MO152CORRELATION OF PERCEIVED FRAILTY WITH MEASURED FRAILTY IN AN ADULT HAEMODIALYSIS POPULATION

Abstract Background and Aims Frailty is a measure of physiological reserve and the ability to respond to physiological stress. Increasing frailty predicts adverse health outcomes in patients with end stage renal disease (ESRD) Despite this, frailty is not routinely measured in clinical practice where clinician perception of frailty is used to inform decision making. The Clinical Frailty Scale (CFS) is a clinical judgement-based score that is a useful screening tool for frailty. Increasing frailty measured by CFS is predictive of adverse outcomes in patients with advanced chronic kidney disease (CKD) including falls, worsening disability, care home admissions, hospitalizations and ultimately mortality. It has been widely used in the assessment of patients with COVID-19 to help inform decisions regarding ceiling of care. This study aimed to assess the correlation between clinician perception of frailty and frailty as measured using the CFS. Method Frailty was assessed for all patients undergoing in centre hospital haemodialysis (n=53) in a single dialysis unit in Northern Ireland. A CFS score was calculated for all patients by a clinician who routinely uses the CFS in clinical practice. Patients with a score of 1-3 were classified as not frail, 4-5 as intermediately frail and 6-9 as frail. Nephrologists received basic education about frailty. They were then asked to categorize their patients as non-frail, intermediately frail or frail. The relationship between measured and perceived frailty was assessed using percent agreement. Participant characteristics of frail patients who were misclassified as intermediately frail or non-frail by clinicians were compared to those patients correctly classified as non-frail by clinicians. Fisher’s exact test was employed for categorical variables and t-tests were employed for pseudo normally distributed continuous variables. Results Of the 53 participants, the median age was 59 years (26-89). 41.5% were women. The median time on dialysis was 1.6 years. According to the CFS, 6 patients were categorised as non-frail, 30 patients as intermediately frail and 17 as frail. Among frail participants, 41% were correctly perceived as frail by their nephrologist. Among non-frail participants, 100% were correctly perceived as non-frail by their nephrologist. Among those who were frail according to the CFS, those misclassified as intermediately frail or non-frail, were younger (median age of those misclassified 49 years vs 62 years of those not mis-classified, P=0.03) but did not differ by sex (P=1), time on dialysis (P=0.39), presence of diabetes (P=0.30) or presence of vascular disease (P=1). Conclusion In this study of adult patients undergoing chronic haemodialysis, perceived frailty correlated with measured frailty using the CFS less than 50% of the time. This suggests that clinical perception is not an accurate surrogate for frailty status in this population group. Additionally, this study suggests that younger patients with ESRD are less likely to be correctly perceived as frail. Such misclassification could influence clinical decisions for treatment, including candidacy for kidney transplantation.

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Ethical Aspects of Genotype Disclosure: Perceptions of Participants in a Nutrigenetic Study in Finland

Public Health Genomics ◽

10.1159/000512640 ◽

2021 ◽

pp. 1-11

Author(s):

Suchetana De ◽

Maaria Tringham ◽

Anu Hopia ◽

Raija Tahvonen ◽

Anna-Maija Pietilä ◽

...

Keyword(s):

Basic Education ◽

Ethical Issues ◽

Research Process ◽

Lifestyle Changes ◽

Knowledge Assessment ◽

Categorical Variables ◽

Continuous Variables ◽

Allele Status ◽

Group Members ◽

Questionnaire Online

Objective: The aim of this study was to gain insight into the understanding of genetics and perceptions on the ethical issues related to genotype disclosure of the participants in a nutrigenetic study. Methods: A close-ended questionnaire was developed based on literature and discussions among the research group members. The questionnaire contained a total of 33 questions, which were divided into 4 categories – demographics, knowledge assessment, concerns related to participation, and opinions on disclosure of information. Majority of the participants (250 out of 281) of a nutrigenetic study, in which effect of disclosing APOE allele status on lifestyle changes was studied, completed the questionnaire online following the informed consent process. The responses from the knowledge assessment and the concern categories were transformed into knowledge and concern scales, respectively, and analysed by descriptive statistical methods. The statistical associations between the categorical variables were determined using χ2 test of independence. The relationship between the continuous variables was assessed using Pearson product-moment correlation coefficient and internal consistency of questions by Cronbach’s alpha. Results: No correlation was observed between the level of education and knowledge scores. About 10% of the participants thought that the genetic predisposition would be stressful to them and their family members. Conclusions: Careful distribution of information before a nutrigenetic study supports understanding and reduces concerns of genetic susceptibility. In Finland, strong basic education is likely to have strengthened the trust in research process.

