Screening Of Elderly Patients Research Articles

Applicability of Global Leadership Initiative on Malnutrition (GLIM) criteria in nutrition risk screening for patients over 60 years old with digestive system tumors – A retrospective study

ObjectiveThis study aimed to identify the most effective nutritional risk screening tool for elderly patients with digestive system tumors. MethodsNutritional risk screening was performed using Nutritional Risk Screening 2002 (NRS2002), prognostic nutritional index (PNI) and Geriatric Nutritional Risk Index (GNRI) for elderly patients who underwent surgical resection of digestive tumor. Comparative analysis of each nutritional screening tool was conducted through Kappa test and ROC curve. ResultsMalnourished individuals diagnosed by the Global Leadership Initiative on Malnutrition (GLIM) criteria had lower levels of hematological parameters (serum albumin, pre-albumin, total protein and hemoglobin) and poorer body composition parameters (body mass index, body fat percentage, edema index, upper arm muscle circumference, skeletal muscle index, and phase angle; P<0.05). NRS2002 demonstrated a sensitivity of 75.56% and specificity of 38.16% under the GLIM criteria, showing moderate agreement (Kappa=0.346, P<0.001). PNI had an average sensitivity of 71.11% and the highest specificity at 87.23%, but exhibited no consistency with GLIM (Kappa=0.152, P=0.062). GNRI showed the highest sensitivity at 91.11% and general specificity at 37.14%, aligning closely with GLIM criteria (Kappa=0.711, P<0.001). GNRI had the highest predictive value (AUC=0.870, 95% CI: 0.801–0.939), followed by NRS2002 (AUC=0.687, 95% CI: 0.589–0.785). Patients diagnosed with malnutrition via GNRI-GLIM exhibited higher rates of surgical site infection (χ2=15.534, P<0.001) and 3-month readmission (χ2=4.499, P=0.034). ConclusionGNRI and NRS2002 demonstrate good performance as GLIM criteria for nutritional screening in elderly patients with digestive tumors, with GNRI being potentially more suitable. Moreover, GNRI-GLIM can predict short-term prognosis in these patients.

Rapidly progressing scalp melanoma in an elderly patient.

A rapidly progressing scalp melanoma incorrectly diagnosed and managed as a 'chronic wound', lead to delayed referral to dermatologist and correct diagnosis. This case highlights the importance of early diagnosis of scalp melanoma and of frailty screening in elderly patients.

THE RELATIONSHIP BETWEEN CANCER INFORMATION OVERLOAD AND ATTITUDES FOR CANCER SCREENING IN GERIATRIC PATIENTS WHO HAVE HAD SURGICAL PROCEDURE: A CROSS-SECTIONAL STUDY

This study aimed to determine the relationship between cancer information overload and attitudes toward cancer screening in elderly patients who underwent surgery. A total of 123 geriatric individuals participated in the cross-sectional study. The mean age of the participants in the study was 70.63±5.81. It was determined that 17.1% of the individuals had cancer, 30.9% had cancer in their first degree relatives, 52% had cancer screening before, and the most common screenings were colonoscopy (23.6%), pap smear (14.6%), and breast self-examination (8.1%). It was determined that the total score averages of the attitude scale for cancer screening of those who obtained information about cancer from the internet/media were significantly lower (p=0.030). It was determined that there was a significant moderate negative correlation between cancer information overload and the total scores of the attitude scale for cancer screening (r=-0.303, p=0.001). To encourage screening in the geriatric population and to prevent the risks of unnecessary screening, arrangements should be made to facilitate access to accurate information.

Primary health care providers knowledge of dementia and cognitive assessment tools for elderly populations in Southeast Nigeria: A pilot survey.

