scholarly journals Reproducibility and responsiveness of the Frailty Index and Frailty Phenotype in older hospitalized patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marlies Feenstra ◽  
Frederike M.M. Oud ◽  
Carolien J. Jansen ◽  
Nynke Smidt ◽  
Barbara C. van Munster ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Frailty Index ◽  
Correlation Coefficients ◽  
Medical Patients ◽  
Frailty Phenotype ◽  
Intra Class Correlation ◽  
Frailty Status ◽  
Smallest Detectable Change ◽  
Standard Error Of Measurement

Abstract Background There is growing interest for interventions aiming at preventing frailty progression or even to reverse frailty in older people, yet it is still unclear which frailty instrument is most appropriate for measuring change scores over time to determine the effectiveness of interventions. The aim of this prospective cohort study was to determine reproducibility and responsiveness properties of the Frailty Index (FI) and Frailty Phenotype (FP) in acutely hospitalized medical patients aged 70 years and older. Methods Reproducibility was assessed by Intra-Class Correlation Coefficients (ICC), standard error of measurement (SEM) and smallest detectable change (SDC); Responsiveness was assessed by the standardized response mean (SRM), and area under the receiver operating characteristic curve (AUC). Results At baseline, 243 patients were included with a median age of 76 years (range 70–98). The analytic samples included 192 and 187 patients in the three and twelve months follow-up analyses, respectively. ICC of the FI were 0.85 (95 % confidence interval [CI]: 0.76; 0.91) and 0.84 (95% CI: 0.77; 0.90), and 0.65 (95% CI: 0.49; 0.77) and 0.77 (95% CI: 0.65; 0.84) for the FP. SEM ranged from 5 to 13 %; SDC from 13 to 37 %. SRMs were good in patients with unchanged frailty status (< 0.50), and doubtful to good for deteriorated and improved patients (0.43–1.00). AUC’s over three months were 0.77 (95% CI: 0.69; 0.86) and 0.71 (95% CI: 0.62; 0.79) for the FI, and 0.68 (95% CI: 0.58; 0.77) and 0.65 (95% CI: 0.55; 0.74) for the FP. Over twelve months, AUCs were 0.78 (95% CI: 0.69; 0.87) and 0.82 (95% CI: 0.73; 0.90) for the FI, and 0.78 (95% CI: 0.69; 0.87) and 0.75 (95% CI: 0.67; 0.84) for the FP. Conclusions The Frailty Index showed better reproducibility and responsiveness properties compared to the Frailty Phenotype among acutely hospitalized older patients.

Prediction of lymph node metastase in NSCLC

2010 ◽  
Vol 01 (05) ◽  
pp. 219-226 ◽  
Author(s):  
F. Beyer ◽  
B. Buerke ◽  
J. Gerss ◽  
K. Scheffe ◽  
M. Puesken ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Fdg Pet ◽  
Automatic Segmentation ◽  
Correlation Coefficients ◽  
Mediastinal Lymph Nodes ◽  
Intra Class Correlation ◽  
Axial Diameter ◽  
Pet Ct ◽  
Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT.Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

scholarly journals The Framingham risk score is associated with incident frailty, or is it?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hui Shi ◽  
Mei-Ling Ge ◽  
Birong Dong ◽  
Qian-Li Xue
Keyword(s):  
Older Adults ◽  
Risk Score ◽  
Cox Regression ◽  
Activity Level ◽  
Cvd Risk ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Adverse Health Outcomes ◽  
Comorbidity Burden