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Prevalence, screening, treatment, and complications of osteoporosis and osteopenia in Medicare patients with chronic lymphocytic leukemia (CLL).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24050 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24050-e24050

Author(s):

Danielle M. Brander ◽

Kevin C. Oeffinger ◽

Melissa A. Greiner ◽

Michaela Ann Dinan

Keyword(s):

Cumulative Incidence ◽

Fragility Fractures ◽

National Sample ◽

Adverse Outcomes ◽

Lymphocytic Leukemia ◽

Categorical Variables ◽

Fee For Service ◽

Continuous Variables ◽

Mineral Density ◽

Health Maintenance

e24050 Background: Despite treatment advances, patients (pts) with CLL, a common chronic cancer affecting the elderly, often experience adverse outcomes due to their comorbidities and frequent lack of routine health maintenance. We examined osteoporosis/osteopenia (OSTEO) prevalence, rates of bone mineral density (BMD, g/cm2) screening by dual-energy x-ray absorptiometry (DXA), use of bisphosphonates, and fragility fractures among Medicare pts with CLL. Methods: We identified a cohort of CLL pts >65 years with Medicare fee-for-service between 1/1/2011-12/31/2015 using the Medicare 5% national sample. Controls (5:1) were matched based on age, sex, race, and year of eligibility. Among those with OSTEO, we compared rates of bisphosphonates. Chi-square tests for categorical variables and Wilcoxon Rank-sum tests for continuous variables were used to compare CLL vs controls. Cumulative incidence of BMD screening and fragility fractures were estimated using the cumulative incidence function and compared to controls using Gray tests. For fragility fractures, we compared among subgroups with and without OSTEO. Results: Baseline characteristics are in the Table. Compared to controls, CLL pts were more likely to have OSTEO (p < .001) but less bisphosphonate use (p = .006). The 3-yr cumulative incidence of fragility fractures was higher among CLL pts (8.0%, 95% CI 7.5%-8.6%) vs controls (7.2%, 6.9%-7.4%; p = .002) as well as among those without an OSTEO diagnosis (p = .02). Cumulative 3-yr DXA use was higher among CLL pts vs controls ( < .001); however, DXA 3-yr incidence was lower in CLL pts who had chemotherapy (13.2%, 11.4%-15.4%) vs none (17.0%, 16.2%-17.9%, p = .002). Conclusions: It appears that CLL pts may have a higher risk of osteoporosis and higher rates of fragility fractures than non-CLL individuals. Fragility fractures are higher even in the subgroup of CLL pts without OSTEO, suggesting that pts may be underdiagnosed. [Table: see text]

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Immune related adverse events and their treatment in melanoma patients receiving ipilimumab.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e14598 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e14598-e14598 ◽

Cited By ~ 3

Author(s):

Gerardo Cabanillas

Keyword(s):

Clinical Practice ◽

Adverse Events ◽

Immune Checkpoint Inhibitor ◽

Insurance Coverage ◽

Female Gender ◽

Gastrointestinal Diseases ◽

Categorical Variables ◽

Continuous Variables ◽

Regular Care ◽

Melanoma Patients

e14598 Background: Ipilimumab is an immune checkpoint inhibitor approved for the treatment of melanoma. Immune-related adverse events (irAEs) may occur as adverse effects. Most reports on irAEs are from clinical trials, which may not reflect community clinical practice and outcomes. We used a health insurance based database to identify irAEs and their treatment among patients with melanoma that received Ipilimumab, as part of regular care. Methods: We identified all melanoma patients aged 18 and older who received Ipilimumab from the Truven Health Analytics Marketscan database between 2011 and 2014. Patients had continuous insurance coverage from the period of six months prior to Ipilimumab and three months after. We further assessed the treatment for each irAEs. IrAEs were defined base on claims with one or more 228 ICD-9 codes; irAEs had to occur within a 6-month window before treatment. We used summary statistics such as means and standard deviations for continuous variables, frequencies and percentages for categorical variables. Results: The cohort included 1225 patients. Median age was 60 years, 62% were male; 343 (35.44%) patients had one or more irAEs, and 48.6% (211) were treated at least once. Young age and female gender were associated with a higher likelihood of having an irAEs. Endocrinopathies and gastrointestinal diseases were the most common irAEs. The most frequent irAEs was colitis in 27% of patients, followed by hypothyroidism 26%. Six different drugs were used to treat irAEs, and corticosteroids being the most frequently prescribed. Few patients with colitis received Infliximab 14%; and cyclosporine was prescribed in one patient with pancreatitis Conclusions: One third of the patients with melanoma treated with Ipilimumab in the community developed irAEs. Corticosteroids were the most frequent drugs used to treat irAEs. Our results show that toxicity remains high with the use of this agent in clinical practice.