Primary health care remains the widely available first point of medical care in Nigeria and in other low- and middle-income countries. Recognizing the rising prevalence of dementia in these settings, primary healthcare providers should be trained on cognitive assessment. However, little is known about the current Nigerian primary healthcare providers' knowledge of dementia, cognitive assessment tools, and use in elderly populations. The aim of this study was to evaluate primary healthcare providers' knowledge of dementia and cognitive assessment tools in Southeast Nigeria in preparation for the introduction of digital tablet-based assessment tool. This is a cross-sectional mixed method descriptive pilot survey carried out in a comprehensive healthcare center affiliated with Nnamdi Azikiwe University Teaching Hospital. Fifty healthcare workers participated. Convenience sampling was employed involving all consenting primary healthcare providers in comprehensive healthcare center-Nnamdi Azikiwe University Teaching Hospital. A structured questionnaire was distributed for generation of both qualitative and quantitative data. The mean age of the 50 primary healthcare providers was 36.6 years, with females constituting 80%. Mean practice duration was 10.8 years. Their response on the mean age at which patients may need a cognitive assessment was reported as 52.8 years. Primary healthcare providers reported that dementia is associated with memory loss and can be genetically inherited. None of the respondents were familiar with Montreal cognitive assessment, or any form of tablet-based cognitive assessment tool. Most (86%) knew about the mini mental state examination. Primary healthcare providers are deficient in knowledge of dementia Alzheimer's or cognitive assessment tools, and so they do not routinely carryout cognitive screening in elderly patients during clinic visits. It is important to train all cadres of primary healthcare staff on the use and benefit of cognitive assessment using culturally validated user-friendly tool to improve quality of care for the elderly population.

The Role of Age and Comorbidities in Esophagogastric Cancer Chemoradiation of the Frail Elderly (>70 Years): An Analysis from a Tertiary High Volume-Center

Elderly patients > 70 years of age with esophageal cancer (EC) represent a challenging group as frailty and comorbidities need to be considered. The aim of this retrospective study was to evaluate the efficacy and side effects of curative chemoradiation therapy (CRT) with regard to basic geriatric screening in elderly patients in order to elucidate prognostic factors. Thirty-four elderly patients > 70 years with EC treated at our cancer center between May 2014 and October 2018 fulfilled the selection criteria for this retrospective analysis. Treatment consisted of intravenous infusion of carboplatin/paclitaxel or fluorouracil (5-FU)/cisplatin with the intention of neoadjuvant or definite chemoradiation. Clinicopathological data including performance status (ECOG), (age-adjusted) Charlson comorbidity index (CCI), Frailty-scale by Fried, Mini Nutritional Assessment Short Form, body mass index, C-reactive protein to albumin ratio, and treatment-related toxicity (CTCAE) were assessed. Data were analyzed as predictors of overall survival (OS) and progression-free survival (PFS). All patients (ten female, 24 male) received combined CRT (22 patients in neoadjuvant, 12 patients in definite intent). Median age was 75 years and the ECOG index between 0 and 1 (52.9% vs. 35.3%); four patients were rated as ECOG 3 (11.8%). Median follow-up was 24 months. Tumors were mainly located in the lower esophagus or esophagogastric-junction with an T3 stage (n = 25; 75.8%) and N1 stage (n = 28; 90.3%). 15 patients (44.1%) had SCC, 19 patients (55.9%) AC. 26 of the patients (76.5%) were scored as prefrail and 50% were in risk for malnutrition (n = 17). In relation to the BMI, ten patients (29.4%) were ranked as overweight, and 15 patients were presented in a healthy state of weight (44.1%). Grade 3 acute toxicity (or higher) occured in nine cases (26.5%). Most of the patients did not show any late toxicities (66.7%). Trimodal therapy provides a significant prolonged OS (p = 0.049) regardless of age, but without impact on PFS. Our analysis suggests that chemoradiation therapy is feasible for elderly patients (>70 years) with tolerable toxicity. Trimodal therapy of EC shows a positive effect on OS and PFS. Further studies are needed to elucidate benefitting subgroups within the elderly. In addition to age, treatment decisions should be based on performance status, nutritional condition and multidisciplinary validated geriatric screening tools.

Testing Visual Binding by the TMA-93 in People Aged 75 and Over.

TMA-93 examines relational binding using images. The test has been proven to be discriminative for diagnosing early Alzheimer's disease by biomarkers. Norms for this test are available, but the elderly, at high risk for Alzheimer's disease, have not yet been widely represented. To extend normative data on the TMA-93 for people aged 75 and over. An extension of the Spanish TMA-93 normative study was undertaken. Only cognitively unimpaired people aged 75 and over were included. Age, gender, and educational attainment were registered as socio-demographic variables. Using histograms analysis, median comparisons, and linear regression analysis, we selected variables that demonstrated influence on TMA-93 total scores and provided percentile-base reference data according to combinations of those variables. We included 431 new participants, resulting in a total sample of 657 individuals (median age = 78, interquartile range = 76-81, range = 75-93). Percentile-base reference data stratified by a combination of age ranges (75-79, n = 428; and ≥80 years, n = 229), and educational attainment (< first grade, n = 253; first grade, n = 209; > first grade, n = 195) revealed that participants achieved a minimum TMA-93 total score of 26/30 at the 50th-percentile regardless of stratum. At the 10th-percentile, a maximum of 24/30 was achieved in the more educated stratum contrasting with a minimum of 19/30 in the less educated stratum. Although mitigated by lower levels of education, performance on the TMA-93 is widely preserved in cognitively unimpaired people aged 75 and over. The test could facilitate the screening of elderly patients with memory complaints.