Abstract Backgrounds Cardiovascular disease (CVD) risk factors are individually associated with frailty. This study examined whether Framingham CVD risk score (FRS) as an aggregate measure of CVD risk is associated with incident frailty among Chinese older adults. Methods This study used data from the China Health and Retirement Longitudinal Study. A sample of 3,618 participants aged 60 to 95 years and without CVD at baseline were followed for four years. FRS was calculated at baseline. Frailty status was defined as not-frail (0–2 criteria) or frail (3–5 criteria) based on the physical frailty phenotype consisting of five binary criteria (weakness, slowness, exhaustion, low activity level, and weight loss). After excluding subjects who were frail (n = 248) at baseline, discrete-time Cox regression was used to evaluate the relationship between FRS and incident frailty. Results During a median follow-up of 4.0 years, 323 (8 %) participants developed CVD and 318 (11 %) subjects had frailty onset. Higher FRS was associated with greater risk of incident frailty (HR: 1.03, 95 % CI: 1.00 to 1.06) after adjusting for education, marital status, obesity, comorbidity burden, and cognitive function. This association however was no longer significant (HR: 1.00, 95 % CI: 0.97 to 1.03) after additionally adjusting for age. These findings remained essentially unchanged after excluding subjects with depression (n = 590) at baseline or incident CVD (n = 323) during the 4-year follow-up. Conclusions The FRS was not independently associated with incident frailty after adjusting for chronological age. More research is needed to assess the clinical utility of the FRS in predicting adverse health outcomes other than CVD in older adults.

scholarly journals Reliability of Tibiofemoral Contact Area and Centroid Location in an Upright, Open MRI (UO-MRI)

2020 ◽  
Author(s):  
Andrew Schmidt ◽  
David J. Stockton ◽  
Michael A. Hunt ◽  
Andrew Yung ◽  
Bassam A. Masri ◽  
...  
Keyword(s):  
Measurement Error ◽  
Contact Area ◽  
Joint Mechanics ◽  
Detectable Change ◽  
Intra Class Correlation ◽  
Open Mri ◽  
Smallest Detectable Change ◽  
Knee Joint Mechanics ◽  
Standard Error Of Measurement ◽  
Centroid Location

Abstract Background: Biomechanical studies are often performed using conventional closed-bore MR, which has necessitated simulating weightbearing load on the joint. The clinical applicability of these biomechanical findings is unclear because of the limitations of simulating weightbearing. Upright, open MRI (UO-MRI) can be used to assess knee joint mechanics, in particular contact area and centroid location. However, it is not clear how reliably measurements of contact area and centroid location can be made in upright weightbearing postures. Methods: Manual segmentation of cartilage regions in contact was performed and centroids of those contact areas were automatically determined for the medial (MC) and lateral (LC) tibiofemoral compartments. To assess reliability, inter-rater, test-retest, and intra-rater reliability were determined by intra-class correlation (ICC 3,1 ), standard error of measurement (SEM), smallest detectable change with 95% confidence (SDC 95 ). Accuracy was assessed by using a high-resolution, 7T MRI as a reference and determined by measurement error (%). Results: Contact area and centroid location reliability (inter-rater, test-retest, and intra-rater) for sagittal scans in the MC demonstrated ICC 3,1 values from 0.95-0.99 and 0.98-0.99 respectively, and in the LC from 0.83-0.91 and 0.95-1.00 respectively. The smallest detectable change in contact area was 1.28% in the MC and 0.95% in the LC. Contact area and centroid location reliability for coronal scans in the MC demonstrated ICC 3,1 values from 0.90-0.98 and 0.98-1.00 respectively, and in the LC from 0.76-0.94 and 0.93-1.00 respectively. The smallest detectable change in contact area was 0.65% in the MC and 1.41% in the LC. Contact area segmentation was accurate to within 4.81% measurement error. Conclusions: Knee contact area and contact centroid location can be assessed in upright weightbearing MRI with good to excellent reliability and accuracy within 5%. The lower field strength used in upright, weightbearing MRI does not compromise the reliability of tibiofemoral contact area and centroid location measures.

How to choose PET-CT or CT in the diagnosis and staging of lung cancer

2010 ◽  
Vol 01 (05) ◽  
pp. 213-218
Author(s):  
X. Tao ◽  
H. Liu ◽  
T. Jiang ◽  
X. Zheng ◽  
S. Liu
Keyword(s):  
Lymph Nodes ◽  
Fdg Pet ◽  
Automatic Segmentation ◽  
Correlation Coefficients ◽  
Mediastinal Lymph Nodes ◽  
Intra Class Correlation ◽  
Axial Diameter ◽  
Pet Ct ◽  
Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT. Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

scholarly journals Prevalence and Prognostic Significance of Frailty in Gerontal Inpatients With Pre-clinical Heart Failure: A Subgroup Analysis of a Prospective Observational Cohort Study in China

