1
|
Montero-Marco J, Charlo-Bernardos M, Subirón-Valera AB, Erickson H, Herrero-Cortina B, Altarribas-Bolsa E. The role of nursing care continuity report in predicting length of hospital stay in older people: A retrospective cohort study. J Clin Nurs 2024; 33:1830-1838. [PMID: 38178555 DOI: 10.1111/jocn.16953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/29/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission. AIM To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days). RESEARCH DESIGN AND SETTING A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR. RESULTS A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital-acquired pressure ulcers. CONCLUSIONS Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital-acquired ulcers at hospital discharge. RELEVANCE TO CLINICAL PRACTICE Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation. NO PATIENT OR PUBLIC CONTRIBUTION No direct patient contact was made during the data collection.
Collapse
Affiliation(s)
- Jesica Montero-Marco
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - Marta Charlo-Bernardos
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - Ana Belén Subirón-Valera
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Beatriz Herrero-Cortina
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
- Universidad San Jorge, Zaragoza, Spain
| | - Elena Altarribas-Bolsa
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| |
Collapse
|
2
|
Sheng OC, Wu WT, Peng CH, Yao TK, Chen IH, Wang JH, Yeh KT. Therapeutic advantage of teriparatide in very elderly patients with proximal femoral fractures: a functional and BMD analysis. BMC Musculoskelet Disord 2024; 25:288. [PMID: 38614984 PMCID: PMC11015553 DOI: 10.1186/s12891-024-07373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/21/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Teriparatide, a recombinant parathyroid hormone, is pivotal in osteoporosis treatment, particularly in post-surgical recovery for hip fractures. This study investigates its efficacy in functional recovery post-hip fracture surgery in elderly patients, a demographic particularly susceptible to osteoporotic fractures. METHODS In this retrospective cohort study, 150 elderly patients with proximal femoral fractures undergoing open reduction and internal fixation were enrolled. They were categorized into two groups: receiving 20 µg of daily teriparatide injections for 18 months and receiving standard antiresorptive medications during a 24-month follow-up. Detailed records of patient demographics, Fracture Risk Assessment Tool scores, and comorbidities were kept. Key outcomes, including bone mineral density (BMD) and functional scores (Barthel Index and Visual Analog Scale for hip pain), were evaluated at 3 and 24 months post-surgery. RESULTS Out of the original cohort, 126 patients (20 men and 106 women with an average age of 85.5 ± 9.3 years) completed the study. The teriparatide group exhibited significant enhancements in both functional scores and BMD when compared to the control group. Notably, functional improvements were less pronounced in male patients compared to female patients. Additionally, the incidence of new fractures was markedly lower in the teriparatide group. CONCLUSION Administering teriparatide daily for 18 months post-surgery for proximal femoral fractures significantly benefits very elderly patients by improving functionality and bone density, with observed differences in recovery between genders. These results reinforce the efficacy of teriparatide as a potent option for treating osteoporosis-related fractures in the elderly and highlight the importance of considering gender-specific treatment and rehabilitation strategies.
Collapse
Affiliation(s)
- Ooi Chin Sheng
- School of Medicine, Tzu Chi University, Hualien, 970374, Taiwan
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien, 970374, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970374, Taiwan
| | - Cheng-Huan Peng
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Ting-Kuo Yao
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Ing-Ho Chen
- School of Medicine, Tzu Chi University, Hualien, 970374, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien, 970374, Taiwan.
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970473, Taiwan.
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970374, Taiwan.
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien, 970374, Taiwan.
| |
Collapse
|
3
|
Bertelsen AS, Masud T, Suetta C, Rosenbek Minet L, Andersen S, Lauridsen JT, Ryg J. ROBot-assisted physical training of older patients during acUte hospitaliSaTion-study protocol for a randomised controlled trial (ROBUST). Trials 2024; 25:235. [PMID: 38576046 PMCID: PMC10993432 DOI: 10.1186/s13063-024-08044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND During hospitalisation, older patients spend most of their time passive in bed, which increases the risk of functional decline and negative adverse outcomes. Our aim is to examine the impact of robot-assisted physical training on functional status in older geriatric patients during acute hospitalisation. METHODS This is a single-centre investigator-blinded placebo-controlled randomised controlled trial including geriatric patients aged ≥ 65 years, able to ambulate before hospitalisation, and with expected length of stay ≥ 2 days. In addition to standard physiotherapy treatment, the intervention group receive active robot-assisted resistance training and the control group passive robot-assisted sham training. Exclusion criteria are as follows: ambulation without assistance at the time of inclusion, known severe dementia, delirium, patients who have received less than three training sessions at discharge, terminal illness, recent major surgery/lower extremity fracture, conditions contradicting the use of training robot, lower extremity metastases, deemed unsuitable for robot-assisted training by a healthcare professional, or weight > 165 kg. The primary outcome is functional status assessed by change in Barthel Index-100 and 30-s chair stand test between inclusion and day of discharge. Secondary outcomes include functional status at 1- and 3-month follow-up, quality of life, depression, concern about falling, falls, cognition, qualitative interviews, need of homecare, discharge destination, readmissions, healthcare costs, sarcopenia, muscle quantity (bioimpedance), and mortality. Clinical meaningful change of the Barthel Index is 5 points. A recent study in geriatric patients reported a 6.9-point change following exercise. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 244 participants per group (n = 488) are needed to detect the same mean difference. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 74 participants per group (n = 148) are needed to detect a minimum clinical change of 2.6 repetitions for 30-s chair stand test. Recruitment started in January 2023 and is expected to continue for 19 months including follow-up. DISCUSSION If our study shows that in-hospital robot-assisted training prevents functional decline in older patients, this may have a major impact on the individual patient due to increased wellbeing and a higher level of independency. In addition, society will benefit due to potential decrease in the need of municipality-delivered homecare following discharge. TRIAL REGISTRATION ClinicalTrials.gov NCT05782855. Registration date: March 24, 2023.
Collapse
Affiliation(s)
- Ann Sophia Bertelsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
- Open Patient Data Explorative Network, OPEN, Odense University Hospital, Region of Southern Denmark, Odense, Denmark.
| | - Tahir Masud
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Geriatric Medicine, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Charlotte Suetta
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Rosenbek Minet
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jørgen T Lauridsen
- Department of Economics, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| |
Collapse
|
4
|
Zhou J, Zha F, Liu F, Wan L, Zhou M, Long J, Chen M, Xue K, Wang Y. Reliability and validity of a graphical computerized adaptive test Longshi scale for rapid assessment of activities of daily living in stroke survivors. Sci Rep 2024; 14:7625. [PMID: 38561344 PMCID: PMC10985115 DOI: 10.1038/s41598-024-57671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Stroke survivors frequently experience difficulties in daily activities, such as bathing, feeding, and mobility. This study aimed to evaluate the reliability and validity of a computer-adaptive test-Longshi scale (CAT-LS) for assessing activities of daily living (ADL) in stroke survivors. This cross-sectional study collected data using an electronic application. The ADL function of stroke survivors in rehabilitation departments of hospitals was assessed using both the CAT-LS and BI. Correlations between the CAT-LS and Barthel index (BI) and concurrent validity were evaluated using Pearson's correlation test and multiple linear regression. Interrater reliability was evaluated using the intraclass correlation coefficient based on a two-way random effect. The internal consistency of the CAT-LS was assessed using Cronbach's coefficient (α) and corrected item-total correlations. Overall, 103 medical institutions in China were used in this study. In total, 7151 patients with stroke were included in this study. The CAT-LS classified patients into three ADL groups (bedridden, domestic, and community) with significantly different BI scores (P < 0.05). The CAT-LS results obtained using the decision-tree scoring model were consistent with the scores for each BI item. A strong correlation was observed between CAT-LS and BI (Pearson's r: 0.6-0.894, P < 0.001). The CAT-LS demonstrated good internal consistency (Cronbach's α, 0.803-0.894) and interrater reliability (ICC, 0.928-0.979). CAT-LS is time-efficient and requires < 1 min to administer. The CAT-LS is a reliable and valid tool for assessing ADL function in stroke survivors and can provide rapid and accurate assessments that reduce the burden on healthcare professionals. Further validation of this tool in other populations and settings is necessary.Study registration number: No.: ChiCTR2000034067; http://www.chictr.org.cn/showproj.aspx?proj=54770 .
Collapse
Affiliation(s)
- Jing Zhou
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
- Department of Neurology, Institutes of Brain Science, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Biological Science, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Fubing Zha
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Fang Liu
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Li Wan
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Mingchao Zhou
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Jianjun Long
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Miaoling Chen
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Kaiwen Xue
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China.
| |
Collapse
|
5
|
Yamaguchi K, Abe T, Matsumoto S, Nakajima K, Shimizu M, Takeuchi I. Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study. BMC Geriatr 2024; 24:250. [PMID: 38475701 DOI: 10.1186/s12877-024-04872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND An increasing number of older patients require emergency abdominal surgery for acute abdomen. They are susceptible to surgical stress and lose their independence in performing daily activities. Laparoscopic surgery is associated with faster recovery, less postoperative pain, and shorter hospital stay. However, few studies have examined the relationship between laparoscopic surgery and physical functional decline. Thus, we aimed to examine the relationship between changes in physical function and the surgical procedure. METHODS In this was a single-center, retrospective cohort study, we enrolled patients who were aged ≥ 65 years and underwent emergency abdominal surgery for acute abdomen between January 1, 2019, and December 31, 2021. We assessed their activities of daily living using the Barthel Index. Functional decline was defined as a decrease of ≥ 20 points in Barthel Index at 28 days postoperatively, compared with the preoperative value. We evaluated an association between functional decline and surgical procedures among older patients, using multiple logistic regression analysis. RESULTS During the study period, 852 patients underwent emergency abdominal surgery. Among these, 280 patients were eligible for the analysis. Among them, 94 underwent laparoscopic surgery, while 186 underwent open surgery. Patients who underwent laparoscopic surgery showed a less functional decline at 28 days postoperatively (6 vs. 49, p < 0.001). After adjustments for other covariates, laparoscopic surgery was an independent preventive factor for postoperative functional decline (OR, 0.22; 95% CI, 0.05-0.83; p < 0.05). CONCLUSIONS In emergency abdominal surgery, laparoscopic surgery reduces postoperative physical functional decline in older patients. Widespread use of laparoscopic surgery can potentially preserve patient quality of life and may be important for the better development of emergency abdominal surgery.
Collapse
Affiliation(s)
- Keishi Yamaguchi
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minamiku, Yokohama, 232-0024, Japan.
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
| | - Takeru Abe
- Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan
| | - Shokei Matsumoto
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kento Nakajima
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minamiku, Yokohama, 232-0024, Japan
| | - Masayuki Shimizu
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minamiku, Yokohama, 232-0024, Japan
| |
Collapse
|
6
|
Hosseinpour A, Azami P, Hosseinpour H, Attar A, Koushkie Jahromi M. Efficacy of exercise training-based cardiac rehabilitation programmes after transcatheter aortic valve implantation: A systematic review and meta-analysis. Int J Cardiol Cardiovasc Risk Prev 2024; 20:200238. [PMID: 38322761 PMCID: PMC10844670 DOI: 10.1016/j.ijcrp.2024.200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
Background The beneficial effects of exercise training-based cardiac rehabilitation (CR) in different cardiac conditions have been previously studied. In this meta-analysis, we focused on the potential impact of CR on patients undergoing transcatheter aortic valve implantation (TAVI). Methods Multiple databases were searched in a systematic approach to find the eligible studies. All the studies investigating the potential impact of exercise training-based CR programmes on exercise capacity and health-related quality of life in patients undergoing TAVI were retrieved. The primary endpoint of interest was 6-min walk test (6MWT). The pooled standardized mean difference (SMD) and 95 % confidence interval (CI) were measured to compare the improvement or worsening the endpoints using a random- or fixed-effects model, as appropriate. Results A total of eleven studies (685 patients) were considered eligible for quantitative synthesis. The results showed that performing exercise training-based CR after TAVI is associated with significant improvement in 6MWT (SMD 0.59, 95 % CI (0.48; 0.71), p < 0.01), Barthel index (SMD 0.73, 95 % CI (0.57; 0.89), p < 0.01), 12-item Short Form (SF-12) physical (SMD 0.30, 95 % CI (0.08; 0.52), p < 0.01) and mental (SMD 0.27, 95 % CI (0.05; 0.49), p = 0.02) survey scores, and hospital anxiety and depression scale - depression (HADS-D) score (SMD -0.26, 95 % CI (-0.42; -0.10), p < 0.01). Conclusion Performing exercise training-based CR following TAVI has significant benefits regarding physical capacity and health-related quality of life irrespective of the programme duration.