Паранеопластическая нефропатия. Клиническое наблюдение

The case of membranous nephropathy manifested in nephrotic syndrome in a patient, newly diagnosed with lung cancer, is reported. Brief data on the paraneoplastic glomerular disease are provided, the need for cancer screening in elderly patients with nephrotic syndrome is emphasized.

Reliability and validity of the Japanese version of the 4A's Test for delirium screening in the elderly patient.

Although many screening tools for delirium are available, delirium is still occasionally overlooked or misdiagnosed. One of the reasons for this is the lack of brief screening tools that do not require specialized training to use. The 4 'A's test (the 4AT) is a validated screening tool for delirium that can be administered in a very short time without specialized training. Herein, we evaluated the reliability and validity of the Japanese version of the 4AT (the 4AT-J). A total of 150 patients aged ≥65 years were enrolled. Their demographics and clinical characteristics were obtained within 24hr of their hospitalization. On each patient's high-risk day of developing delirium, the 4AT-J was administered by a nurse, and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-Ⅴ) and the Japanese version of Delirium Rating Scale-Revised-98 (DRS-98-J) were administered by a psychiatrist. Our analyses revealed that when a cut-off score of 4, the 4AT-J showed high sensitivity and specificity. The Cronbach's α-coefficient was similar to that of the original version. A receiver operating curve analysis showed sufficient power of the 4AT-J to discriminate delirium. The 4AT-J showed adequate reliability and validity for delirium screening in elderly patients.

The impact of age when screening for latent tuberculosis infection - is it a problem?

Abstract Background Older population in developed countries represents a large reservoir of tuberculosis (TB) infection. Knowledge if age can contribute to false negative results in the immunological tests available for screening latent TB infections (LTBI) is critical to improve their usefulness in Public Health strategies for TB control. The aim of this study was to ascertain whether age was a risk factor for false negative (FN) results in the tuberculin skin test (TST) and in an interferon gamma release assay (IGRA). Methods Retrospective cohort study carried out using data from the Portuguese National Tuberculosis Surveillance system (2008-2015). Were included all active pulmonary TB cases with an IGRA (n = 597) and/or TST (n = 6185) result. TST outcomes were interpreted using a 5mm (TST-5mm) and 10mm (TST-10mm) cutoff. Logistic regression analysis crude and sex-adjusted was used to evaluate the association of age to the risk of FN results. Results Patients with a TST result presented a mean age of 42.7 years and patients with an IGRA result presented a median age of 45.5 years. TST-5mm, TST-10mm and IGRA had 36.5%, 43.9% and 24.5% FN results, respectively. Older patients presented a statistically significant association with the risk of FN TST results, regardless of using a 5mm [71-80years: OR 2.209; &amp;gt;80years: OR 2.491; p &amp;lt; 0.001] or 10mm [71-80years: OR 1.986; &amp;gt;80years: OR 2.308; p &amp;lt; 0.001] cut-off. Age was not a predictive factor for FN IGRA results. However, older patients presented a significant association with indeterminate IGRA results [71-80years: OR 3.808; &amp;gt;80years: OR 5.214; p &amp;lt; 0.001]. Conclusions When using TST as part of the Public Health strategies for screening elderly patients, healthcare professionals should bear in mind that there is an increased risk of obtaining a FN result. On the other hand, age did not show an association with the occurrence of FN IGRA results, which suggests that this test could perform better when screening for LTBI in older patients. Key messages TST in elderly people is associated with false negative results thus, when using this test for screening for LTBI, a negative result should be interpreted with caution. IGRA was not associated with false negative results in elderly people, however indeterminate results can occur more frequently, thus performing better in this population group.

