Predicting chemotherapy toxicity in older adults: Comparing the predictive value of the CARG Toxicity Score with oncologists' estimates of toxicity based on clinical judgement

2019 ◽  
Vol 10 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Erin B. Moth ◽  
Belinda E. Kiely ◽  
Natalie Stefanic ◽  
Vasikaran Naganathan ◽  
Andrew Martin ◽  
...  
Keyword(s):  
Older Adults ◽  
Predictive Value ◽  
Clinical Judgement ◽  
Chemotherapy Toxicity ◽  
Toxicity Score

scholarly journals Polish Translation and Validation of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire to Assess Nutritional and Non-Nutritional Risk Factors of Sarcopenia in Older Adults

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1061
Author(s):  
Roma Krzymińska-Siemaszko ◽  
Ewa Deskur-Śmielecka ◽  
Arkadiusz Styszyński ◽  
Katarzyna Wieczorowska-Tobis
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Assessment ◽  
Predictive Value ◽  
High Sensitivity ◽  
Community Dwelling ◽  
Nutritional Risk ◽  
Polish Language ◽  
Community Dwelling Older Adults ◽  
Translation And Validation

A simple, short, cheap, and reasonably sensitive and specific screening tool assessing both nutritional and non-nutritional risk factors for sarcopenia is needed. Potentially, such a tool may be the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire, which is available in a seven-item (MSRA-7) and five-item (MSRA-5) version. The study’s aim was Polish translation and validation of both MSRA versions in 160 volunteers aged ≥60 years. MSRA was validated against the six sets of international diagnostic criteria for sarcopenia used as the reference standards. PL-MSRA-7 and PL-MSRA-5 both had high sensitivity (≥84.9%), regardless of the reference standard. The PL-MSRA-5 had better specificity (44.7–47.2%) than the PL-MSRA-7 (33.1–34.7%). Both questionnaires had similarly low positive predictive value (PL-MSRA-5: 17.9–29.5%; PL-MSRA-7: 14.4–25.2%). The negative predictive value was generally high for both questionnaires (PL-MSRA-7: 89.8–95.9%; PL-MSRA-5: 92.3–98.5%). PL-MSRA-5 had higher accuracy than the PL-MSRA-7 (50.0–55% vs. 39.4–45%, respectively). Based on the results, the Mini Sarcopenia Risk Assessment questionnaire was successfully adopted to the Polish language and validated in community-dwelling older adults from Poland. When compared with PL-MSRA-7, PL-MSRA-5 is a better tool for sarcopenia risk assessment.

scholarly journals Predictive Value of Initial Triage Vital Signs for Critically Ill Older Adults

2013 ◽  
Vol 14 (5) ◽  
pp. 453-460 ◽  
Author(s):  
Michael LaMantia ◽  
Paul Stewart ◽  
Timothy Platts-Mills ◽  
Kevin Biese ◽  
Cory Forbach ◽  
...  
Keyword(s):  
Older Adults ◽  
Critically Ill ◽  
Predictive Value ◽  
Vital Signs ◽  
Initial Triage

Predicting Chemotherapy Toxicity in Older Adults and the Importance of Geriatric Assessment

2012 ◽  
Vol 30 (5) ◽  
pp. 560-560 ◽  
Author(s):  
Joep Lagro ◽  
Stephanie A. Studenski ◽  
Marcel G.M. Olde Rikkert
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Chemotherapy Toxicity

Attended With and Head-Turning Sign can be clinical markers of cognitive impairment in older adults

2017 ◽  
Vol 29 (11) ◽  
pp. 1763-1769 ◽  
Author(s):  
Pinar Soysal ◽  
Cansu Usarel ◽  
Gul Ispirli ◽  
Ahmet Turan Isik
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Cognitive Assessment ◽  
Screening Methods ◽  
Operating Characteristics ◽  
Head Turning ◽  
Sensitivity Specificity

