COLONOSCOPY COMPLICATIONS IN THE ELDERLY: the impact of age and multimorbidity

ContextAge has been considered an independent risk factor for colonoscopy complications, especially when associated with multimorbidity.ObjectivesThe primary objective was to verify the relationships between age, multimorbidity and colonoscopy complications in the elderly.MethodsA retrospective cohort including patients of 60 years or older who had undergone a colonoscopy. Data relating to age, multimorbidities according to the cumulative illness scale for geriatrics and the Charlson index and complications related to bowel preparation and procedure (sedation and exam) were collected.ResultsOf the 207 patients (mean age 70.47 ± 7.04) with appropriate indication for colonoscopy according to the American Society for Gastrointestinal Endoscopy, 43 (20.77%) patients had some colonoscopy complications: 1 (0.48%) with the sedation (apnea), 4 (1.93%) with the procedure (abdominal pain and bacteremia) and 38 (18.35%) with the bowel preparation (acute renal failure, hypotension). Individuals ≥80 years had an RR = 3.4 (1.2-10.1),P = 0.025, and those with a Charlson index 3 had an RR = 5.2 (1.6-16.8), P = 0.006, for complications. The cumulative illness rating scale for geriatrics was not associated with complications (P = 0.45).ConclusionThere was a significant risk of complications in ≥80 years and in the group with a Charlson index 3. The cumulative illness rating scale for geriatrics was not a good predictor of risk in this sample.

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The impact of levothyroxine exposure on delivery outcome in hypothyroid pregnant women (PETAL study): A five-year retrospective cohort study

Obstetric Medicine ◽

10.1177/1753495x211064108 ◽

2021 ◽

pp. 1753495X2110641

Author(s):

Diana Oprea ◽

Nadine Sauvé ◽

Jean-Charles Pasquier

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Caesarean Delivery ◽

Significant Risk ◽

Significant Risk Factor ◽

Singleton Pregnancy ◽

Delivery Outcome ◽

The Impact

Background Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome. Methods This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome. Results Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different. Conclusion Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.

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Glucose variability and the risks of stroke, myocardial infarction, and all-cause mortality in individuals with diabetes: retrospective cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-020-01134-0 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Da Young Lee ◽

Kyungdo Han ◽

Sanghyun Park ◽

Ji Hee Yu ◽

Ji A. Seo ◽

...

Keyword(s):

Myocardial Infarction ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

The Elderly ◽

Glucose Variability ◽

All Cause Mortality ◽

Nationwide Observational Study ◽

The Impact

Abstract Background Previous research regarding long-term glucose variability over several years which is an emerging indicator of glycemic control in diabetes showed several limitations. We investigated whether variability in long-term fasting plasma glucose (FG) can predict the development of stroke, myocardial infarction (MI), and all-cause mortality in patients with diabetes. Methods This is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. A total of 624,237 Koreans ≥ 20 years old with diabetes who had undergone health examinations at least twice from 2005 to 2008 and simultaneously more than once from 2009 to 2010 (baseline) without previous histories of stroke or MI. As a parameter of variability of FG, variability independent of mean (VIM) was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31, 2017. Results During follow-up, 25,038 cases of stroke, 15,832 cases of MI, and 44,716 deaths were identified. As the quartile of FG VIM increased, the risk of clinical outcomes serially increased after adjustment for confounding factors including duration and medications of diabetes and the mean FG. Adjusted hazard ratios (95% confidence intervals) of FG VIM quartile 4 compared with quartile 1 were 1.20 (1.16–1.24), 1.20 (1.15–1.25), and 1.32 (1.29–1.36) for stroke, MI and all-cause mortality, respectively. The impact of FG variability was higher in the elderly and those with a longer duration of diabetes and lower FG levels. Conclusions In diabetes, long-term glucose variability showed a dose–response relationship with the risk of stroke, MI, and all-cause mortality in this nationwide observational study.

