[The interrater reliability of four common comorbidity indexes used in elderly patients]

Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason

BACKGROUND AND PURPOSE

Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason.

METHODS

This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors.

RESULTS AND DISCUSSION

In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization.

CONCLUSIONS

Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.

Study on the Consistency Between Automatic Measurement Based on Convolutional Neural Network Technology and Manual Visual Evaluation in Intracavitary Ultrasonic Cine of Anterior Pelvic

OBJECTIVES

This study was to evaluate the application of automatic measurement based on convolutional neural network (CNN) technology in intracavitary ultrasound cine of anterior pelvic.

METHODS

A total of 500 patients who underwent pelvic floor ultrasound examination at Peking University Shenzhen Hospital from July 2021 to February 2022 were retrospectively retrieved by the picture archiving and communication system (PACS) system, and 300 cases were used as a training set. The training set was labeled by three experienced ultrasound physicians to train CNN models and develop an automatic measurement software. The remaining 200 cases were used as a test set. Automatic measurement software identified relevant anatomical structures frame by frame and determined the two frames with the greatest difference, calculated the bladder neck descent (BND), urethral rotation angle (URA), and retrovesical angle (RA). Meanwhile, two experienced ultrasound physicians evaluated the resting frame and the maximum Valsalva frame on the cines by manual visual evaluation, labeled the anatomical structures in the corresponding frame, such as the inferoposterior margin of pubic symphysis, the mid-axis of pubic symphysis, bladder contour, and urethra in the front, and calculated BND, URA, and RA. Considering that the residual urine volume (RUV) in the bladder may affect the results, enrolled patients were grouped according to the RUV (10-50 mL, 50-100 mL, and >100 mL). The consistency of the results by automatic measurement and manual visual evaluation was evaluated using the intraclass correlation coefficient (ICC) and the Bland-Altman graph.

RESULTS

Of the 200 cases in the test set, 120 cases were successfully identified by the CNN automatic software with a 60% recognition rate. In the case of successful identification, the ICC of manual visual evaluation measurement and automatic measurement was 0.936 (BND), 0.911 (URA), 0.756 (RA in rest), and 0.877 (RA at maximum Valsalva), respectively. In addition, the RUV had a negligible effect on the consistency. The Bland-Altman plot shows the proportion of samples outside the limit was below 5%.

CONCLUSIONS

CNN-based automatic measurement software exhibited high reliability in anterior pelvic measurement, which results in a significantly enhanced measurement efficiency.

Brief pain inventory and pain detection questionnaire based on WeChat and paper versions for collecting data on patients with herpes zoster-induced neuralgia: An analysis for their validity and reliability

BACKGROUND

This study explored the validity and reliability of brief pain inventory (BPI) and pain detection questionnaire (PD-Q) based on WeChat and paper versions for collecting data on patients with herpes zoster-induced neuralgia.

METHODS

The study participants were 160 patients with herpes zoster-induced neuralgia admitted in our hospital from December 2017 to June 2020. Initially, the participants were randomly divided into group A (n = 80) and group B (n = 80). Then, they were required to complete the Chinese versions of the BPI and PD-Q. In group A, the WeChat version was finished first, followed by the paper version. In group B, the paper version was completed first, followed by the WeChat version. Then, the test-retest reliability was analyzed by comparing the intraclass correlation coefficient (ICC) between the 2 groups. Bland-Altman plots and Pearson correlation coefficient were used to analyze the concordance between the paper and WeChat versions.

RESULTS

Patients generally preferred the WeChat version of the BPI and PD-Q, particularly men and patients with pain duration ≥ 30 minutes. Specifically, no significant differences in the completion time of the BPI and PD-Q was found between the 2 groups. All patients had high test-retest reliability and internal consistency for both WeChat and paper versions (BPI: ICC, 0.913; Cronbach alpha coefficient, 0.959; PD-Q: ICC, 0.825; Cronbach alpha coefficient, 0.894). Bland-Altman plots indicated no significant systematic deviations between the WeChat and paper versions. Pearson correlation coefficient revealed a strong correlation between BPI (Spearman, 0.928) and PD-Q (Spearman, 0.830) questionnaires.

CONCLUSION

The WeChat and paper versions of the BPI and PD-Q have good repeatability, reliability, and consistency for collecting data on patients with herpes zoster-induced neuralgia.

