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Li N, Zheng HY, He WQ, He XY, Li R, Cui WB, Yang WL, Dong XQ, Shen ZQ, Zheng YT. Treatment outcomes amongst older people with HIV infection receiving antiretroviral therapy. AIDS 2024; 38:803-812. [PMID: 38578958 PMCID: PMC10994140 DOI: 10.1097/qad.0000000000003831] [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: 09/06/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES There is conflicting data regarding the response of older people with HIV (PWH) to antiretroviral therapy (ART). The objective of this study was to evaluate the long-term immunological and virological responses, changes in regimen, and adverse drug reactions (ADRs) in older participants (50+ years) compared with younger (18-34 years) and middle-aged (35-49 years) PWH. METHODS A retrospective review of medical records was conducted on 1622 participants who received ART in Yunnan Province, China, from 2010 to 2019. The study compared CD4+ T-cell counts, CD4+/CD8+ ratio, and relative numbers between different groups using the Kruskal-Wallis test. Cox proportional hazards regression models were used to identify variables associated with the occurrence of immune reconstitution insufficiency. The rates of immune reconstitution, incidence of ADRs, and rates of treatment change were analyzed using the chi-squared test or Fisher's exact test. RESULTS Over 95% achieved viral load 200 copies/ml or less, with no age-related difference. However, older participants exhibited significantly lower CD4+ T-cell counts and CD4+/CD8+ recovery post-ART (P < 0.001), with only 32.21% achieving immune reconstitution (compared with young: 52.16%, middle-aged: 39.29%, P < 0.001) at the end of follow-up. Middle-aged and elderly participants changed ART regimens more because of ADRs, especially bone marrow suppression and renal dysfunction. CONCLUSION Although the virological response was consistent across age groups, older individuals showed poorer immune responses and higher susceptibility to side effects. This underscores the need for tailored interventions and comprehensive management for older patients with HIV.
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Affiliation(s)
- Na Li
- School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming
- State Key Laboratory of Genetic Evolution & Animal Models, Key Laboratory of Bioactive Peptides of Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan
- Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Hong-Yi Zheng
- State Key Laboratory of Genetic Evolution & Animal Models, Key Laboratory of Bioactive Peptides of Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan
| | - Wen-Qiang He
- State Key Laboratory of Genetic Evolution & Animal Models, Key Laboratory of Bioactive Peptides of Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan
| | - Xiao-Yan He
- State Key Laboratory of Genetic Evolution & Animal Models, Key Laboratory of Bioactive Peptides of Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan
| | - Rui Li
- State Key Laboratory of Genetic Evolution & Animal Models, Key Laboratory of Bioactive Peptides of Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan
| | - Wen-Bo Cui
- Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Wei-Lin Yang
- Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Xing-Qi Dong
- Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Zhi-Qiang Shen
- School of Pharmaceutical Sciences and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming
| | - Yong-Tang Zheng
- State Key Laboratory of Genetic Evolution & Animal Models, Key Laboratory of Bioactive Peptides of Yunnan Province, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan
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2
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Rong C, Yang F, Chen Y, Wang M, Ai C, Luo Y, Gao P, Weng Y, Huang X, Gu M, Huang W, Xia Y. Low‑dose venetoclax combined with azacitidine in older and frail patients with newly diagnosed acute myeloid leukaemia. Oncol Lett 2024; 27:228. [PMID: 38586209 PMCID: PMC10996028 DOI: 10.3892/ol.2024.14362] [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: 10/31/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
In the present study, the aim was to evaluate the clinical efficacy and safety of low-dose venetoclax combined with azacitidine for the treatment of older and frail patients with newly diagnosed acute myeloid leukaemia (AML). Data of 26 older patients with newly diagnosed AML admitted to Yuyao People's Hospital (Yuyao, China) between January 2021 and May 2023 were retrospectively analysed. The treatment regimens were as follows: Subcutaneous injection of 100 mg azacitidine on days 1-5 and 100 mg oral venetoclax on days 3-16 or 200 mg oral venetoclax on days 3-30. The median age of the 26 patients was 73 years. After the first course of treatment, the complete remission (CR) and CR with incomplete haematological recovery rate was 84.6%, and the objective response rate was 96.2%. The most common adverse events noted during treatment were haematological adverse events including grade 3/4 granulocytosis (57.7%), febrile neutropenia (30.8%), pulmonary infection (32.0%), thrombocytopenia (42.3%) and anaemia (42.3%). A total of 13 (50.0%) patients did not require platelet (PLT) infusion during treatment. The main non-haematological adverse reactions included gastrointestinal reactions such as nausea, vomiting and diarrhoea. Patients were followed up until December 2023, with a median follow-up time of 9.5 months (range, 1.9-26.0 months). Of the 26 patients, nine (34.6%) patients experienced relapse, with a mean recurrence time of 5.9 months. In conclusion, preliminary results indicated that low-dose venetoclax combined with azacitidine is effective and safe for the treatment of older and frail patients with newly diagnosed AML, providing a new treatment option for these patients.
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Affiliation(s)
- Chunmeng Rong
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Fang Yang
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Yalu Chen
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Ming Wang
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Cheng Ai
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Yuqing Luo
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Panpan Gao
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Yiqin Weng
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Xiaguang Huang
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Meier Gu
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Weiping Huang
- Clinical Laboratory Department, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
| | - Yongming Xia
- Department of Hematopathology, Yuyao People's Hospital, Yuyao, Zhejiang 315400, P.R. China
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Tucci A, Masina L, Luminari S. Curative intent therapy for DLBCL in the elderly. Leuk Lymphoma 2024; 65:560-569. [PMID: 38206922 DOI: 10.1080/10428194.2024.2302323] [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: 09/14/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
Older patients with aggressive lymphoma are extremely heterogeneous due to the high frequency of functional limitations and comorbidities and to the different biological profiles and clinical behavior of the disease. The stratification in three geriatric categories (fit-unfit-frail) based on multidimensional geriatric assessment (GA) helps physicians tailor a potentially curative treatment.While an intensive approach with the standard R-CHOP regimen is feasible in fit patients, leading to similar long-term response and survival rates compared to younger ones, in unfit patients a balance between treatment toxicity and curative intent can be obtained through the reduction of dose intensity. Frail patients, treated with best supportive care so far, could benefit from a chemo-free approach with new target drugs. These novel agents, either alone or in combination with chemo-immunotherapy, are changing the therapeutic landscape of older patients with aggressive lymphoma, both in first-line therapy and in the setting of the relapsed/refractory disease.
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Affiliation(s)
| | | | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
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4
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Stempel JM, Shallis RM, Wong R, Podoltsev NA. Challenges in management of older patients with chronic myeloid leukemia. Leuk Lymphoma 2024:1-14. [PMID: 38652861 DOI: 10.1080/10428194.2024.2342559] [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: 02/01/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have significantly improved the survival of patients with chronic myeloid leukemia (CML), however, older patients are often underrepresented in pivotal trials. Approximately 20% of older adults never start treatment and face significant barriers to accomplish favorable outcomes. The treatment goal is to improve survival, prevent progression, and preserve quality of life. This is achieved through optimizing TKI doses and employing discontinuation strategies to attain treatment-free remission (TFR), a goal increasingly pursued by older patients. Imatinib may be favored as the front-line option for older individuals due to its side effect profile and cost. Bosutinib's favorable cardiovascular tolerability makes it a suitable second-line agent, but lower-dose dasatinib may likewise be an attractive option. The prevalence of comorbidities can preclude the use of second generation TKIs in some older patients. Optimal care for older patients with CML centers on personalized treatment, close monitoring, and proactive support.
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Affiliation(s)
- Jessica M Stempel
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
| | - Rong Wong
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA
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Legoux JL, Faroux R, Barrière N, Le Malicot K, Tougeron D, Lorgis V, Guerin-Meyer V, Bourgeois V, Malka D, Aparicio T, Baconnier M, Lebrun-Ly V, Egreteau J, Khemissa Akouz F, Terme M, Lepage C, Boige V. First-Line LV5FU2 with or without Aflibercept in Patients with Non-Resectable Metastatic Colorectal Cancer: A Randomized Phase II Trial (PRODIGE 25-FFCD-FOLFA). Cancers (Basel) 2024; 16:1515. [PMID: 38672597 PMCID: PMC11049283 DOI: 10.3390/cancers16081515] [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: 03/27/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Fluropyrimidine monotherapy is an option for some patients with inoperable metastatic colorectal cancer. Unlike bevacizumab, the addition of aflibercept, an antibody acting as an anti-angiogenic agent, has never been evaluated in this context. The aim of the study was to determine whether aflibercept could increase the efficacy of fluoropyrimidine monotherapy without increasing toxicity. This multicenter phase II non-comparative trial evaluated the addition of aflibercept to infusional 5-fluorouracil/folinic acid (LV5FU2 regimen) as first-line treatment in patients unfit to receive doublet cytotoxic chemotherapy. The primary endpoint was 6-month progression-free survival (PFS). The clinical hypotheses expected a PFS rate at 6 months of over 40% (60% expected). A total of 117 patients, with a median age of 81 years, were included: 59 in arm A (LV5FU2-aflibercept) and 58 in arm B (LV5FU2 alone). Six-month PFS was 54.7% in both arms (90% CI 42.5-66.5 in both). Median overall survival was 21.8 months (arm A) and 25.1 months (arm B). Overall toxicity was more common in arm A: grade ≥ 3 toxicity in 82% versus 58.2%. Given the 6-month PFS, the study can be considered positive. However, the toxicity of aflibercept in this population was high, and continuation of the trial into phase III is not envisaged.
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Affiliation(s)
- Jean-Louis Legoux
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU d’Orléans, 14 avenue de l’Hôpital, CS 86709, 45067 Orleans CEDEX 2, France
| | - Roger Faroux
- Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Les Oudairies, Boulevard Stéphane Moreau, 85925 La Roche sur Yon, France;
| | - Nicolas Barrière
- Department of Hepato-Gastroenterology and Digestive Oncology, Hôpital Européen, 6 Rue Désirée Clary, CS 70356, 13331 Marseille CEDEX 03, France;
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive (FFCD), EPICAD INSERM LNC-UMR 1231, Faculté de Médecine, University of Burgundy and Franche Comté, 7, Boulevard Jeanne d’Arc, 21079 Dijon, France;
| | - David Tougeron
- Department of Hepato-Gastroenterology, CHU de Poitiers, 2 Rue de la Miletrie, BP 577, 86021 Poitiers, France;
| | - Véronique Lorgis
- Department of Medical Oncology, Institut de Cancérologie de Bourgogne, GRReCC, 18 Cours Général de Gaulle, 21000 Dijon, France;
| | - Véronique Guerin-Meyer
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Boulevard Jacques Monod, 44805 Saint Herblain, France;
| | - Vincent Bourgeois
- Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Duchenne, Allée Jacques Monod-BP 609, 62321 Boulogne Sur Mer, France;
| | - David Malka
- Department of Cancer Medicine, Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif CEDEX, France; (D.M.); (V.B.)
| | - Thomas Aparicio
- Department of Gastroenterology, Saint Louis Hospital, APHP, Université Paris Cité, Paris, 1 Avenue Claude Vellefaux, 75475 Paris, France;
| | - Matthieu Baconnier
- Department of Gastroenterology, Centre Hospitalier Annecy-Genevois, 1 Avenue de l’Hôpital, 74374 Pringy, France;
| | - Valérie Lebrun-Ly
- Department of Medical Oncology, CHU Dupuytren, 2 Avenue Martin Luther King, 87042 Limoges, France;
| | - Joëlle Egreteau
- Radiotherapy and Medical Oncology, Groupe Hospitalier Bretagne Sud, 5 Avenue de Choiseul, BP 12233, 56322 Lorient CEDEX, France;
| | - Faïza Khemissa Akouz
- Department of Hepato-Gastroenterology and Digestive Oncology, Saint Jean Hospital, 20 Avenue du Languedoc, BP 49954, 66046 Perpignan CEDEX 9, France;
| | - Magali Terme
- INSERM U970—PARCC (Paris Cardiovascular Research Center), European Georges Pompidou Hospital, Université Paris Descartes, Sorbonne Paris Cité, 56 rue Leblanc, 75015 Paris, France;
| | - Côme Lepage
- INSERM U866, Université de Bourgogne, 7 Boulevard Jeanne d’Arc, BP 27877, 21078 Dijon CEDEX, France;
| | - Valérie Boige
- Department of Cancer Medicine, Gustave Roussy, 114 rue Edouard Vaillant, 94805 Villejuif CEDEX, France; (D.M.); (V.B.)