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Frailty and sarcopenia

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0053 ◽

2020 ◽

pp. 521-531

Author(s):

Andrew Clegg ◽

Harnish Patel

Keyword(s):

Skeletal Muscle Mass ◽

Care Home ◽

Adverse Outcomes ◽

Care Needs ◽

Clinical Frailty Scale ◽

Health Events ◽

Health And Social Care ◽

Events Detection ◽

And Function ◽

Adverse Health Events

Sarcopenia and frailty are inter-related expressions of ageing which identify people at risk of important adverse health events such as falls, disability, and mortality, and the consequent health and social care needs such as hospitalization or care home admission. Sarcopenia is the progressive and generalized loss of skeletal muscle mass and function with age. It has a complex aetiology involving neurohormonal, immunological, and nutritional mechanisms, and is a core component of frailty, which is characterized by reduced biological reserves across a range of physiological systems that increase vulnerability to adverse outcomes following minor stressor events. Detection of frailty should be an essential part of assessment of older people, and the Clinical Frailty Scale is a simple tool based on comprehensive geriatric assessment that enables assignment of a frailty category based on clinical judgement.

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36. Maternity-associated Infective Endocarditis in the United States: Similar Outcomes to Non-pregnant Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.035 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S19-S20

Author(s):

Michael M Dagher ◽

Emily Eichenberger ◽

Kateena L Addae-Konadu ◽

Sarah K Dotters-Katz ◽

Vance G Fowler ◽

...

Keyword(s):

Drug Abuse ◽

Infective Endocarditis ◽

Patient Characteristics ◽

The United States ◽

Adverse Outcomes ◽

Categorical Variables ◽

Thromboembolic Events ◽

Continuous Variables ◽

Research Support ◽

Research Grant

Abstract Background Little is known about infective endocarditis (IE) occurring during pregnancy. In this analysis, we sought to define the patient characteristics, risk factors, and outcome of maternity-associated IE (maIE). Methods The National Readmissions Database was used to identify admissions for IE in female patients aged 12 – 55 years discharged between Oct. 2015 and Dec. 2017. Demographics, comorbidities, and outcomes were obtained. Differences between groups were analyzed using weighted Chi-squared test for categorical variables and weighted linear regression for continuous variables. Weighted multivariate regressions adjusted for demographics, hospital, etiologic organism, and comorbid conditions to assess the association between maternity status and outcomes. Results Out of 10,271 identified IE admissions (corresponding to a national estimate of 19,626 admissions), maIE accounted for 320 (national estimate 617) (3.1%). Of these maIE admissions, 41.2% were antepartum admissions, 26.3% resulted in delivery, 18.3% were postpartum, and 11.3% were an early or abnormal pregnancy. Patients with maIE were younger (28.4 ± 3.9 vs. 36.6 ± 8.0, P < 0.001) and more likely insured by Medicaid (73.3% vs. 46.6%, P < 0.001). Although generally healthier, patients with maIE had higher rates of drug abuse (75.7% vs. 58.5%, P < 0.001). In unadjusted comparisons maIE was associated with lower rates of 60-day mortality and thromboembolic events. In adjusted analysis only differences between rates of thromboembolic events were significant (adjusted incremental difference: -17.1%, 95% confidence interval: -22.7% to -11.6%). Differences in rates of valve procedures, mechanical ventilation, length of stay, and inpatient costs were not statistically significant (Figure). Regression-adjusted Outcomes Conclusion Compared with other reproductive aged female IE patients, patients with maIE are younger, healthier, more likely insured by Medicaid, and report higher rates of drug abuse. After adjustment, they receive similar management and do not appear to be at higher risk for adverse outcomes including mortality. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Actavis (Grant/Research Support)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Research Grant or Support)Affinium (Consultant)Allergan (Grant/Research Support)Ampliphi Biosciences (Consultant)Basilea (Consultant, Research Grant or Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Research Grant or Support)Contrafect (Consultant, Research Grant or Support)Cubist (Grant/Research Support)Debiopharm (Consultant)Destiny (Consultant)Durata (Consultant)Forest (Grant/Research Support)Genentech (Consultant, Research Grant or Support)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Research Grant or Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)Medimmune (Consultant, Research Grant or Support)Merck (Consultant, Research Grant or Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Research Grant or Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Research Grant or Support)Tetraphase (Consultant)Theravance (Consultant, Research Grant or Support)Trius (Consultant)xBiotech (Consultant)