ABSTRACTBackground:Comprehensive neurocognitive assessment may not be performed in clinical practice, as it takes too much time and requires special training. Development of easily applicable, time-saving, and cost effective screening methods has allowed identifying the individuals that require further evaluation. The aim of present study was to assess the diagnostic value of the Attended With (AW) and Head-Turning Sign (HTS) for screening cognitive impairment (CI).Methods:Comprehensive geriatric assessment was performed in 529 elderly outpatients, and the presence or absence of AW and HTS was investigated in them all.Results:Of the 529 patients, of whom the mean age was 75.67 ± 8.29 years, 126 patients were considered as CI (102 dementia, 24 mild CI). The patients with positive AW had significantly lower scores on Mini-Mental State Examination, Cognitive State Test, and Montreal Cognitive Assessment, and activities of daily living compared to AW (−) patients (p < 0.001). Similar significant findings were obtained in the patients with positive and negative HTS (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of AW in detecting CI were 92%, 37%, 31.4%, and 93.7%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of HTS were 80%, 64%, 41.8%, and 91.5%, respectively. The area under the receiver-operating characteristics curve was 0.90 for AW and 0.82 for HTS.Conclusion:AW and HTS are fast, simple, effective, and sensitive methods for detecting CI. Therefore, they can be used for older adults attending the primary care settings with memory loss. Those with positive AW or HTS can be referred to the relevant centers for detailed cognitive assessment.

Predicting chemotherapy toxicity in older adults with lung cancer

2013 ◽  
Vol 4 (4) ◽  
pp. 334-339 ◽  
Author(s):  
Xiaomeng Nie ◽  
Dan Liu ◽  
Qiang Li ◽  
Chong Bai
Keyword(s):  
Lung Cancer ◽  
Older Adults ◽  
Chemotherapy Toxicity

scholarly journals Validation of a Prediction Tool for Chemotherapy Toxicity in Older Adults With Cancer

2016 ◽  
Vol 34 (20) ◽  
pp. 2366-2371 ◽  
Author(s):  
Arti Hurria ◽  
Supriya Mohile ◽  
Ajeet Gajra ◽  
Heidi Klepin ◽  
Hyman Muss ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Prediction Model ◽  
Receiver Operating Characteristic Curve ◽  
Predictive Model ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Chemotherapy Toxicity ◽  
Operating Characteristic Curve ◽  
Grade 3

Purpose Older adults are at increased risk for chemotherapy toxicity, and standard oncology assessment measures cannot identify those at risk. A predictive model for chemotherapy toxicity was developed (N = 500) that consisted of geriatric assessment questions and other clinical variables. This study aims to externally validate this model in an independent cohort (N = 250). Patients and Methods Patients age ≥ 65 years with a solid tumor, fluent in English, and who were scheduled to receive a new chemotherapy regimen were recruited from eight institutions. Risk of chemotherapy toxicity was calculated (low, medium, or high risk) on the basis of the prediction model before the start of chemotherapy. Chemotherapy-related toxicity was captured (grade 3 [hospitalization indicated], grade 4 [life threatening], and grade 5 [treatment-related death]). Validation of the prediction model was performed by calculating the area under the receiver-operating characteristic curve. Results The study sample (N = 250) had a mean age of 73 years (range, 65 to 94 [standard deviation, 5.8]). More than one half of patients (58%) experienced grade ≥ 3 toxicity. Risk of toxicity increased with increasing risk score (36.7% low, 62.4% medium, 70.2% high risk; P < .001). The area under the curve of the receiver-operating characteristic curve was 0.65 (95% CI, 0.58 to 0.71), which was not statistically different from the development cohort (0.72; 95% CI, 0.68 to 0.77; P = .09). There was no association between Karnofsky Performance Status and chemotherapy toxicity (P = .25). Conclusion This study externally validated a chemotherapy toxicity predictive model for older adults with cancer. This predictive model should be considered when discussing the risks and benefits of chemotherapy with older adults.

scholarly journals A Processed EEG based Brain Anesthetic Resistance Index Predicts Postoperative Delirium in Older Adults: A Dual Center Study

2021 ◽  
Author(s):  
Mary Cooter ◽  
Thomas Bunning ◽  
Sarada S. Eleswarpu ◽  
Mitchell T. Heflin ◽  
Shelley McDonald ◽  
...  
Keyword(s):  
Older Adults ◽  
Predictive Value ◽  
Postoperative Delirium ◽  
Multivariable Analysis ◽  
Surgical Patients ◽  
Anticholinergic Drugs ◽  
Derivation Cohort ◽  
Anesthetic Drugs ◽  
Processed Eeg ◽  
Combined Estimation