Interpretation of the SARC-F questionnaire in patients undergoing gastrointestinal cancer surgery

Aim: Sarcopenia is a skeletal muscle disorder associated with decreased muscle mass and functional capacity. The SARC-F questionnaire facilitates sarcopenia screening in elderly patients. The present study investigates the applicability of the SARC-F questionnaire to sarcopenia screening in patients scheduled for gastrointestinal (GI) cancer surgery and its relationship with postoperative outcomes. Methods: This cross-sectional study was carried out with elderly patients scheduled for GI cancer surgery. The study included 71 patients consisting of 47 males and 24 females. The risk of sarcopenia was assessed by the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falling (SARC-F) questionnaire. Patients with a SARC-F score ≥4 were considered to be at risk of sarcopenia. The demographic data, nutritional status and comorbidity data of the patients were recorded. Statistical analysis was conducted to assess postoperative complications in those patients at risk of sarcopenia. Results: The mean age of 71 study patients was 72.6 ± 5.6 years. There were 15 (21.1%) patients with a SARC-F score ≥ 4. The postoperative complication rate was 60% in patients with a SARC-F score ≥ 4 in comparison with 28.5% of those with a SARC-F score < 4, and the difference was statistically significant (p=0.024). The SARC-F score ≥ 4 group also had a longer hospital stay (p<0.001). Furthermore, the univariate analysis for postoperative complications revealed that SARC-F scores ≥ 4, age ≥ 75 years, and BMI ≥ 30 kg/m2 were statistically significant. Conclusion: We believe that the SARC-F questionnaire has a place in sarcopenia screening in patients scheduled for GI surgery, and it is possible to predict postoperative adverse outcomes.

Comparison of two screening instruments to detect dementia in Indian elderly subjects in a clinical setting.

Objective:Cognitive screening in elderly patients receiving treatment for chronic medical conditions in a busy outpatient clinical setting is crucial to detect dementia at an earlier stage. Although Hindi Mini-Mental State Examination (HMSE) is an established screening tool for the geriatric population in India, but cannot be administered with the informant. Our study aims to compare two screening instruments, Informant based - Eight-item Interview to Differentiate Aging and Dementia (AD8) and HMSE among elderly patients attending medical outpatient service (OPD) in a tertiary care hospital.Method:A total of 776 subjects aged ≥65 years and receiving treatment from medicine OPD in a tertiary care hospital were screened for dementia using AD8 and HMSE. The clinical diagnosis was established after detailed clinical assessment using ICD-10 criterion. Sensitivity and specificity were calculated for both screening tools and ROC curves were plotted considering ICD-10 diagnosis as the gold standard.Results:Comparison of receiver operating characteristic (ROC) curves showed that HMSE (AUC = 0.77) were better than AD8 (AUC = 0.61) in detecting dementia. Although increasing the cut-off value of AD8 from a recommended score of ≥2 to ≥3 improved sensitivity from 35% to 48.9%, high false-positive rate limited its utility as a cognitive screening tool.Conclusion:Although AD8 is easy to use and quickly administered with either patient or informant, it does not seem to be a suitable cognitive screening test for Indian elderly with chronic medical disorders. HMSE at a cut-off score of ≤23 is able to find out dementia among geriatric patients in a busy medical setting.

GERiatric Screening in the treatment of elderly patients with Ovarian Carcinoma (GERSOC): study protocol for a pragmatic, cluster randomised controlled trial

BackgroundApproximately 40% of the newly diagnosed patients with advanced ovarian cancer are aged 70 years or older. Standard treatment for advanced disease consists of cytoreductive surgery and combination chemotherapy. In older patients, standard treatment is often withheld or prematurely stopped due to suspected frailty. It remains challenging to distinguish fit elderly patients who can endure standard therapy from frail patients who may benefit from an adapted treatment strategy. As a comprehensive geriatric assessment (CGA) can contribute to the identification of frail patients and improve tailored therapy in this population, screening tests were developed to select those who may benefit from a CGA. However, the use of these geriatric screening tests has rarely been compared with usual clinical care. The GERSOC-trial will evaluate whether geriatric screening in elderly patients with advanced-stage ovarian cancer improves treatment completion and quality of life.MethodsThis pragmatic, cluster randomised controlled trial will be conducted at a minimum of 20 hospitals in the Netherlands. Hospitals are randomly assigned to geriatric screening care (in which a geriatric screening comprised of the G8 questionnaire and the Timed Up and Go test is performed), or care as usual (in which current usual care is continued). A total of 320 patients aged ≥ 70 years with primary, advanced-stage ovarian carcinoma will be included. Patients considered fit on geriatric screening will receive standard treatment; patients who are considered unfit will be referred to a geriatrician for analysis and treatment advice. The primary outcome is the percentage difference in completed standard and adapted therapies between the two study arms. Secondary outcomes include quality of life, cost-effectiveness and survival.DiscussionThis trial aims to gather evidence for the use of geriatric screening in treatment decision-making in elderly patients with advanced ovarian cancer. If proven feasible, beneficial and cost-effective, geriatric screening may be implemented in routine clinical practice.Trial registrationNetherlands Trial Registry, ID: NL6745. Registered on 2 August 2017.