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Kashiwazaki D, Hori E, Akioka N, Maruyama K, Yamamoto S, Kuwayama N, Noguchi K, Kuroda S. Clinical Significance of Carotid Endarterectomy and Carotid Artery Stenting in Older Patients Over 80. Neurol Med Chir (Tokyo) 2024; 64:147-153. [PMID: 38403718 DOI: 10.2176/jns-nmc.2023-0245] [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] [Indexed: 02/27/2024] Open
Abstract
As the average life expectancy increases, neurosurgeons are likely to encounter patients aged 80 years and above with carotid stenosis; however, whether old age affects clinical post-treatment outcomes of carotid endarterectomy (CEA) or carotid artery stenting (CAS) remains inconclusive. Thus, this study aimed to evaluate the outcomes following CEA or CAS in patients aged 80 years and above. This study included older over 80 years (n = 34) and younger patients (<80 years; n = 222) who underwent CEA or CAS between 2012 and 2022. All of them were followed up for a mean of 55 months. All-cause mortality, the incidence of vascular events, ability to perform daily activities, and nursing home admission rates were assessed. During follow-up periods, 34 patients (13.3%) died due to coronary artery disease, malignancy, and pneumonia, and the incidence was significantly higher in the elderly group than in the younger group (P = 0.03; HR, 3.01; 95% CI, 1.53-5.56). The incidence of vascular events did not differ between the older group (29.5%) and the younger group (26.9%, P = 0.58); however, the incidence was significantly higher in patients with high-intensity plaques than in those without that (P = 0.008; HR, 2.83, 95%CI, 1.27-4.87). The decline in the ability to perform daily activities and increased nursing home admission rates were high in elderly patients (P < 0.01). Although the mortality rate was higher in the elderly group, subsequent vascular events were comparable to that in the younger group. The results suggest that CEA and CAS are safe and useful treatments for carotid stenosis in older patients, especially to prevent ipsilateral ischemic stroke.
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Affiliation(s)
- Daina Kashiwazaki
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Emiko Hori
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Naoki Akioka
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Kunitaka Maruyama
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Shusuke Yamamoto
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Naoya Kuwayama
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Kyo Noguchi
- Departments of Radiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Satoshi Kuroda
- Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
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Tsuji T, Yamasaki K, Kondo K, Hongu N, Matsumoto Y, Fukuo K, Habu D. Association between being at-risk of malnutrition and discontinued home medical care among older patients: a 1-year follow-up study. J Hum Nutr Diet 2024; 37:574-582. [PMID: 38229274 DOI: 10.1111/jhn.13281] [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: 08/18/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. METHODS Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. RESULTS In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished). CONCLUSIONS At-risk of malnutrition was associated with discontinuation of home medical care among older patients.
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Affiliation(s)
- Taeko Tsuji
- Department of Health and Nutrition, Faculty of Human Science, Osaka Aoyama University, Minoh, Japan
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Nishinomiya, Japan
| | - Kyoko Kondo
- Research Support Platform, Osaka Metropolitan University Graduate School of Medicine, Osaka-shi, Japan
| | - Nobuko Hongu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Yoshinari Matsumoto
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
| | - Keisuke Fukuo
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Japan
| | - Daiki Habu
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Osaka-shi, Japan
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Suryapranata APSP, Keijsers CJPW, Kurstjens S, Van Strien AM. Discrepancies in corrected calcium versus ionised calcium in a geriatric population: an observational study. Age Ageing 2024; 53:afae072. [PMID: 38610061 DOI: 10.1093/ageing/afae072] [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: 11/14/2023] [Revised: 02/10/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Calcium can be measured as ionised (Ca-ionised) or albumin-adjusted total calcium (Ca-albumin). Current clinical guidelines predominantly utilise Ca-albumin, despite Ca-ionised being the gold standard. Discrepancies can occur between these measurement modalities and can lead to clinical dilemmas. It remains unclear how large these discrepancies are in older patients. This study investigated the discrepancies between Ca-ionised and Ca-albumin in geriatric patients. METHODS This is an observational study of all geriatric patients (n = 876) in the Jeroen Bosch Hospital (January 2018 and January 2021) in whom both Ca-ionised and Ca-albumin were measured. Misclassification of calcaemic state (i.e. low, normal or high) was calculated (percentages), the measure of agreement was described using Cohen's Kappa and for the continuous data Pearson's correlation coefficient was used. Relevant categories of age and renal function were considered for effect modification effects and studied by interaction terms in a regression model. RESULTS In one-third of the measurements, there was a misclassification. Ca-albumin measurements failed to identify 28% of hypocalcaemia. In 3.5%, hypercalcemia based on Ca-albumin was not confirmed by Ca-ionised. The correlation coefficient between Ca-ionised and Ca-albumin was 0.743 (P = 0.01) and measure of agreement by Kappa was 0.213 (P < 0.001). In the oldest old (≥ 85 years) and patients with eGFR <30 ml/min/1.73 m2 ,the agreement by Kappa was lower, with values of 0.192 and 0.104, respectively. CONCLUSION There is a discrepancy between Ca-albumin and Ca-ionised in one-third of the geriatric patients, leading to clinical dilemmas. In the oldest old and patients with renal dysfunction, this problem is most pronounced.
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Affiliation(s)
| | | | - Steef Kurstjens
- Laboratory of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, s-Hertogenbosch, the Netherlands
| | - Astrid M Van Strien
- Department of Geriatric Medicine, Jeroen Bosch Hospital, s- Hertogenbosch, the Netherlands
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9
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Martín-Martínez A, Viñas P, Carrillo I, Martos J, Clavé P, Ortega O. The Impact of Frailty, Oropharyngeal Dysphagia and Malnutrition on Mortality in Older Patients Hospitalized for Covid-19. Aging Dis 2024; 15:927-938. [PMID: 37548930 PMCID: PMC10917529 DOI: 10.14336/ad.2023.0425-2] [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: 02/24/2023] [Accepted: 04/25/2023] [Indexed: 08/08/2023] Open
Abstract
COVID-19 hospital mortality is higher among older patients through as yet little-known factors. We aimed to assess the effect of frailty (FR), oropharyngeal dysphagia (OD) and malnutrition (MN) on mortality in hospitalized COVID-19 older patients. Prospective cohort study of older patients (>70 years) with COVID-19 admitted to a general hospital from April 2020 to January 2021. Patients were evaluated on admission, discharge and at 1- and 3-months follow up. FR was assessed with FRAIL-VIG, OD with Volume-Viscosity Swallowing Test and MN with GLIM criteria. Clinical characteristics and outcomes, including intra-hospital, 1- and 3-month mortality, were analyzed. 258 patients were included (82.5±7.6 years; 58.9% women); 66.7% had FR (mild 28.7%, moderate 27.1% and severe 10.9%); 65.4%, OD and 50.6%, MN. OD prevalence increased from non-FR patients through the severity levels of FR: mild, moderate and severe (29.8%, 71.6%, 90.0%, 96.2%; p<0.0001, respectively), but not that of MN (50.6%, 47.1%, 52.5%, 56.0%). Mortality over the whole study significantly increased across FR categories (9.3% non-FR; 23.0% mild; 35.7% moderate; 75.0% severe; p<.001). Functionality (Barthel pre-admission, HR=0.983, CI-95%:0.973-0.993; p=0.001), OD (HR=2.953, CI-95%:0.970-8.989; p=0.057) and MN (HR=4.279, CI-95%:1.658-11.049; p=0.003) were independent risk factors for intra-hospital mortality. FR, OD and MN are highly prevalent conditions in older patients hospitalized with COVID-19. Functionality, OD and MN were independent risk factors for intra-hospital mortality.
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Affiliation(s)
- Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
| | - Irene Carrillo
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Josep Martos
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
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10
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Holmberg B, Svensson A, Helge A, Bremer A. Self-determination in older patients: Experiences from nurse-dominated ambulance services. J Adv Nurs 2024. [PMID: 38523337 DOI: 10.1111/jan.16152] [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: 08/21/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
AIM To describe ambulance clinicians' experiences of self-determination in older patients. DESIGN The study had an inductive and explorative design, guided from a life-world perspective. METHODS Thirty-two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes. FINDINGS The ambulance clinicians assessed the older patients' exercise of self-determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision-making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision-makers. CONCLUSION Expectations that older patients with impaired decision-making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision-making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role. IMPLICATIONS AND IMPACT The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision-making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes. REPORTING METHOD This study adhered to COREQ guidelines. PATIENT AND PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Bodil Holmberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Anders Svensson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Adam Helge
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Anders Bremer
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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11
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Murakami N, Kabayama M, Yano T, Nakamura C, Fukata Y, Morioka C, Fang W, Nako Y, Omichi Y, Koujiya E, Godai K, Kido M, Tseng W, Wada T, Nakamura T, Hirotani A, Fukuda T, Tamatani M, Okuda Y, Ikushima M, Baba Y, Nagano M, Nakamura Y, Rakugi H, Kamide K. Actual conditions for returning home after hospitalization among older patients receiving home medical care in Japan: OHCARE Study. Geriatr Gerontol Int 2024; 24 Suppl 1:320-326. [PMID: 38267253 DOI: 10.1111/ggi.14802] [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: 08/26/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
AIM To examine the actual conditions of older patients receiving home medical care after hospitalization over a period of 2 years in Japan. METHODS The study population included 102 participants, aged ≥65 years, receiving home medical care, who consented to participate in the Osaka Home Care Registry (OHCARE) study in Japan over a period of 2 years. We investigated the actual conditions for returning home after hospitalization. RESULTS The median age of the 102 participants was 84 years, and 61 (59.8%) were women. In the group that returned home, 42 (55.3%) of the respondents desired to recuperate in a familiar place, as in advanced care planning (ACP). During the 2-year follow-up period, the group that did not return home had significantly more deaths. A multivariate analysis showed the association in the presence of ACP (odds ratio: 4.72, 95% confidence interval: 1.60-13.86) and cardiac disease (odds ratio: 0.25, 95% confidence interval: 0.08-0.76). The lack of ACP in the medical records when the patient was admitted to the hospital may have prevented the return home. CONCLUSION In older patients who had difficulty returning home after hospitalization, the lack of ACP in home medical care may have been an influencing factor. ACP could help continue with home medical care. Geriatr Gerontol Int 2024; 24: 320-326.
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Affiliation(s)
- Naoko Murakami
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Mai Kabayama
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Tomoko Yano
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Chika Nakamura
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yuka Fukata
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Chihiro Morioka
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Wen Fang
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yumiko Nako
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Yuki Omichi
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Eriko Koujiya
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Kayo Godai
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Michiko Kido
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Winston Tseng
- School of Public Health, University of California, Berkeley, California, USA
| | - Taizo Wada
- Osaka Home Medical Care Clinic, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
- Japan Organization of Occupational Health and Safety, Osaka Rosai Hospital, Osaka, Japan
| | - Kei Kamide
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
- Department of Geriatric and General Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan
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12
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Gong Y, Liu Q, Hu Q. Leading Causes of In-Hospital Death of Older Patients of Different Age Groups in Shanghai. Risk Manag Healthc Policy 2024; 17:435-453. [PMID: 38449512 PMCID: PMC10914961 DOI: 10.2147/rmhp.s450864] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Background Despite great achievements in clinical medicine, the in-hospital mortality of older patients remains high. How to reduce the in-hospital mortality of older inpatients is of great clinical value in clinical practice. This study is to analyze the leading causes of in-hospital death of older inpatients of different ages in Shanghai. Methods An observational study was conducted in Shanghai. A total of 3894 older inpatients (≥60 years old) were investigated. According to the age stratification standard of World Health Organization, they were divided into young older patients group (aged 60 to 74), old older patients group (aged 75 to 89) and very old patients group (aged ≥90). Diseases of in-hospital death of older inpatients in different age groups were classified according to the 10th edition of the International Classification of Diseases. Constituent ratio of causes of in-hospital death in each group was analyzed. Results The constituent ratio of pulmonary infection had the highest rate of in-hospital death in older patients. The constituent ratio of lung malignant tumors had the highest rate of in-hospital death in young older patients. The constituent ratio of pulmonary infection had the highest rate of in-hospital death in old older patients. The constituent ratio of pulmonary infection had the highest rate of in-hospital death in very old patients. Conclusion The leading cause of in-hospital death of young older patients group was lung malignant tumor. The leading cause of in-hospital death of old older patients group and very older patients group was pulmonary infection. Great importance should be attached to the prevention of lung tumor and lung infection in the elderly. Results of this study will provide a basis for health administrative departments to formulate corresponding health-care policies for older patients.
