scholarly journals Functional Performance After Complex Endovascular Aortic Repair: A Single-Center Retrospective Cohort Study

2021 ◽  
pp. 152660282110282
Author(s):  
Britt W. C. M. Warmerdam ◽  
Yara van Holstein ◽  
Daniël Eefting ◽  
Carla S. P. van Rijswijk ◽  
Rutger W. van der Meer ◽  
...  
Keyword(s):  
Nursing Home ◽  
Patient Group ◽  
Functional Outcomes ◽  
Retrospective Cohort ◽  
Functional Performance ◽  
Care Pathway ◽  
Functional Decline ◽  
Single Center ◽  
Total Patient

Purpose Complex endovascular aortic repair (EVAR) procedures provide a treatment option for patients with aortic aneurysms involving visceral branches. Good technical results and short-term outcomes have been reported. Whether complex EVAR provides acceptable functional outcomes is not clear. The current study aims to describe postoperative functional outcomes in complex EVAR patients—an older and relatively frail patient group. Materials and Methods A single-center retrospective cohort study was performed, using data from a computerized database of consecutive patients who underwent complex EVAR in the Leiden University Medical Center (LUMC, The Netherlands) between July 2013 and September 2020. As of May 2017, patients scheduled for complex EVAR were referred to a geriatric care pathway to determine (Instrumental) Activities of Daily Living ((I)ADL) scores at baseline and, if informed consent was given, after 12 months. For the total patient group, adverse functional performance outcomes were: discharge to a nursing home and 12-month mortality. For the patients included in geriatric follow-up, the additional outcome was the incidence of functional decline (defined by a ≥2 point increase in (I)ADL-score) at 12-month follow-up Results Eighty-two patients underwent complex EVAR, of which 68 (82.9%) were male. Mean age was 73.3 years (SD=6.3). Within 30 days postsurgery, 6 patients (7.3%) died. Mortality within 12 months for the total patient group was 14.6% (n=12). After surgery, no patients had to be discharged to a nursing home. Fifteen patients (18.3%) were discharged to a rehabilitation center. Twenty-three patients gave informed consent and were included in geriatric follow-up. Five patients (21.7%) presented functional decline 12 months postsurgery and 4 patients had died (17.4%) by that time. This means that 39.1% of the patients in the care pathway suffered an adverse outcome. Conclusion To our knowledge, this is the only study that examined functional performance after complex EVAR, using a prospectively maintained database. No patients were newly discharged to a nursing home and functional performance results at 12 months are promising. Future multidisciplinary research should focus on determining which patients are most prone to deterioration of function, so that efforts can be directed toward preventing postoperative functional decline.

scholarly journals The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

2021 ◽  
Author(s):  
C. J. Koppel ◽  
B. W. Driesen ◽  
R. J. de Winter ◽  
A. E. van den Bosch ◽  
R. van Kimmenade ◽  
...  
Keyword(s):  
Coronary Artery ◽  
The Netherlands ◽  
Multicentre Study ◽  
Ct Angiography ◽  
Patient Group ◽  
Care Pathway ◽  
Coronary Anomalies ◽  
Work Up ◽  
Ischaemia Detection

Abstract Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.

Effectiveness of a Weight-Loss Intervention in Preventing Frailty and Functional Decline in Community-Dwelling Obese Older People. A Randomized Controlled Trial

2021 ◽  
pp. 1-9
Author(s):  
M. Serra-Prat ◽  
M. Terradellas ◽  
I. Lorenzo ◽  
M. Arús ◽  
E. Burdoy ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Weight Loss ◽  
Functional Performance ◽  
Controlled Trial ◽  
Functional Decline ◽  
Community Dwelling ◽  
Weight Loss Intervention ◽  
Randomized Controlled ◽  
Study Intervention

Background: Obesity is a risk factor for frailty and muscle weakness, so weight loss in obese older adults may prevent frailty and functional decline. Objective: To assess the safety and efficacy of a multimodal weight-loss intervention in improving functional performance and reducing frailty risk in obese older adults. Design: Randomized controlled trial with 2 parallel arms. Setting and participants: Community-dwelling obese adults aged 65-75 years with body mass index (BMI) 30-39 kg/m2. Intervention: 6-month multimodal intervention based on diet and a physical activity program. Control group: Usual care. Main and secondary outcome measures: Frailty (Fried criteria) rate and functional performance at 6, 12, and 24 months of follow-up, respectively. Intermediate outcome measures: Weight loss, body composition changes, and metabolic and inflammatory biomarker changes. Results: N=305. The study intervention increased gait speed at 12 and 24 months of follow-up, but had no significant effect on frailty prevention. It was effective in reducing weight, BMI, fat mass, interleukin 6, and insulin resistance and improving self-reported quality of life. Conclusions: The study intervention was not demonstrated to be effective in preventing frailty in obese people aged 65-75 years at 24 months of follow-up. However, it allowed weight loss and a reduction in inflammatory and insulin resistance markers, which could have a long-term effect on frailty that requires further research.