Collapse
Affiliation(s)
- Alireza Hosseinpour
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouria Azami
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Armin Attar
- Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | |
Collapse
|
7
|
Inoo S, Kono Y, Kanzaki H, Horiguchi S, Kato H, Yamasaki Y, Hirata S, Kuraoka S, Matsueda K, Okanoue S, Satomi T, Hamada K, Iwamuro M, Kawano S, Kawahara Y, Okada H, Otsuka M. Association of screening tool scores with overall survival in older patients with unresectable gastrointestinal or biliary pancreatic cancer: A retrospective study. J Geriatr Oncol 2024:101714. [PMID: 38331689 DOI: 10.1016/j.jgo.2024.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Shoko Inoo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yoshiyasu Kono
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of Internal Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama, 708-0841, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Shoichiro Hirata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Sakiko Kuraoka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Katsunori Matsueda
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Shotaro Okanoue
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takuya Satomi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kenta Hamada
- Department of Practical Gastrointestinal endoscopy, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yoshiro Kawahara
- Department of Internal Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama, 708-0841, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of Internal Medicine, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji 670-8540, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| |
Collapse
|
8
|
Asahi R, Kamo T, Yuguchi S, Azami M, Ogihara H, Momosaki R. Effects of weekend rehabilitation on vertebral compression fractures in the elderly. Physiother Res Int 2024; 29:e2049. [PMID: 37776524 DOI: 10.1002/pri.2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/07/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION This retrospective cohort study aimed to investigate the effect of rehabilitation and without weekend therapy on Activities of daily living (ADL) and readmission in vertebral fracture patients aged 60 years and older. METHODS The present study used a hospital-based database created by JMDC Inc. The JMDC hospital-based database is an epidemiological database that has been storing medical claims and Diagnosis Procedure Combination survey data. This study included 40,743 admitted patients aged 60 years or older who were admitted for rehabilitation purposes with a diagnosis of compression fracture of the thoracic and/or lumbar spine based on a previous diagnostic survey. We extracted the medical information from the database. Patients who received rehabilitation 7 days a week were classified into two groups: the "weekend rehabilitation group" and "nonweekend rehabilitation group." To reduce confounding effects related to differences in patient background, we used propensity score with multiple logistic regression models. Analysis of the JMDC database was conducted with the approval of the Institutional Review Board (approval number: 1228-1). Because all data were anonymized, informed consent was not required. RESULTS Propensity score matching resulted in 13,790 cases being included in the analysis. Barthel index (BI) at discharge, change in BI, and readmission were significantly different between the weekend rehabilitation and nonweekend rehabilitation groups. Multiple logistic regression analysis suggested a reduced odds of readmission with weekend rehabilitation (odds ratio = 0.907, 95% confidence interval [CI] = 0.843-0.975, p-value = 0.008). Furthermore, greater changes in BI and BI at discharge were associated with the effect of weekend rehabilitation (unstandardized [B] = 3.922, 95% CI = 2.925-4.919), (unstandardized [B] = 3.512, 9% CI = 2.424-4.6), respectively. CONCLUSIONS Weekend rehabilitation was considered as an important part of the treatment program to acquire ADL and to prevent readmission.
Collapse
Affiliation(s)
- Ryoma Asahi
- School of Health Sciences, Japan University of Health Sciences, Hirasuka, Satte City, Saitama, Japan
| | - Tomohiko Kamo
- Department of Rehabilitation, Gunma Paz University, Takasaki City, Gunma, Japan
| | - Satoshi Yuguchi
- School of Health Sciences, Japan University of Health Sciences, Hirasuka, Satte City, Saitama, Japan
| | - Masato Azami
- School of Health Sciences, Japan University of Health Sciences, Hirasuka, Satte City, Saitama, Japan
| | - Hirofumi Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano City, Nagano, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
| |
Collapse
|
9
|
Watanabe K, Tsuji T, Saruta Y, Matsuzawa H, Shimodaira Y, Iijima K. Impact of Functional Status on Development of Clostridioides difficile Infection and Increase in Inhospital Mortality among Antibiotic Users. Digestion 2023; 105:131-139. [PMID: 37995669 DOI: 10.1159/000535306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Functional status is one of the surrogates of advanced age, an established risk factor for Clostridioides difficile infection (CDI). We aimed to investigate the usefulness of functional status in the clinical management of CDI. METHODS We enrolled all hospitalized adult patients receiving antibiotics from a retrospective hospital-based cohort in Japan between 2016 and 2020. Using the Barthel index (BI), which is an objective scale of functional status, we investigated the association of BI with developing CDI and its impact on inhospital mortality in patients with CDI. RESULTS We enrolled 17,131 patients with 100 cases of CDI. Multivariable analysis revealed that lower BI (≤25) was an independent risk factor for developing CDI (adjusted odds ratio, 4.11; 95% confidence interval, 2.62-6.46). Furthermore, a combination of BI and Charlson comorbidity index (CCI) showed an adjusted odds ratio of 36.40 (95% confidence interval, 17.30-76.60) in the highest risk group. A high-risk group according to the combination of BI and CCI was estimated to have significantly higher inhospital mortality in patients with CDI using the Kaplan-Meier method (p = 0.017). A combination of lower BI and higher CCI was an independent predictor of inhospital mortality even in the multivariable Cox regression model (adjusted hazard ratio, 3.00; 95% confidence interval, 1.01-8.88). CONCLUSIONS Assessment of functional status, especially combined with comorbidities, was significantly associated with developing CDI and may also be useful in predicting inhospital mortality.
Collapse
Affiliation(s)
- Kenta Watanabe
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tsuyotoshi Tsuji
- Department of Gastroenterology, Akita City Hospital, Akita, Japan
| | - Yohei Saruta
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Yosuke Shimodaira
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
10
|
Tsai JCH, Chang YY, Hsu CY, Chen HJ, Chan FT, Shi ZY. The Epidemiological Analysis of COVID-19 Outbreaks in Nursing Homes during the Period of Omicron Variant Predominance. Healthcare (Basel) 2023; 11:2868. [PMID: 37958011 PMCID: PMC10648883 DOI: 10.3390/healthcare11212868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The main purpose of this study was to evaluate the epidemic trend and risk factors associated with COVID-19 outbreaks in nursing homes during the period of Omicron variant predominance. METHODS The study analyzed the risk factors associated with SARS-CoV-2 infection and death among the 327 residents and 129 healthcare workers (HCWs) in three hospital-affiliated nursing homes through a multivariate Cox regression model. RESULTS The rates of receiving a COVID-19 booster dose were 70.3% for the residents and 93.0% for the healthcare workers (HCWs), respectively. A number of asymptomatic individuals, including 54 (16.5%) residents and 15 (11.6%) HCWs, were detected through mass screening surveillance tests. The COVID-19 infection rates during the outbreaks were 41.6% among residents and 48.1% among HCWs, respectively. The case fatality rate among residents was 10.3%. None of the HCWs were hospitalized or died. The multivariate Cox regression model showed that the risk of COVID-19 infection increased in males (HR 2.46; 95% CI 1.47-4.11; p = 0.001), Barthel index ≥ 61 (HR 1.93; 95% CI 1.18-3.17; p = 0.009), and dementia (HR 1.61; 95% CI 1.14-2.27; p = 0.007). The risk of COVID-19 death increased with pneumonia (HR 11.03; 95% CI 3.02-40.31; p < 0.001), hospitalization (HR 7.18; 95% CI 1.97-26.25; p = 0.003), and admission to an intensive care unit (HR 8.67; 95% CI 2.79-26.89; p < 0.001). CONCLUSIONS This study highlighted the high infection rates with a substantial proportion of asymptomatic infections for both residents and HCWs, as well as a high case fatality rate for the residents among nursing homes during the Omicron epidemic period. We suggest implementing mass screening through regular surveillance testing as an effective strategy for early detection of COVID-19 and for preventing transmission during an epidemic period. Pneumonia is the primary risk associated with COVID-19 death. Early detection and prompt treatment of pneumonia for vulnerable residents in nursing homes are crucial to protect them from potential mortality.
Collapse
Affiliation(s)
- Jeffrey Che-Hung Tsai
- Department of Emergency Medicine, Taichung Veterans General Hospital, Puli Branch, Nantou 545402, Taiwan;
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Ying-Ying Chang
- Nursing Department, Taichung Veterans General Hospital, Puli Branch, Nantou 545402, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Group, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Hui-Ju Chen
- Infection Control Team, Taichung Veterans General Hospital, Puli Branch, Nantou 545402, Taiwan
| | - Feng-Tse Chan
- Nursing Department, Taichung Veterans General Hospital, Puli Branch, Nantou 545402, Taiwan
| | - Zhi-Yuan Shi
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Industrial Engineering & Enterprise Information, Tunghai University, Taichung 407224, Taiwan
| |
Collapse
|
11
|
Geng C, Yang G, Zhou H, Wang H, Li Y, Leng Y, Zhang Z, Jian Y, Chen W. Low Barthel index score is a poor prognostic factor for newly diagnosed multiple myeloma patients. Clin Exp Med 2023; 23:2593-2600. [PMID: 36703087 DOI: 10.1007/s10238-023-01002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
The basic activities of daily life may affect the prognosis of multiple myeloma (MM) patients and the Barthel index (BI) is currently the most widely used tool to evaluate basic activities of daily life, but few studies have evaluated its prognostic value in MM. We retrospectively enrolled patients with newly diagnosed MM and analyzed the association between the BI and the survival of newly diagnosed MM patients. We totally analyzed 538 patients and found that median overall survival (OS) and progression-free survival (PFS) were significantly shorter in the low BI (≤ 85) group compared with the high BI (> 85) group. Univariate Cox proportional hazards regression analysis showed that the low BI was associated with shorter OS and PFS. It was also confirmed that the low BI was poor prognostic factor for OS and PFS in multivariable analyses. In the propensity score matching analysis, patients with low BI also had shorter OS and PFS. Our study suggested that the low BI was a poor prognostic factor for patients with newly diagnosed MM.
Collapse
Affiliation(s)
- Chuanying Geng
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Guangzhong Yang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Huixing Zhou
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Huijuan Wang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yanchen Li
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yun Leng
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhiyao Zhang
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yuan Jian
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
12
|
Baldeh M, Youkee D, Lakoh S, Rudd A, Langhorne P, Deen GF, Conteh ZF, Lisk DR, O'Hara J, Thompson M, Brima MT, Wang Y, Wolfe CDA, Sackley CM. Stroke in Sierra Leone. the stroke risk factors for people with HIV: A prospective case-control study. J Stroke Cerebrovasc Dis 2023; 32:107279. [PMID: 37523881 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND HIV infection rates are relatively low in Sierra Leone and in West Africa but the contribution of HIV to the risk factors for stroke and outcomes is unknown. In this study, we examined stroke types, presentation, risk factors and outcome in HIV stroke patients compared with controls. METHODS We used data from the Stroke in Sierra Leone Study at 2 tertiary hospitals in Freetown, Sierra Leone. A case control design was used to compare stroke type, presentation, risk factors and outcome in sero-positive HIV patients with HIV negative stroke controls. Controls were matched for age and gender and a 1:4 ratio cases to controls was used to optimize power. Analysis was performed using the Pearson x2 for categorical variable, Paired-T test and Mann-Whitney U test for continuous variables. A p-value of less than 0.05 was taken as the level of statistical significance. RESULTS Of 511 (51.8%) stroke patients tested for HIV, 36 (7.1%) were positive. Univariate unmatched analysis showed a stroke mean age of 49 years in HIV-positive versus 58 years in HIV-negative population (p = <0.001). In the case-control group, ischaemic stroke is the major type reported in both populations, HIV-negative population: 77 (53.5%) versus HIV-positive: 25 (69.4%) (p = 0.084). Hypertension is the most prevalent risk factor in both groups, HIV-positive: 23 (63.9%) versus HIV-negative: 409 (86.1%) (p = 0.001). Lower CD4+ count is associated in-hospital mortality (p = <0.001). CONCLUSION These findings support the current call for timely management of stroke and HIV through integrated care.
Collapse
Affiliation(s)
- Mamadu Baldeh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, UK.
| | - Daniel Youkee
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Anthony Rudd
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, School of Cardiovascular and Metabolic Health, University of Glasgow
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Zainab F Conteh
- Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jessica O'Hara
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Michael Tanu Brima
- Connaught Teaching Hospital, University of Sierra Leone teaching Hospital Complex, Freetown, Sierra Leone
| | - Yanzhong Wang
- School of Life Course and Population Sciences, King's College London, London, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London, London, UK
| | - Charles DA Wolfe
- School of Life Course and Population Sciences, King's College London, London, UK; National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London, London, UK
| | | |
Collapse
|
13
|
Pan Y, Xu M, Mei Y, Wang Y, Zhang Q. Activities of daily living predict periprocedural myocardial infarction and injury following percutaneous coronary intervention: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:427. [PMID: 37644419 PMCID: PMC10466711 DOI: 10.1186/s12872-023-03468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In recent years, there has been growing interest in exploring the relationship between activities of daily living (ADL) and cardiovascular diseases. This retrospective cross-sectional study aimed to investigate the association of ADL measured by Barthel index (BI) with periprocedural myocardial infarction (PMI) and injury following percutaneous coronary intervention (PCI). METHODS Enrolled patients were stratified into impaired and unimpaired ADL groups according to their BI scores. Logistic regressions were conducted to explore the association of ADL on admission with periprocedural myocardial injury and infarction. Restricted cubic spline (RCS) curve and subgroup analysis were also performed. RESULTS Totally, 16.4% of patients suffered from PMI; the mean age was 65.8 ± 10.4 years old. RCS analysis showed that the morbidity of periprocedural myocardial infarction and injury showed a downward tendency with increasing BI scores. Multivariable logistic regression analysis demonstrated that impaired ADL was an independent risk factor for periprocedural myocardial infarction (OR = 1.190, 95% CI [1.041, 1.360], P = 0.011) and injury (OR = 1.131, 95% CI [1.017, 1.257], P = 0.023). Subgroup analysis showed that the association between ADL and PMI was founded in several subgroups, while the association between ADL and periprocedural myocardial injury was founded only in BMI ≥ 24 kg/m2 subgroup. CONCLUSION Impaired ADL at hospital admission was an independent risk factor for periprocedural myocardial infarction and injury among patients following PCI.