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Affiliation(s)
- Yu Gong
- Department of Internal Medicine, Division of Nephrology, Telemedicine Center, Shanghai Municipal Eighth People’s Hospital, Shanghai, People’s Republic of China
| | - Qianxia Liu
- Department of Medical Affairs Management, Division of Medical Record Management, Shanghai Municipal Eighth People’s Hospital, Shanghai, People’s Republic of China
| | - Qiang Hu
- Department of Surgery, Shanghai Municipal Eighth People’s Hospital, Shanghai, People’s Republic of China
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13
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Collerais BM, Studer T, Gaboreau Y. [Care of patients in nursing homes, what stumbling blocks and stepping for general practitioners? A qualitative study]. Geriatr Psychol Neuropsychiatr Vieil 2024; 22:58-68. [PMID: 38573145 DOI: 10.1684/pnv.2024.1151] [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] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Due to increased dependency and health needs, the follow-up of the patients in nursing home (NH) by general practitioners (GP) is difficult, in a context of an aging population and declining medical density. This study sought to describe facilitating or limiting factors faced by GP in Drôme, Isère and Savoy in their NH patients' follow-up and to collect suggestions for improvement. A qualitative study, with phenomenological analysis, was identified factors linked to patients (complexity, specific needs, Doctor-patient relationship affected, ethical considerations), to physicians (to conjugate his office activity with visits and emergencies) and to NH (cooperation with information sharing amongst professional microcosm, their representations by GP). The Covid pandemic revived questions about the meaning of care but revealed adaptive work reveals the challenges GP face at NH, as well as prospects for improvment.
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Affiliation(s)
| | - Tommy Studer
- Département de médecine générale, Université Grenoble Alpes, Grenoble, France
| | - Yoann Gaboreau
- Département de médecine générale, Université Grenoble Alpes, Grenoble, France, Maison de santé pluri-professionnelle, Les marches, Porte-de-Savoie, France
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14
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Gareri P, Gallelli L, Gareri I, Rania V, Palleria C, De Sarro G. Deprescribing in Older Poly-Treated Patients Affected with Dementia. Geriatrics (Basel) 2024; 9:28. [PMID: 38525745 PMCID: PMC10961769 DOI: 10.3390/geriatrics9020028] [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: 01/14/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs'. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out in a Center for Dementia in collaboration with a university center. The primary outcomes were: (1) deprescribing inappropriate drugs through the Beers and STOPP&START criteria; (2) assessing duplicate drugs and the risk of iatrogenic damage due to drug-drug and drug-disease interactions. Overall, 69 men and 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 patients were home care patients and 114 were outpatient. The average number of the drugs used in the sample was 9.4 drugs per patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs per patient (p = 0.04). Overall, 74 potentially inappropriate drugs were used (36.1%). Of these, long half-life benzodiazepines (8.8%), non-steroidal anti-inflammatory drugs (3.4%), tricyclic antidepressants (3.4%), first-generation antihistamines (1.4%), anticholinergics (11.7%), antiplatelet drugs (i.e., ticlopidine) (1.4%), prokinetics in chronic use (1.4%), digoxin (>0.125 mg/day) (1.4%), antiarrhythmics (i.e., amiodarone) (0.97%), and α-blockers (1.9%) were included. The so-called "duplicate" drugs were overall 26 (12.7%). In total, ten potentially dangerous prescriptions were found for possible interactions (4.8%). We underline the importance of checking all the drugs taken periodically and discontinuing drugs with the lowest benefit-to-harm ratio and the lowest probability of adverse reactions due to withdrawal. Computer tools and adequately trained teams (doctors, nurses, and pharmacists) could identify, treat, and prevent possible drug interactions.
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Affiliation(s)
- Pietro Gareri
- Department of Frailty, Center for Cognitive Disorders and Dementia (CDCD) Catanzaro Lido—ASP Catanzaro, Magna Graecia University, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Ilaria Gareri
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
| | - Vincenzo Rania
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
| | - Caterina Palleria
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
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15
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Castañeda S, Navarro Ceballos C, Usón Jaeger J, de Miguel Benadiba C, Gómez Martín E, Martínez Díaz-Guerra G, Alvarez-Galovich L. Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts. Geriatrics (Basel) 2024; 9:24. [PMID: 38525741 PMCID: PMC10961758 DOI: 10.3390/geriatrics9020024] [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: 11/01/2023] [Revised: 01/15/2024] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Vertebral fragility fractures (VFF) pose a challenge for appropriate care. The aim of this study was to develop consensus recommendations for the management of VFF in older people from a multidisciplinary approach. Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was defined as 80% of responses of 8 (agree) and 9 (strongly agree) on a Likert scale. Consensus was achieved in 22 recommendations (62.8%). The experts agreed on the need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®), did not achieve an agreed consensus. Also, there was consensus regarding the administration of calcium/vitamin D supplements, the withdrawal of toxic habits, and personalized physical exercise. Participants agreed on the administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. Although there was multidisciplinary agreement on diagnostic tests and non-pharmacological and pharmacological treatment in frail older people, therapeutic objectives should be individualized for every patient. In addition to the specific recommendations, close collaboration between the geriatrician and the primary care physician is essential for the optimal chronic management of frail patients with fragility fractures.
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Affiliation(s)
- Santos Castañeda
- Rheumatology Service, Hospital Universitario La Princesa, IIS-Princesa, 28006 Madrid, Spain
- Cátedra UAM-Roche, EPID-Future, Department of Medicine, Autonomous University of Madrid (UAM), 28049 Madrid, Spain
| | | | - Jaqueline Usón Jaeger
- Rheumatology Service, Hospital General Universitario de Móstoles, Móstoles, 28935 Madrid, Spain;
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Schröder S, Westhoff MS, Pfister T, Seifert J, Bleich S, Koop F, Proskynitopoulos PJ, Glahn A, Heck J. Drug safety in older patients with alcohol use disorder: a retrospective cohort study. Ther Adv Psychopharmacol 2024; 14:20451253241232563. [PMID: 38384595 PMCID: PMC10880528 DOI: 10.1177/20451253241232563] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/07/2024] [Indexed: 02/23/2024] Open
Abstract
Background Older patients with alcohol use disorder are at particular risk of developing adverse drug reactions due to multimorbidity, polypharmacy, and altered organ function. Objectives In this study, we investigated the frequency and characteristics of potentially serious alcohol-medication interactions, potentially inappropriate medications (PIMs) for older adults, and potential drug-drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period. Design Retrospective monocentric cohort study. Methods Prescribed medications were screened for potentially serious alcohol-medication interactions, PIMs, and pDDIs using the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria, the PRISCUS 2.0 list, the FORTA (Fit fOR The Aged) classification, and the drug interaction program AiDKlinik®. Results We enrolled 114 patients aged ⩾65 years with alcohol use disorder, who were treated in an addiction unit of a university hospital in Germany. About 80.7% of the study population had at least one potentially serious alcohol-medication interaction. Potentially serious alcohol-medication interactions most commonly affected the cardiovascular (57.7%) and the central nervous system (32.3%). A total of 71.1% of the study population received at least one prescription of a FORTA C or D drug, compared with 42.1% who received at least one PIM prescription according to the PRISCUS 2.0 list. A total of 113 moderate and 72 severe pDDIs were identified in the study population. Conclusion Older patients with alcohol use disorders are frequently exposed to potentially serious alcohol-medication interactions, PIMs, and pDDIs. Improvements in the quality of prescribing should primarily target the use of cardiovascular and psychotropic drugs.
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Affiliation(s)
- Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tabea Pfister
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Felix Koop
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Alexander Glahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
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Dusonchet A, Varenne O, Puscas T, Saadi M, Hagege A, Calvet D, Mas J, Turc G. Does Atrial Septal Anatomy Still Matter in the Etiological Evaluation of Ischemic Stroke Beyond the Age of 60? J Am Heart Assoc 2024; 13:e031684. [PMID: 38353217 PMCID: PMC11010114 DOI: 10.1161/jaha.123.031684] [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: 07/11/2023] [Accepted: 11/14/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Patent foramen ovale (PFO) is causally associated with stroke in some patients younger than 60 years, especially when it is large or associated with an atrial septal aneurysm (ASA). After 60 years of age, this association is less well understood. We assessed the relationships between detailed atrial septal anatomy and the cryptogenic nature of stroke in this population. METHODS AND RESULTS We reviewed all patients aged 60 to 80 years admitted to our stroke center for ischemic stroke who underwent contrast echocardiography between 2016 and 2021. The atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) classification was used to reevaluate the etiological workup. Associations between cryptogenic stroke and (1) PFO presence or (2) categories of PFO anatomy (nonlarge PFO without ASA, nonlarge PFO with ASA, large PFO without ASA, and large PFO with ASA) were assessed using logistic regression. Among 533 patients (median National Institutes of Health Stroke Scale score=1), PFO was present in 152 (prevalence, 28.5% [95% CI, 24.9-32.5]). Compared with noncryptogenic stroke, cryptogenic stroke (n=218) was associated with PFO presence (44.5% versus 17.5%; P<0.0001). Among patients with a PFO, septal anatomy categories were associated with cryptogenic stroke (P=0.02), with a strong association for patients with both large PFO and ASA (38.1% versus 14.5%, P=0.002). CONCLUSIONS PFO presence remains strongly associated with cryptogenic stroke between 60 and 80 years of age. Large PFO, ASA, and their association were strongly associated with cryptogenic stroke in this age group. Our results support performing contrast echocardiography even after 60 years of age, although the optimal secondary prevention therapy in this population remains to be determined in randomized trials.
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Affiliation(s)
- Antoine Dusonchet
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Olivier Varenne
- Department of CardiologyHôpital Cochin, AP‐HP, Université Paris CitéParisFrance
| | - Tania Puscas
- Department of CardiologyHôpital Européen Georges Pompidou, AP‐HP, Université Paris CitéParisFrance
| | - Malika Saadi
- Department of CardiologyHôpital Cochin, AP‐HP, Université Paris CitéParisFrance
| | - Albert Hagege
- Department of CardiologyHôpital Européen Georges Pompidou, AP‐HP, Université Paris CitéParisFrance
| | - David Calvet
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Jean‐Louis Mas
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et NeurosciencesHôpital Sainte‐Anne, Université Paris Cité, INSERM U1266, and FHU NeurovascParisFrance
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18
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van Veelen NM, van de Wall BJM, Hoepelman RJ, IJpma FFA, Link BC, Babst R, Groenwold RHH, van der Velde D, Diwersi N, van Heijl M, Houwert RM, Beeres FJP. Let's Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study. JMIR Res Protoc 2024; 13:e52917. [PMID: 38349719 PMCID: PMC10900084 DOI: 10.2196/52917] [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: 09/27/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. OBJECTIVE This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. METHODS This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. RESULTS Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. CONCLUSIONS Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52917.
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Affiliation(s)
- Nicole Maria van Veelen
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Ruben J Hoepelman
- Department of Trauma Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, Universitair Medisch Centrum Groningen, Groningen, Netherlands
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Universitair Medisch Centrum Leiden, Leiden, Netherlands
| | | | - Nadine Diwersi
- Department of General and Trauma Surgery, Kantonsspital Obwalden, Sarnen, Switzerland
| | - Mark van Heijl
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, Netherlands
| | - R Marijn Houwert
- Department of Trauma Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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19
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Yamamoto Y, Tanaka S, Matsuura K, Yamamoto S, Urano K, Okita J, Kato E, Odagiri T, Deguchi Y. Effectiveness of opioid switching for dyspnea and its predictors in cancer patients: a single-center retrospective observational study. Jpn J Clin Oncol 2024:hyae008. [PMID: 38323655 DOI: 10.1093/jjco/hyae008] [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: 11/16/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Morphine is the most used opioid for dyspnea, but other opioids such as oxycodone and fentanyl are increasingly used, and opioid switching to these is sometimes undertaken. No studies have verified the effectiveness of opioid switching for relief of dyspnea. We retrospectively investigated the effectiveness of opioid switching for dyspnea and its predictors. METHODS All patients with opioid switching for dyspnea during hospitalization at Komaki City Hospital from January 2019 to August 2022 were included. Opioid switching was defined as a change to another opioid, and the assessment period for evaluating the effectiveness and adverse events of opioid switching was set as 1 week. Patients with Numeric Rating Scale or Japanese version of the Support Team Assessment Schedule reduction for dyspnea of at least 1, or with clear improvement based on medical records, were considered valid. Mitigating factors for dyspnea were identified using logistic regression analysis. RESULTS Of the 976 patients with opioid switching, 57 patients had opioid switching for relief of dyspnea. Of these, opioid switching was effective in 21 patients (36.8%). In a multivariate analysis, older patients (odds ratio: 5.52, 95% CI: 1.50-20.20, P < 0.01), short prognosis for post-opioid switching (odds ratio: 0.20, 95% CI: 0.04-0.87, P = 0.03) and cachexia (odds ratio: 0.12, 95% CI: 0.02-0.64, P < 0.01) were significantly associated with opioid switching effects for dyspnea. There were no serious adverse events after opioid switching. CONCLUSION This study indicates that opioid switching for dyspnea may have some effect. Furthermore, opioid switching for dyspnea may be more effective in older patients and less effective in terminally ill patients or in those with cachexia.