Background: Some older adults show exaggerated responses to drugs that act on the brain, such as increased delirium risk in response to anticholinergic drugs. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG based-measure of the brain's neurophysiologic resistance to anesthetic dose-related changes, and hypothesized that it would predict postoperative delirium. Methods: We defined the Duke Anesthesia Resistance Scale (DARS) as the average BIS index divided by the quantity 2.5 minus the average age-adjusted end-tidal MAC (aaMAC) inhaled anesthetic fraction. The relationship between DARS and postoperative delirium was analyzed in derivation (Duke; N=69), validation (Mt Sinai; N=70), and combined estimation cohorts (N=139) of older surgical patients (age >/= 65). In the derivation cohort, we identified a threshold relationship between DARS and for delirium and identified an optimal cut point for prediction. Results: In the derivation cohort, the optimal DARS threshold for predicting delirium was 27.0. The delirium rate was 11/49 (22.5%) vs 11/20 (55.0%) and 7/57 (12.3%) vs 6/13 (46.2%) for those with DARS >/= 27 vs those with DARS < 27 in the derivation and validation cohorts respectively. In the combined estimation cohort, multivariable analysis found a significant association of DARS <27.0 with postoperative delirium (OR=4.7; 95% CI: 1.87, 12.0; p=0.001). In the derivation cohort, the DARS had an AUC of 0.63 with sensitivity of 50%, specificity of 81%, positive predictive value of 0.55, and negative predictive value of 0.78. The DARS remained a significant predictor of delirium after accounting for opioid, midazolam, propofol, non-depolarizing neuromuscular blocker, phenylephrine and ketamine dosage, and for nitrous oxide and epidural usage. Conclusions: These results, if confirmed by larger future studies, suggest than an intraoperative processed EEG-based measure of lower brain anesthetic resistance (i.e. DARS <27) could be used in older surgical patients as an independent predictor of postoperative delirium risk.

scholarly journals A Path to Early Diagnosis of MCI and Dementia: Integrating myMemCheck Into the Primary Care Workflow

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 261-262
Author(s):  
William Mansbach ◽  
Ryan Mace ◽  
Theresa Frangiosa ◽  
Virginia Biggar ◽  
Meryl Comer ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Predictive Value ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Cognitive Status ◽  
Diagnostic Process ◽  
Characteristic Analysis ◽  
Self Assessment ◽  
Study Results

Abstract Barriers to the early detection of mild cognitive impairment (MCI) and dementia can delay diagnosis and treatment. myMemCheck® was developed as a rapid free cognitive self-assessment tool that can be completed in the practice setting or at home to identify older adults that would benefit from a more comprehensive cognitive evaluation for MCI and dementia. Two prospective cross-sectional studies (N = 59; N = 357) were conducted to examine the psychometric properties and clinical utility of myMemCheck®. myMemCheck® evidenced adequate reliability (test-retest, r = 0.67) and strong construct validity (η2 = 0.29, discriminating normal, MCI, dementia). Receiver operating characteristic analysis evidenced an optional myMemCheck® cut score for identifying older adults with MCI or dementia (sensitivity = 0.80, specificity = 0.67, positive predictive value = 0.91, negative predictive value = 0.43). myMemCheck® explained 25% of cognitive status beyond basic patient information. We provide specific suggestions for integrating myMemCheck® into practice to optimize workflow. Study results are further interpreted in the context of two national online surveys (healthcare professionals, N = 181; consumers, N = 1740). Healthcare professionals widely agreed on the need (94%) and importance (86%) of cognitive self-assessments. Public demand for cognitive self-assessment was confirmed by consumers who trialed myMemCheck® as part of their survey participation—86% agreed on the need for a tool like myMemCheck®. Mixed methods findings suggest that myMemCheck® could fast- track the diagnostic process, facilitate appropriate referrals for cognitive and neuropsychological evaluation, reduce assessment burden in healthcare, and prevent negative outcomes associated with undetected cognitive impairment.

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