scholarly journals Quality of Life in the Fourth Age: Exercise Experiences of Nursing Home Residents

2007 ◽  
Vol 15 (3) ◽  
pp. 272-286 ◽  
Author(s):  
Afroditi Stathi ◽  
Piers Simey
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Exercise Intervention ◽  
Fear Of Falling ◽  
Functional Decline ◽  
Nursing Home Residents ◽  
Logical Approach ◽  
Supportive Environment

Life in the Fourth Age has been typified as a time of continued functional decline and reduced quality of life. Exercise might positively affect this experience. This study explored the exercise experiences of nursing home residents age 86–99 years who participated in a 6-month exercise intervention. An interpretive phenomeno-logical approach was adopted. Twenty-one interviews were held with 14 residents at baseline and 7 residents at follow-up. Although their expectations were initially conservative, by the end of the intervention participants noted improved quality of life through better mobility, decreased fear of falling, and feelings of achievement and success. They valued the program as an opportunity to do something for themselves, to add something to their weekly routine, to meet other people, and to be more active generally. The professionalism of the exercise instructor appears to have been critical, balancing principles of safe and effective practice with the need to ensure that participants had fun in a supportive environment.

scholarly journals Modified completely intrafascial radical cysprostatectomy for bladder cancer: a single-center, blinded, controlled study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiao Wang ◽  
Jia Guo ◽  
Lei Wang ◽  
Min Wang ◽  
Xiaodong Weng ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Erectile Function ◽  
Functional Outcomes ◽  
Cancer Control ◽  
Controlled Study ◽  
Control Group ◽  
Single Center ◽  
Significant Difference ◽  
Urinary Control

Abstract Background We have proposed a modified, completely intrafascial radical cysprostatectomy (RC) to treat bladder cancer patients with the aim of preserving the patients’ post-surgical urinary control and erectile function. This study aimed to evaluate the oncological and functional outcomes of this innovation relatively to that with the conventional technique. Methods A retrospective, single-center, blinded, and controlled study was conducted using the medical data of patients since the past 5 years from the hospital database. A total of 44 patients were included, including 20 who received complete intrafascial cysprostatectomy and 24 who received conventional interfascial surgeries. The patients’ continent and sexual information of 1-year follow-up after the surgery were extracted. The oncological and functional outcomes of the 2 groups were compared and analyzed. Results The demographics parameters of the 2 groups showed no significant difference. The results of follow-up of the oncological outcomes did not reveal any significant difference between the completely intrafascial group and the conventional interfascial group in terms of the positive surgical margins, local recurrences, and distant metastasis. Patients following neobladder diversion in the intrafascial group showed a faster recovery of the urinary control, with a 76.9% (10/13) daytime continent rate at 3-month, as well as 46.2% (6/13) and 58.3% (7/12) nighttime continent rates at 3-month and 6-month, respectively. Regarding the sexual functions, our results revealed significant advantages in favor of completely intrafascial technique on the post-surgical International Index of Erectile Function (IIEF)-5 score at 3-, 9-, and 12-month follow-up relative to that with the conventional interfascial process. Thus, the IIEF score of patients in the intrafascial group was 11.4 ± 3.5 at 3-month, 14.1 ± 3.6 at 9-month, and 15.2 ± 3.8 at 12-month follow-up after the cystectomy, which was significantly greater than that of the patients in the control group. Conclusions Our novel data illustrated that the modified completely intrafascial technique could result in a better sexual function and faster continence recovery for patients following RC, without any compromise in the cancer control. Thus, this technique could be considered as an alternative extirpative technique for bladder cancer treatment in a clinical setting.

scholarly journals A 52 month follow-up of functional decline in nursing home residents – degree of dementia contributes

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Anne-Sofie Helvik ◽  
Knut Engedal ◽  
Jūratė Šaltytė Benth ◽  
Geir Selbæk
Keyword(s):  
Nursing Home ◽  
Functional Decline ◽  
Nursing Home Residents

scholarly journals Case Report and Cohort Analysis of Drug-Induced Liver Injury Associated with Daptomycin

2014 ◽  
Vol 58 (8) ◽  
pp. 4902-4903 ◽  
Author(s):  
Nicole Bohm ◽  
Charles Makowski ◽  
Mario Machado ◽  
Adam Davie ◽  
Nelson Seabrook ◽  
...  
Keyword(s):  
Case Report ◽  
Liver Injury ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Single Center ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Retrospective Cohort Analysis ◽  
Creatinine Kinase Level