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Affiliation(s)
| | - Shion Tanaka
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Katsuhiko Matsuura
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Seiji Yamamoto
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Kimihiko Urano
- Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan
| | - Junya Okita
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Eisuke Kato
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
- Department of Palliative Care, Seino Kosei Hospital, Gifu Seino Medical Center, Gifu, Japan
| | - Yuko Deguchi
- Departments of Pharmacy, Komaki City Hospital, Komaki, Aichi, Japan
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20
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Kishioka A, Ochiai Y, Kikuchi D, Hoteya S. Symptomatic epiphrenic diverticulum in an older patient successfully treated nonsurgically. Intern Med 2024:2774-23. [PMID: 38311429 DOI: 10.2169/internalmedicine.2774-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Epiphrenic diverticulum is a rare condition commonly diagnosed in middle-aged adults. Symptoms include dysphagia and regurgitation, which are associated with underlying esophageal motility disorders. We herein report a 93-year-old woman with dysphagia diagnosed with symptomatic epiphrenic diverticulum by computed tomography, esophagogastroduodenoscopy, and esophagography. The patient was successfully treated non-surgically without any complications. This case demonstrates that conservative treatment is an option for older high-risk patients.
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Affiliation(s)
- Ayumi Kishioka
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | | | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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21
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Noda T, Kamiya K, Hamazaki N, Yamashita M, Miki T, Nozaki K, Uchida S, Ueno K, Maekawa E, Terada T, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. Screening for sarcopenia with SARC-F in older patients hospitalized with cardiovascular disease. Eur J Cardiovasc Nurs 2024:zvae017. [PMID: 38315615 DOI: 10.1093/eurjcn/zvae017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES SARC-F ≥ 4 points are used for detecting sarcopenia; however, finding a lower SARC-F cut-off value may lead to early detection of sarcopenia. We investigated the SARC-F score with the highest sensitivity and specificity value to identify sarcopenia in older patients with cardiovascular disease (CVD). Motor performances were also examined for each SARC-F score. METHODS This retrospective cross-sectional study examined the sensitivity and specificity of every 1-point increase in SARC-F score to predict sarcopenia. Eligible participants included patients with CVD (≥ 65 years old) who were admitted for acute CVD treatment and participated in cardiac rehabilitation. Patients completed the SARC-F questionnaire and the sarcopenia assessment. Areas under the curves (AUCs) were investigated for the ability to predict sarcopenia. Multivariable linear regression was used to compare the mean value of physical functions (e.g., Walking speed, leg strength, and 6-minute walking distance) of each SARC-F score. RESULTS A total of 1066 participants (63.8% male; median age: 78 years) were included. Sarcopenia was present in 401 patients. SARC-F cut-off ≥ 2 presented the optimal balance between sensitivity (68.3%) and specificity (55.6%) to detect sarcopenia (the AUCs = 0.658; 95% confidence interval: 0.625-0.691). Even when the patients have low scores (1-3), increasing every 1 point of SARC-F score was associated with lower physical functions, such as lower muscle strength and shorter walking distance (all p < 0.001). CONCLUSIONS SARC-F cut-off ≥ 2 was optimal for screening sarcopenia, and even a low SARC-F score is helpful in finding earlier sarcopenia and low physical function in patients with CVD.
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Affiliation(s)
- Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Division of Research, ARCE Inc., Sagamihara, Japan
| | - Takashi Miki
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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22
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Niederwieser C, Kröger N. Hematopoietic cell transplantation (HCT) in MDS patients of older age. Leuk Lymphoma 2024:1-15. [PMID: 38315612 DOI: 10.1080/10428194.2024.2307444] [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: 11/23/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
Hematopoietic cell transplantation (HCT) has evolved to an essential treatment in younger and more recently in elderly patients with myelodysplastic syndrome (MDS), the age group with the highest incidence. Less intense conditioning regimens and improvements in supportive therapy have reduced considerably transplant related mortality and in the same time increased the access to this curative treatment. Timing of HCT in the course of the disease assumes a crucial role. Detection of disease progression, geriatric assessment, comorbidity evaluation, and identification of transplant-specific risks are becoming increasingly important in this context. Novel statistical methods, molecular biomarkers, and quantification of tumor burden pre- and post-HCT will play an essential role in years to come. More effective and less toxic treatments to reduce the tumor burden before and/or after HCT are expected to improve the outcome. In this review article we discuss the current views and what we can expect.
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Affiliation(s)
- Christian Niederwieser
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Abraham J, Holzer KJ, Lenard EM, Meng A, Pennington BRT, Wolfe RC, Haroutounian S, Calfee R, Hammil CW, Kozower BD, Cordner TA, Schweiger J, McKinnon S, Yingling M, Baumann AA, Politi MC, Kannampallil T, Miller JP, Avidan MS, Lenze EJ. A Perioperative Mental Health Intervention for Depressed and Anxious Older Surgical Patients: Results From a Feasibility Study. Am J Geriatr Psychiatry 2024; 32:205-219. [PMID: 37798223 PMCID: PMC10852892 DOI: 10.1016/j.jagp.2023.09.003] [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: 07/03/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES The perioperative period is challenging and stressful for older adults. Those with depression and/or anxiety have an increased risk of adverse surgical outcomes. We assessed the feasibility of a perioperative mental health intervention composed of medication optimization and a wellness program following principles of behavioral activation and care coordination for older surgical patients. METHODS We included orthopedic, oncologic, and cardiac surgical patients aged 60 and older. Feasibility outcomes included study reach, the number of patients who agreed to participate out of the total eligible; and intervention reach, the number of patients who completed the intervention out of patients who agreed to participate. Intervention efficacy was assessed using the Patient Health Questionnaire for Anxiety and Depression (PHQ-ADS). Implementation potential and experiences were collected using patient surveys and qualitative interviews. Complementary caregiver feedback was also collected. RESULTS Twenty-three out of 28 eligible older adults participated in this study (mean age 68.0 years, 65% women), achieving study reach of 82% and intervention reach of 83%. In qualitative interviews, patients (n = 15) and caregivers (complementary data, n = 5) described overwhelmingly positive experiences with both the intervention components and the interventionist, and reported improvement in managing depression and/or anxiety. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F = 12.13, p <0.001). CONCLUSIONS The study procedures were reported by participants as feasible and the perioperative mental health intervention to reduce anxiety and depression in older surgical patients showed strong implementation potential. Preliminary data suggest its efficacy for improving depression and/or anxiety symptoms. A randomized controlled trial assessing the intervention and implementation effectiveness is currently ongoing.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO.
| | - Katherine J Holzer
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Emily M Lenard
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Alicia Meng
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Bethany R Tellor Pennington
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Rachel C Wolfe
- Department of Pharmacy (RCW), Barnes-Jewish Hospital, St. Louis, MO
| | - Simon Haroutounian
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Ryan Calfee
- Department of Orthopaedic Surgery (RC), Washington University School of Medicine, St. Louis, MO
| | - Chet W Hammil
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Theresa A Cordner
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Julia Schweiger
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Sherry McKinnon
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Michael Yingling
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
| | - Ana A Baumann
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Mary C Politi
- Department of Surgery (CWH, BDK, AAB, MCP), Washington University School of Medicine, St. Louis, MO
| | - Thomas Kannampallil
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - J Philip Miller
- Institute for Informatics (JA, TK, JPM), Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Michael S Avidan
- Department of Anesthesiology (JA, KJH, AM, BRTP, SH, TAC, SM, TK, MSA), Washington University School of Medicine, St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EML, JS, MY, EJ), Washington University School of Medicine, St. Louis, MO
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24
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Berthelsen C, Møller N, Bunkenborg G. Transitional care model for older adults with multiple chronic conditions: An evaluation of benefits utilising an umbrella review. J Clin Nurs 2024; 33:481-496. [PMID: 38108223 DOI: 10.1111/jocn.16913] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023]
Abstract
AIMS To synthesise and describe the combined evidence from systematic reviews of interventions using elements from the Transitional Care Model, on the content and timeframe of the interventions and the related improvement of outcomes for older patients with multiple chronic conditions. BACKGROUND The population of older patients with multiple chronic conditions is increasing worldwide and trajectories are often complicated by risk factors. The Transitional Care Model may contain elements to support transitions between hospital and home. DESIGN An umbrella review. REVIEW METHODS A comprehensive search in five electronic databases was performed in April 2021 based on the search terms: 'Patients ≥60 years,' 'multi-morbidity,' 'Transitional care model,' 'Transitional care,' and 'Systematic review.' PRISMA guidelines was used. RESULTS Five systematic reviews published from 2011 to 2020 comprising 62 intervention studies (59 randomised controlled trials and three quasi-experimental trials) were included in the review. The synthesis predominantly revealed significant improvements in decreasing re-admissions and financial costs and increasing patients' quality of life and satisfaction during discharge. CONCLUSION The results of the review indicate that multiple elements from the Transitional Care Model have achieved significant improvements in older patients' transitions from hospital to home. Especially a combination of coordination, communication, collaboration and continuity of care in transitions, organised information and education for patients and pre-arranged structured post-discharge follow-ups. IMPACT The transition from hospital to home is a complex process for older patients with multiple chronic conditions. A specific focus on coordination, continuity, and patient education should be implemented in the discharge process. Nurses with specialised knowledge in transitional care are needed to ensure safe transitions. PATIENT AND PUBLIC CONTRIBUTION The umbrella review is part of a larger research program which involved a patient expert advisory board, which participated in discussing the relevance of the elements within the umbrella review.