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Abstract 3625: Do Patients Who Meet SCD-HeFT Criteria in Clinical Practice Differ from Patients Enrolled in SCD-HeFT?

Circulation ◽

10.1161/circ.116.suppl_16.ii_822-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Sana M Al-Khatib ◽

Yongfei Wang ◽

Kerry L Lee ◽

Daniel B Mark ◽

Jeanne E Poole ◽

...

Keyword(s):

Clinical Practice ◽

Randomized Clinical Trials ◽

Beta Blockers ◽

Nyha Class ◽

Cardiac Resynchronization ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Icd Implantation ◽

Baseline Characteristics

Background: Many studies have demonstrated the lack of generalizability of randomized clinical trials’ findings to clinical practice. We conducted this study to determine whether the baseline characteristics of patients meeting SCD-HeFT criteria in the ACC-NCDR ICD Registry are similar to those of patients enrolled in SCD-HeFT. Methods: Of the 1,438 US hospitals participating in the ICD Registry, 85% submit data on all ICD implants. We identified patients with NYHA class II or III symptoms and an LVEF ≤ 35%. We excluded patients with an MI within 40 days, CABG within 1 month, and PCI within 3 months prior to ICD implantation. We also excluded patients who received an ICD for secondary prevention or an ICD with cardiac resynchronization therapy. Baseline characteristics were compared using the t-test for continuous variables and the chi-square test for categorical variables. Results: Patients in the ICD Registry are significantly older and have more co-morbidities than patients enrolled in SCD-HeFT (Table ). The rates of use of ACE-inhibitors and digoxin were significantly lower in the Registry than in the trial (p <0.01 for both). The rates of use of beta-blockers, aspirin and statins were significantly higher in the Registry than in the trial (p <0.01 for all) Conclusions: The baseline characteristics and medical management of patients who receive an ICD in clinical practice are significantly different from those of patients enrolled in SCD-HeFT. Future studies should investigate whether these differences translate into differences in ICD effectiveness.

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Preoperative MRI findings and prediction of diagnostic utility of foramen ovale electrodes

Journal of Neurosurgery ◽

10.3171/2018.12.jns182093 ◽

2020 ◽

Vol 132 (3) ◽

pp. 692-699 ◽

Cited By ~ 1

Author(s):

Sarah K. Bick ◽

Marjan S. Dolatshahi ◽

Benjamin L. Grannan ◽

Andrew J. Cole ◽

Daniel B. Hoch ◽

...

Keyword(s):

Minimally Invasive ◽

Treatment Decision ◽

Temporal Lobectomy ◽

Categorical Variables ◽

Continuous Variables ◽

Foramen Ovale ◽

Mri Findings ◽

Noninvasive Methods ◽

Diagnostic Modality ◽

Diagnostic Investigations

OBJECTIVEForamen ovale electrodes (FOEs) are a minimally invasive method to localize mesial temporal seizures in cases in which noninvasive methods are inconclusive. The objective of this study was to identify factors predicting the ability of FOEs to yield a diagnosis in order to determine optimal candidates for this procedure.METHODSAll cases of diagnostic investigations performed with FOEs at the authors’ institution between 2005 and 2017 were reviewed. FOE investigation was defined as diagnostic if it led to a treatment decision. Demographic and clinical variables for diagnostic and nondiagnostic investigations were compared using a Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables.RESULTSNinety-three patients underwent investigations performed with FOEs during the study period and were included in the study. FOE investigation was diagnostic in 75.3% of cases. Of patients who underwent anterior temporal lobectomy following diagnostic FOE evaluation, 75.9% were Engel class I at last follow-up (average 40.1 months). When the diagnostic and nondiagnostic FOE groups were compared, patients who had diagnostic investigations were more likely to be male (57.1% male vs 26.1% in the nondiagnostic group, p = 0.015). They were also more likely to have temporal lesions on preoperative MRI (p = 0.018).CONCLUSIONSFOEs are a useful, minimally invasive diagnostic modality resulting in a treatment decision in 75% of cases. Male patients and patients with temporal lesions on MRI may be most likely to benefit from FOE investigation.