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High Cumulative Illness Rating Scale (CIRS) Score in CLL Correlates with Short CLL Telomere Length and Decreased Survival

Blood ◽

10.1182/blood.v128.22.4362.4362 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4362-4362

Author(s):

Lin Yang ◽

Sara Beiggi ◽

Yunli Zhang ◽

Sara Kost ◽

Robert Schmidt ◽

...

Keyword(s):

Overall Survival ◽

Telomere Length ◽

Rating Scale ◽

Conflicts Of Interest ◽

Tumor Biology ◽

Leukemia Cell ◽

Surrogate Marker ◽

The Elderly ◽

Lymphocytic Leukemia ◽

The Impact

Abstract The impact of chronic disease on the development and progression of cancer is increasingly recognized. Chronic lymphocytic leukemia (CLL) is a disease of the elderly and many of these patients have multiple comorbidities, which could shorten an individual's life, either directly or by enhancing CLL progression. In normal cells, including buccal cells (BC), it is known that chronic illness and age can shorten telomere length and this is a surrogate marker of overall survival. In the present study, we have examined the relationship between comorbidities and BC telomere length in CLL patients and determined whether these features can predict patient survival and disease aggressiveness. Telomere length in isolated genomic DNA from buccal and CLL cells of 196 CLL patients was measured at the time of diagnosis, using multiplex quantitative real-time PCR. Comorbidities were measured by the Cumulative Illness Rating Scale (CIRS) and CLL aggressiveness by leukemia cell telomere length. The median age of patients at diagnosis was 66 years (range, 39-89). With a median follow-up of 4.86 years (range, 0.05-7.69 years), approximately half the patients have progressed and one quarter have died. The median CIRS score of these patients was 3 (range, 0-12); a score of ≥7 was considered high. In patients with an elevated CIRS score, a direct correlation was found with increasing age (P<0.0001, r=0.42). In addition, independent of the effects of age, an increased CIRS score was found to correlate with poor overall survival (P=0.048, r=0.18). The median BC relative telomere length (T/S) of 2.01 (range, 0.70-5.66) was longer than the median CLL T/S of 0.53 (range, 0.07-2.48). There was no correlation between buccal and CLL telomere lengths (P=0.21). BC telomere lengths shortened with increasing age (P=0.011), but showed no association with markers of CLL disease, survival or high CIRS scores (P=0.08, r=-0.16). Meanwhile, patients with shorter CLL telomeres showed more aggressive disease with unmutated IGHVstatus (P<0.0001), higher Rai stage (P=0.02), shorter lymphocyte doubling time (P=0.004), earlier time to treatment (P<0.0001) and shorter overall survival (P=0.02). More importantly, short CLL telomere lengths occurred independent of increasing age (P=0.47), and significantly correlated with high CIRS scores (P=0.03, r=-0.18). In summary, while BC telomere lengths shorten with age in CLL cases, it is not predictive of survival or comorbidities in CLL. In contrast, independent of age, short CLL telomeres correlate with increasing CIRS scores and both predict poor survival. These results suggest that comorbidities in CLL may affect tumor biology, enhancing disease progression. This finding may partly explain the more aggressive clinical course of CLL in the elderly. Whether altering comorbidities in CLL can influence disease aggressiveness and survival requires further study. Disclosures No relevant conflicts of interest to declare.

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Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Low Body Weight Patients

Clinical Medicine Insights: Blood Disorders ◽

10.1177/1179545x19863814 ◽

2019 ◽

Vol 12 ◽

pp. 1179545X1986381 ◽

Cited By ~ 1

Author(s):

Daniel Dybdahl ◽

Grant Walliser ◽

Michelle Pershing ◽

Christy Collins ◽

David Robinson

Keyword(s):