ABSTRACTA patient receiving daptomycin developed asymptomatic transaminitis and hyperbilirubinemia without concurrent multiorgan dysfunction or elevation of his creatinine kinase level. After ruling out other etiologies, the liver injury was attributed to daptomycin and was subsequently resolved. A single-center retrospective cohort analysis of baseline and follow-up liver function panels (n= 614) from all admissions from 2008 to 2013 during which daptomycin was administered did not reveal any other cases of probable or definite drug-induced liver injury associated with daptomycin.

scholarly journals P1486CHRONIC DIALYSIS IN ELDERLY PATIENTS: FUNCTIONAL PERFORMANCE STATUS AND TREATMENT OUTCOMES - A SINGLE-CENTER STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Krystsina Kurylovich ◽  
Kirill Komissarov
Keyword(s):  
Elderly Patients ◽  
Functional Status ◽  
Functional Performance ◽  
Performance Status ◽  
Functional Decline ◽  
High Serum ◽  
Phosphorus Level ◽  
Frail Patients ◽  
Target Values

Abstract Background and Aims The presence of multiple comorbid conditions and different geriatric impairments in elderly patients leads to a certain specificity in the management of this cohort of patients. The aim was to assess changes in functional performance status and treatment outcomes in elderly patients on chronic dialysis. Method A single-center longitudinal prospective study was conducted, which included 48 patients aged 65 years and older who underwent dialysis (hemodialysis and continuous ambulatory peritoneal dialysis) for more than 3 months. Participants’ functional performance status was measured by the Frailty Scale of Rockwood (FSR) at baseline and after a year of treatment. Functional performance status decline was defined as deterioration by 1 or more positions on the FSR, stable was defined as no difference between baseline and follow-up, and improvement was defined as a gain of 1 or more positions. At baseline, all participants were assessed by the Charlson Comorbidity Index (CCI) and standard lab tests were carried out. All data are presented as median and quartiles (25%; 75%). Results The median of age was 69 (67; 74) and 39.6% were women. The main causes of end-stage renal disease were hypertension (33.3%) and diabetes (31.3%). There were 83.3% hemodialysis patients and 31.3% received dialysis up to 1 year. At baseline 16.7% of patients were frail, 54.2% - pre-frail and 29.1% were fit. Among frail patients at the 1-year follow-up, 62.5% died, 12.5% had received a kidney transplant (KT), 25% showed a further functional performance status decline. Among pre-frail patients, almost half (46.2%) experienced functional decline and 15.4% died; the functional status remained unchanged in 30.8% of patients and 3.8% was transplanted; 1 patient (3.8%) had an improvement in functional performance status. Among fit patients, over half (57.2%) showed stable functional status, a functional decline was observed in 21.4% of patients (all of them became frail), 7.1% died and 14.3% had received a KT. All patients, who had stable functional performance status after a year of treatment, had target values of kt/v, albumin, and phosphorus at baseline. All deceased patients (20.8%) had CCI ≥ 6, 60% of them had high serum phosphorus level. Most functional performance status decline among participants was associated with a loss of mobility, which was most often caused by the progression of chronic heart failure (both independently and after heart attack) or chronic arterial failure (diabetic, due to obliterating atherosclerosis of the lower extremities), including the development of critical limb ischemia, especially in patients on hemodialysis. The distribution of patients according to the FSR in the initial assessment and re-assessment are presented in the table below. Conclusion Functional decline is highly prevalent in elderly patients on chronic dialysis, the risk is higher among frail and pre-frail patients. In most cases, functional performance status decline is associated with a loss of mobility due to the progression of chronic heart or arterial failure. Death probability is higher among frail patients and those with high serum phosphorus level (because of inadequate dialysis due to the initially severe condition of these patients) and high CCI. Achievement in the complex of the target values of kt/v, serum albumin, and phosphorus levels can help to maintain the functional status stable.

Predictors of Functional Decline in Nursing Home Residents: The Shelter Project

2019 ◽  
Vol 75 (8) ◽  
pp. 1600-1605 ◽  
Author(s):  
Massimiliano Fedecostante ◽  
Graziano Onder ◽  
Paolo Eusebi ◽  
Giuseppina Dell’Aquila ◽  
Elisa Zengarini ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Nursing Home ◽  
Protective Factor ◽  
Functional Decline ◽  
Nursing Home Residents ◽  
Quality Of Healthcare ◽  
Severe Dementia ◽  
Mixed Effect

Abstract Background The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics. Methods Longitudinal observational study involving 1,760 older (≥65 y) residents of NH participating in the SHELTER* study (57 NH in eight countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a 1 year follow-up. Facility and country effects were taken into account. Results During the study period 891 (50.6%), NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence, and used more antipsychotics. In the mixed-effect logistic regression model, factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor. Conclusions Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents’ care might be an important strategy to improve the outcome of this vulnerable population.

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