Frequency of Screening for Weaning From Mechanical Ventilation: Two Contemporaneous Proof-of-Principle Randomized Controlled Trials.

It is unknown whether more frequent screening of invasively ventilated patients, identifies patients earlier for a spontaneous breathing trial, and shortens the duration of ventilation. We assessed the feasibility of conducting a large trial to evaluate screening frequency in critically ill adults in the North American context. We conducted two contemporaneous, multicenter, pilot, randomized controlled trials (the LibeRation from MEchanicaL VEntilAtion and ScrEening Frequency [RELEASE] and Screening Elderly PatieNts For InclusiOn in a Weaning [SENIOR] trials) to address concerns regarding the potential for higher enrollment, fewer adverse events, and better outcomes in younger patients. Ten and 11 ICUs in Canada, respectively. Parallel trials of younger (RELEASE < 65 yr) and older (SENIOR ≥ 65 yr) critically ill adults invasively ventilated for at least 24 hours. Each trial compared once daily screening to "at least twice daily" screening led by respiratory therapists. In both trials, we evaluated recruitment (aim: 1-2 patients/month/ICU) and consent rates, reasons for trial exclusion, protocol adherence (target: ≥ 80%), crossovers (aim: ≤ 10%), and the effect of the alternative screening frequencies on adverse events and clinical outcomes. We included 155 patients (53 patients [23 once daily, 30 at least twice daily] in RELEASE and 102 patients [54 once daily, 48 at least twice daily] in SENIOR). Between trials, we found similar recruitment rates (1.32 and 1.26 patients/month/ICU) and reasons for trial exclusion, high consent and protocol adherence rates (> 92%), infrequent crossovers, and few adverse events. Although underpowered, at least twice daily screening was associated with a nonsignificantly faster time to successful extubation and more successful extubations but significantly increased use of noninvasive ventilation in both trials combined. Similar recruitment and consent rates, few adverse events, and comparable outcomes in younger and older patients support conduct of a single large trial in North American ICUs assessing the net clinical benefits associated with more frequent screening.

Is Duplex carotid artery screening prior to CABG justified?

Objectives:To evaluate the use of duplex carotid artery screening in patients undergoing coronary artery bypass graft (CABG).Methods:This descriptive, observational study was conducted in Radiology Department at King Fahad Military Medical Complex, Dhahran, Kingdomof Saudi Arabia from April 2015-2018. All Saudi patients (n=178) who underwent duplex carotid sonography prior to CABG were retrospectively reviewed for essential morphologic and hemodynamic information to estimate severity of extra-cranial internal carotid artery (ICA) stenosis. Patients with combined CABG and cardiac surgery, and those with limited carotid studies were excluded. Advancing age (65 years or above), gender, smoking, obesity, diabetes (DM), hypertension (HTN), dyslipidemia, coronary vessel disease, cardiac disease and previous stroke were recorded. Post-coronary artery bypass graft neurologic event (namely, transient ischemic attack [TIA] or stroke) was recorded. Chi-square test was used to determine association of stenosis degree with post-CABG neurologic event.Results:One hundred twenty eight patients (72%) were having ICA disease, while significant carotid artery stenosis (>70%) was seen in 11 patients (6.2%). Post-coronary artery bypass graft neurologic event was seen in 4.5% of patients. Advancing age, significant ICA stenosis and multi-vessel coronary disease were seen associated with a post-CABG event.Conclusion:Significant ICA stenosis on duplex screening in elderly patients with multi-vessel coronary artery disease or certain risk factors may predict post-CABG stroke.

Patient screening for early detection of aortic stenosis (AS)-review of current practice and future perspectives.

