile. AE were registered only in a small number of patients.

Physicians using spinal manipulative treatment in The Netherlands: a description of their characteristics and their patients

BackgroundVarious health care professionals apply Spinal Manipulative Treatment (SMT) in daily practice. While the characteristics of chiropractors and manual therapists and the characteristics of their patient populations are well described, there is little research about physicians who use SMT techniques. A distinct group of physicians in The Netherlands has been trained in musculoskeletal (MSK) medicine, which includes the use of SMT. Our objective was to describe the characteristics of these physicians and their patient population.MethodsAll registered MSK physicians were approached with questionnaires and telephone interviews to collect data about their characteristics. Data about patient characteristics were extracted from a web-based register. In this register physicians recorded basic patient data (age, gender, the type and duration of the main complaint, concomitant complaints and the type of referral) at the first consultation. Patients were invited to fill in web-based questionnaires to provide baseline data about previous treatments and the severity of their main complaint. Functional impairment was measured with Patient Reported Outcome Measures (PROMs).ResultsQuestionnaires were sent to 138 physicians of whom 90 responded (65%). Most physicians were trained in MSK medicine after a career in other medical specialities. They reported to combine their SMT treatment with a variety of diagnostic and treatment options part of which were only permissible for physicians, such as prescription medication and injections. The majority of patients presented with complaints of long duration (62.1% > 1 year), most frequently low back pain (48.1%) or neck pain (16.9%), with mean scores of 6.0 and 6.2, respectively, on a 0 to10 numerical rating scale (NRS) for pain intensity. Mean scores on all PROMs showed moderate impairment. Patients most frequently reported previous treatment by physical therapists (68.1%), manual therapists (37.7%) or chiropractors (17.0%).ConclusionOur study showed that MSK physicians in The Netherlands used an array of SMT techniques. They embedded their SMT techniques in a broad array of other diagnostic and treatment options, part of which were limited to medical doctors. Most patients consulted MSK physicians with spinal pain of long duration with moderate functional impairment.

Effect of MRI on preterm infants and their families: a randomised trial with nested diagnostic and economic evaluation

BackgroundWe tested the hypothesis that routine MRI would improve the care and well-being of preterm infants and their families.DesignParallel-group randomised trial (1.1 allocation; intention-to-treat) with nested diagnostic and cost evaluations...

Whole Lung Irradiation in Patients With Relapsed Ewing Sarcoma

There is no standard treatment procedure for relapsed Ewing sarcoma (ES). This retrospective analysis evaluates the outcome and pulmonary function in patients with isolated pulmonary or additional extrapulmonary relapse of ES treated with whole lung irradiation (WLI). 55 patients (median age 21 years, range 7-52 years) with relapsed ES and isolated pulmonary (29) or additional extrapulmonary (26) lesions were analysed (median follow-up 3years, range 7m-11y9m). The multimodal treatment regime included WLI for 30 patients with a dose between 15-18Gy by the complete pulmonary remission after polychemotherapy (CT) or high-dose chemotherapy (HDCT). 2-years local control (2-y. LC) and 3-years overall survival (3-y. OS) were statistically examined. A significant benefit for WLI vs. no WLI was seen for patients with isolated pulmonary relapse – 2-y. LC 71% vs 24%, p=0.02; 3-y. OS 65% vs 24%, p=0.03. No benefit for WLI for 2-y. LC and 3-y. OS was observed in patient’s group with additional extrapulmonary lesions. Combined treatment modalities including WLI demonstrated superior outcome in comparison to treatment modes without WLI. So, a superior values for 2-y. LC and 3-y. OS were received for the multimodal treatment including CT or HDCT, resection of residual pulmonary lesion and completed with WLI (71%, p=0.03 and 68%, p=0.04 correspondingly). The poorest values were observed after HDCT alone with busulfan/melphalan (2-y. LC 12%, 3-y. OS 0%). A progress of the pulmonary lesions during the treatment was observed only by the treatment modalities without WLI. 1 from 30 irradiated patients developed an acute pulmonary toxicity with moderate functional impairment. In total, 37% of patients without radiotherapy of primary ES tumor developed pulmonary lesions in the relapsed ES independently of primary tumor site. These data indicate a benefit for WLI in patients with ES relapse and isolated pulmonary lesions. An acceptable pulmonary and cardiac toxicity was observed after WLI. As long as there is no randomized prospective analysis, the present data confirm the indication for WLI in relapsed Ewing tumor with isolated lung manifestations. For patients with additional extrapulmonary relapse the WLI can be discussed by the complete remission of all manifested lesions.