2020 ◽  
Vol 7 ◽  
Author(s):  
Pei-Pei Zheng ◽  
Si-Min Yao ◽  
Jing Shi ◽  
Yu-Hao Wan ◽  
Di Guo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Subgroup Analysis ◽  
Frailty Index ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Frailty Phenotype ◽  
Observational Cohort ◽  
Clinical Heart Failure

Objective: To evaluate the prognostic value of frailty in gerontal pre-clinical heart failure (stage B heart failure, SBHF) inpatients.Background: The association between frailty and SBHF remains unknown.Methods: We conducted a subgroup analysis of a prospective observational cohort study on frailty. The previous study recruited 1,000 elderly inpatients who were consecutively admitted to a tertiary referral hospital in Beijing, China, from September 2018 to February 2019. The outcomes were all-cause death or readmission at 1-year follow-up. SBHF was diagnosed for asymptomatic cardiac structural or functional abnormalities. Frailty was assessed using the Comprehensive Geriatric Assessment-Frailty Index (CGA-FI).Results: Overall, 531 inpatients aged ≥65 years were deemed to have SBHF and followed up for 1 year. Of them, 34.5% exhibited frailty. During the follow-up period, all-cause death or readmission occurred in 157 (29.5%) participants. Of these participants, 36.6% (67/183) and 25.9% (90/348) belonged to the frail and non-frail groups, respectively (χ2 = 6.655, P = 0.010). Frailty, defined by the CGA-FI, rather than Fried frailty phenotype, could independently predict 1-year all-cause death or readmission (hazard ratio, 1.56; 95% confidence interval, 1.03–2.35; P = 0.034) and was more suitable for predicting all-cause death or readmission than N-terminal pro-B-type natriuretic peptide in female SBHF inpatients aged 80 years or over(AUCCGA−FI vs. AUCNT−proBNP 0.654 vs. 0.575, P = 0.017).Conclusions: Frailty is highly prevalent even among SBHF inpatients aged ≥65 years. The CGA-FI can independently predict 1-year all-cause death or readmission, rather than Fried frailty phenotype. Frailty in gerontal SBHF inpatients deserves more attention.Clinical Trial registration: ChiCTR1800017204; date of registration: 07/18/2018.

scholarly journals THE ASSOCIATION OF MORTALITY WITH DEMENTIA IN VETERANS ENROLLED IN A MEMORY DISORDERS CLINIC: THE EFFECT OF FRAILTY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S874-S875
Author(s):  
Aakashi Shah ◽  
Raquel Apracio-Ugarriza ◽  
Amar Morani ◽  
Mercedes Rodriguez-Suarez ◽  
Jorge G Ruiz
Keyword(s):  
Proportional Hazards ◽  
Neuropsychological Testing ◽  
Frailty Index ◽  
Positive Association ◽  
Cox Proportional Hazards ◽  
Memory Disorders ◽  
Frailty Status ◽  
Proportional Hazards Regression ◽  
Study Results

Abstract Dementia is a syndrome of deterioration in cognition and ability to perform everyday activities. Frailty, a state of vulnerability to stressors leading to increased morbidity, mortality and utilization is a determinant of dementia. The aim was to determine if dementia leads to increased mortality in Veterans and whether frailty affects this association. We conducted a retrospective cohort study of 308 Veterans enrolled in VA memory disorders clinic during 2016-2019. Dementia was diagnosed based on complete clinical assessments, brain imaging and neuropsychological testing. A 44–item frailty index (FI) was constructed using demographics, comorbidities, medications, laboratory tests, and activities of daily living. Patients were divided into non-Frail (FI&lt;0.21) and Frail (FI≥0.21). After adjusting for age, race, ethnicity, income, education, substance abuse, BMI, comorbidities, hospitalizations, medication use, the association of dementia with mortality was assessed using Cox proportional hazards regression. Patients were 55.2% White, 74% non-Hispanic, and the mean age was 74.4 ± 8.3 years. 113 patients were diagnosed with dementia out of which 27 died. Over a median follow-up period of 526 days (Interquartile Range: 431.5 days), there were 27 deaths. There was a significant and positive association of dementia with mortality significant even after all adjustments, HR=2.65 (95% CI: 1.02-6.92), p: 0.045. After subgroup analysis, there was no significant association between mortality and dementia according to frailty status. Our study results suggest that dementia is associated with a higher risk for mortality in Veterans at a Memory Disorders clinic. Frailty did not modify the effect.