Desigualdades raciais no estadiamento clínico avançado em mulheres com câncer de mama atendidas em um hospital de referência no Rio de Janeiro, Brasil

Resumo Este estudo teve como objetivo analisar a associação entre raça/cor da pele e estadiamento clínico em mulheres com câncer de mama em um hospital de referência para tratamento oncológico do Sistema Único de Saúde. Trata-se de estudo seccional com 863 mulheres de 18 anos de idade ou mais, com câncer de mama incidente e estadiamento clínico até IIIC, matriculadas em um hospital de referência no Rio de Janeiro e entrevistadas entre novembro de 2016 e outubro de 2018. Foram coletadas variáveis sociodemográficas, de hábitos de vida e clínicas. Utilizou-se o escore de propensão com a técnica de ponderação para balancear os grupos de comparação quanto aos potenciais confundidores. A associação entre raça/cor da pele e estadiamento clínico foi analisada por meio das equações de estimação generalizada após balanceamento. O nível de significância de 5% foi adotado em todas as análises. Observou-se que 35,9% das mulheres se declararam brancas; 21,3%, pretas; e 42,8%, pardas. Mulheres de cor da pele preta apresentaram 63% mais chance de ter estadiamento II e III quando comparadas com as brancas (OR=1,63; IC95% 1,01-2,65). Conclui-se que mulheres pretas são diagnosticadas com tumores mais avançados quando comparadas com mulheres brancas.

Respiratory Muscle Strengths and Their Association with Lean Mass and Handgrip Strengths in Older Institutionalized Individuals

The study of reduced respiratory muscle strengths in relation to the loss of muscular function associated with ageing is of great interest in the study of sarcopenia in older institutionalized individuals. The present study assesses the association between respiratory muscle parameters and skeletal mass content and strength, and analyzes associations with blood cell counts and biochemical parameters related to protein, lipid, glucose and ion profiles. A multicenter cross-sectional study was performed among patients institutionalized in nursing homes. The respiratory muscle function was evaluated by peak expiratory flow, maximal respiratory pressures and spirometry parameters, and skeletal mass function and lean mass content with handgrip strength, walking speed and bioimpedance, respectively. The prevalence of reduced respiratory muscle strength in the sample ranged from 37.9% to 80.7%. Peak expiratory flow significantly (p < 0.05) correlated to handgrip strength and gait speed, as well as maximal inspiratory pressure (p < 0.01). Maximal expiratory pressure significantly (p < 0.01) correlated to handgrip strength. No correlation was obtained with muscle mass in any of parameters related to reduced respiratory muscle strength. The most significant associations within the blood biochemical parameters were observed for some protein and lipid biomarkers e.g., glutamate-oxaloacetate transaminase (GOT), urea, triglycerides and cholesterol. Respiratory function muscle parameters, peak expiratory flow and maximal respiratory pressures were correlated with reduced strength and functional impairment but not with lean mass content. We identified for the first time a relationship between peak expiratory flow (PEF) values and GOT and urea concentrations in blood which deserves future investigations in order to manage these parameters as a possible biomarkers of reduced respiratory muscle strength.

Self-rated health and associated factors in elderly patients with non-Hodgkin lymphoma

BACKGROUND

Self-rated health is a useful indicator for understanding health issues in elderly populations and considered to be a predictor of adverse health outcomes in this group. This study aims to identify factors associated with self-rated health in elderly people with non-Hodgkin's lymphoma.

METHODS

Cross-sectional study performed at a cancer referral hospital in Rio de Janeiro, Brazil, included 162 patients, aged 60 or more years. All patients received a Multidimensional Geriatric Assessment, including seven health dimensions, and socio-demographic, epidemiological and it were collected clinical data. Descriptive analyses were performed and prevalence ratios were calculated to assess associations between self-rated health and the independent variables. Multivariate analysis was performed using Poisson's regression, to a ≤0.05 level of statistical significance.

RESULTS

The study population mean age was 68.8 (SD=7.1) years; most were women, lived with a partner and had little education. Prevalence of fair/poor self-rated health was 33.6%. Being female, not living with a partner, functional dependence, depressive symptoms and nutritional risk/malnutrion showed associations with fair/poor self-rated health. In the multiple model, dependence in instrumental activities of daily living (PR 2.96; 95%CI 1.66-5.30) and presence of depressive symptoms (PR 1.78; 95%CI 1.15-2.75) remained associated with fair/poor health.

CONCLUSION

Variation in perceived health status supports the hypothesis that self-rated health is related to multiple issues, regardless of disease status. The risk profile for poor self-rated health identified may be a useful tool in care for older cancer patients, as it points to those at higher risk of adverse health outcomes.