Collapse
Affiliation(s)
- Yifan Pan
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Min Xu
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Yaosheng Mei
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Yunxiang Wang
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Qiongli Zhang
- Department of Cardiology, Yongkang Hospital, Yongkang, Zhejiang, 321300, China.
| |
Collapse
|
14
|
Glimmerveen A, Holewijn S, Vermeer S. Association between clinician reported outcome and patient reported outcome measures one year after stroke. J Stroke Cerebrovasc Dis 2023; 32:107156. [PMID: 37178516 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES Patient reported outcome measures (PROM) are increasingly important in the evaluation of care. In this study we evaluate patient PROM in stroke patients and the association with clinical reported outcomes. MATERIALS AND METHODS Of 3706 first-ever stroke patients, 1861 were discharged home and invited to fill out PROM at discharge, 90 days and one-year after stroke. PROM include mental and physical health and patients' self-reported functionals status, all available via International Consortium for Health Outcomes Measurement. Clinician reported measures as NIHSS, Barthel index were collected during hospital admission and modified Rankin Scale (mRS) 90 days after stroke. PROM compliance was evaluated. Clinician reported measures were related to PROM. RESULTS 844 (45%) of the invited stroke patients filled out PROM. In general, those patients were younger and less severely affected (higher Barthel index and lower mRS). Compliance after enrolment is about 75%. Barthel index and mRS correlated with all PROM at 90 days and one-year. In age and gender adjusted multiple regression analysis, mRS was a consistent predictor for all PROM subsets, and Barthel index holds predictive value for physical health and patients' self-reported functional status. CONCLUSIONS Participation rate to fill out PROM is only 45% among stroke patients who were discharged home, and compliance rate is around 75% up one-year follow-up. PROM associated with the clinician reported functional outcome measures Barthel index, and mRS score. Low mRS score is a consistent predictor of better PROM at one year. We propose to use mRS in stroke care evaluation, until PROM participation improves.
Collapse
Affiliation(s)
- Astrid Glimmerveen
- Department of Neurology, Rijnstate Hospital, P.O. box 9555, 6800 TA, Arnhem, the Netherlands; Department of Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, P.O. box 217, 7500 AE, Enschede, the Netherlands.
| | - Suzanne Holewijn
- Department of Surgery and Vascular Center, Rijnstate Hospital, P.O. box 9555, 6800 TA, Arnhem, the Netherlands
| | - Sarah Vermeer
- Department of Neurology, Rijnstate Hospital, P.O. box 9555, 6800 TA, Arnhem, the Netherlands; Department of Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, P.O. box 217, 7500 AE, Enschede, the Netherlands
| |
Collapse
|
15
|
Yamaguchi K, Matsumoto S, Abe T, Nakajima K, Senoo S, Shimizu M, Takeuchi I. Predictive value of total psoas muscle index for postoperative physical functional decline in older patients undergoing emergency abdominal surgery. BMC Surg 2023; 23:171. [PMID: 37355574 DOI: 10.1186/s12893-023-02085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Older individuals increasingly require emergency abdominal surgeries. They are susceptible to surgical stress and loss of independence in performing daily activities. We hypothesized that the psoas muscle volume would be significantly associated with postoperative functional decline (FD) in older patients undergoing emergency abdominal surgery and aimed to evaluate the use of the psoas muscle volume on computed tomography (CT) scans. METHODS A retrospective, single-center study of patients aged ≥ 65 years who had undergone emergency abdominal surgery between January 2019 and June 2021 was performed. We assessed patients' activities of daily living using the Barthel Index. FD was defined as a ≥ 5-point decrease between preoperative and 28-day postoperative values. The psoas muscle volume was measured by CT, which was used for diagnosis, and normalized by height to calculate total psoas muscle index (TPI). We evaluated associations between FD and TPI using receiver operating characteristics (ROC) analysis and multiple logistic regression analysis. RESULTS Of 238 eligible patients, 71 (29.8%) had clinical postoperative FD. Compared to the non-FD group, the FD group was significantly older and had a higher proportion of females, higher Charlson Comorbidity Index, lower body mass index, higher American Society of Anesthesiology score, lower serum albumin level, and lower TPI. ROC analyses revealed that TPI had the highest area under the curve (0.802; 95% confidence interval [CI], 0.75-0.86). A multivariable logistic regression model revealed that low TPI was an independent predictor of postoperative FD (odds ratio, 0.14; 95% CI, 0.06-0.32). CONCLUSIONS TPI can predict postoperative FD due to emergency abdominal surgery. Identification of patients who are at high risk of FD before surgery may be useful for enhancing the regionalized system of care for emergency general surgery.
Collapse
Affiliation(s)
- Keishi Yamaguchi
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
| | - Shokei Matsumoto
- Department of Trauma and Emergency Surgery, Saiseikai Yokohama-Shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-Ku, Yokohama-Shi, Kanagawa, 230-0012, Japan.
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
| | - Kento Nakajima
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
| | - Satomi Senoo
- Department of Trauma and Emergency Surgery, Saiseikai Yokohama-Shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-Ku, Yokohama-Shi, Kanagawa, 230-0012, Japan
| | - Masayuki Shimizu
- Department of Trauma and Emergency Surgery, Saiseikai Yokohama-Shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-Ku, Yokohama-Shi, Kanagawa, 230-0012, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
| |
Collapse
|
16
|
Hekim HH, Güneş Gencer GY, Palaz EA, Temel Aksu N, Delibaş Katı Ş, Toraman NF, Yaman A. Can trunk control scales differentiate for dependent and independent ambulation in ischemic stroke patients? Turk J Phys Med Rehabil 2023; 69:171-179. [PMID: 37671375 PMCID: PMC10475903 DOI: 10.5606/tftrd.2023.10773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/29/2022] [Indexed: 09/07/2023] Open
Abstract
Objectives: This study aimed to compare the ability of trunk control scales (TCSs) to distinguish independent ambulation and investigate whether there was a relationship between TCSs and activities of daily living in patients with stroke. Patients and methods: The prospective, cross-sectional study was conducted with a total of 126 patients (52 females, 74 males; mean age: 64.9±10.7 years; range, 40 to 88 years) between August 2018 and January 2020. According to their ability to walk 10 m, the patients were divided into three groups: the nonambulatory group (Group 1, n=31), those who required an assistive device while walking (Group 2, n=35), and those who could walk independently (Group 3, n=60). The Stroke Rehabilitation Assessment of Movement Instrument (STREAM), Postural Assessment Scale for Stroke Patients Scale (PASS), Trunk Impairment Scale, Trunk Recovery Scale, Trunk Control Test, and Modified Barthel Index (MBI) were used to determine the relationship between TCSs and activities of daily living. Results: The median TCS scores differed between the groups; the lowest score was of Group 1, and the highest score was of Group 3 (p
Collapse
Affiliation(s)
- H. Hale Hekim
- Department of Physical Medicine and Rehabilitation, Health Science University, Antalya Training and Research Hospital, Antalya, Türkiye
| | | | - E. Ayşen Palaz
- Private Artrolife Clinic, Physical Medicine and Rehabilitation, Antalya, Türkiye
| | | | - Şennur Delibaş Katı
- Department of Neurology, Health Science University, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Naciye Füsun Toraman
- Department of Physical Medicine and Rehabilitation, Health Science University, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Aylin Yaman
- Department of Neurology, Health Science University, Antalya Training and Research Hospital, Antalya, Türkiye
| |
Collapse
|
17
|
Pan L, Wang H, Cao X, Ning T, Li X, Cao Y. A Higher Postoperative Barthel Index at Discharge is Associated with a Lower One-Year Mortality After Hip Fracture Surgery for Geriatric Patients: A Retrospective Case‒Control Study. Clin Interv Aging 2023; 18:835-843. [PMID: 37251305 PMCID: PMC10224694 DOI: 10.2147/cia.s409282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose To evaluate the relationship between the postoperative Barthel index assessing activities of daily living at discharge and the one-year mortality after hip fracture surgery. Methods Patients with hip fracture admitted to Peking University First Hospital from January 2015 to January 2020 were enrolled retrospectively according to the inclusion and exclusion criteria. The Barthel index and other related confounding variables were collected. Logistic regression and Kaplan‒Meier survival curves were constructed to explore the relationship between the postoperative Barthel index at discharge and the one-year mortality of geriatric patients after hip fracture surgery. Results A total of 444 patients with a mean age of 81.61±6.14 years were included. A significant difference was not observed in the preoperative Barthel index at admission between the deceased group and the surviving group (38.90±15.83 vs 36.96±10.74, p=0.446). However, the difference in the postoperative Barthel index at discharge between these two groups was statistically significant (43.08±14.40 vs 53.18±13.43, P<0.001). The multivariable logistic regression analysis revealed that the postoperative Barthel index at discharge was an independent risk factor for one-year mortality after adjustment for confounding variables (adjusted OR 0.73, 95% CI 0.55-0.98, p˂0.05). The Kaplan‒Meier survival curve showed that patients who had a high Barthel index (≥50) at discharge had a significantly lower mortality in the long term than patients with a low Barthel index (<50) at discharge (P< 0.001). Conclusion The postoperative Barthel index at discharge was independently associated with the one-year mortality of geriatric patients after hip fracture surgery. A higher postoperative Barthel index at discharge indicated a lower mortality after hip fracture surgery. The Barthel index at discharge has the potential to provide essential prognostic information for early risk stratification and directing future care.
Collapse
Affiliation(s)
- Liping Pan
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Hao Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xiangyu Cao
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Taiguo Ning
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Xueying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| | - Yongping Cao
- Department of Orthopedics, Peking University First Hospital, Beijing, 100034, People’s Republic of China
| |
Collapse
|
18
|
Youkee D, Deen GF, Baldeh M, Conteh ZF, Fox-Rushby J, Gbessay M, Johnson J, Langhorne P, Leather AJ, Lisk DR, Marshall IJ, O'Hara J, Pessima S, Rudd A, Soley-Bori M, Thompson M, Wafa H, Wang Y, Watkins CL, Williams CE, Wolfe CDA, Sackley CM. Stroke in Sierra Leone: Case fatality rate and functional outcome after stroke in Freetown. Int J Stroke 2023:17474930231164892. [PMID: 36905336 DOI: 10.1177/17474930231164892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND There is limited information on long-term outcomes after stroke in sub-Saharan Africa (SSA). Current estimates of case fatality rate (CFR) in SSA are based on small sample sizes with varying study design and report heterogeneous results. AIMS We report CFR and functional outcomes from a large, prospective, longitudinal cohort of stroke patients in Sierra Leone and describe factors associated with mortality and functional outcome. METHODS A prospective longitudinal stroke register was established at both adult tertiary government hospitals in Freetown, Sierra Leone. It recruited all patients ⩾ 18 years with stroke, using the World Health Organization definition, from May 2019 until October 2021. To reduce selection bias onto the register, all investigations were paid by the funder and outreach conducted to raise awareness of the study. Sociodemographic data, National Institute of Health Stroke Scale (NIHSS), and Barthel Index (BI) were collected on all patients on admission, at 7 days, 90 days, 1 year, and 2 years post stroke. Cox proportional hazards models were constructed to identify factors associated with all-cause mortality. A binomial logistic regression model reports odds ratio (OR) for functional independence at 1 year. RESULTS A total of 986 patients with stroke were included, of which 857 (87%) received neuroimaging. Follow-up rate was 82% at 1 year, missing item data were <1% for most variables. Stroke cases were equally split by sex and mean age was 58.9 (SD: 14.0) years. About 625 (63%) were ischemic, 206 (21%) primary intracerebral hemorrhage, 25 (3%) subarachnoid hemorrhage, and 130 (13%) were of undetermined stroke type. Median NIHSS was 16 (9-24). CFR at 30 days, 90 days, 1 year, and 2 years was 37%, 44%, 49%, and 53%, respectively. Factors associated with increased fatality at any timepoint were male sex (hazard ratio (HR): 1.28 (1.05-1.56)), previous stroke (HR: 1.34 (1.04-1.71)), atrial fibrillation (HR: 1.58(1.06-2.34)), subarachnoid hemorrhage (HR: 2.31 (1.40-3.81)), undetermined stroke type (HR: 3.18 (2.44-4.14)), and in-hospital complications (HR: 1.65 (1.36-1.98)). About 93% of patients were completely independent prior to their stroke, declining to 19% at 1 year after stroke. Functional improvement was most likely to occur between 7 and 90 days post stroke with 35% patients improving, and 13% improving between 90 days to 1 year. Increasing age (OR: 0.97 (0.95-0.99)), previous stroke (OR: 0.50 (0.26-0.98)), NIHSS (OR: 0.89 (0.86-0.91)), undetermined stroke type (OR: 0.18 (0.05-0.62)), and ⩾1 in-hospital complication (OR: 0.52 (0.34-0.80)) were associated with lower OR of functional independence at 1 year. Hypertension (OR: 1.98 (1.14-3.44)) and being the primary breadwinner of the household (OR: 1.59 (1.01-2.49)) were associated with functional independence at 1 year. CONCLUSION Stroke affected younger people and resulted in high rates of fatality and functional impairment relative to global averages. Key clinical priorities for reducing fatality include preventing stroke-related complications through evidence-based stroke care, improved detection and management of atrial fibrillation, and increasing coverage of secondary prevention. Further research into care pathways and interventions to encourage care seeking for less severe strokes should be prioritized, including reducing the cost barrier for stroke investigations and care.