Reliability, feasibility and satisfaction of telemedicine evaluations for cervical dystonia

2019 ◽  
Vol 26 (9) ◽  
pp. 560-567
Author(s):  
Avram Fraint ◽  
Glenn T. Stebbins ◽  
Gian Pal ◽  
Cynthia L. Comella
Keyword(s):  
Cervical Dystonia ◽  
Visual Inspection ◽  
Rating Scale ◽  
Correlation Coefficients ◽  
Summary Score ◽  
Spasmodic Torticollis ◽  
Kappa Statistics ◽  
Intra Class Correlation ◽  
Neurologic Diseases

Introduction Telemedicine is used successfully for evaluating patients with neurologic diseases, but has not been tested in cervical dystonia (CD). CD is uniquely suited for telemedicine as the scales validated to assess its severity rely only on visual inspection. The study sought to determine reliability, feasibility and satisfaction of telemedicine visits for evaluating CD. Methods Patients 18 years and older with a diagnosis of CD and scheduled for botulinum toxin (BoNT) injections were recruited, with a total of 46 enrolled. Dystonia severity was evaluated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) motor severity subscale. Three total evaluations took place: an initial telemedicine evaluation on the day prior to a scheduled BoNT injection; an in-person evaluation in clinic immediately before injections; and a follow-up telemedicine visit 4–6 weeks after injection with subsequent completion, by both participants and the clinician, of satisfaction questionnaires. Agreement between telemedicine and in-person TWSTRS data was calculated using intra-class correlation coefficients (ICC) and kappa statistics where appropriate. Feasibility was determined by the percent of patients completing all three visits, and satisfaction with telemedicine visits was determined based on answers to satisfaction questionnaires. Results There was excellent agreement between visit types for the TWSTRS motor severity summary score (κ = 0.890; 95th CI 0.713; 0.949). Only two individual TWSTRS items failed to meet the threshold for moderate agreement. Feasibility and satisfaction were high. Discussion Telemedicine is reliable and feasible in the evaluation of CD. Some CD patients would prefer telemedicine visits. Participants and the clinician were satisfied with telemedicine visits.

Smartphone “Selfies”—A reliable and accurate tool for measuring elbow range of motion

2019 ◽  
pp. 175857321986920
Author(s):  
Maegan N Shields ◽  
Anthony M Vaichinger ◽  
Shawn W O’Driscoll
Keyword(s):  
Range Of Motion ◽  
Correlation Coefficients ◽  
Clinic Visit ◽  
Senior Author ◽  
Mean Difference ◽  
Intra Class Correlation ◽  
Loss To Follow Up ◽  
Flexion Extension ◽  
Elbow Function

Background To determine if self-taken photographs (“selfies”), performed independently after instruction by video or illustrated handout, would be an accurate and reliable tool for capturing elbow range of motion in patients with elbow contractures. Methods Fifty patients presenting with elbow contractures participated in the study. After completion of the selfie, the senior author clinically measured flexion and extension with a goniometer. The angles from the photographs were measured and analyzed. Results The agreement between goniometer and “selfie” measurements correlated closely (R2 = 0.98) and agreement was excellent in both extension and in flexion with intra-class correlation coefficients of 0.95 (95% CI 0.92 to 0.97) in extension with a mean difference of 2° (95% CI −3° to 7°), and 0.93 (95% CI 0.89 to 0.96) in flexion with a mean difference of 4° (95% CI 0° to 8°). Systematic errors were low in extension, 0° (95% CI, ±11°) and in flexion −3° (95% CI, ±10°). Six patients demonstrated ≥10° difference between clinical and selfie measurements. Ability to take a usable selfie was inversely correlated with age (R2 = 0.97). Discussion Self-taken flexion–extension photographs are a reliable and accurate tool for measuring elbow range of motion. Errors in the selfie technique are well tolerated and appear to have a negligible effect upon measurements of motion. This important parameter of elbow function can therefore be obtained outside a normal clinic visit, thereby improving frequency of follow-up assessments (and minimizing loss to follow-up) necessary for quality control and research.