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Affiliation(s)
- Connie Berthelsen
- Medical department, Zealand University Hospital, Køge, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nicoline Møller
- Research Unit, Zealand University Hospital, Roskilde, Denmark
| | - Gitte Bunkenborg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Roskilde, Denmark
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25
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Brooks D, Smiles JP, Murphy AP, Cowan T, Soeyland T, Hullick C, Arendts G. Assessment and management of older patients with abdominal pain in the emergency department. Emerg Med Australas 2024; 36:149-158. [PMID: 38176903 DOI: 10.1111/1742-6723.14361] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Daniel Brooks
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - John P Smiles
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Andrew P Murphy
- Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Timothy Cowan
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Torgrim Soeyland
- Port Macquarie Base Hospital, Mid-North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Caroyln Hullick
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle and Staff Specialist in Emergency Medicine, Belmont Hospital, Newcastle, New South Wales, Australia
| | - Glenn Arendts
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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26
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Shimizu T, Suda K, Matsumoto Harmon S, Komatsu M, Ota M, Ushirozako H, Inomata K, Minami A, Yamada K, Endo T, Takahata M, Iwasaki N, Takahashi H, Koda M, Yamazaki M. Effect of urgent surgery within 8 hours compared to surgery between 8 and 24 hours on perioperative complications and neurological prognosis in patients older than 70 years with cervical spinal cord injury: a propensity score-matched analysis. J Neurosurg Spine 2024:1-11. [PMID: 38277664 DOI: 10.3171/2023.11.spine23810] [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: 07/21/2023] [Accepted: 11/21/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study aimed to investigate the effect of surgery within 8 hours on perioperative complications and neurological prognosis in older patients with cervical spinal cord injury by using a propensity score-matched analysis. METHODS The authors included 87 consecutive patients older than 70 years who had cervical spinal cord injury and who had undergone posterior decompression and fusion surgery within 24 hours of injury. The patients were divided into two groups based on the time from injury to surgery: surgery within 8 hours (group 8 hours) and between 8 and 24 hours (group 8-24 hours). Following the preliminary study, the authors established a 1:1 matched model using propensity scores to adjust for baseline characteristics and neurological status on admission. Perioperative complication rates and neurological outcomes at discharge were compared between the two groups. RESULTS Preliminary analysis of 87 prematched patients (39 in group 8 hours and 48 in group 8-24 hours) revealed that the motor index score (MIS) on admission was lower for lower extremities (12.3 ± 15.5 vs 20.0 ± 18.6, respectively; p = 0.048), and total extremities (26.7 ± 27.1 vs 40.2 ± 30.6, respectively; p = 0.035) in group 8 hours. In terms of perioperative complications, group 8 hours had significantly higher rates of cardiopulmonary dysfunction (46.2% vs 25.0%, respectively; p = 0.039). MIS improvement (the difference in scores between admission and discharge) was greater in group 8 hours for lower extremities (15.8 ± 12.6 vs 9.0 ± 10.5, respectively; p = 0.009) and total extremities (29.4 ± 21.7 vs 18.7 ± 17.7, respectively; p = 0.016). Using a 1:1 propensity score-matched analysis, 29 patient pairs from group 8 hours and group 8-24 hours were selected. There were no significant differences in baseline characteristics, neurological status on admission, and perioperative complications between the two groups, including cardiopulmonary dysfunction. Even after matching, MIS improvement was significantly greater in group 8 hours for upper extremities (13.0 ± 10.9 vs 7.8 ± 8.3, respectively; p = 0.045), lower extremities (14.8 ± 12.7 vs 8.3 ± 11.0, respectively; p = 0.044) and total extremities (27.8 ± 21.0 vs 16.0 ± 17.5, respectively; p = 0.026). CONCLUSIONS Results of the comparison after matching demonstrated that urgent surgery within 8 hours did not increase the perioperative complication rate and significantly improved the MIS, suggesting that surgery within 8 hours may be efficient, even in older patients.
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Affiliation(s)
- Tomoaki Shimizu
- 1Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido
- 2Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki; and
| | - Kota Suda
- 1Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido
| | | | - Miki Komatsu
- 1Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido
| | - Masahiro Ota
- 1Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido
| | - Hiroki Ushirozako
- 1Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido
| | - Kento Inomata
- 1Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido
- 2Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki; and
| | - Akio Minami
- 1Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Hokkaido
| | - Katsuhisa Yamada
- 3Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Tsutomu Endo
- 3Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Masahiko Takahata
- 3Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Norimasa Iwasaki
- 3Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Hiroshi Takahashi
- 2Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki; and
| | - Masao Koda
- 2Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki; and
| | - Masashi Yamazaki
- 2Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki; and
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Fernández-Salido M, Alhambra-Borrás T, Casanova G, Garcés-Ferrer J. Value-Based Healthcare Delivery: A Scoping Review. Int J Environ Res Public Health 2024; 21:134. [PMID: 38397625 PMCID: PMC10888410 DOI: 10.3390/ijerph21020134] [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] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Healthcare systems are transforming from the traditional volume-based model of healthcare to a value-based model of healthcare. Value generation in healthcare is about emphasising the health outcomes achieved by patients and organisations while maintaining an optimal relationship with costs. This scoping review aimed to identify the key elements and outcomes of implementing value-based healthcare (VBHC). The review process included studies published from 2013 to 2023 in four different databases (SpringerLink, PubMed, ProQuest and Scopus). Of the 2801 articles retrieved from the searches, 12 met the study's inclusion criteria. A total of 11 studies referred to value as the relationship between the outcomes achieved by patients and the costs of achieving those outcomes. Most of the studies highlighted the presence of leadership, the organisation of care into integrated care units, the identification and standardisation of outcome measures that generate value for the patient, and the inclusion of the patient perspective as the most prominent key elements for optimal VBHC implementation. Furthermore, some benefits were identified from VBHC implementation, which could shed light for future implementation actions. Therefore, the VBHC model is a promising approach that may contribute to an improvement in the efficiency and sustainability of healthcare.
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Affiliation(s)
- Mirian Fernández-Salido
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Tamara Alhambra-Borrás
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Georgia Casanova
- Centre for Socio-Economic Research on Ageing, IRCCS-INRCA National Institute of Health & Science on Ageing, 60124 Ancona, Italy;
| | - Jorge Garcés-Ferrer
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
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Amano S, Ohta R, Sano C. Relationship between Anemia and Readmission among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study. J Clin Med 2024; 13:539. [PMID: 38256673 PMCID: PMC10816581 DOI: 10.3390/jcm13020539] [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: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Readmission rates among older adults are a growing concern, and the association of readmission with anemia and the potential benefits of a systematic assessment and intervention remain unclear. This study investigated the association between anemia and readmission within 28 and 90 days in an older population. Data from 1280 patients admitted to the Department of General Medicine of Unnan City Hospital between April 2020 and December 2021 were retrospectively analyzed. Variables such as anemia status, Charlson comorbidity index (CCI) score, Functional Independence Measure (FIM) score, and dependent status were evaluated. Multivariate logistic regression was used to determine the associations between 28-day and 90-day readmissions. The average age was 84.9 years, and the prevalence of anemia was 36.4%. The readmission rates within 28 and 90 days were 10.4% and 19.1%, respectively. Anemia was significantly associated with readmission in both periods (28-day adjusted odds ratio, 2.28; 90-day adjusted odds ratio, 1.65). CCI score, FIM score, and dependent status were also identified as significant factors. Anemia is significantly associated with short- and medium-term readmissions in older patients. Addressing anemia, along with other identified factors, may help reduce readmission rates.
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Affiliation(s)
- Shiho Amano
- Community Care, Unnan City Hospital, Daito-cho Iida, Unnan 699-1221, Japan;
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Enya-cho, Izumo 693-8501, Japan;
| | - Ryuichi Ohta
- Community Care, Unnan City Hospital, Daito-cho Iida, Unnan 699-1221, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Enya-cho, Izumo 693-8501, Japan;
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Maidana D, Arroyo-Álvarez A, Arenas-Loriente A, Barreres-Martín G, Muñoz-Alfonso C, Bompart Berroteran D, Esteve Claramunt F, Blanco del Burgo R, Cepas-Guillén P, Garcia-Blas S, Bonanad C. Inflammation as a New Therapeutic Target among Older Patients with Ischemic Heart Disease. J Clin Med 2024; 13:363. [PMID: 38256497 PMCID: PMC10816645 DOI: 10.3390/jcm13020363] [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: 12/17/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Cardiovascular (CV) diseases remain a global health challenge, with ischemic heart disease (IHD) being the primary cause of both morbidity and mortality. Despite optimal pharmacological therapy, older patients with IHD exhibit an increased susceptibility to recurrent ischemic events, significantly impacting their prognosis. Inflammation is intricately linked with the aging process and plays a pivotal role in the evolution of atherosclerosis. Emerging anti-inflammatory therapies have shown promise in reducing ischemic events among high-risk populations. This review aims to explore the potential of targeted anti-inflammatory interventions in improving clinical outcomes and the quality of life for older patients with IHD.
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Affiliation(s)
- Daniela Maidana
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Andrea Arroyo-Álvarez
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | | | - Guillermo Barreres-Martín
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Carles Muñoz-Alfonso
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Daznia Bompart Berroteran
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Francisca Esteve Claramunt
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | - Regina Blanco del Burgo
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
| | | | - Sergio Garcia-Blas
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
- Cardiology Department, Clinic University Hospital of Valencia, 46026 Valencia, Spain
| | - Clara Bonanad
- INCLIVA—Instituto de Investigación Sanitaria, Biomedical Research Institute, 46010 Valencia, Spain (F.E.C.)
- Cardiology Department, Clinic University Hospital of Valencia, 46026 Valencia, Spain
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Badino G, Veronese N, Cella A. Effectiveness of a kinesio-taping-based treatment in stage IV sacral pressure ulcers in older patients: a pilot study. J Wound Care 2024; 33:60-65. [PMID: 38197280 DOI: 10.12968/jowc.2024.33.1.60] [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] [Indexed: 01/11/2024]
Abstract
OBJECTIVE As reduced tissue vascularity is one of the mechanisms that prevent skin ulcers from healing, treatments that can improve local circulation could accelerate their clinical resolution. Given that kinesio-taping (KT) can improve tissue blood circulation and lymphatic drainage, we aimed to determine whether applying KT close to stage IV pressure ulcers (PUs) could improve their healing. METHOD Older patients with stage IV sacral PUs, and impaired mobility and functional dependency who were consecutively admitted in a six-month period to the Home Care service of Galliera Hospital (Genoa, Italy) were screened for participation in this pilot clinical trial. Patients' PUs were divided into two treatment areas-in the experimental intervention, KT was applied close to a portion of the PU, while the contralateral portion of the same lesion was treated according to the standard protocol ('control'). The surface reduction of both portions was measured every four days, for a total of five examinations (timepoints (T2-T6) after the baseline evaluation (T1). RESULTS A total of 12 patients (male=5, female=7; mean age 78.83±8.94 years) fulfilled the inclusion criteria and were enrolled in the study. At all timepoints (T2-T6), the mean percentage reduction was significantly greater in KT-treated areas than in control areas: T2=20.66% versus 6.17%, respectively; p<0.001; T3=37.33% versus 17.31%, respectively; p<0.001; T4=57.01% versus 30.06%, respectively; p<0.001; T5=69.04% versus 40.55%, respectively; p<0.001; and T6=80.34% versus 51.91%, respectively; p<0.001. Furthermore, from T3 onwards, a significantly higher number of KT-treated areas than control areas had halved in size, the maximum difference being recorded at T5 (10 versus two, respectively; p=0.002). CONCLUSION From the findings of this pilot study, KT would seem to be an effective, rapid, low-cost therapy for advanced sacral PUs in older patients with impaired mobility and functional dependency. Declaration of interest: The authors have no conflicts of interest to declare.
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Affiliation(s)
- Giorgio Badino
- Difficult Wound Healing Unit, Local Health Agency 'ASL3 Genovese', Genoa, Italy
| | - Nicola Veronese
- Department of Internal Medicine, Geriatric Unit, University of Palermo, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Primary Care Department, Local Health Agency 'ASL2 Savonese', Savona, Italy
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Liao S, Wang L. Correlation of health literacy, health management self-efficacy, and attitude in elderly patients with schizophrenia: A cross-sectional study. Nurs Open 2024; 11:e2065. [PMID: 38268261 PMCID: PMC10724592 DOI: 10.1002/nop2.2065] [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: 05/10/2023] [Revised: 09/12/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM The study investigated the relationship between chronic diseases and health problems, emotional health status, health literacy, health self-management attitude, and health management self-efficacy in older patients with schizophrenia. It is expected to provide multiple health perspectives in the care of older patients with schizophrenia and improve their health literacy and self-management. DESIGN A cross-sectional study. METHODS Data collection from 2020/09 to 2021/10, the study of older patients with schizophrenia who were diagnosed with schizophrenia and were over 50 years, live in residential mental rehabilitation institutions in eastern Taiwan as older people. Data were collected on demographic variables, chronic diseases, health problems, health literacy, healthy management self-efficacy, and attitudes. RESULTS The study results show 61.49 years (SD = 6.57), the gender, health literacy, and health management self-efficacy can effectively explain the variance of health self-management state by 18.5% (F(3,116) = 10.01, p < 0.000), in which health literacy (β = 0.28, t = 3.07, p = 0.003) and health management self-efficacy (β = 0.19, t = 2.03, p = 0.04) that in the analysis of predictors, emotional health status, and health literacy not only have significant explanatory power on health management self-efficacy and the performance of physical functions but are also important factors affecting the quality of life among the elderly; the important influencing factor of health management self-efficacy and health self-management behaviour is health literacy. Therefore, health literacy is crucial to the health attitudes of older patients with schizophrenia. CONCLUSION This study found that increased health literacy among older patients with schizophrenia can enhance their attitude and ability to manage their health. IMPLICATIONS FOR THE PROFESSION AND NO PATIENT OR PUBLIC CONTRIBUTION: Nursing can provide nursing measures related to individual health literacy to help patients improve their health literacy, maintain the health of chronic older patients with schizophrenia, reduce elderly schizophrenia disability, enhance patients' ability to manage their self-efficacy and health self-management attitude, and improving the health and quality of life of patients.