Collapse
Affiliation(s)
- Daniel Youkee
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
- Connaught Teaching Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Freetown, Sierra Leone
| | - Mamadu Baldeh
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Zainab F Conteh
- Connaught Teaching Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Freetown, Sierra Leone
| | - Julia Fox-Rushby
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | | | | | - Peter Langhorne
- Academic Section of Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew Jm Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course & Population Sciences, King's College London, London, UK
| | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Iain J Marshall
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | - Jessica O'Hara
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Sahr Pessima
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Anthony Rudd
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Marina Soley-Bori
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
- Connaught Teaching Hospital, University of Sierra Leone Teaching Hospital Complex, Freetown, Freetown, Sierra Leone
| | - Hatem Wafa
- School of Life Course & Population Sciences, King's College London, London, UK
| | - Yanzhong Wang
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Christine E Williams
- College of Medicine and Allied Health Sciences, The University of Sierra Leone, Freetown, Sierra Leone
| | - Charles DA Wolfe
- School of Life Course & Population Sciences, King's College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care South London, National Institute for Health Research, London, UK
| | - Catherine M Sackley
- School of Life Course & Population Sciences, King's College London, London, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
19
|
Ceruti S, Glotta A, Biggiogero M, Marzano M, Bona G, Previsdomini M, Saporito A, Capdevila X. Long-Term Evolution of Activities of Daily Life (ADLs) in Critically Ill COVID-19 Patients, a Case Series. Healthcare (Basel) 2023; 11:healthcare11050650. [PMID: 36900655 PMCID: PMC10001119 DOI: 10.3390/healthcare11050650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill COVID-19 patients admitted to a COVID-19 center in Lugano (Switzerland). METHODS A retrospective analysis on consecutive patients discharged alive from ICU with COVID-19 ARDS was performed based on a follow-up one year after hospital discharge; ADLs were assessed through the Barthel index (BI) and the Karnofsky Performance Status (KPS) scale. The primary objective was to assess differences in ADLs at hospital discharge (acute ADLs) and one-year follow-up (chronic ADLs). The secondary objective was to explore any correlations between ADLs and multiple measures at admission and during the ICU stay. RESULTS A total of 38 consecutive patients were admitted to the ICU; a t-test analysis between acute and chronic ADLs through BI showed a significant improvement at one year post discharge (t = -5.211, p < 0.0001); similarly, every single task of BI showed the same results (p < 0.0001 for each task of BI). The mean KPS was 86.47 (SD 20.9) at hospital discharge and 99.6 at 1 year post discharge (p = 0.02). Thirteen (34%) patients deceased during the first 28 days in the ICU; no patient died after hospital discharge. CONCLUSIONS Based on BI and KPS, patients reached complete functional recovery of ADLs one year after critical COVID-19.
Collapse
Affiliation(s)
- Samuele Ceruti
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
- Correspondence: ; Tel.: +41-079/440-73-92
| | - Andrea Glotta
- Department of Critical Care, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Maira Biggiogero
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Martino Marzano
- Department of Internal Medicine, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Giovanni Bona
- Clinical Research Unit, Clinica Luganese Moncucco, 6900 Lugano, Switzerland
| | - Marco Previsdomini
- Department of Intensive Care Medicine, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Andrea Saporito
- Service of Anesthesiology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Xavier Capdevila
- Department of Anesthesia and Intensive Care, Centre Hospitalier Universitaire de Montpellier, 34000 Montpellier, France
| |
Collapse
|
20
|
Lian IB, Chiu PF, Hsieh YC, Ou YH, Lin CM. Can chronic kidney disease staging early predict outcome of large-artery ischemic stroke with impaired renal function? Ther Adv Chronic Dis 2023; 14:20406223231153564. [PMID: 36815092 PMCID: PMC9940177 DOI: 10.1177/20406223231153564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/11/2023] [Indexed: 02/19/2023] Open
Abstract
Background Ischemic stroke poses a major threat to human beings, and a prompt intravenous thrombolytic management remains the gold standard protocol for stroke sufferers. Although the role of thrombolytic therapy (r-tPA) for ischemic stroke patients and those with underlying impaired renal function has been advocated as effective treating strategy, there is still a lack of investigation as to finding out baseline important variables that are capable of early outcome prediction. Objectives In this project, we hypothesize that the change of clinical chronic kidney disease (CKD) staging (delta stage = CKD stage after 3-month follow-up - CKD stage at admission) could serve as a crucial predictor of the prognosis of patients. Design This is a cohort longitudinal retrospective study. Sources and Methods A total of 765 cerebral artery ischemic stroke patients with impaired renal function were recruited and followed up for 1 year. Among them, 116 had received the thrombolytic treatment (r-tPA) after being evaluated at the triage in the emergency department and the rest had not (non-r-tPA). Propensity-matching was applied to compare the mortality between the r-tPA and non-r-tPA groups. Multiple logistic regression (LR) and decision tree (DT) algorithm were used to identify important prediction factors for mortality as well as the improvement in neurological function. Results The 1-year mortality rates for r-tPA and non-r-tPA groups were 32.8% and 44.4%, respectively. The propensity-matched odds ratio of mortality for the r-tPA group compared with the non-r-tPA group is 0.469, with p = 0.003. Logistic regressions suggest that age, Hct, diabetes mellitus type 2, coronary artery disease, and delta stage are important factors for mortality for the non-r-tPA group, whereas age, diabetes mellitus type 2, chronic heart failure, hospital day, and delta stage are important factors for the r-tPA group. On the usage of antihypertensive drugs, ACEI/ARB was not associated with mortality (p = 0.198), whereas the diuretic was, with odds ratio at 1.619 (p = 0.025), indicating higher mortality after administration. Both LR and DT analyses indicate that delta stage is the most important predictor. For the r-tPA group, patients with delta stage ⩽0 had a 24% mortality, while that for delta stage >0 the mortality is 75%. For non-r-tPA patients, the corresponding mortalities were 30.9 and 66.3, respectively. Delta stage is also useful for predicting patients' improvement of neurological function, assessed by NIHSS, mRS, and Barthel Index. The areas under the curve for the three assessments are 0.83, 0.835, and 0.663, respectively. Conclusion Large-artery ischemic stroke patients who received thrombolytic treatment had significantly lower mortality, even when presenting underlying impaired renal function. The change of CKD staging (delta stage) is capable of acting as a powerful clinical baseline surrogate for both r-tPA and non-r-tPA patients in terms of early outcome prediction. Long-term use of diuretics could be potentially harmful to this group of patients. Moreover, delta stage correlates well with clinical long-term neurological functionality assessment (NIHSS, mRS, and Barthel index), which is helpful in aiding urgent clinical decision-making.
Collapse
|
21
|
Bernard A, Serna-Higuita LM, Martus P, Mirakaj V, Koeppen M, Zarbock A, Marx G, Putensen C, Rosenberger P, Haeberle HA. COVID-19 does not influence functional status after ARDS therapy. Crit Care 2023; 27:48. [PMID: 36740717 PMCID: PMC9899507 DOI: 10.1186/s13054-023-04330-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Health-related quality of life after surviving acute respiratory distress syndrome has come into focus in recent years, especially during the coronavirus disease 2019 pandemic. OBJECTIVES A total of 144 patients with acute respiratory distress syndrome caused by COVID-19 or of other origin were recruited in a randomized multicenter trial. METHODS Clinical data during intensive care treatment and data up to 180 days after study inclusion were collected. Changes in the Sequential Organ Failure Assessment score were used to quantify disease severity. Disability was assessed using the Barthel index on days 1, 28, 90, and 180. MEASUREMENTS Mortality rate and morbidity after 180 days were compared between patients with and without COVID-19. Independent risk factors associated with high disability were identified using a binary logistic regression. MAIN RESULTS The SOFA score at day 5 was an independent risk factor for high disability in both groups, and score dynamic within the first 5 days significantly impacted disability in the non-COVID group. Mortality after 180 days and impairment measured by the Barthel index did not differ between patients with and without COVID-19. CONCLUSIONS Resolution of organ dysfunction within the first 5 days significantly impacts long-term morbidity. Acute respiratory distress syndrome caused by COVID-19 was not associated with increased mortality or morbidity.
Collapse
Affiliation(s)
- Alice Bernard
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Lina Maria Serna-Higuita
- grid.10392.390000 0001 2190 1447Institute for Clinical Epidemiology and Applied Biometry, Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Peter Martus
- grid.10392.390000 0001 2190 1447Institute for Clinical Epidemiology and Applied Biometry, Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Valbona Mirakaj
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Michael Koeppen
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Alexander Zarbock
- grid.5949.10000 0001 2172 9288Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
| | - Gernot Marx
- grid.412301.50000 0000 8653 1507Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Putensen
- grid.15090.3d0000 0000 8786 803XDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Helene Anna Haeberle
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| |
Collapse
|
22
|
Maki Y, Goda A, Koumo M, Yamamoto T, Yokoyama K, Ueno M, Kishimoto A, Kusumoto M, Takagawa M, Takahashi T, Takahashi C, Nakajima K, Hashimoto M, Hosokawa T, Kobayashi M, Katsura J, Yanagibashi K. Negative impact of behavior restriction amidst a clustered COVID-19 infection on immobility syndrome in older patients negative for COVID-19: report from a chronic care hospital in Japan. Nagoya J Med Sci 2023; 85:93-102. [PMID: 36923609 PMCID: PMC10009640 DOI: 10.18999/nagjms.85.1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 03/18/2023]
Abstract
Previous studies have reported on associations between immobility syndrome and the COVID-19 pandemic. However, little is known about the aggravation of this syndrome in older patients negative for COVID-19 infection amidst behavior restriction due to a clustered COVID-19 infection. Patients hospitalized one month before a clustered COVID-19 infection occurred in our hospital were recruited. Rehabilitation therapy was suspended for 25 days during behavior restriction. The ability of daily living of the patients was evaluated with the functional independence measure and Barthel index. Chronological changes in the functional independence measure and Barthel index scores were evaluated monthly, beginning one month before the clustered COVID-19 infection to one month after re-initiation of rehabilitation therapy. Patients with minimum scores in the functional independence measure (18) and Barthel index (0) prior to the clustered COVID-19 infection were excluded. Functional independence measure scores of 73 older patients and the Barthel index scores of 48 patients were analyzed. The mean total functional independence measure score amidst the behavior restriction significantly changed from 36.3 to 35.1 (p = 0.019), while statistical significance was not detected in the mean motor subtotal (from 21.6 to 20.9 with p = 0.247) or cognitive subtotal functional independence measure scores (from 14.6 to 14.2 with p = 0.478). During the behavior restriction, the mean Barthel index scores declined from 25.8 to 23.2 without statistical significance (p = 0.059). Behavior restriction due to a clustered COVID-19 infection may aggravate immobility syndrome in older patients who are negative for COVID-19.
Collapse
Affiliation(s)
- Yoshinori Maki
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Masatoshi Koumo
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Tetsuya Yamamoto
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Kouta Yokoyama
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Masashi Ueno
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Asuka Kishimoto
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Masami Kusumoto
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Mayumi Takagawa
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Tamako Takahashi
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Chiharu Takahashi
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Keisuke Nakajima
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Mika Hashimoto
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Tsumugi Hosokawa
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Misuzu Kobayashi
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Junichi Katsura
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| | - Ken Yanagibashi
- Department of rehabilitation, Ryozenkai Hikari Hospital, Otsu, Japan
| |
Collapse
|
23
|
Amini Harandi A, Pakdaman H, Karamiani F, Mohammadi F, Shirzadeh Barough S, Siavoshi F, Ilkhani S, Sahraian M. Fampridine in multiple sclerosis patients with acute phase of cervical transverse myelitis: a double-blind, randomized placebo-controlled trial. Neurol Sci 2023; 44:393-6. [PMID: 36094772 DOI: 10.1007/s10072-022-06380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/01/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fampridine is a potassium channel blocker drug used to improve walking ability in patients with multiple sclerosis (MS). We evaluated the effect of fampridine in patients with MS in the acute phase of transverse myelitis. METHODS In a randomized, placebo-controlled trial, 30 patients who had their first episode of cervical myelitis with quadriparesis presentation, with the final diagnosis of MS, were randomly divided into two equal groups. The intervention group received intravenous methylprednisolone (IVMP) for 7 days plus fampridine. The placebo group received IVMP for 7 days plus placebo. To compare the treatment results, we compared the Barthel index (BI) scores of the groups at the start of the trial and the 21st day after the start of treatment. RESULTS There was no significant difference in baseline characteristics between the intervention and placebo groups in terms of mean age, sex, and mean admission BI (p > 0.05). Mean (SD) admission BI in placebo and intervention groups was 27.20 (7.341) and 27.87(5.78), respectively (p = 0.784). The measured mean (SD) BI after treatment was 48.73 (15.54) in the placebo and 64.93 (11.81) in the intervention group (p = 0.003) after 3 weeks. CONCLUSION Using fampridine plus IVMP in the acute phase of transverse myelitis in MS patients improved the disease's symptoms and increased the daily activity ability of patients.
Collapse
|
24
|
Ryrsø CK, Hegelund MH, Dungu AM, Faurholt-Jepsen D, Pedersen BK, Ritz C, Krogh-Madsen R, Lindegaard B. Association between Barthel Index, Grip Strength, and Physical Activity Level at Admission and Prognosis in Community-Acquired Pneumonia: A Prospective Cohort Study. J Clin Med 2022; 11. [PMID: 36362554 DOI: 10.3390/jcm11216326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Impaired functional status is a risk factor for hospitalization in patients with community-acquired pneumonia (CAP). The aim was to determine the influence of functional status and physical activity level on severe outcomes, including length of stay, admission to the intensive care unit (ICU), readmission, and mortality in patients with CAP. Methods: A prospective cohort study among patients hospitalized with CAP. Functional status was assessed with the Barthel index and grip strength, and physical activity level was assessed using the international physical activity questionnaire. Linear regression was used to assess the association with length of stay, and logistic regression was used to assess the risk of severe outcomes. Results: Among 355 patients admitted with CAP, 18% had a low Barthel index (<80), 45% had a low grip strength, and 75% had a low physical activity level. Low Barthel index was associated with increased risk of ICU admission (OR 3.6, 95% CI 1.2−10.9), longer length of stay (27.9%, 95% CI 2.3−59.7%), readmission within 30, 90, and 180 days (OR 2.1−2.4, p < 0.05), and mortality within 90 and 180 days (OR 4.2−5.0, p < 0.05). Low grip strength was associated with increased risk of 90 days readmission (OR 1.6, 95% CI 1.0−2.6, p < 0.05) and mortality within 30, 90, and 180 days (OR 2.6−3.2, p < 0.05). Low physical activity level was associated with increased risk of readmission within 90 and 180 days (OR 1.8−2.1, p < 0.05) and mortality within 30, 90, and 180 days (OR 3.3−5.5, p < 0.05). Conclusions: Impaired functional status and low physical activity level were associated with a longer length of stay and increased risk of ICU admission, readmission, and mortality in patients hospitalized with CAP. Routine assessment of functional status and physical activity level in clinical care could enable early identification of individuals with excess risk for a poor prognosis. Trial registration: ClinicalTrials.gov, NCT03795662.