A Brain Electrical Activity Electroencephalographic-Based Biomarker of Functional Impairment in Traumatic Brain Injury: A Multi-Site Validation Trial

The potential clinical utility of a novel quantitative electroencephalographic (EEG)-based Brain Function Index (BFI) as a measure of the presence and severity of functional brain injury was studied as part of an independent prospective validation trial. The BFI was derived using quantitative EEG (QEEG) features associated with functional brain impairment reflecting current consensus on the physiology of concussive injury. Seven hundred and twenty adult patients (18-85 years of age) evaluated within 72 h of sustaining a closed head injury were enrolled at 11 U.S. emergency departments (EDs). Glasgow Coma Scale (GCS) score was 15 in 97%. Standard clinical evaluations were conducted and 5 to 10 min of EEG acquired from frontal locations. Clinical utility of the BFI was assessed for raw scores and percentile values. A multinomial logistic regression analysis demonstrated that the odds ratios (computed against controls) of the mild and moderate functionally impaired groups were significantly different from the odds ratio of the computed tomography (CT) postive (CT+, structural injury visible on CT) group (p = 0.0009 and p = 0.0026, respectively). However, no significant differences were observed between the odds ratios of the mild and moderately functionally impaired groups. Analysis of variance (ANOVA) demonstrated significant differences in BFI among normal (16.8%), mild TBI (mTBI)/concussed with mild or moderate functional impairment, (61.3%), and CT+ (21.9%) patients (p < 0.0001). Regression slopes of the odds ratios for likelihood of group membership suggest a relationship between the BFI and severity of impairment. Findings support the BFI as a quantitative marker of brain function impairment, which scaled with severity of functional impairment in mTBI patients. When integrated into the clinical assessment, the BFI has the potential to aid in early diagnosis and thereby potential to impact the sequelae of TBI by providing an objective marker that is available at the point of care, hand-held, non-invasive, and rapid to obtain.

Sprawność funkcjonalna pacjentów w podeszłym wieku hospitalizowanych w oddziałach neurologicznych

Wstęp. Sprawność funkcjonalna osób starszych może być określana jako zdolność do wykonywania normalnych codziennych życiowych zadań bezpiecznie i samodzielnie.Cel. Celem pracy było określenie sprawności funkcjonalnej pacjentów w podeszłym wieku hospitalizowanych w oddziałach neurologicznych.Materiał i metody. Badania przeprowadzono w grupie 113 pacjentów w podeszłym wieku przebywających w oddziałach neurologicznych szpitali na terenie miasta Lublina. Materiał badawczy zebrano za pomocą dwóch standaryzowanych narzędzi: skali Barthel i skali Katza (ADL).Wyniki. Dokonując oceny pacjentów skalą Barthel stwierdzono, że 38,00% to pacjenci w I kategorii, 52,20% znalazło się w kategorii II a 9,80% zakwalifikowano do kategorii III. W ocenie skalą ADL 68,10% badanych były to osoby sprawne, 12,40% osoby umiarkowanie sprawne i 19,50% były to osoby niesprawne.Wnioski. Badana grupa pacjentów starszych w oddziałach neurologicznych wykazywała umiarkowaną niesprawność funkcjonalną. Wiek istotnie różnicował sprawność funkcjonalną badanych pacjentów. Wykształcenie wpływało na stopień samodzielności pacjentów neurologicznych. (PNN 2017;6(3):102–106)

Severity and features of frailty in systemic sclerosis-associated interstitial lung disease