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The Physical Context of Child Development

Current Directions in Psychological Science ◽

10.1177/0963721420980719 ◽

2021 ◽

Vol 30 (1) ◽

pp. 41-48

Author(s):

Gary W. Evans

Keyword(s):

Child Development ◽

Observational Studies ◽

Physiological Stress ◽

Personal Characteristics ◽

Adverse Outcomes ◽

Structural Quality ◽

Physical Context ◽

Physical Setting ◽

Physical Features

Child development reflects interactions between personal characteristics and the physical and social environment. Psychology, however, lacks analysis of physical features that influence child development. In this article, I describe a preliminary taxonomy of physical-setting characteristics that can influence child development, focusing on environmental stressors such as noise, crowding, and chaos along with structural quality of housing, day care, and schools. Adverse outcomes associated with suboptimal physical settings during childhood include cognitive and socioemotional difficulties along with chronic physiological stress. Both direct effects on the child as well as indirect effects occurring via significant persons surrounding the child are described. Methodological limitations, particularly reliance on observational studies, are a weakness in the current literature, but increasingly more rigorously obtained findings yield converging evidence of the effects of physical settings on child development.

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Small Choroidal Melanoma: Correlation of Growth Rate with Pathology

Ocular Oncology and Pathology ◽

10.1159/000517203 ◽

2021 ◽

pp. 1-10

Author(s):

Vishal Raval ◽

Shiming Luo ◽

Emily C. Zabor ◽

Arun D. Singh

Keyword(s):

Growth Rate ◽

Retinal Pigment ◽

Choroidal Melanoma ◽

Case Series ◽

Subretinal Fluid ◽

Categorical Variables ◽

Continuous Variables ◽

Basal Diameter ◽

Orange Pigment ◽

Rpe Atrophy

Purpose: The aim of the study was to evaluate equivalence of growth rate and pathologic confirmation in small choroidal melanoma (SCM). Design: This study is a case series. Subjects, Participants, and Controls: A total of 61 patients with a choroidal melanocytic tumor of size 5.0–16.0 mm in the largest basal diameter and 1.0–2.5 mm in thickness were classified into the pathology-confirmed group (n = 19), growth-confirmed group (n = 30), and with combined observations (n = 12). Methods: Distribution of clinical variables (age, gender, laterality, tumor dimensions, tumor location, and presence of orange pigment, subretinal fluid, drusen, and retinal pigment epithelial [RPE] atrophy) between the groups was analyzed. Patient and disease characteristics were summarized as the median and interquartile range for continuous variables and the frequency and percentage for categorical variables. Comparisons were made using the Wilcoxon rank sum test for continuous variables and either Fisher’s exact test or the χ2 test for categorical variables with a p value threshold of 0.05 for statistical significance. Growth rate (change in basal dimension/12 months) diagnostic of SCM was quantified. Main Outcome Measures: The primary aim of this study was to test the hypothesis that “growth” was diagnostic of SCM with the secondary aim of quantifying the malignant “growth rate” (growth rate of SCM). Results: The clinical characteristics among all 3 groups were similar except more patients with symptoms (68 vs. 20 vs. 42%, p = 0.004) and juxtapapillary location (p = 0.03) were in the pathology group than in the growth-confirmed group. Those in the combined and growth-confirmed groups had more patients with drusen (11 vs. 60 vs. 50%, p = 0.003) and RPE atrophy (11 vs. 23 vs. 67%, p = 0.003), respectively, than in the pathology group. The median time to detect growth was 9 months (range 3–26 months). The mean growth rate in basal dimension was 1.8 mm/12 months (range, 0.0–7.4 mm; [95% CI: 1.32–2.28]). Conclusions and Relevance: Choroidal melanocytic lesions exhibiting a defined growth rate can be clinically diagnosed as SCM without a need for biopsy.

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The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

Psychological Medicine ◽

10.1017/s0033291721002932 ◽

2021 ◽

pp. 1-11

Author(s):

Yini Wang ◽

Xueqin Gao ◽

Zhenjuan Zhao ◽

Ling Li ◽

Guojie Liu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Significant Risk ◽

Type D Personality ◽

Adverse Outcomes ◽

Combined Effect ◽

Continuous Variables ◽

Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

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