Collapse
|
25
|
Qie XJ, Liu ZH, Guo LM. Evaluation of progressive early rehabilitation training mode in intensive care unit patients with mechanical ventilation. World J Clin Cases 2022; 10:8152-8160. [PMID: 36159546 PMCID: PMC9403689 DOI: 10.12998/wjcc.v10.i23.8152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/27/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit (ICU). Unfortunately, this treatment process prolongs the ICU stay of patients with an increased incidence of delirium, which ultimately affects the prognosis.
AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.
METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021. According to the random number table method, they were divided into the control and intervention groups. The control group received routine nursing and rehabilitation measures, whereas the intervention group received progressive early rehabilitation training. In addition, the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time, ICU hospitalization time, functional independence measure (FIM) score, Barthel index, and the incidence of complications (deep venous thrombosis, pressure sores, and acquired muscle weakness).
RESULTS In the intervention group, the incidence of delirium was significantly lower than in the control group (28% vs 52%, P < 0.001). In the intervention group, the duration of delirium, mechanical ventilation time, and ICU stay were shorter than in the control group (P < 0.001). The FIM and Barthel index scores were significantly higher in the intervention group than the control group (P < 0.001). The total incidence of complications in the intervention group was 3.15%, which was lower than 17.89% in the control group (P < 0.001).
CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation, which improved prognosis and quality of life.
Collapse
Affiliation(s)
- Xiao-Jing Qie
- Department of Cardiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Zhi-Hong Liu
- Department of Intensive Care Unit, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Min Guo
- Department of Cardiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| |
Collapse
|
26
|
Huo HL, Gui YY, Xu CM, Zhang Y, Li Q. Effects of the information–knowledge–attitude–practice nursing model combined with predictability intervention on patients with cerebrovascular disease. World J Clin Cases 2022; 10:6803-6810. [PMID: 36051130 PMCID: PMC9297409 DOI: 10.12998/wjcc.v10.i20.6803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cerebrovascular disease (CVD) poses a serious threat to human health and safety. Thus, developing a reasonable exercise program plays an important role in the long-term recovery and prognosis for patients with CVD. Studies have shown that predictive nursing can improve the quality of care and that the information –knowledge–attitude–practice (IKAP) nursing model has a positive impact on patients who suffered a stroke. Few studies have combined these two nursing models to treat CVD.
AIM To explore the effect of the IKAP nursing model combined with predictive nursing on the Fugl–Meyer motor function (FMA) score, Barthel index score, and disease knowledge mastery rate in patients with CVD.
METHODS A total of 140 patients with CVD treated at our hospital between December 2019 and September 2021 were randomly divided into two groups, with 70 patients in each. The control group received routine nursing, while the observation group received the IKAP nursing model combined with predictive nursing. Both groups were observed for self-care ability, motor function, and disease knowledge mastery rate after one month of nursing.
RESULTS There was no clear difference between the Barthel index and FMA scores of the two groups before nursing (P > 0.05); however, their scores increased after nursing. This increase was more apparent in the observation group, and the difference was statistically significant (P < 0.05). The rates of disease knowledge mastery, timely medication, appropriate exercise, and reasonable diet were significantly higher in the observation group than in the control group (P < 0.05). The satisfaction rate in the observation group (97.14%) was significantly higher than that in the control group (81.43%; P < 0.05).
CONCLUSION The IKAP nursing model, combined with predictive nursing, is more effective than routine nursing in the care of patients with CVD, and it can significantly improve the Barthel index and FMA scores with better knowledge acquisition, as well as produce high satisfaction in patients. Moreover, they can be widely used in the clinical setting.
Collapse
Affiliation(s)
- Hong-Liang Huo
- Department of Nursing, The Fourth Affiliated Hospital of Qiqihar Medical University, Qiqihar 161000, Heilongjiang Province, China
| | - Yuan-Yuan Gui
- Nursing School, Qiqihar Medical University, Qiqihar 161006, Heilongjiang Province, China
| | - Chun-Miao Xu
- Nursing School, Qiqihar Medical University, Qiqihar 161006, Heilongjiang Province, China
| | - Yan Zhang
- Nursing School, Qiqihar Medical University, Qiqihar 161006, Heilongjiang Province, China
| | - Qiang Li
- Nursing School, Qiqihar Medical University, Qiqihar 161006, Heilongjiang Province, China
| |
Collapse
|
27
|
Lin G, Dong B, Li Y, Huang W. Diagnostic value of cardiac magnetic resonance imaging for myocardial fibrosis in patients with heart failure and its predictive value for prognosis. Am J Transl Res 2022; 14:4657-4665. [PMID: 35958487 PMCID: PMC9360878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the diagnostic value of cardiac magnetic resonance imaging (CMRI) for myocardial fibrosis (MF) in patients with heart failure (HF) and its predictive value for prognosis. METHODS A total of 180 patients with heart failure who were hospitalized in the Cardiology Department of The First People's Hospital of Shangqiu City from September 2019 to May 2021 were selected and assigned to Group B (n=80) given levosimendan and Group A (n=100) given levosimendan combined with ivabradine hydrochloride. The cardiac function indicators (left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and left ventricular end-systolic diameter (LVESD) were measured by nuclear magnetic resonance (MRI). Myocardial fibrosis (MF)-related indicators (pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), N-terminal propeptide of procollagen type III (PIIINP), connective tissue growth factor (CTGF), and hyaluronic acid (HA), inflammatory factors (Hs-CRP and IL-8) were measured using ELISA. Quality of life (QoL) and physical recovery (6-min walking test (6MWT), Fugl-Meyer Assessment (FMA), and Barthel index) of the two groups were compared. The late gadolinium enhancement (LGE) was used to analyze the occurrence of MF in patients. The patients were further divided into the LGE (+) group (cases) and LGE (-) group (cases). The changes of cardiac function indicators before treatment were analyzed, and their predictive value was analyzed. RESULTS Compared with Group B, Group A showed a lower incidence of complications, and presented a higher LVEF level and lower levels of LVESV, LVESD, ICTP, PIIINP, CTGF, HA, LN, and inflammatory factors. The area under the curves of LVESV, LVESD, and LVEF in predicting MF were all >0.7. CONCLUSION Levosimendan combined with ivabradine hydrochloride can effectively alleviate MF in patients with MF, and CMRI has a good predictive value for MF in such patients, which is worthy of clinical promotion.
Collapse
Affiliation(s)
- Guangyao Lin
- Medical Imaging Center, The First People's Hospital of Shangqiu City No. 292, Kai Xuan Nan Road, Shangqiu 476100, Henan, China
| | - Bei Dong
- Medical Imaging Center, The First People's Hospital of Shangqiu City No. 292, Kai Xuan Nan Road, Shangqiu 476100, Henan, China
| | - Yuzhou Li
- Medical Imaging Center, The First People's Hospital of Shangqiu City No. 292, Kai Xuan Nan Road, Shangqiu 476100, Henan, China
| | - Wenqi Huang
- Medical Imaging Center, The First People's Hospital of Shangqiu City No. 292, Kai Xuan Nan Road, Shangqiu 476100, Henan, China
| |
Collapse
|
28
|
Walter N, Rupp M, Bärtl S, Uecker C, Alt V. The Definition of the Term "Orthogeriatric Infection" for Periprosthetic Joint Infections. Geriatr Orthop Surg Rehabil 2022; 13:21514593221111649. [PMID: 35794870 PMCID: PMC9251973 DOI: 10.1177/21514593221111649] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction In the background of the aging population, an increase of geriatric patients with specific age-related co-morbidities has already been seen over the years for proximal femur fractures in orthopaedic surgery as well as other medical disciplines. However, the geriatric aspect has not been well recognized in periprosthetic joint infection (PJI) patients so far. Therefore, this paper seeks to provide an overview on the co-morbidities of PJI patients with respect to the definition of geriatric patients. Material and methods In this single-center retrospective study, patients treated between 2007 and 2020 for PJI were included (n = 255). Patients were defined as geriatric according to the consensus definition criteria of the Federal Working Group of Clinical Geriatric Facilities e.V., the German Society for Geriatrics e.V. and the German Society for Gerontology and Geriatrics e.V. based on age (≤70 years), geriatric multimorbidity and the Barthel index (≤30). Results Applying the criteria defined 184 of the 255 (72.2%) PJI patients as geriatric infection patients. Regarding geriatric comorbidity, incontinence was most prevalent (38.1%), followed by immobility (25.6%). Comparing the geriatric infection patients with those classified as non-geriatric (n = 71) revealed that geriatric patients had a longer hospital stay and spent more days in the intensive care unit (ICU). Also, the amputation rate and the 5-year mortality rate was significantly increased (n = 15, 8.2% vs n = 1, 1.4%, P = .007 and n = 24, 13.0% vs n = 5, 7.0%, P = .005). The Barthel index showed a significant correlation with mortality (r = -.22, P = .011). Discussion We propose to use the term orthogeriatric infection patients in those cases in order to focus treatment not only on the orthopaedic infections but also on the important geriatric aspects. Conclusion The inclusion of geriatric physicians into the multidisciplinary team approach for PJI patients might be beneficial.
Collapse
Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Susanne Bärtl
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Claus Uecker
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| |
Collapse
|
29
|
Qiao R, Jia S, Zhao W, Xia X, Su Q, Hou L, Li D, Hu F, Dong B. Prevalence and correlates of disability among urban-rural older adults in Southwest China: a large, population-based study. BMC Geriatr 2022; 22:517. [PMID: 35739469 PMCID: PMC9229854 DOI: 10.1186/s12877-022-03193-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 06/03/2022] [Indexed: 02/08/2023] Open
Abstract
Background As one of the challenges of aging, older adults with disabilities are often overlooked in remote areas of many developing countries, including southwest China. Similar populations would undoubtedly benefit from a representative, high-quality survey of large samples, which would also enrich global disability data. This study aims to assess the prevalence of disability and associated factors among urban and rural older adults in a typical representative region. Method A large-scale baseline survey was conducted between March and September 2020 using face-to-face interviews with a multistage stratified random sample of 16,536 participants aged ≥ 60 years. Disability was assessed using the BI scale, with a score of 100 representing normal status, 65–95 as mild disability, 45–60 as moderate disability, and 0–40 as severe disability. The prevalence of disability was estimated by demographics and health characteristics, and their associations were explored by robust Poisson regression analysis. Results The prevalence of disability among older adults was 19.4%, and the prevalence of mild, moderate, and severe disability was 16.8%, 1.5%, and 1.1%, respectively. All variables, including older age, residence in a rural area, higher number of hospitalizations, comorbidities, poor self-rated health, falls, cognitive impairment, mental impairment, and alienation from friends and relatives, were shown to be associated with a higher adjusted prevalence of disability. Only formal education can reduce the risk of disability. Conclusion The prevalence of disability among older adults is high in both urban and rural settings in southwest China, and a number of important factors associated with disability have been identified. In addition to increased attention to the health status of older adults, further research on scientific management and effective disability interventions is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03193-2.
Collapse
Affiliation(s)
- Runjuan Qiao
- National Clinical Research Center for Geriatrics and Department of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Shuli Jia
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Wanyu Zhao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Xia
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiaoli Su
- National Clinical Research Center for Geriatrics and Department of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Lisha Hou
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Daiping Li
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fengjuan Hu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics and Department of General Practice, West China Hospital, Sichuan University, Chengdu, China. .,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
30
|
Koumo M, Goda A, Maki Y, Yokoyama K, Yamamoto T, Hosokawa T, Katsura J, Yanagibashi K. Indicators Predicting Inpatient Mortality in Post-Stroke Patients Admitted to a Chronic Care Hospital: A Retrospective Pilot Study. Healthcare (Basel) 2022; 10:healthcare10061038. [PMID: 35742088 PMCID: PMC9222313 DOI: 10.3390/healthcare10061038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
Evidence concerning the mortality of post-stroke patients admitted to a chronic-phase hospital seems to be lacking. This pilot study aimed to identify mortality-related clinical variables in the admission of post-stroke patients from a retrospective perspective. A group of 38 non-survival stroke patients and another group of 46 survival stroke patients in a chronic-phase ward of the single center were recruited. Clinical variables including age, sex, stroke type, and Barthel index (BI) score were collected. The difference in the age and BI scores on admission were statistically significant between the two groups (p < 0.01). Polytomous logistic regression analysis revealed that age (odds ratio = 1.09, p = 0.03, and 95% confidence interval: 1.01−1.07), male sex (odds ratio = 5.04, p = 0.01, and 95% confidence interval: 1.39−18.27), and BI scores on admission (odds ratio = 0.90, p = 0.01, and 95% confidence interval: 0.83−0.97) could be prognostic variables. The percentage of correct classification was 83.3%. Age, male sex, and BI scores on admission may be prognostic indicators. The result of this study could lay the groundwork for palliative care for such a clinical population.