BackgroundSystemic sclerosis-associated interstitial lung disease (SSc-ILD) is characterized by multiple symptoms and comorbidities. The cumulative impact of these deficits can be summarized using the concept of frailty; however, frailty has not been characterized in patients with SSc-ILD. MethodsPatients with SSc-ILD and non-CTD fibrotic ILD were recruited from specialized clinics. Frailty was assessed using a 42-item patient-reported Frailty Index, calculated as the proportion of reported deficits divided by the total number of surveyed items. Frailty was defined as a Frailty Index >0.21. Unadjusted and multivariate analyses were used to identify correlates of frailty. ResultsThe study cohort included 86 patients with SSc-ILD and 167 patients with non-CTD fibrotic ILD. The mean age in SSc-ILD was 60.5 years, 80% were women, and on average patients had mild to moderate restrictive lung function impairment (mean FVC 78%-predicted, DLCO 51%-predicted). The mean Frailty Index was 0.23 ± 0.15, with 55% of the SSc-ILD population meeting criteria for frailty. Dyspnea had the strongest association with the Frailty Index (r = 0.62, p < 0.001) and was the only variable independently associated with frailty on multivariate analysis. Frailty severity was similar in SSc-ILD and non-CTD fibrotic ILD, including with adjustment for differences in baseline cohort characteristics. ConclusionFrailty is highly prevalent in patients with SSc-ILD, indicating that chronological age significantly underestimates biological age in this population. Dyspnea is the variable with the strongest association with frailty in SSc-ILD; however, future studies are needed to identify additional modifiable determinants of frailty and the ability of frailty to predict outcomes in SSc-ILD.

HCV clearance after direct-acting antivirals in patients with cirrhosis by stages of liver impairment: The ITAL-C network study

BackgroundSustained virological response (SVR12) rates at 12 weeks after treatment for HCV-infected patients with decompensated cirrhosis are used when referring to those with moderate functional impairment, while few data are available for those with more severe impairment. The use of the cirrhosis staging system proposed by D’Amico might provide new insights on timing for antiviral therapy. MethodsWe investigated efficacy (SVR12), safety, and post-treatment variations in clinical and laboratory parameters in 2612 patients with advanced fibrosis (n=575) or cirrhosis (n=2037). Cirrhosis was in the compensated phase (without/with varices) or had previously been in the decompensated stage. Different direct-acting antiviral (DAA) regimens were administered in accordance with scientific guidelines. ResultsThe SVR12 rate was 97.6% in patients with advanced fibrosis. For patients with cirrhosis, the rate was 96.5% in stage 1, 95.1% in stage 2, 100% in stage 3, 95.7% in stage 4, and 93.6% in stage 5. These rates were independent of gender, age, HCV genotype, and treatment schedule. Positive changes in biochemical parameters and CPT classes following therapy were evident in compensated and previously decompensated patients. ConclusionOur findings support the use of DAAs in patients with advanced cirrhosis (stages 3–5) who are at greatest risk and have the most to gain from therapy.

The Stroop-Interference-NoGo-Test (STING): A Fast Screening Tool for the Global Assessment of Neuropsychological Impairments

Abstract Background With the Stroop-Interference-NoGo-Test (STING), we introduce an efficient and sensitive screening tool for the assessment of mild to moderate cognitive impairment. Its development was motivated by the ongoing economization of diagnostics and therapy in clinics as well as by the increased recognition of the effects of cognitive impairments on quality of life and professional reintegration. Established screenings such as the MoCA, MMSE and CAMCOG are either more time-consuming or lack sensitivity with regard to mild to moderate impairments in relevant domains. Methods STING is based on the idea of an omnibus test. It integrates attentional, lexical-semantic, speed- and inhibitory components. In this way, a basic sensorimotor component is separated from a higher-order cognitive/executive component, which allows for differentiation between cognitive and generalised or merely sensorimotor impairments. The norms are based on data from 907 participants (386 M, 521 F). Its discriminative power was investigated in 64 patients (32 M, 32 F) with heterogeneous, but predominantly mild to moderate neuropsychological impairments. Results The split-half reliability is essentially r=0.82–0.95. For the parallel-test reliability, the index is r=0.82–0.91, whereas the test-retest stability is estimated somewhat lower (r=0.48–0.81). Practice effects are moderate (7–12%). STING is correlated with many familiar tests, but sets itself apart from mere intelligence testing. Within the age category of 12–34 years, the number of correct items in the more complex second half of the test was predictive for clinical caseness, with a sensitivity of 83% and a specificity of 47%. Between the ages of 35 and 64, the classification was improved by the combination with the ratio of both halves, which represents set-shifting costs. Here the sensitivity of 71% goes hand in hand with a specificity of 70%. Discussion STING provides a measure that can be considered sufficiently sensitive for use in the global assessment of cognitive impairment. A positive result does not replace a neuropsychological assessment, but indicates the need for one. The test offers an opportunity to neurologists, psychologists and psychiatrists to objectify mild to moderate, transient, or chronic functional impairments and to evaluate their course over time.