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Affiliation(s)
- Su‐Jung Liao
- Department of Nursing, College of NursingTzu Chi University of Science and TechnologyHualienTaiwan, Republic of China
| | - Lin‐Jie Wang
- Department of NursingYuli Hospital, Ministry of Health and WelfareHualienTaiwan, Republic of China
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Wang J, Wang Y, Na N, Liu M, Xiu L, Lu X, Zhu X. Risk Perception Scale of Disease Aggravation for older patients with non-communicable diseases: Instrument development and cross-sectional validation study. J Adv Nurs 2024; 80:287-300. [PMID: 37403201 DOI: 10.1111/jan.15774] [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: 07/28/2022] [Revised: 05/04/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
AIM The present study aimed to develop the Risk Perception Scale of Disease Aggravation for older patients with non-communicable diseases and evaluate its psychometric properties. DESIGN Instrument development and cross-sectional validation study were conducted. METHODS This study contained four phases. In phase I, a systematic literature review was conducted to identify the conception of disease aggravation and risk perception. In phase II, a draft scale was formulated from face-to-face semi-structured in-depth interviews by Colaizzi's seven-step qualitative analysis method and group discussions among the researchers. In phase III, domains and items of the scale were revised in accordance with the suggestions from Delphi consultation and patient feedback. In phase IV, psychometric properties were evaluated. FINDINGS Exploratory and confirmatory factor analyses determined four structural factors. Convergent and discriminant validities were acceptable because the average variance extracted coefficients ranged from .622 to .725, and the square roots of the average variance extracted coefficients for the four domains were larger than those of bivariate correlations between domains. The scale also exhibited excellent internal consistency and test-retest reliability (Cronbach's alpha coefficient = .973, intraclass correlation coefficient = .840). CONCLUSIONS Risk Perception Scale of Disease Aggravation is a new instrument that measures the risk perception of disease aggravation for older patients with non-communicable diseases, including possible reason, serious outcome, behaviour control and affection experience. The scale contains 40 items that are scored on a 5-point Likert scale, and it has acceptable validity and reliability. IMPACT The scale is applied to identify different levels of risk perception of disease aggravation for older patients with non-communicable diseases. Clinical nurses can provide targeted interventions to improve older patients' risk perception of disease aggravation based on levels of risk perception during hospitalization and the period before discharge. PATIENT OR PUBLIC CONTRIBUTION Experts provided suggestions for revising the scale dimensions and items. Older patients participated in the scale revision process to improve the wording of the scale.
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Affiliation(s)
- Jizhe Wang
- School of Nursing, Qingdao University, Qingdao, China
| | - Ying Wang
- Qingdao Municipal Hospital Group, Qingdao, China
| | - Na Na
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mengqi Liu
- Cheeloo College of Medicine, School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Lulu Xiu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohong Lu
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiuli Zhu
- School of Nursing, Qingdao University, Qingdao, China
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van Erp RAL, de Rooij SE, Wymenga ANM, Zeegers AVCME, van der Palen J. Feasibility study of the Digital Patient Benefit Assessment Scale (P-BAS): A Digital Tool to Assess Individual Patient Goals. Gerontol Geriatr Med 2024; 10:23337214241230159. [PMID: 38328389 PMCID: PMC10848793 DOI: 10.1177/23337214241230159] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
The study objective was to assess the feasibility of the Patient Benefit Assessment Scale (P-BAS), a digital tool designed to enable older outpatients (≥70 years) to elucidate at home their individual goals regarding their current medical issue. Several digital tools are developed to assist older people in identifying their goals, thereby facilitating the process of shared decision making. However, studies on the feasibility of these digital tools, especially in older patients, are limited. Data were collected from 36 older patients. The study comprised three stages. In stage I and II, cognitive interviews were conducted to strengthen the feasibility of the P-BAS. In stage III, 80% of the patients completed the P-BAS independently at home. The cognitive interviews provided insight into patients' interpretation and individual understanding of the digital visual P-BAS and associated opportunities for improvement, which were subsequently implemented. One conclusion is that the digital visual P-BAS might be of added value for patients and contributes to the process of shared decision making, assuring that the goals of the patient will be into account in treatment options. Findings are useful for researchers interested in technological tools that contribute to shared decision making.
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Affiliation(s)
- Rozemarijn A L van Erp
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | | | | | - Job van der Palen
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
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Rodríguez-Mañas L, Moreno-Villares JM, Álvarez Hernández J, Romero Secín AA, López Díaz-Ufano ML, Suárez González F, Costa-Grille A, López-Miranda J, Fernández-Garcia JM. Awareness and Self-Reported Knowledge and Training on Nutrition in Older People among Primary Care Practitioners. J Frailty Aging 2024; 13:157-162. [PMID: 38616372 DOI: 10.14283/jfa.2024.11] [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] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To assess the awareness and training of primary care physicians on nutrition in older patients. DESIGN Observational, real-world data survey. SETTING Primary Care. PARTICIPANTS One hundred sixty-two physicians, generalists and specialists, working in primary care. MEASUREMENTS Participants received an online questionnaire with 18 questions concerning the importance of nutrition, degree of knowledge, needs, and training in nutrition. The results were evaluated using univariate descriptive analysis, with a percentage for each chosen answer. Logistic regression models were used to evaluate if answers were related to training in nutrition and professional experience. RESULTS 43.2% of participants reported that nutrition is very important in individuals over 65 years old, and 90% were aware of the importance of nutrition in healthy aging. Nutritional problems affect 30 to 50% of patients, according to 44.7% of participants. 89.2% agree about the need for nutritional assessment in older patients; however, the professionals believe they should be better prepared. Two out of three respondents consider the training received in nutrition during their undergraduate course or continuing medical education as deficient. Time of professional practice was mainly associated with conceptual facts, while continuing medical education did with practical issues, mainly the use of screening and diagnostic tools [FRAIL (OR: 3.16; 95%IC: 1.55-6.46), MNA-SF (OR: 6.455; 95%IC: 2.980-13.981) and SARC-F (OR: 3.063; 95%IC: 1.284-7.309)]. CONCLUSION Although primary care professionals are aware of the importance of nutrition in older patients, there are still gaps in daily practice that could be improved by developing educational strategies.
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Affiliation(s)
- L Rodríguez-Mañas
- Leocadio Rodríguez-Mañas, Servicio de Geriatría, Hospìtal Universitario de Getafe, Ctra. de Toledo, Km 12.5; 28905-Getafe, Spain.
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Araki T, Yamazaki Y, Kimoto M, Goto N, Ikuyama Y, Takahashi Y, Kosaka M. Practical Utility of a Clinical Pathway for Older Patients with Aspiration Pneumonia: A Single-Center Retrospective Observational Study. J Clin Med 2023; 13:230. [PMID: 38202237 PMCID: PMC10779523 DOI: 10.3390/jcm13010230] [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: 11/12/2023] [Revised: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction: Clinical pathways (CPWs) are patient management tools based on a standardized treatment plan aimed at improving quality of care. This study aimed to investigate whether CPW-guided treatment has a favorable impact on the outcomes of hospitalized older patients with aspiration pneumonia. Method: This retrospective study included patients with aspiration pneumonia, aged ≥ 65 years, and hospitalized at a community hospital in Japan. CPW implementation was arbitrarily determined by the attending physician upon admission. Outcomes were compared according to with or without the CPW (CPW-group and non-CPW groups). Propensity score (PS)-based analyses were used to control for confounding factors. Logistic regression analyses were conducted to evaluate the impact of CPW on the clinical course and outcomes. Results: Of 596 included patients, 167 (28%) received the CPW-guided treatment. The mortality rate was 16.4%. In multivariable model, CPW implementation did not increase the risk for total and 30-day mortality, and resulted in shorter antibiotic therapy duration (≤9 days) (PS matching (PSM): odds ratio (OR) 0.50, p = 0.001; inverse provability of treatment weighting (IPTW): OR 0.48, p < 0.001) and length of hospital stay (≤21 days) (PSM: OR 0.67, p = 0.05; IPTW: OR 0.66, p = 0.03). Conclusions: This study support CPW utility in this population.
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Affiliation(s)
- Taisuke Araki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (N.G.); (Y.I.)
- Center of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, Suzaka 382-8577, Japan; (Y.Y.); (M.K.); (M.K.)
| | - Yoshitaka Yamazaki
- Center of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, Suzaka 382-8577, Japan; (Y.Y.); (M.K.); (M.K.)
| | - Masanobu Kimoto
- Center of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, Suzaka 382-8577, Japan; (Y.Y.); (M.K.); (M.K.)
| | - Norihiko Goto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (N.G.); (Y.I.)
- Center of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, Suzaka 382-8577, Japan; (Y.Y.); (M.K.); (M.K.)
| | - Yuichi Ikuyama
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan; (N.G.); (Y.I.)
- Center of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, Suzaka 382-8577, Japan; (Y.Y.); (M.K.); (M.K.)
| | - Yuko Takahashi
- Division of Clinical Laboratory, Nagano Prefectural Shinshu Medical Center, Suzaka 382-8577, Japan;
| | - Makoto Kosaka
- Center of Infectious Diseases, Nagano Prefectural Shinshu Medical Center, Suzaka 382-8577, Japan; (Y.Y.); (M.K.); (M.K.)
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Nielsen RL, Andersen AL, Kallemose T, Damgaard M, Bornæs O, Juul-Larsen HG, Strejby Christensen LW, Jawad BN, Andersen O, Rasmussen HH, Munk T, Lund TM, Houlind MB. Evaluation of Multi-Frequency Bioelectrical Impedance Analysis against Dual-Energy X-ray Absorptiometry for Estimation of Low Muscle Mass in Older Hospitalized Patients. J Clin Med 2023; 13:196. [PMID: 38202202 PMCID: PMC10779600 DOI: 10.3390/jcm13010196] [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: 11/15/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
The accuracy of multi-frequency (MF) bioelectrical impedance analysis (BIA) to estimate low muscle mass in older hospitalized patients remains unclear. This study aimed to describe the ability of MF-BIA to identify low muscle mass as proposed by The Global Leadership Initiative on Malnutrition (GLIM) and The European Working Group on Sarcopenia in Older People (EWGSOP-2) and examine the association between muscle mass, dehydration, malnutrition, and poor appetite in older hospitalized patients. In this prospective exploratory cohort study, low muscle mass was estimated with MF-BIA against dual-energy X-ray absorptiometry (DXA) in 42 older hospitalized adults (≥65 years). The primary variable for muscle mass was appendicular skeletal muscle mass (ASM), and secondary variables were appendicular skeletal muscle mass index (ASMI) and fat-free mass index (FFMI). Cut-off values for low muscle mass were based on recommendations by GLIM and EWGSOP-2. MF-BIA was evaluated against DXA on the ability to estimate absolute values of muscle mass by mean bias, limits of agreement (LOA), and accuracy (5% and 10% levels). Agreement between MF-BIA and DXA to identify low muscle mass was evaluated with sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). The association between muscle mass, dehydration, malnutrition, and poor appetite was visually examined with boxplots. MF-BIA overestimated absolute values of ASM with a mean bias of 0.63 kg (CI: -0.20:1.46, LOA: -4.61:5.87). Agreement between MF-BIA and DXA measures of ASM showed a sensitivity of 86%, specificity of 94%, PPV of 75% and NPV of 97%. Boxplots indicate that ASM is lower in patients with malnutrition. This was not observed in patients with poor appetite. We observed a tendency toward higher ASM in patients with dehydration. Estimation of absolute ASM values with MF-BIA should be interpreted with caution, but MF-BIA might identify low muscle mass in older hospitalized patients.