Collapse
Affiliation(s)
- Masatoshi Koumo
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan
- Correspondence: ; Tel.: +81-(0)75-574-4313
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
- Department of Neurosurgery, Hikone Chuo Hospital, Shiga 522-0054, Japan
| | - Kouta Yokoyama
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Tetsuya Yamamoto
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Tsumugi Hosokawa
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Junichi Katsura
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| | - Ken Yanagibashi
- Department of Rehabilitation, Hikari Hospital, Shiga 520-0002, Japan; (M.K.); (Y.M.); (K.Y.); (T.Y.); (T.H.); (J.K.); (K.Y.)
| |
Collapse
|
31
|
Wiedl A, Förch S, Fenwick A, Lisitano L, Röttinger T, Nachbaur T, Otto A, Mayr E. Orthogeriatric co-management: differences in outcome between major and minor fractures. Eur J Trauma Emerg Surg 2022; 48:2953-2966. [PMID: 35482035 PMCID: PMC9360167 DOI: 10.1007/s00068-022-01974-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/09/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Literature shows that orthogeriatric co-management improves the outcomes of patients with hip fractures. Corresponding research with more diverse fragility fracture groups is lacking. Therefore, an examination was performed prospectively as a 2 year-follow-up on an orthogeriatric co-managed ward, comparing relevant outcome parameters for major and minor fragility fractures. METHODS All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included and their injuries, orthogeriatric parameters such as the Barthel Index (BI), Parker Mobility Score (PMS) and place of residence (POR). Patients were separated into two groups of either immobilizing major (MaF) or non-immobilizing minor (MiF) fractures. 2 years later, a follow-up was conducted via telephone calls and questionnaires mailed to patients and/or their relatives. RESULTS 740 (574 major vs. 166 minor injuries) patients were initially assessed, with a follow-up rate of 78.9%. The in-house, 1-year, and 2-year-mortality rates were 2.7, 27.4, and 39.2%, respectively. Mortality was significantly higher for MaF in the short term, but not after 2 years. On average, during the observation period, patients regained their BI by 36.7 points (95% CI: 33.80-39.63) and PMS was reduced by 1.4 points (95% CI: 1.16-1.68). No significant differences were found in the readmission rate, change in BI, PMS or POR between the MaF and MiF groups. CONCLUSION The relevance of orthogeriatric treatment to improving functional and socioeconomic outcomes was confirmed. The similarity of the results from both fracture groups emphasizes the need for a multidisciplinary approach also for minor fractures.
Collapse
Affiliation(s)
- Andreas Wiedl
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Stefan Förch
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Annabel Fenwick
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Leonard Lisitano
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Timon Röttinger
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Thilo Nachbaur
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Alexander Otto
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Edgar Mayr
- Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| |
Collapse
|
32
|
Kojima I, Tanaka S, Otobe Y, Suzuki M, Koyama S, Kimura Y, Ishiyama D, Maetani Y, Kusumi H, Terao Y, Abe R, Nishizawa K, Yamada M. What is the optimal nutritional assessment tool for predicting decline in the activity of daily living among older patients with heart failure? Heart Vessels 2022; 37:1356-1362. [PMID: 35122493 DOI: 10.1007/s00380-022-02033-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022]
Abstract
The clinical importance of nutritional management in activities of daily living (ADL) among older inpatients with heart failure (HF) is greatly increasing. We determined the optimal nutritional assessment tool that can predict ADL decline among older inpatients with HF. We prospectively investigated 91 inpatients aged ≥ 65 years with HF in an acute hospital. We measured their nutritional status at admission using nutrition indices: the controlling nutritional status (CONUT), the geriatric nutritional risk index, the prognostic nutritional index, and the mini nutritional assessment. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the malnutrition status assessed by each nutritional index category and the ADL decline measured by the Barthel index (BI) in the univariate and multivariate analyses. Among the participants, 28.6% (n = 26; median age 81.5 years; 69.2% men) of the participants were included in the Reduced BI group and 71.4% (n = 65; median age 79.0 years; 67.7% men) in the Maintained BI group. The Reduced BI group showed a significantly higher CONUT value than the Maintained BI group, but there were no significant differences in other nutritional indices. In the multivariate logistic regression analysis, a higher CONUT score was associated with a significantly elevated risk of Reduced BI (adjusted OR 0.24; 95%CI 0.08-0.75; p = 0.014). We found that CONUT is an appropriate nutritional assessment tool for predicting ADL decline among older inpatients with HF in the early phase of hospitalization.
Collapse
Affiliation(s)
- Iwao Kojima
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan. .,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan.
| | - Shu Tanaka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yuhei Otobe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan.,Department of Electrical Engineering, Health and Sports Technology Course, Kanto Gakuin University, Kanagawa, Japan
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yusuke Maetani
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Haruhiko Kusumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yusuke Terao
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Reon Abe
- Department of Rehabilitation Medicine, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan
| | - Kenya Nishizawa
- Division of Cardiology, Department of Internal Medicine, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
| |
Collapse
|
33
|
Ikeda T, Suzuki T, Takagi M, Murakami M. Effect of Early Rehabilitation Treatment on Activities of Daily Living in Patients Receiving Conservative Treatment for Vertebral Compression Fracture. Prog Rehabil Med 2021; 6:20210049. [PMID: 34963904 PMCID: PMC8652343 DOI: 10.2490/prm.20210049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/04/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives : Vertebral compression fractures are common among older people. Currently, knowledge of the effects of early rehabilitation treatment on the recovery of activities of daily living (ADL) in older patients who receive conservative treatment for these fractures is limited. Using the instrumental variable (IV) method, we examined the effects on ADL at discharge of a delay in initiating rehabilitation treatment. Methods In this retrospective cohort study, data from the Japanese Diagnosis Procedure Combination database were analyzed. The subjects were patients with vertebral compression fracture who had undergone rehabilitation treatment during their hospitalization between 2014 and 2019 in one of the 29 acute-care hospitals in Yamagata Prefecture. We analyzed data from 1706 patients (mean age, 82.1 years). The independent variable was the number of days between hospital admission and the start of rehabilitation treatment, and the outcome was the Barthel index (BI) score at discharge. An IV method was applied, with adjustments for covariates, including demographics and functional status at admission. Results Most patients started rehabilitation treatment within 3 days of hospital admission. Our IV method showed that the interval between hospital admission and the start of rehabilitation treatment was significantly associated with the BI score at discharge. The coefficient was -2.71 (95% confidence interval [CI]: -5.06 to -0.35). Conclusions A delay in initiating rehabilitation treatment had a negative effect on ADL at discharge. This result emphasizes the importance of including early rehabilitation treatment in acute care, as recommended by several existing guidelines for the treatment of orthopedic diseases.
Collapse
Affiliation(s)
- Takaaki Ikeda
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Tomoto Suzuki
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masayasu Murakami
- Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan
| |
Collapse
|
34
|
Watanabe S, Morita Y, Suzuki S, Kochi K, Ohno M, Liu K, Iida Y. Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients. Prog Rehabil Med 2021; 6:20210054. [PMID: 35083381 PMCID: PMC8710675 DOI: 10.2490/prm.20210054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association between the Rehabilitation Activity Time score (RATs)-a score based on the level and duration of rehabilitation activities-of ventilated patients in the intensive care unit (ICU) and activities of daily living (ADL) dependence at discharge. METHODS This retrospective, single-center study evaluated patients aged >18 years who underwent mechanical ventilation in the ICU for at least 48 h. The patients were categorized into the low- and high-dose rehabilitation groups based on the median RATs. The primary outcome was the rate of ADL dependence at discharge, defined as a Barthel index of <70. The association between low or high doses of rehabilitation and the primary outcome was assessed using multiple logistic regression analysis adjusted by baseline factors. RESULTS The rate of ADL dependence at discharge was significantly lower in the high-dose rehabilitation group (low dose 81% vs. high dose 22%, P<0.001). Multivariate analysis showed a significantly lower ADL dependence at discharge among those who received high-dose rehabilitation (P<0.001). Increased RATs during the entire ICU admission period and during ICU admission after meeting the criteria for physiological stability was significantly associated with lower ADL dependence at discharge (P<0.001). Moreover, a higher RATs from low-level activity before meeting the criteria for physiological stability also showed a significant association with lower ADL dependence at discharge (P=0.047). CONCLUSIONS ADL dependence was significantly lower among those who underwent high-dose rehabilitation. The RATs was consistently associated with ADL dependence at discharge.
Collapse
Affiliation(s)
- Shinichi Watanabe
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Yasunari Morita
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Shuichi Suzuki
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Kaito Kochi
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Mika Ohno
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
| | - Yuki Iida
- Department of Physical Therapy, School of Health Science, Toyohashi Sozo University, Toyohashi, Aichi, Japan
| |
Collapse
|
35
|
Kautzky-Willer A, Harreiter J, Thomas A, Burger J, Schneeweiß U, Deischinger C, Klein W, Moser H. Women With Cerebral Infarction Feature Worse Clinical Profiles at Admission but Comparable Success to Men During Long-Term Inpatient Neurorehabilitation. Front Aging Neurosci 2021; 13:663215. [PMID: 34867261 PMCID: PMC8637730 DOI: 10.3389/fnagi.2021.663215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/27/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: Little is known about possible sex and gender differences in post-stroke neurorehabilitation outcomes. We aimed to analyze if functional performance, prevalence and impact of comorbidities at admission, and success of inpatient stroke-neurorehabilitation differ between men and women. Methods: Retrospective cohort analysis of 1,437 men and 907 women with prior cerebral infarction treated at a neurorehabilitation clinic between 2012 and 2017; multiple linear regression was used to examine the influence of sex/gender as well as multiple confounders on health and functional outcomes. The main outcome measures were Barthel index (BI) at admission and its change during 4 weeks inpatient neurorehabilitation. Results: Men had been diagnosed with osteoporosis less frequently than women but more often with type 2 diabetes mellitus, coronary artery or chronic kidney disease (p ≤ 0.01). Although twice as many women presented with pre-stroke depression compared to men, the risk of post-stroke depression detected during rehabilitation was comparable. Men were more likely to have less than 30 days between diagnosis and neurorehabilitation start than women (p < 0.03). At admission, women exhibited less autonomy, a lower BI, a higher pain score and worse 2-min walk test (2′WT) compared to men (p < 0.001). Among males osteoporosis and peripheral artery disease independently predicted BI at admission, in women it was pre-stroke depression, dementia, and arterial fibrillation. During neurorehabilitation, both sexes improved regarding BI, pain and walk tests (p < 0.001). Despite comparable rehabilitation effectiveness, women still had worse functional outcomes than males at discharge. Time after stroke to start of neurorehabilitation and length of the stay but, most strongly, the simple 2′WT at admission, and in women, pain intensity independently predicted post-stroke functional status and recovery. Conclusion: Women presented with worse functional status at admission to neurorehabilitation. Although men and women showed similar rehabilitation effectiveness, women still displayed worse clinical outcome measures and higher levels of pain at discharge. Early access and gender-sensitive, personalized post-stroke care with more focus on different comorbidities and psychosocial factors like pain levels and management, could further improve neurorehabilitation outcomes.
Collapse
Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Institute, Gars am Kamp, Austria.,Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Anita Thomas
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Johannes Burger
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ulrich Schneeweiß
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Carola Deischinger
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfhard Klein
- Neurologisches Therapiezentrum Gmundnerberg, Altmünster, Austria
| | - Hermann Moser
- Neurologisches Therapiezentrum Gmundnerberg, Altmünster, Austria
| |
Collapse
|
36
|
Hosoda T, Hamada S. Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study. BMC Geriatr 2021; 21:638. [PMID: 34772350 PMCID: PMC8586826 DOI: 10.1186/s12877-021-02597-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02597-w.
Collapse
Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, 210-0013, Japan.
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
37
|
Hiratsuka Y, Michihata N, Jo T, Matsui H, Inoue A, Murakami A, Fushimi K, Yasunaga H. Improvement in Activities of Daily Living after Cataract Surgery in the Very Old. Ann Clin Epidemiol 2021; 3:109-115. [PMID: 38505472 PMCID: PMC10760468 DOI: 10.37737/ace.3.4_109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/16/2021] [Indexed: 03/21/2024]
Abstract
BACKGROUND The benefits of cataract surgery for patients aged ≥90 years in terms of improvements in activities of daily living (ADL) have been poorly evaluated using only limited data. Using a large nationwide administrative database of hospitalized patients, we investigated the improvement of ADL after cataract surgery in the very old (age of ≥90 years). METHODS We identified 84,747 patients with cataracts aged 80 to 89 years and 7,253 patients with cataracts aged ≥90 years who underwent cataract surgery in both eyes during hospitalization from April 2014 to March 2015. A retrospective matched-pair cohort study was performed to compare the proportion of patients with improved ADL after cataract surgery. We also compared the length of hospital stay between the two groups. RESULTS Patients aged ≥90 years were more likely to be female and have a lower ADL score at admission. In the 1:4 matched-pair analysis with 7,253 versus 29,012 pairs, a lower proportion of patients aged ≥90 years had an improved ADL score (odds ratio, 0.33; 95% confidence interval, 0.29-0.36; P < 0.001) even after adjusting for other variables. Patients aged ≥90 years had a slightly shorter length of hospital stay than those aged 80 to 89 years (7.5 vs. 8.2 days, respectively; P < 0.001). CONCLUSIONS In this large nationwide cohort of patients with cataracts, those aged ≥90 years showed significantly poorer improvement of ADL than did patients aged 80 to 89 years. Cataract surgery before the age of 90 years may be recommended for patients with cataracts.