In Europe, approximately one million people over 75 years suffer from severe aortic stenosis (AS), one of the most serious and most common valve diseases, and this disease burden is increasing with the aging population. A diagnosis of severe symptomatic AS is associated with an average life expectancy of 2-3 years and necessitates a timely valve intervention. Guidelines for valve replacement therapy have been established but only a proportion of patients with symptomatic AS actually receive this life-saving treatment. The decision for valve intervention in asymptomatic patients with severe AS is often more challenging and likely results in fewer patients receiving treatment in comparison to their symptomatic counterparts. This article reviews the epidemiology and clinical manifestations of AS, the associated economic burden of AS to the healthcare system, the diagnosis of AS and the possible mechanisms for the introduction of routine screening in elderly patients. Elderly patients typically visit healthcare providers more frequently than younger patients, thereby providing increased opportunities for ad hoc AS screening and this, along with raising patient awareness of the symptoms of AS, has the potential to result in the earlier diagnosis and treatment of AS and increased patient survival.

Adaptação de teste para rastreio de delirium em idosos admitidos em serviço de urgência

OBJECTIVE: Delirium is one of the most frequent syndromes among elderly patients admitted to emergency units and, despite presenting well-established symptoms and signs, there are still diagnostic failures. Thus, the aim of the study was to adapt the Abbreviated Mental Test (AMT) as a screening tool for delirium in elderly adults admitted to an emergency department. METHODS: This cross-sectional study was conducted at the emergency department of a university hospital in Brasília, Brazil between April and June, 2014. We evaluated 90 patients of both sexes, aged 60 years or older. The Confusion Assessment Method O (CAM) Instrument was considered the gold standard for diagnosing delirium. The complete translated AMT, administered in four different culturally adapted models, as well as condensed models, were compared to the CAM receiver operating characteristics curve (significance < 0.05; H0: AUC = 0.5). Inter-rater agreement was evaluated with the kappa test, using SPSS version 22.0.0.0. RESULTS: The prevalence of delirium was 25.6%. The best of the four AMT models presented sensitivity and specificity of 78.3% and 85.1%, respectively, with good inter-rater reproducibility (Kappa = 0.793). The best condensed model included four questions, with sensitivity and specificity of 82.6% and 82.1%, respectively, and a kappa of 0.746. CONCLUSIONS: Compared to the gold standard, the adapted AMT (complete or condensed) was adequate as an alternative for quick delirium screening in elderly patients admitted to an emergency department, especially for unaccompanied patients with no prior cognitive deficit.

Incidence and risk factors for aspiration pneumonia after cardiovascular surgery in elderly patients.

Pneumonia after cardiovascular surgery is the leading cause of mortality. Postoperative aspiration pneumonia becomes a critical issue in the management of cardiovascular surgery in the aging society. The aim of this study was to investigate the incidence and risk factors of aspiration pneumonia after cardiovascular surgery for elderly patients. This study consisted of 123 elderly patients (>65years old) who survived their final extubation following cardiovascular surgery at Kinan Hospital. Patients were divided into aspiration pneumonia and no pneumonia groups. Postoperative aspiration pneumonia was diagnosed by two independent physicians according to the nursing- and healthcare-associated pneumonia guidelines by the Japanese Respiratory Society. Among the patients, 12 (9.8%) had aspiration pneumonia. There were no differences in patients' characteristics between the groups except for a history of cerebral vascular disorder (aspiration pneumonia 42% vs no pneumonia 15%, p=0.04) and ejection fraction (EF) (aspiration pneumonia 56±21% vs no pneumonia 66±13%, p=0.02). Only six (5%) patients needed more than 12h intubation. There was no difference in the operative factors between the groups. Neurological deficit was more frequently observed in the aspiration pneumonia group (33 vs 5%, p=0.005). Multivariable logistic regression analysis showed that the history of cerebral vascular disorder and neurological deficit after surgery was independent risk factors for aspiration pneumonia after cardiovascular surgery. Our results could assist in screening elderly patients who should be more carefully evaluated before oral nutrition to minimize morbidity and mortality after cardiovascular surgery.