Epigenetic Age Acceleration and Change in Frailty in MOBILIZE Boston

2022 ◽  
Author(s):  
Benjamin Seligman ◽  
Sarah D Berry ◽  
Lewis A Lipsitz ◽  
Thomas G Travison ◽  
Douglas P Kiel
Keyword(s):  
Dna Methylation ◽  
Smoking Status ◽  
Frailty Index ◽  
450K Array ◽  
Frailty Phenotype ◽  
Cross Sectional ◽  
Epigenetic Age ◽  
Epigenetic Age Acceleration ◽  
Frailty Score

Abstract Age-associated changes in DNA methylation have been implicated as one mechanism to explain the development of frailty, however previous cross-sectional studies of epigenetic age acceleration (eAA) and frailty have had inconsistent findings. Few longitudinal studies have considered the association of eAA with change in frailty. We sought to determine the association between eAA and change in frailty in the MOBILIZE Boston cohort. Participants were assessed at two visits 12-18 months apart. Intrinsic, extrinsic, GrimAge, and PhenoAge eAA were assessed from whole blood DNA methylation at baseline using the Infinium 450k array. Frailty was assessed by a continuous frailty score based on the frailty phenotype and by frailty index (FI). Analysis was by correlation and linear regression with adjustment for age, sex, smoking status, and BMI. 395 participants with a frailty score and 431 with a FI had epigenetic and follow-up frailty measures. For the frailty score and FI cohorts, respectively, mean (SD) ages were 77.8 (5.49) and 77.9 (5.47), 232 (58.7%) and 257 (59.6%) were female. All participants with epigenetic data identified as white. Baseline frailty score was not correlated with intrinsic or extrinsic eAA, but was correlated with PhenoAge and, even after adjustment for covariates, GrimAge. Baseline FI was correlated with extrinsic, GrimAge, and PhenoAge eAA with and without adjustment. No eAA measure was associated with change in frailty, with or without adjustment. Our results suggest that no eAA measure was associated with change in frailty. Further studies should consider longer periods of follow-up and repeated eAA measurement.

Self-Management Behaviours and Change in Frailty Status among Community-Dwelling Older Adults: A National Longitudinal Population-based Cohort Study

2022 ◽  
Author(s):  
Thi Lien To ◽  
Ching-Pyng Kuo ◽  
Chih-Jung Yeh ◽  
Wen-Chun Liao ◽  
Meng-Chih Lee
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Chronic Diseases ◽  
Community Dwelling ◽  
Self Management ◽  
Geriatric Syndrome ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Community Dwelling Older Adults

Abstract Background: Frailty in older adults is a common geriatric syndrome that can be reversed, thus coping strategies for the aging population are essential. Self-management behaviours may represent cost-effective strategies to reverse physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association of self-management behaviours with changes in frailty status over a four-year follow-up period (2007 to 2011).Methods: This data was retrieved from the Taiwan Longitudinal Study of Aging (TLSA), which is a prospective cohort study of 1,283 community-dwelling older adults aged 65 years and older without cognitive impairment. Frailty was assessed based on Fried's frailty phenotype, in which ≥ three criteria indicate frail. Self-management behaviours (maintaining body weight, quitting smoking, drinking less, exercising, diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multivariate logistic regression analyses were used to investigate the associations between self-management behaviours and changes in frailty status.Results: The prevalence of frailty was 8.7% at baseline and 8.1% after four years of follow-up, with 196 (15.3%) deaths. Overall, 74.6% of participants remained in the same state (non-frail or frail), 23.5% worsened (non-frail to frail, including missing data, and frail to death), and only 1.95% improved (frail to non-frail). Being aged ≥ 75-years-old, chronic diseases, and an absence of self-management behaviours were associated with higher risks of frailty at baseline and after follow-up. Exercise was significantly associated with a reversal of frailty in community-dwelling older adults (RR, 3.11; 95% CI, 1.95, 4.95) after adjusting for personal and disease covariates, regardless of whether death was coded as frail or not.Conclusions: Self-management behaviours beneficially reverse frailty status; maintaining regular exercise was especially associated with a reversal of frailty in community-dwelling older adults, even among individuals over 75-years-old and with chronic diseases. Older adults should be encouraged to perform adequate physical exercise to prevent the progression of frailty and ameliorate frailty status.

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