Collapse
Affiliation(s)
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Akira Inoue
- Department of Ophthalmology, Juntendo University School of Medicine
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University School of Medicine
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| |
Collapse
|
38
|
Kanahori M, Matsumoto Y, Fujiwara T, Kimura A, Tsutsui T, Arisumi S, Oyamada A, Ohishi M, Ikuta K, Tsuchiya K, Tayama N, Tomari S, Miyahara H, Mae T, Hara T, Saito T, Arizono T, Kaji K, Mawatari T, Fujiwara M, Takasaki M, Shin K, Ninomiya K, Nakaie K, Antoku Y, Iwamoto Y, Nakashima Y. Predictive factors of non-treatment and non-persistence to osteoporosis medication after fragility hip fractures at 3 years after discharge: a multicentre, prospective cohort study in the northern Kyushu district of Japan. Arch Osteoporos 2021; 16:132. [PMID: 34515859 DOI: 10.1007/s11657-021-00988-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We examined osteoporosis medication use and factors affecting persistence in 497 patients with fragility hip fractures. Only 25.5% of patients received continuous medication for 3 years, and 44.1% of patients received no treatment. Low Barthel index at discharge was a risk factor for both non-treatment and non-persistence to osteoporosis medication. PURPOSE Fragility hip fractures (FHF) caused by osteoporosis decrease the quality of life and worsen life expectancy. Use of osteoporosis medication may be an efficient method in the prevention of secondary FHF. However, previous studies have reported low rates of osteoporosis medication and persistence after FHF. This study aimed to evaluate osteoporosis medication use and factors affecting persistence in patients with FHF in the northern Kyushu area of Japan. METHODS A total of 497 FHF patients aged ≥ 60 years with a 3-year follow-up were included. We prospectively collected data from questionnaires sent every 6 months regarding compliance with osteoporosis medication. We compared baseline characteristics among three groups: no treatment (NT), no persistence (NP), and persistence (P), and conducted multivariable regression models to determine covariates associated with non-treatment (NT vs. NP/P) and non-persistence (NP vs. P). RESULTS There were 219 (44.1%), 151 (30.4%), and 127 (25.5%) patients in the NT, NP, and P groups, respectively. Factors associated with non-treatment were male sex, chronic kidney disease, no previous osteoporosis treatment, and low Barthel index (BI) at discharge. The only factor associated with non-persistence was a low BI at discharge. Factors associated with a low BI at discharge were male sex, older age, trochanteric fracture, and surgical delay. CONCLUSION Low BI at discharge is a risk factor for both non-treatment and non-persistence to osteoporosis medication. Therefore, appropriate interventions to improve BI may result in persistence to osteoporosis medication.
Collapse
Affiliation(s)
- Masaya Kanahori
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Tomoko Tsutsui
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Shinkichi Arisumi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Akiko Oyamada
- Department of Orthopaedic Surgery, Saga Handicapped Children's Hospital, Saga, Japan
| | - Masanobu Ohishi
- Department of Orthopaedic Surgery, Chihaya Hospital, Fukuoka, Japan
| | - Ko Ikuta
- Department of Orthopaedic Surgery, Karatsu Red Cross Hospital, Saga, Japan
| | - Kuniyoshi Tsuchiya
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Kyushu Hospital, Fukuoka, Japan
| | - Naohisa Tayama
- Department of Orthopaedic Surgery, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Shinji Tomari
- Department of Orthopaedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Hisaaki Miyahara
- Department of Orthopaedic Surgery, National Hospital Organization Kyushu Medical Centre, Fukuoka, Japan
| | - Takao Mae
- Department of Orthopaedic Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Aso Iizuka Hospital, Fukuoka, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Takeshi Arizono
- Department of Orthopaedic Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Kozo Kaji
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Masami Fujiwara
- Department of Orthopaedic Surgery, Sada Hospital, Fukuoka, Japan
| | - Minoru Takasaki
- Department of Orthopaedic Surgery, Harasanshin Hospital, Fukuoka, Japan
| | - Kunichika Shin
- Department of Orthopaedic Surgery, Saiseikai Yahata General Hospital, Fukuoka, Japan
| | - Kenichi Ninomiya
- Department of Orthopaedic Surgery, Koga Hospital 21, Fukuoka, Japan
| | - Kazutoshi Nakaie
- Department of Orthopaedic Surgery, National Hospital Organization Fukuoka-Higashi Medical Centre, Fukuoka, Japan
| | - Yasuaki Antoku
- Faculty of Medicine, Hospital Informatic Centre, Oita University, Oita, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| |
Collapse
|
39
|
Pan H, Zhao Y, Wang H, Li X, Leung E, Chen F, Cabrera J, Tsui KL. Influencing factors of Barthel index scores among the community-dwelling elderly in Hong Kong: a random intercept model. BMC Geriatr 2021; 21:484. [PMID: 34488653 PMCID: PMC8422750 DOI: 10.1186/s12877-021-02422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Barthel Index (BI) is one of the most widely utilized tools for assessing functional independence in activities of daily living. Most existing BI studies used populations with specific diseases (e.g., Alzheimer’s and stroke) to test prognostic factors of BI scores; however, the generalization of these findings was limited when the target populations varied. Objectives The aim of the present study was to utilize electronic health records (EHRs) and data mining techniques to develop a generic procedure for identifying prognostic factors that influence BI score changes among community-dwelling elderly. Methods Longitudinal data were collected from 113 older adults (81 females; mean age = 84 years, SD = 6.9 years) in Hong Kong elderly care centers. Visualization technologies were used to align annual BI scores with individual EHRs chronologically. Linear mixed-effects (LME) regression was conducted to model longitudinal BI scores based on socio-demographics, disease conditions, and features extracted from EHRs. Results The visualization presented a decline in BI scores changed by time and health history events. The LME model yielded a conditional R2 of 84%, a marginal R2 of 75%, and a Cohen’s f2 of 0.68 in the design of random intercepts for individual heterogeneity. Changes in BI scores were significantly influenced by a set of socio-demographics (i.e., sex, education, living arrangement, and hobbies), disease conditions (i.e., dementia and diabetes mellitus), and EHRs features (i.e., event counts in allergies, diagnoses, accidents, wounds, hospital admissions, injections, etc.). Conclusions The proposed visualization approach and the LME model estimation can help to trace older adults’ BI score changes and identify the influencing factors. The constructed long-term surveillance system provides reference data in clinical practice and help healthcare providers manage the time, cost, data and human resources in community-dwelling settings.
Collapse
Affiliation(s)
- Hao Pan
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Yang Zhao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hailiang Wang
- School of Design, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Eman Leung
- School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Frank Chen
- Department of Management Sciences, City University of Hong Kong, Hong Kong, China
| | - Javier Cabrera
- Department of Statistics, Rutgers University, New Brunswick, NJ, USA
| | - Kwok Leung Tsui
- School of Data Science, City University of Hong Kong, Hong Kong, China.,Grado Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| |
Collapse
|
40
|
Harada T, Nakamae T, Kamei N, Fujimoto Y, Manabe H, Tanaka N, Fujiwara Y, Yamada K, Tsuchikawa Y, Morisako T, Maruyama T, Adachi N. Surgical outcomes of cervical myelopathy in patients with athetoid cerebral palsy. Eur J Orthop Surg Traumatol 2021. [PMID: 34455477 DOI: 10.1007/s00590-021-03109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Surgical treatment for cervical myelopathy with athetoid cerebral palsy remains unestablished. Instrumented fusion is reported to have good clinical results; however, there are no data of decompression surgery for this pathology in recent years. This study aimed to assess the surgical outcomes of laminoplasty with or without posterior instrumented fusion for cervical myelopathy in patients with athetoid cerebral palsy. METHODS A multi-centre surgical series of patients with cervical myelopathy and athetoid cerebral palsy were enrolled in this study. All patients showed symptoms and signs suggestive of cervical myelopathy and underwent laminoplasty with or without instrumented fusion. The Japanese Orthopaedic Association (JOA) score, Barthel index (BI), and changes in the C2-C7 sagittal Cobb angle in the lateral plain radiograph were analysed. RESULTS There were 25 patients (16 men and 9 women; mean age, 54.4 ± 10.8 years) with cervical myelopathy and athetoid cerebral palsy who underwent surgical treatment. The mean follow-up period was 41.9 ± 35.6 months. Overall, the BI significantly improved after surgery, whereas the JOA score and C2-C7 angle did not improve postoperatively. The recovery rate of the JOA score in the laminoplasty group was significantly higher than that of the fusion group (P = 0.02). CONCLUSIONS Cervical laminoplasty with or without instrumented fusion for treating cervical myelopathy due to athetoid cerebral palsy is effective in improving activities of daily living. Cervical laminoplasty may be an effective and less invasive surgical method for selective patients, especially for those with small involuntary movements and no remarkable cervical kyphosis nor instability.
Collapse
|
41
|
Koutalos AA, Chalatsis GI, Varsanis G, Malizos KN, Karachalios T. The effect of zoledronic acid and high-dose vitamin D on function after hip fractures. A prospective cohort study. Eur J Orthop Surg Traumatol 2021; 32:1145-1152. [PMID: 34387721 DOI: 10.1007/s00590-021-03092-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Hip fractures are associated with functional decline and increased mortality. The aim of this study was to investigate the effect of zoledronic acid and high-dose vitamin D on function and mortality after hip fractures. PATIENTS AND METHODS Forty-five patients received zoledronic acid and high dose of vitamin D during hospitalization after fracture management. These patients were compared with a control group of 46 patients. Pre- and postoperative prospectively collected data including ASA score, Charlson comorbidity score, presence of dementia, Vitamin D, and the Barthel index were available. Final follow-up was performed after one year. Primary outcome was patients' function at final follow-up as measured with Barthel index score. Secondary outcomes included mortality, assessment of pain, and complications. RESULTS Barthel index score at final follow-up was decreased in both groups. There was no significant difference in Barthel index between the two groups (15.5 ± 5.0 vs 15.8 ± 5.8, p = 0.850). However, the Barthel index in the control group decreased beyond the smallest detectable change (3 points). Mortality was statistically different between groups (8.8% vs 28.2%, p = 0.047). Complications and pain at final follow-up were not different between groups. Multivariate analysis revealed that preoperative Barthel index and Charlson comorbidity score independently affected function at final follow-up. Logistic regression analysis disclosed that not receiving active treatment and complications were associated with increased mortality. CONCLUSIONS Medical treatment after surgical management of hip fractures results in reduced mortality and lessens the functional decline associated with these fractures.
Collapse
Affiliation(s)
- Antonios A Koutalos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece.
| | - George I Chalatsis
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| | - Georgios Varsanis
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery & Musculoskeletal Trauma, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| |
Collapse
|
42
|
Inui T, Watanabe Y, Kurata Y, Suzuki T, Matsui K, Ishii K, Kurozumi T, Kawano H. Early postoperative Barthel index score and long-term walking ability in patients with trochanteric fractures walking independently before injury: a retrospective cohort study. Arch Orthop Trauma Surg 2021; 141:1283-1290. [PMID: 32705380 DOI: 10.1007/s00402-020-03548-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trochanteric fractures are one of the most common fragility fractures, and the number of the patients is increasing worldwide. Identifying prognostic factors is important to manage and minimize the social losses caused by postoperative walking impairment. The purpose of this retrospective study is to clarify the association between early postoperative Barthel index score and postoperative long-term walking ability among patients with trochanteric fractures who could walk independently before injury. MATERIALS AND METHODS Consecutive patients with trochanteric fractures aged ≥ 65 years who were walking independently before injury were included. Patients were divided into two groups according to the Barthel index score measured within 1 week after surgery; the cut-off value was set at 20 points. The prevalence of walking impairment after 1 year was compared between these two groups after adjusting for confounding factors in a complete case analysis and using the data introduced by the multiple imputation method. RESULTS Among the 758 eligible patients, 254 patients (34%) had their walking ability evaluated after 1 year from injury. The patients in the lower Barthel index group showed a significantly impaired walking ability in both analyses (adjusted odds ratio 5.5 and 2.4, 95% confidence intervals 2.4-13 and 1.5-3.8, respectively). CONCLUSIONS The present results suggested that the Barthel index score measured in the early postoperative period after trochanteric fractures was associated with the level of long-term walking impairment in patients who could walk independently before injury.
Collapse
Affiliation(s)
- Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan. .,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Yoshiaki Kurata
- Division of Orthopaedic Trauma, Sapporo Tokushukai Hospital, 1-1-1 Oyachi-higashi, Atsubetsu-ku, Sapporo, Hokkaido, Japan
| | - Takashi Suzuki
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Keisuke Ishii
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Taketo Kurozumi
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| |
Collapse
|
43
|
Trevissón-Redondo B, López-López D, Pérez-Boal E, Marqués-Sánchez P, Liébana-Presa C, Navarro-Flores E, Jiménez-Fernández R, Corral-Liria I, Losa-Iglesias M, Becerro-de-Bengoa-Vallejo R. Use of the Barthel Index to Assess Activities of Daily Living before and after SARS-COVID 19 Infection of Institutionalized Nursing Home Patients. Int J Environ Res Public Health 2021; 18:7258. [PMID: 34299709 PMCID: PMC8304574 DOI: 10.3390/ijerph18147258] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
The objective of the present study was to evaluate the activities of daily living (ADLs) using the Barthel Index before and after infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and also to determine whether or not the results varied according to gender. The ADLs of 68 cohabiting geriatric patients, 34 men and 34 women, in two nursing homes were measured before and after SARS-CoV-2 (Coronavirus 2019 (COVID-19)) infection. COVID-19 infection was found to affect the performance of ADLs in institutionalized elderly in nursing homes, especially in the more elderly subjects, regardless of sex. The COVID-19 pandemic, in addition to having claimed many victims, especially in the elderly population, has led to a reduction in the abilities of these people to perform their ADLs and caused considerable worsening of their quality of life even after recovering from the disease.