Application and comparison of two kinds of nutritional evaluation methods in nutritional screening in elderly patients with spontaneous intracerebral hemorrhage

Objective To investigate the application effect of two methods, the nutritional risk screening 2002 (NRS 2002) and the mini nutritional assessment short-form (MNA-SF), on nutritional screening in elderly patients with spontaneous intracerebral hemorrhage, and to evaluate the applicability of two kinds of methods. Methods Using NRS 2002 and MNA-SF, the malnutrition risk screening was performed in 60 cases of elderly patients with cerebral hemorrhage.Based on malnutrition risk score results, the potential nutritional risks were judged, and the application effectiveness was compared between two nutritional evaluation tools. Results Among 60 cases, there were 59 (98.3%) cases with NRS-2002 score≥3, and 1 (1.7%) case with NRS-2002 score <3.By contrast, using the MNA-SF analysis, among 60 cases there were 3 (5.0%) cases with score of 12-14, 7 (11.7%) cases with score of 8-11, and 50 (83.3%) cases with score of 0-7.No statistically significant difference was found between these two methods for analyzing the malnutrition risk incidence (χ2=1.034, P=0.619). Conclusion The risk grade of malnutrition is very high in elderly patients with spontaneous intracerebral hemorrhage during the period of hospitalization. NRS 2002 and MNA-SF are both applicable for the nutritional screening in the elderly patients with spontaneous cerebral hemorrhage. Clinical application is more convenient, fast and comprehensive with MNA-SF than with NRS 2002. Key words: Cerebral hemorrhage; Nutrition assessment

Primary care physicians' endorsement of the importance of shared decision making in diverse cancer screening contexts.

179 Background: Despite widespread advocacy, shared decision making (SDM) is not routinely used in office-based cancer screening discussions. We describe primary care physicians’ (PCPs) endorsement of the importance of SDM in different cancer screening contexts. Methods: Between 3/15-5/15 we administered a mailed survey to PCPs randomly selected from the American Medical Association’s Master File. Using 5-point Likert scales, we report PCP’s ratings of the importance of SDM for 11 specific screening scenarios graded by the US Preventive Service Task Force (USPSTF), four specific to not screening elderly patients. Multivariable logistic regression, accounting for repeated observations, was used to estimate the association of physicians’ endorsement of SDM as ‘very important’ with (1) USPSTF grade A [highest endorsement] vs. others, and (2) if scenario pertained to not screening among the elderly. The model controlled for physician age, gender, race, specialty, medical school affiliation, practice size, and PCP’s internal/external motivation for SDM. Results: PCPs were on average 52 years of age, 38% female, and 69% white (N = 288). They were most likely to rate SDM as ‘very important’ for colorectal cancer (CRC) screening in adults aged 50-75 (69%), and least likely for CRC screening in adults aged &gt; 85 (34%). Model results indicated PCPs were significantly (p &lt; 0.01) more likely to endorse SDM as ‘very important’ for A-grade services compared to others, particularly D-grade services (OR = 0.63), and less likely to do so when decision was not to screen among elderly (OR = 0.45). PCPs with more internal motivation for SDM were more likely to endorse its importance (OR = 2.29), but no other physician characteristic was associated with SDM endorsement. Conclusions: The more PCPs internally value SDM, the more likely they are to endorse it as very important regardless of screening scenario. Yet, PCPs’ endorsement varied by USPSTF grade, being particularly low when screening was not recommended, especially when the decision pertained to screening not recommended among elderly patients.

Screening for metabolic syndrome in older patients with severe mental illness: Two-years observational study

IntroductionPatients with serious psychiatric illness (SMI) have a reduced quality of life and life expectancy than the general population. Metabolic syndrome (MS) is a clinical aspect determining who should be considered to reduce the risk of serious and chronic organic factors, even more significant in the elderly.ObjectivesTo evaluate metabolic screening of elderly patients with severe mental illness (SMI).AimsTo evaluate the importance of routine screening of metabolic parameters in elderly guests of residential facilities with or without SMI; metabolic screening at baseline and after two of hospitalization.MethodsElderly inpatients (44 Tot) with Severe Mental Illness (SMI: bipolar disorder: 34%; schizophrenia: 46%; other: 20%) vs elderly inpatients (78 Tot). Data collected at baseline: psychiatric diagnosis; any previous diagnosis of hypertension, diabetes, dyslipidemia; ECG. At baseline and for two years were administered following scale: BPRS; PANSS; Qli; MMSE, ADL.ResultsAfter two years metabolic screening has recorded at least one of the new interactions between the five factors of MS (ATP III) in 50% of patients with: one (34%); two (21%); three (11%); four (3%) new altered parameters. In MS inpatients, 53% of new metabolic alterations were recorded in 53% (MS inpatients) vs 23% without MS after two years.ConclusionsOur results showed a higher frequency of MS in patients with SMI than comparison subjects. Haloperidol was the antipsychotic medication that caused minor impact on the development of metabolic disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.