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Affiliation(s)
- Rikke Lundsgaard Nielsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Olivia Bornæs
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
| | - Louise Westberg Strejby Christensen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Baker Nawfal Jawad
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, 9220 Aalborg, Denmark;
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital—Herlev and Gentofte, 2100 Copenhagen, Denmark
| | - Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital—Herlev and Gentofte, 2100 Copenhagen, Denmark
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Morten Baltzer Houlind
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark;
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Kasiukiewicz A, Wojszel ZB. The Prevalence of the Frailty Syndrome in a Hospital Setting-Is Its Diagnosis a Challenge? A Comparison of Four Frailty Scales in a Cross-Sectional Study. J Clin Med 2023; 13:86. [PMID: 38202093 PMCID: PMC10780177 DOI: 10.3390/jcm13010086] [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: 11/24/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The study aimed to assess the prevalence of the frailty syndrome in older patients hospitalized in the geriatric ward depending on the diagnostic criteria used, the feasibility of particular diagnostic scales in hospitalized patients, and their compatibility; 416 patients (81.2 ± 6.91 years) admitted to the Department of Geriatrics of Hospital of the Ministry of the Interior and Administration in Bialystok within eight months were included in the study. Four diagnostic scales were used to identify the frailty syndrome: Fried criteria, 7-point Clinical Frailty Scale (CFS), 40-item Frailty Index (FI), and FRAIL Scale. Depending on the scale, the prevalence of frailty syndrome varied from 26.8% (FRAIL Scale), 52.3% (Clinical Frailty Scale), and 58.1% (Fried criteria) up to 62.9% (Frailty Index). We observed the highest feasibility for CFS (100%) and the lowest for the Fried scale (79.8%). The highest level of agreement was found between the CFS and Frailty Index, with 80.3% consistent ratings (Cohen Kappa 0.6). Patients in the geriatric ward are characterized by a high prevalence of frailty, although it differs depending on the criteria. The most difficult to use in daily practice was the Fried scale, while the Clinical Frailty Scale was determined feasible in all patients.
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Affiliation(s)
- Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Department of Geriatrics, Marian Zyndram Koscialkowski Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, 15-089 Bialystok, Poland;
- Department of Geriatrics, Marian Zyndram Koscialkowski Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
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Yamasaki S. Feasibility of Quality of Life Assessment in Patients with Lymphoma Aged ≥80 Years Receiving Reduced-Intensity Chemotherapy: A Single-Institute Study. Hematol Rep 2023; 16:1-10. [PMID: 38247991 PMCID: PMC10801517 DOI: 10.3390/hematolrep16010001] [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: 09/20/2023] [Revised: 10/19/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Quality of life (QOL) must be carefully monitored in older patients with lymphoma who are suitable for chemotherapy, but few reports have assessed QOL in older patients who received reduced-intensity chemotherapy. This study investigated QOL in patients with lymphoma aged ≥80 years to clarify the feasibility of such assessments following reduced-intensity chemotherapy. QOL was prospectively analyzed (using the QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD)] and the SF-36®, a comprehensive survey of patient health) among 13 patients (seven women) aged ≥80 years with lymphoma who received reduced-intensity chemotherapy at 4-week intervals at Kyushu University Beppu Hospital between June 2022 and August 2023. Patients were assessed at baseline, in the middle of the protocol, at the end of the protocol, and 6 months after the end of the protocol. The overall response rate was 69%. Almost all severe adverse events (10 patients) occurred during early cycles (cycles 1-2). Common adverse events included hematological toxicities such as neutropenia (10 patients). The daily activity (p = 0.048) and social attitude (p = 0.027) scores of the QOL-ACD and the general health perception (p = 0.044) and social functioning (p = 0.030) scores of the SF-36® were significantly improved during and after chemotherapy. Reduced-dose chemotherapy, if implemented before treatment selection, might permit evaluations of QOL in older patients aged ≥80 years; further investigation is warranted.
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Affiliation(s)
- Satoshi Yamasaki
- Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan; or ; Tel.: +81-977-27-1600; Fax: +81-977-27-1641
- Department of Internal Medicine, Kyushu University Beppu Hospital, 4546 Tsurumihara, Tsurumi, Beppu 874-0838, Japan
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Järbrink H, Forsberg A, Erhag HF, Lundälv J, Bjerså K, Engström M. Recovering from physical trauma in late life, a struggle to recapture autonomy: A grounded theory study. J Adv Nurs 2023. [PMID: 38130055 DOI: 10.1111/jan.16035] [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: 05/24/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
AIM The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma. DESIGN A qualitative study with a constructivist grounded theory design. METHODS Fifteen in-depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology. RESULTS The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges. CONCLUSION Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process. IMPACT As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns. REPORTING METHOD Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Hanna Järbrink
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery Sahlgrenska, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Forsberg
- Institute of Health Sciences, Lund university, Lund, Sweden
- Department of Thoracic Surgery, Skåne University Hospital, Malmö, Sweden
| | - Hanna Falk Erhag
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Gothenburg, Sweden
| | - Jörgen Lundälv
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
- Department of Surgical and Perioperative Sciences, Unit of Surgery, Umeå University, Umeå, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Primary Care, Närhälsan Majorna, Region Västra Götaland, Gothenburg, Sweden
| | - My Engström
- Department of Surgery Sahlgrenska, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Merli F, Pozzi S, Catellani H, Barbieri E, Luminari S. The Role of Geriatric Assessment in the Management of Diffuse Large B-Cell Lymphoma. Cancers (Basel) 2023; 15:5845. [PMID: 38136390 PMCID: PMC10742316 DOI: 10.3390/cancers15245845] [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: 10/30/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The treatment choice for an older patient with diffuse large B-cell lymphoma (DLBCL) depends on many other factors in addition to age, which alone does not reflect the complexity of the aging process. Functional features and comorbidity incidence differ not only between younger and older patients but also among older patients themselves. The comprehensive geriatric assessment (CGA) quickly evaluates fitness status by investigating the patient's different functional areas, degree of autonomy, and presence of comorbidities. Various tools are available to evaluate frailty; which assessment tool to use should be based on the clinical aim. The simplified geriatric assessment (sGA) from the elderly project by the Fondazione Italiana Linfomi, prospectively tested on the largest number of patients, categorizes patients as fit, unfit, or frail, with a decreasing rate of overall survival. The elderly prognostic index (EPI), which combines sGA and IPI scores and hemoglobin level, is the first prognostic score for older patients, with three risk groups for survival. Future GAs should consider new parameters, including sarcopenia, which appears to be inversely related to survival. New tools based on prospective studies can help physicians choose the best treatment in light of the individual patient's characteristics.
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Affiliation(s)
- Francesco Merli
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Stefano Pozzi
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (S.P.)
| | - Hillary Catellani
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (S.P.)
| | - Emiliano Barbieri
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (S.P.)
| | - Stefano Luminari
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
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Maurelli M, Chiricozzi A, Peris K, Gisondi P, Girolomoni G. Atopic Dermatitis in the Elderly Population. Acta Derm Venereol 2023; 103:adv13363. [PMID: 38095061 PMCID: PMC10753596 DOI: 10.2340/actadv.v103.13363] [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: 05/18/2023] [Accepted: 09/11/2023] [Indexed: 12/18/2023] Open
Abstract
Atopic dermatitis is a common inflammatory disease with a chronic and relapsing course. Although considered a childhood disease, it is now evident that atopic dermatitis is also common in adulthood and in the elderly population. Atopic dermatitis typically manifests with bilateral and symmetrical eczematous lesions on the face, trunk and skin folds. Itch is invariably present and may be very severe, markedly affecting daily life and sleep. In older adults, atopic dermatitis may have a high level of impact on quality of life, frequently burdening an already complex comorbid situation. The full assessment of disease burden (localizations, itch severity, sleep alterations, impact on quality of life, disease history, comorbidities) is crucial to identify the most appropriate treatment. In many cases, moderate-to-severe atopic dermatitis in the elderly population can be successfully and safely treated with biological agents inhibiting the interleukin-4/-13 pathway, whereas the use of Janus kinase inhibitors may pose concerns about the safety profile.
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Affiliation(s)
- Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
| | - Andrea Chiricozzi
- Dermatology, Department of Medical Science and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ketty Peris
- Dermatology, Department of Medical Science and Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Brezis MR, Shachar E, Peleg Hasson S, Laskov I, Michaan N, Levy B, Wolf I, Safra T. Effectiveness and safety of standard chemotherapy in older patients with ovarian cancer: a retrospective analysis by age group and treatment regimen. Front Oncol 2023; 13:1289379. [PMID: 38152363 PMCID: PMC10751294 DOI: 10.3389/fonc.2023.1289379] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Objective To evaluate the effectiveness and safety of standard chemotherapy administered to patients >70 years with advanced ovarian cancer (OC). Methods Medical records of 956 advanced-stage patients with OC treated between 2002-2020 with standard surgery and paclitaxel-carboplatin chemotherapy in a three-weekly (PC-3W) or weekly (PC-1W) regimen were reviewed. Treatment response and tolerability were compared between patients ≤70 years (N=723) and >70 years (N=233) with stratification to septuagenarians (>70-80 years) and octogenarians (>80 years). Results Median overall survival (mOS) in patients >70 was 41.26 months (95% confidence interval [Cl], 37.22-45.14) and median progression-free survival (mPFS) was 11.04 months (95% Cl, 8.97-15.74). No statistically significant differences in mPFS and mOS were observed between septuagenarians and octogenarians. Patients >70 treated with PC-1W versus PC-3W had significantly longer mOS (57.17 versus 30.00 months) and mPFS (19.09 versus 8.15 months). Toxicity rates were mostly similar between younger and older patients. Among patients >70 treated with PC-1W, the rate of neutropenia (75.7% versus 51.8%, p=0.0005), thrombocytopenia (41.0% versus 22.2%, p=0.0042) and anemia (78.1% versus 51.9%, p<0.0001) were significantly higher and the rate of grade 2 alopecia was statistically significantly lower compared with those >70 treated with PC-3W. Significantly more patients treated with PC-1W completed ≥6 chemotherapy cycles, suggesting better tolerability of this regimen. Conclusions Older patients with OC may benefit from improved OS with reasonable toxicity if treated with standard chemotherapy. Older patients treated with PC-1W are more likely to complete the full chemotherapy course and survive longer compared with those treated with conventional PC-3W.
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Affiliation(s)
- Miriam R. Brezis
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eliya Shachar
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Peleg Hasson
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Michaan
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Levy
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Safra
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pham-Scottez A, Gallarda T, Calvez M, Silva J, Barruel D, Masson VDL, Lahaye J, Perquier F, Sarazin M, Gourevitch R. Characteristics of older patients in the largest French psychiatric emergency centre. Front Psychiatry 2023; 14:1298497. [PMID: 38161722 PMCID: PMC10756208 DOI: 10.3389/fpsyt.2023.1298497] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.
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Affiliation(s)
- Alexandra Pham-Scottez
- Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Thierry Gallarda
- Centre d’Evaluation des Troubles Psychiques et du Vieillissement (CETPV), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | | | - Jérôme Silva
- Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - David Barruel
- Département d’Information Médicale (DIM), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Valérie Dauriac-Le Masson
- Département d’Information Médicale (DIM), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Justine Lahaye
- Cellule Epidémiologie, GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Florence Perquier
- Centre for Addiction and Mental Health, Cundill Centre for Depression and Mental Health, Toronto, ON, Canada
| | - Marie Sarazin
- Department of Neurology of Memory and Language, GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Paris, France
- Université Paris-Saclay, BioMaps, Service Hospitalier Frédéric Joliot CEA, CNRS, Inserm, Orsay, France
| | - Raphaël Gourevitch
- Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
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Alukal JJ, Li F, Thuluvath PJ. Older Patients With Acute on Chronic Liver Failure Have a Higher Waitlist Mortality, but Acceptable Post Liver Transplantation Survival When Compared To Younger Patients. Clin Gastroenterol Hepatol 2023:S1542-3565(23)01000-5. [PMID: 38072285 DOI: 10.1016/j.cgh.2023.11.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND & AIMS There is a paucity of studies on older patients (≥65 years) who develop acute on chronic liver failure (ACLF). The objectives of our study were to determine clinical characteristics and outcomes of older patients listed for liver transplantation (LT). METHODS Adults listed for LT with estimated ACLF (Est-ACLF) between 2005 and 2021 were identified using the United Network for Organ Sharing database and subdivided into older and younger age (18-64 years) groups. Kaplan-Meier survival analyses were used to evaluate survival, and a competing-risk model (Fine-Gray) was used to evaluate risk factors for survival on the waitlist. Logistic regression was done to evaluate risk factors. RESULTS A total of 4313 older (14%) and 26,628 younger (86%) patients were listed for LT, and 2142 (49.6%) and 16,931 (63.5%) were transplanted, respectively. Older patients had a higher 30-day waitlist mortality than younger patients (20.4% vs 16.7%; P < .0001); this was more pronounced in Est-ACLF-2 (23.7% vs 14.8%; P < .0001) and Est-ACLF-3 (43.3% vs 29.9%; P < .0001). One-year post-LT, patient survival in older patients with Est-ACLF grades 1, 2, and 3 were 86.4%, 85.5%, and 77% respectively; younger patients had better survival across all Est-ACLF grades. When adjusted for transplant eras, respiratory failure was the only independent risk factor for increased 1-year post-LT mortality in older patients. CONCLUSION Older patients with Est-CLF had significantly higher waitlist mortality than younger patients, but had acceptable 1-year post-LT survival including those with Est-ACLF-3; therefore, age alone should not be considered as a contraindication for LT. Older patients with respiratory failure should be carefully selected for LT.
