Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization

BACKGROUND

Diabetic Foot Ulcers (DFUs) are a common and feared complication of type 1 and type 2 diabetes. People with DFUs often present a significant clinical complexity due to multimorbidity, frailty, polypharmacy, and disabling conditions. Frailty, defined using the accumulation of health deficits model, has shown to predict worsening health status, hospitalizations, and death in older persons. There are no clinical studies, to date, that have examined the prevalence and effect of frailty on DFUs outcomes. The aim of our study was to explore the impact of frailty on DFUs healing and re-hospitalization in a cohort of patients hospitalized with DFUs.

DESIGN

prospective cohort study.

SETTING AND PARTICIPANTS

The frailty status of 76 consecutive hospitalized patients with DFUs was assessed by using the Frailty Index (FI).

MEASUREMENTS

The primary outcome was the non-healing of the DFU. Secondary outcome was re-hospitalization events (for any cause) within 6 months from hospital discharge. Frailty was defined as FI>0.25.

RESULTS

Out of 76 patients (median age 65 years, range 31-84), 56 (74%) were frail. At six months, 81.5% of frail patients had non-healing of the DFU compared to 55% in non-frail patients (p=0.02). The rate of of re-hospitalization was also higher in frail compared to non-frail (90.3% vs 54%, respectively; p=0.01) patients. In multivariable analyses, frailty was significantly associated with a more than fivefold increased risk of DFU non-healing [odds ratio 5.54 (95% confidence interval 1.28-23.91), p=0.02]. Similarly, re-hospitalization was also significantly higher in frail patients compared to the non-frail ones.

CONCLUSIONS

In hospitalized patients with DFUs, frailty was highly prevalent. Frailty emerged as an independent risk factor for DFU non-healing and re-hospitalization events. Patients with DFUs require a comprehensive assessment of their frailty status which would enable personalization of their management and interventions.

Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience

Objective

The aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation.

Methods

This study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI).

Results

NT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome.

Conclusion

SCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.

The Frail'BESTest: an adaptation of the "balance evaluation system test" for frail older adults; Concurrent validity, responsiveness, validity for fall prediction and detection of slower walkers

BACKGROUND

The Frail'BESTest was developed in order to include frail older adults when they are using the BESTest. Recently, psychometrics properties (internal coherence, systems usefulness, complementarity and inter-rater reliability) of the Frail'BESTest were tested. To complete these analyses, this study will aim the assessment of its concurrent validity, responsiveness, predictive validity on falls occurrence, and slower walkers detection.

METHODS

The correlation between the Frail'BESTest and the Gait Speed Test permitted to assess concurrent validity. The variation between the initial test score and the score obtained after the completion of a rehabilitation program was used to evaluate responsiveness with MANOVA analysis and standard response mean (SRM) calculation. Predictive validity was assessed with receiver-operating characteristic curves and area under the curve (AUC) analysis regarding falls occurrence. Slower walkers detection thresholds were computed by receiver-operating characteristic curves for the Frail'BESTest and the Tinetti test.

RESULTS

The concurrent validity of the test was good (r = 0.74; p < 0.001). The Standard Error of measurement was at 2.81 points and the Minimal Detectable Change at 7.79 points for the total score of the Frail'BESTest. The SRM was at 0.41 for the Tinetti test and 0.56 for the Frail'BESTest. The AUC, computed according to fall occurrence, was at 0.71 for the Gait Speed test, 0.673 for the Tinetti test and 0.693 for the Frail'BESTest. Both the Tinetti (AUC = 0.87) and the Frail'BESTest (AUC = 0.88) were found suitable for tracking slower walkers.

CONCLUSION

Concurrent validity and responsiveness of the Frail'BESTest were good. As for the Tinetti and the Frail'BESTest, they were unable to predict efficiently falls occurrence in the tested sample. The Frail'BESTest seems enough sensitive to spot the slower walkers efficiently, using a 15/20 threshold method. The Frail'BESTest was found to be a valid and responsive clinical test, therefore it can be recommended as an outcome measure in clinical practice.

The association between hypoparathyroidism and cognitive impairment: a systematic review

CONTEXT AND PURPOSE

Hypocalcemia and low parathyroid hormone levels have been commonly suggested as factors able to induce central nervous system disturbances. However, evidences on the occurrence of cognitive impairment are limited or underestimated. The aim of this review is, therefore, to systematically summarize the available evidence concerning the occurrence of cognitive impairment among subjects suffering from idiopathic or secondary hypoparathyroidism.

METHODS

A systematic selection of the available literature was performed by searching the online databases PubMed, Scopus and Web of Knowledge.

RESULTS

The present systematic review included sixteen case report articles and one cross-sectional controlled study. Case reports were the most representative literature sources and involved ten women and seven men. The presence of cognitive impairment was mostly discussed in association with idiopathic hypoparathyroidism (HPT); five articles described the occurrence of cognitive impairment following postsurgical HPT. The case-controlled study reported a significant presence of peculiar cognitive deficits (e.g. reduced inhibitory control, impairment in visuo-spatial functioning among, and psychomotor retardation) among HPT subjects compared to healthy controls, with serum total calcium and its product with phosphorus as independent predictors of neuropsychological dysfunctions.

CONCLUSION

Even though mostly based on single case reports, the presence of neuropsychological dysfunctions in the context of HPT appears to be a consistent core finding.

Carbapenem Consumption and Rate of carbapenemresistant gram-negative bacteria: results from the Sicilian Surveillance System

Conclusion

The results of the present study highlight the need for comprehensive strategies targeting the appropriate use of antibiotics and infection control measures.

Background

In the last decades, multidrug-resistant gram-negative bacteria have been increasing and they are involved in severe healthcare associated infections. In treating drug-resistant gram-negative bacterial infections, carbapenems are generally administered as a last choice. However, the rate of carbapenemresistant bacteria is constantly increasing the last years. The aim of the present study is to describe the relationship between the rate of carbapenem-resistant gram-negative bacteria and antibiotic consumption intensity.

Study design

In 2017, the Sicilian Region implemented a regional surveillance system to describe and analyze consumption of antibiotics in hospital settings, as well as prevalence of antibiotic resistant microorganisms.

Methods

Resistance data were retrospectively collected from routinary clinical antimicrobial susceptibility tests. Resistance rates (RRs) of carbapenems were calculated and Spearman's correlation analysis was performed to investigate the relationship between annual antibiotic consumption and rate of carbapenem resistance.

Results

In 2015, the overall prevalence of carbapenem-resistant Klebsiella pneumoniae isolates was 43.9 %, and was positively correlated with beta-lactam consumption (R=0.529, p<0.01), and with carbapenem consumption (R=0.364, p<0.05). In 2016, the overall prevalence of carbapenem-resistant Klebsiella pneumoniae isolates was 53.8 %, and was positively correlated with carbapenem antibiotic consumption (R=0.364, p<0.05). In 2017, the overall prevalence of carbapenem-resistant Klebsiella pneumoniae isolates was 58.7 %, and was significantly positively correlated with carbapenem antibiotic consumption (R=0.427, p<0.05). In 2015, the overall prevalence of carbapenem-resistant Escherichia coli isolates was 6.5 %, and was significantly positively correlated with antibiotic consumption for the ATC class J01 (i.e., antibacterial for systemic use) (R=0.402, p<0.05).