Collapse
Affiliation(s)
- Bibiana Trevissón-Redondo
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
| | | | - Pilar Marqués-Sánchez
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Cristina Liébana-Presa
- SALBIS Research Group, Faculty of Health Sciences, Universidad de León, 24071 León, Spain; (B.T.-R.); (P.M.-S.); (C.L.-P.)
| | - Emmanuel Navarro-Flores
- Frailty Research Organizaded Group (FROG), Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain;
| | - Raquel Jiménez-Fernández
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
| | - Inmaculada Corral-Liria
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
| | - Marta Losa-Iglesias
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (R.J.-F.); (I.C.-L.)
| | | |
Collapse
|
44
|
Wojzischke J, Bauer JM, Hein A, Diekmann R. The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients. Nutrients 2021; 13:2292. [PMID: 34371802 DOI: 10.3390/nu13072292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023] Open
Abstract
The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0–100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1–t2, t2–t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2–t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.
Collapse
|
45
|
Yang JL, Ou YH, Liu SY, Lin CH, Chang SW, Lu YH, Shen T, Hsieh CP, Lin CM, Lei RL. Exploring the Effectiveness of PAC Rehabilitation for Elders with Hip Surgery: A Retrospective Study. Ther Clin Risk Manag 2021; 17:641-648. [PMID: 34188477 PMCID: PMC8236282 DOI: 10.2147/tcrm.s317218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hip fractures are high risk and high-impact events in the elderly population; despite orthopedic hip surgery, the disability and mortality rate remains significant. The National Health Insurance Agency in Taiwan established a fragility fracture PAC rehabilitation program to provide functional recovery for these patients after the surgery. However, the current literature on PAC rehabilitation is outdated, and there is an urgent need for the re-evaluation of the program. Methods This is a retrospective cohort study that enrolled 159 patients in the PAC rehabilitation program, followed by hip repair surgery. Outcome measures were the differences in participants’ pre- and post-PAC scores in 1) Barthel index, 2) Numerical Rating Scale (NRS), and 3) Harris Hip Scores (HHS) as surrogate indicators of the functional status, followed by the analysis of subgroups, including sex, age, site of the fracture, type of procedure, and the number of comorbidities. Results After completing PAC rehabilitation, 86.2% of the patients successfully returned to the community with either home or out-patient rehabilitation. The re-admission rate was 3.1% and 3.8% in 14-days and in 30-days follow up, respectively. The difference in pre- and post-Barthel index, NRS, and HHS showed significant improvement (p<0.001), without significant variations between the subgroups. Additionally, the Barthel index showed a positive correlation to HHS and a negative correlation to NRS. Conclusion This study revealed that the current form of post-surgery fragility fracture PAC program effectively improves functional status, reduces the re-admission rate, and facilitates the patient transition back to the community. The results should improve patients’ and physicians’ confidence in such a program.
Collapse
Affiliation(s)
- Ju-Lan Yang
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.,Department of Nursing, College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Yang-Hao Ou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Sen-Yung Liu
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.,Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Shu-Wei Chang
- Department of Medicinal Botanicals and Health Applications, Dayeh University, Changhua, Taiwan
| | - Yueh-Hsiu Lu
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Taishan Shen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Cheng-Pu Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Ming Lin
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ruoh-Lih Lei
- Department of Nursing, College of Nursing, Hungkuang University, Taichung, Taiwan
| |
Collapse
|
46
|
Righi E, Mirandola M, Mazzaferri F, Razzaboni E, Zaffagnini A, Erbogasto A, Vecchia ID, Auerbach N, Ivaldi F, Mongardi M, Minuz P, Milella M, Mehrabi S, Olivieri O, Girelli D, Polati E, Micheletto C, Tacconelli E. Long-Term Patient-Centred Follow-up in a Prospective Cohort of Patients with COVID-19. Infect Dis Ther 2021; 10:1579-90. [PMID: 34152573 DOI: 10.1007/s40121-021-00461-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction To better define COVID-19 long-term impact we prospectively analysed patient-centred outcomes, including general health and symptom duration. Methods Barthel index (BI), St. George’s Respiratory Questionnaire adapted to patients with COVID-19 (aSGRQ) and WHO Clinical Progression Scale (CPS) were measured at enrolment and at 6 weeks from the onset of symptoms. Persistence of most frequently reported symptoms was assessed at 6 weeks and, among symptomatic patients, at 12 weeks from the onset of symptoms. Predictors of impaired general health over time were identified using an ordinal multilevel multivariate model. Results A total of 448 patients (55% men, median age 56 years) were enrolled. WHO-CPS showed mild, moderate and severe disease in 48%, 42% and 10% of patients at admission and mild disease in all patients at follow-up, respectively. BI and aSGRQ were normal in 96% and 93% patients before COVID-19 but only in 47% and 16% at COVID-19 diagnosis and in 87% and 65% at 6-week follow-up. Male gender was identified by all three assessments as a predictor of impaired general health (BI, OR 2.14, p < 0.0001; aSGRQ, OR 0.53, p = 0.003; WHO-CPS, OR 1.56, p = 0.01). Other predictors included age, ICU admission and comorbidities (e.g. cardiovascular disease and cancer) for BI, hospital admission for aSGRQ, age and presence of comorbidities for WHO-CPS. At 6- and 12-week follow-up, 39% and 20% of patients, respectively, were still reporting symptoms. Fatigue and breathlessness were the most frequently reported symptoms. Conclusions Long-term follow-up facilitates the monitoring of health impairment and symptom persistence and can contribute to plan tailored interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00461-3.
Collapse
|
47
|
Lu W, Mao Q. The effects of family follow-up nursing on elderly cognitive impairment patients' Barthel index scores and mental statuses. Am J Transl Res 2021; 13:6702-6709. [PMID: 34306415 PMCID: PMC8290769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effects of family follow-up nursing on the Barthel Index scores and emotional statuses of elderly cognitive impairment patients. METHODS A total of 90 dementia patients with cognitive impairments were randomized into group A, which underwent routine family nursing, or group B, which underwent family follow-up nursing for 6 months. The patients' cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Their disability levels were determined using the Barthel Index and the WHO rating scale (the WHODAS II scale), and the caregiver's burden levels were evaluated using the Zarit Caregiver Burden Interview (ZBI). The negative emotions were assessed using the Negative Mood Regulation Expectancies Scale (the NMRE-C). The two groups' quality of life and living abilities were assessed using the World Health Organization Quality of Life-BREF Scale (the WHOQOL BREF scale) and the Activities of Daily Living Scale (the ADL scale). RESULTS After the intervention, the MMSE and MoCA scores increased in group B compared with the scores in group A (P<0.01). The Barthel Index scores increased, but the WHODAS II scores decreased in group B compared with the scores in group A (all P<0.001). The ZBI score was (34.30±4.19) in group A and (31.64±3.69) in group B (t=3.196, P=0.002). The NMRE-C score was (122.38±10.20) in group A and (144.39±11.30) in group B (t=9.699, P<0.001), and the quality of life and living abilities of the patients in group B improved significantly compared with the quality of life and living abilities of the patients in group A (all P<0.01). CONCLUSION Family follow-up nursing can alleviate cognitive impairment in elderly dementia patients reduce their negative emotions, increase their independent living abilities, and decrease the caregiver's burden. It should be widely applied in clinical settings.
Collapse
Affiliation(s)
- Wei Lu
- College of Medicine and Health Science, Wuhan Polytechnic UniversityWuhan, Hubei Province, China
| | - Qinghua Mao
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan UniversityWuhan, Hubei Province, China
| |
Collapse
|
48
|
Sha L, Xu T, Ge X, Shi L, Zhang J, Guo H. Predictors of death within 6 months of stroke onset: A model with Barthel index, platelet/lymphocyte ratio and serum albumin. Nurs Open 2021; 8:1380-1392. [PMID: 33378600 PMCID: PMC8046075 DOI: 10.1002/nop2.754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS To develop and internally validate a nomogram to predict the risk of death within 6 months of onset of stroke in Chinese. Identifying risk factors with potentially direct effects on the nomogram will improve the quality of risk assessment and help nurses implement preventive measures based on patient-specific risk factors. DESIGN A retrospective study. METHODS We performed a least absolute shrinkage and selection operator (LASSO) regression modelling and multivariate logistic regression analysis to establish a prediction model of death risk in stroke patients within 6 months of onset. LASSO and time-dependent Cox regression models were further used to analyse the 6-month survival of stroke patients. Data were collected from 21 October 2013-6 May 2019. RESULTS The independent predictors of the nomogram were Barthel index (odds ratio (OR) = 0.980, 95% confidence interval (CI) = 0.961-0.998, p = .03), platelet/lymphocyte ratio (OR = 1.005, 95% CI = 1.000-1.010, p = .04) and serum albumin (OR = 0.854, 95% CI = 0.774-0.931, p < .01). This model showed good discrimination and consistency, and its discrimination evaluation C-statistic was 0.879 in the training set and 0.891 in the internal validation set. The DCA indicated that the nomogram had a higher overall net benefit over most of the threshold probability range. The time-dependent Cox regression model established the impact of the time effect of the age variable on survival time. CONCLUSIONS Our results identified three predictors of death within 6 months of stroke in Chinese. These predictors can be used as risk assessment indicators to help caregivers performing clinical nursing work, and in clinical practice, it is suggested that nurses should evaluate the self-care ability of stroke patients in detail. The constructed nomogram can help identify patients at high risk of death within 6 months, so that intervention can be performed as early as possible.
Collapse
Affiliation(s)
- Ling Sha
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Tiantian Xu
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Xijuan Ge
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Lei Shi
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Jing Zhang
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| | - Huimin Guo
- Nursing Division of the Department of NeurologyNanjing Drum Tower Hospital Affiliated to Nanjing University Medical SchoolNanjingChina
| |
Collapse
|
49
|
Kang Y, Fang XY, Wang D, Wang XJ. Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia. BMC Infect Dis 2021; 21:314. [PMID: 33794779 PMCID: PMC8017749 DOI: 10.1186/s12879-021-06006-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older patients hospitalized with community-acquired pneumonia (CAP) are at high risk for short-term mortality. Activity of daily living (ADL) is associated with clinical outcomes in older patients. We aimed to investigate the prognostic value of ADL upon admission on the in-hospital mortality in older patients with CAP. METHODS We conducted a retrospective cohort study involving patients aged ≥65 years admitted to Beijing Chao-Yang hospital due to CAP between June 2012 and June 2020. ADL evaluation upon admission was performed by Barthel Index (BI). Data from all patients were extracted from the electronic medical records. RESULTS Four thousand eight hundred eighty patients were included, 131 patients (2.7%) died during their hospitalization. Median BI in the Deceased group was 45 (20-65), Deceased group had lower BI scores than Survivors group (p < 0.001). Low BI (< 60) was more frequent in patients who died in the hospital than in patients discharged alive (69.5% vs. 13%, p < 0.001). In-hospital mortality was higher among patients with worse ADL upon admission (BI< 60) compared to those BI≥60 (12.6% vs. 0.9%). The worse ADL upon admission (BI< 60) was associated with an increase in the risk of death during CAP hospitalization, worse ADL upon admission (BI< 60) showed an odds ratio (OR) for in-hospital mortality of 7.53 (95%CI: 2.77-20.48; P < 0.01). This association remained significant after adjustment for age, comorbid conditions, respiratory failure, pathogens and laboratory findings (OR, 3.74; 95%CI, 2.37-5.91; P < 0.01). Receiver operating characteristic (ROC) curve revealed that BI upon admission is a predictor related to in-hospital mortality in elderly patients, the area under the ROC curve of BI in predicting in-hospital mortality was 0.81 (with 95% confidence interval: 0.78-0.85). The predictive value of ADL upon admission was better than age in our study population. CONCLUSION Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia.
Collapse
Affiliation(s)
- Yu Kang
- Department of Internal Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiang-Yang Fang
- Department of Internal Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Dong Wang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Juan Wang
- Department of Internal Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| |
Collapse
|
50
|
Causa R, Almagro Nievas D, Bermúdez Tamayo C. [COVID-19 and functional dependence: cohort study of an outbreak in a nursing home for elderly.]. Rev Esp Salud Publica 2021; 95:e202103045. [PMID: 33767129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE Older people have been severely affected by the COVID-19 pandemic. The aim of this study was to describe the main epidemiological findings of a COVID-19 outbreak occurred in March 2020 at a nursing home for elderly in Granada. Risk factors associated with the spread of the virus in the center were investigated. METHODS A retrospective cohort study was conducted, collecting the most relevant clinical and epidemiological findings, occurred during the outbreak follow-up period (from 03/13/2020 to 06/20/2020). The association between the residents' health conditions (underlying diseases, level of physical dependence, level of cognitive impairment) and the risk of infection was estimated using multivariate Cox regression. RESULTS 52 PCR-confirmed COVID-19 cases were identified among the residents and 50 cases among the employees of the nursing home. The epidemic curve was characteristic of a person to person transmission. Among residents with a higher level of physical dependence, according to the Barthel index score, a higher incidence of infection was detected, adjusting for age, sex and health conditions. At 55 days of exposure, moderately (RR 2.82), severely (RR 4.71) and completely (RR 3.49) dependent residents had between 2-4 times greater risk of infection than the minimally dependent residents (p<0.05). CONCLUSIONS The epidemic curve supports the hypothesis of a cross-transmission of infections between residents and staff members of the nursing home. In the context of sustained transmission of the virus, physical dependence of the residents increases the risk of exposure to the virus, facilitating its spreading.
Collapse
Affiliation(s)
- Roberta Causa
- Medicina Preventiva y Salud Pública. Hospital Universitario Puerto Real. Cádiz. España
- Servicio de Epidemiología. Distrito Sanitario Granada Metropolitano. Granada. España
| | - Diego Almagro Nievas
- Servicio de Epidemiología. Distrito Sanitario Granada Metropolitano. Granada. España
| | - Clara Bermúdez Tamayo
- Escuela Andaluza de Salud Pública. Granada. España
- CIBERESP. Ciber de Epidemiología y Salud Pública. Madrid. España
| |
Collapse
|