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Affiliation(s)
- Joseph J Alukal
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, Maryland; Department of Medicine, University of California Riverside School of Medicine, Riverside, California
| | - Feng Li
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, Maryland
| | - Paul J Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Walker K, Yates J, Dening T, Völlm B, Tomlin J, Griffiths C. Quality of life, wellbeing, recovery, and progress for older forensic mental health patients: a qualitative investigation based on the perspectives of patients and staff. Int J Qual Stud Health Well-being 2023; 18:2202978. [PMID: 37079294 PMCID: PMC10120527 DOI: 10.1080/17482631.2023.2202978] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
PURPOSE There is a lack of research informing service requirements for older (aged≥55 years) forensic mental health patients. The aim of this research was to increase knowledge about older forensic mental health patients' quality of life, wellbeing, recovery, and progress, in order to make recommendations of how to facilitate and enhance these factors. METHODS In-depth interviews with patients (N = 37) and staff (N = 48) were undertaken; data were analysed using thematic analysis. RESULTS Environmental (e.g., physical, structural and facilities), relational (staff, family and friends) and individual (characteristics, feelings, behaviours) factors were identified as enablers and/or obstacles to wellbeing, recovery, progress and quality of life. CONCLUSIONS The physical and psychological environment of services needs to be adapted to meet the needs of patients. Therapeutic relationships with staff should be encouraged and a person-centred and individual recovery approach adopted. Prosocial relationships with peers, friends and family need to be fostered to enable positive recovery outcomes. Older patients should be empowered to develop a sense of autonomy to enable quality of life, wellbeing, and recovery, and progress.
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Affiliation(s)
- Kate Walker
- Research and Innovation, Northampton Healthcare NHS Foundation Trust, Northampton, UK
| | - Jen Yates
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Tom Dening
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Birgit Völlm
- Klinik und Poliklinik für Forensische Psychiatrie, University Hospital of Rostock, Rostock, Germany
| | - Jack Tomlin
- School of Law and Criminology, University of Greenwich, London, UK
| | - Chris Griffiths
- Research and Innovation, Northampton Healthcare NHS Foundation Trust, Northampton, UK
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Sutter T, Schittenhelm M, Volken T, Lehmann T. Treatment regimens in patients over 64 years with acute myeloid leukaemia: a retrospective single-institution, multi-site analysis. Hematology 2023; 28:2206694. [PMID: 38078486 DOI: 10.1080/16078454.2023.2206694] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The aim of this study is to investigate the effect of treatment choice on survival, transfusion needs and hospitalizations in patients > 64 years old with newly diagnosed acute myeloid leukaemia (AML). MATERIAL AND METHODS This study retrospectively analysed patients over 64 years with AML diagnosed at a regional healthcare network in Switzerland between 2017 and 2020. Patients underwent four therapy groups: intensive chemotherapy (IC), hypomethylating agent in combination with the BCL2-Inhibitor venetoclax (HMA + VEN), hypomethylating agents alone (HMA) or best supportive care (BSC). RESULTS Of 54 patients 12 (22%) were selected for IC, 13 (24%) for HMA + VEN, 17 (32%) for HMA and 12 (22%) for BSC. The median overall survival of the patients was 76 days, with a significant difference in the four therapy groups (IC 119 days, HMA + VEN 732 days, HMA monotherapy 73 days and BSC 12 days Log-Rank Test Chi2(2): p < 0.001). Patients with HMA + VEN spent significantly less time in the hospital 6.8 days/month compared to IC (19.5 days/month), HMA (20.5 days/month) and BSC (10.5 days/month) (p = 0.005). Transfusion needs were the highest in IC (7.0 RBC/month, 8.0 PC/month) (p = 0.023), whereas there was no difference between HMA + VEN (2.5 RBC/month, 3.2 PC/month), HMA monotherapy (5.3 RBC/month, 6.2 PC/month) and BSC (3.0 RBC/month, 1.4 PC/month). CONCLUSION Our real-world data demonstrate superior OS rates of HMA + VEN when compared to IC, HMC or BSC, with a favourable side effect profile with regard to transfusion needs or hospitalization days. Abbreviations: AML, acute myeloid leukaemia; BCL2, B-cell leukaemia/lymphoma-2; BSC, best supportive care; CR, complete response; Cri, complete response with incomplete haematologic regeneration; FLT3, Fms Related Receptor Tyrosine Kinase 3; EKOS, Ethikkomission Ostschweiz; ELN, European Leukaemia Net; HMA, hypomethylating agent; IC, intensive chemotherapy; IDH, Isocitratdehydrogenase; LDAC, low-dose Cytarabine; NCCN, National Comprehensive Cancer Network; OS, overall survival; PC, platelet concentrate; RBC, red blood cell; RCT, randomized controlled trials; t-AML, therapy relative acute myeloid leukaemia'; VEN, venetoclax.
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Affiliation(s)
- Tabea Sutter
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, Zürich, Switzerland
| | - Marcus Schittenhelm
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, Zürich, Switzerland
| | - Thomas Volken
- ZHAW School of Health Sciences, Institute of Public Health, Winterthur, Switzerland
| | - Thomas Lehmann
- Department of Oncology and Hematology, Cantonal Hospital St Gallen, Zürich, Switzerland
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Nedumannil R, Batterham E, Harding E, Ritchie D, Wei A, Bajel A. Consecutive day dosing of high-dose cytarabine consolidation over 3 days is resource-efficient and safe in older adult patients with acute myeloid leukemia. Leuk Lymphoma 2023; 64:2123-2132. [PMID: 37656967 DOI: 10.1080/10428194.2023.2251071] [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: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023]
Abstract
High-dose cytarabine (HDAC) is conventionally delivered on days 1, 3 and 5 (HDAC-135) as acute myeloid leukemia (AML) post-remission therapy. Limited data is available on alternative HDAC schedules such as HDAC-123 (given consecutively for 3 days). We retrospectively compared the tolerability and efficacy of HDAC-135 and HDAC-123 delivered in sequential cohorts of adult AML patients. Seventy-three patients were included with 33% aged ≥60 years. HDAC-123 was associated with faster hematological recovery, reduced bacteremia and shorter hospitalization. No differences in safety profile or hematological recovery were seen between patients ≥60 years and <60 years receiving HDAC-123 except a shorter median time to neutrophil count recovery after cycle 1 in the latter group. Three patients (8%) receiving HDAC-123, all aged <60 years, required a change in schedule to HDAC-135 due to transient cytarabine-related side effects. HDAC-123 consolidation was well-tolerated by AML patients, including those ≥60 years, and associated with tangible reductions in resource utilization.
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Affiliation(s)
- Rithin Nedumannil
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Emily Batterham
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - Emily Harding
- Department of Pharmacy, The Royal Melbourne Hospital, Parkville, Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Department of Medicine, The University of Melbourne, Parkville, Australia
| | - Andrew Wei
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- Division of Blood Cells and Blood Cancers, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Ashish Bajel
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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Amano S, Suyama S, Nishikura N, Sano C, Ohta R. Complicated Japanese Spotted Fever With Meningitis in an Older Patient: A Case Report. Cureus 2023; 15:e50681. [PMID: 38229818 PMCID: PMC10791036 DOI: 10.7759/cureus.50681] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Japanese spotted fever (JSF) poses a significant public health challenge, mainly due to its atypical presentation in specific demographics. This report details a unique case of JSF in an 89-year-old female who was admitted to a rural hospital exhibiting generalized pain and rapid cognitive decline but no rash. Initially misdiagnosed as polymyalgia rheumatica, her condition was complicated by thrombocytopenia and altered mental state, prompting consideration of tick-borne illnesses. Subsequent serological analysis confirmed JSF despite the absence of its hallmark rash. The patient's condition escalated to include bacteremia and aseptic meningitis. Treatment involved a regimen of minocycline and meropenem, along with endoscopic cauterization of a bleeding rectal ulcer. After treatment, the patient showed improvement and was transferred for rehabilitation. This case highlights the criticality of considering JSF in elderly patients within endemic areas, even when classic symptoms like erythema and petechiae are absent. It underscores the necessity for broad diagnostic perspectives, especially in atypical presentations, and the integration of comprehensive care approaches. The involvement of caregivers and relatives in early detection and seeking medical care promptly is crucial. The report illustrates the complexities in diagnosing and managing advanced JSF cases and stresses the importance of early serological testing and adaptive treatment strategies in managing such challenging cases.
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Affiliation(s)
- Shiho Amano
- Community Care, Unnan City Hospital, Unnan, JPN
| | | | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Tingvold L, Melby L. Three ways of organising general practitioner's medical services in sheltered housing. A qualitative study. Scand J Prim Health Care 2023; 41:400-410. [PMID: 37706637 PMCID: PMC11001341 DOI: 10.1080/02813432.2023.2256381] [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: 01/24/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE Explore care providers' experiences with the organisation of the medical services for residents in round-the-clock staffed sheltered housing. DESIGN Qualitative study and thematic analysis of individual interviews after strategic sampling of participants. SETTING Round-the-clock staffed sheltered housing in seven municipalities, inhabited by various user groups, and GPs in various locations in Norway. SUBJECTS In-depth interviews with 18 participants: 11 managers or employees in sheltered housing and seven GPs. MAIN OUTCOME MEASURES Main themes and subthemes reporting participants' experiences of medical provision to sheltered housing residents. RESULTS Three main models of organizing medical services for round-the-clock staffed sheltered housing were identified: (i) the 'multiple GP' model, where each resident has their own individual GP; (ii) the 'single GP' model, where all residents in the sheltered housing have one common GP; (iii) the 'hybrid' model, where a few dedicated GPs follow up the residents. CONCLUSION Residents in round-the-clock staffed sheltered housing constitute a varied group that generally has substantial medical assistance needs. Given that many residents lack autonomy to manage their own care needs and make decisions, models with fewer GPs like models ii and iii seem to provide a better medical professional offer. Moving towards such an organising of the medical services for sheltered housing residents could have implications for GPs' workload and competence needs. Future studies are needed to test models and assess implications.
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Affiliation(s)
- Laila Tingvold
- Centre for Care Research East, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Line Melby
- Centre for Care Research East, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Casani AP, Ducci N, Lazzerini F, Vernassa N, Bruschini L. Preceding Benign Paroxysmal Positional Vertigo as a Trigger for Persistent Postural-Perceptual Dizziness: Which Clinical Predictors? Audiol Res 2023; 13:942-951. [PMID: 38131807 PMCID: PMC10740490 DOI: 10.3390/audiolres13060082] [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: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Persistent postural-perceptual dizziness (PPPD) is a syndrome described as secondary, when it is the consequence of an organic disorder (s-PPPD), or primary, when no somatic triggers can be identified. We evaluated a group of patients diagnosed as s-PPPD, with Benign Positional Paroxysmal Vertigo (BPPV) as the main somatic trigger, with the aim of identifying the predictive clinical elements of evolution towards PPPD. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS We evaluated 126 patients diagnosed with PPPD; 54 patients were classified as p-PPPD (43%) and 72 as s-PPPD (57%). Of these, 51 patients had BPPV as a somatic trigger of PPPD, and in this group, we evaluated the prevalence of some clinical features (age, sex, latency between the onset of BPPV and the final diagnosis, recurrence of BPPV and the presence of migraine headache) for comparison with a group of patients who suffered from BPPV without an evolution towards PPPD (control group). RESULTS In the group with PPPD secondary to BPPV, we found a significantly higher mean age and a longer latency between the onset of BPPV and the final diagnosis compared to the control group. No difference between the two groups was found regarding sex, recurrence rate and the presence of migraine headache. CONCLUSIONS The parameters most involved as potential precipitants of PPPD after BPPV were the age of the patients and a long latency between the onset of BPPV and the final diagnosis; the mean age of the subjects who developed PPPD following BPPV was significantly higher. These findings lead us to emphasize the importance of the early identification and treatment of BPPV, especially in older patients.
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Affiliation(s)
- Augusto Pietro Casani
- Department of Surgical and Medical Pathology, ENT Section, Pisa University Hospital, 56122 Pisa, Italy; (N.D.); (F.L.); (N.V.); (L.B.)
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