Body Weight ◽

Venous Thromboembolism ◽

Major Bleeding ◽

The Elderly ◽

Primary Objective ◽

Minor Bleeding ◽

Bleeding Events ◽

Thromboembolism Prophylaxis ◽

Vte Prophylaxis ◽

The Impact

Background: The appropriate dose of enoxaparin for venous thromboembolism (VTE) prophylaxis in low body weight patients is unknown. Objective: The aim of this study is to evaluate the impact of enoxaparin dosing on major and minor bleeding events in low body weight patients. Methods: This was a retrospective cohort study of patients weighing less than 45 kg receiving subcutaneous (SC) enoxaparin for VTE prevention. The primary objective was to determine whether enoxaparin dose was associated with major and minor bleeding. The secondary objective was to determine the incidence of VTE by enoxaparin dose. Results: There were 173 patients included in the study, of which 37 patients received 2 different courses of enoxaparin during hospitalization, resulting in 210 enoxaparin courses. Among all enoxaparin courses, 16.2% were associated with major bleeding and 5.2% with minor bleeding. There was no difference in the incidence of major bleeding by dose (enoxaparin 30 mg SC daily, 30 mg SC twice daily, or 40 mg SC daily; P = .409). Patients who experienced major bleeding were older (54.9 ± 16.1 years) than patients who did not (48.4 ± 18.4 years) ( P = .043). There was no difference in the incidence of minor bleeding by dosing schedule ( P = .14). No patients experienced a VTE. Conclusion and Relevance: The risk of bleeding was similar by enoxaparin dose but increased with age in low body weight patients. Given the low incidence of VTE in this study, it is reasonable to consider decreasing the prophylactic enoxaparin dose in low body weight patients, especially in the elderly population.

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Long-Term Effects of Psychological Symptoms after Occupational Injury on Return to Work: A 6-Year Follow-Up

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16020235 ◽

2019 ◽

Vol 16 (2) ◽

pp. 235 ◽

Cited By ~ 1

Author(s):

Po-Ching Chu ◽

Wei-Shan Chin ◽

Yue Leon Guo ◽

Judith Shu-Chu Shiao

Keyword(s):

Return To Work ◽

Injury Severity ◽

Rating Scale ◽

Psychological Symptoms ◽

Occupational Injuries ◽

Significant Risk ◽

Injured Workers ◽

Early Screening ◽

The Impact

Psychological factors may compromise return to work among workers with occupational injuries, and little is known about the long-term consequences of psychological symptoms relating to return to work. The study examined the impact of psychological symptoms on return to work as well as exploring factors associated with return to work among injured workers. A total of 572 workers who experienced occupational injuries were recruited in this prospective cohort study. Surveys of the psychological symptoms using the 5-item Brief Symptom Rating Scale (BSRS-5) were conducted at 3 and 12 months after the injury. All of the workers were invited to join the study at year 6 after the injury. Sociodemographic factors, psychological symptoms, injury severity, and return-to-work status were collected. Approximately 10% of injured workers could not return to work even 6 years after the injury. Severe psychological symptoms within 1 year after the injury presented a significant risk factor for not returning to work 6 years after the injury (adjusted OR = 0.7, 95% CI: 0.5–0.8). Furthermore, age, education level, length of hospitalization, and injury-induced changes in appearance had significant independent influence on return to work as well. These findings highlight the importance of the effects of mental health within 1 year post injury on return to work, and support the concept of early screening, detection, and intervention in at-risk occupational injured workers with severe psychological symptoms.

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Adjunct Analgesic Use for Acute Pain in the Emergency Department

Hospital Pharmacy ◽

10.1310/hpj5202-138 ◽

2017 ◽

Vol 52 (2) ◽

pp. 138-143 ◽

Cited By ~ 6

Author(s):

James Priano ◽

Brian Faley ◽

Gabrielle Procopio ◽

Kevin Hewitt ◽

Joseph Feldman

Keyword(s):

Emergency Department ◽

Acute Pain ◽

Rating Scale ◽

Medical Center ◽

Academic Medical Center ◽

Primary Objective ◽

Opioid Dose ◽

Nonopioid Analgesics ◽

The Impact ◽

Nonopioid Analgesic

Purpose Multimodal analgesia is common practice in the postoperative setting, but the utility of adjunctive analgesia in the emergency department (ED) is less understood. The primary objective of this study was to analyze ED prescriber ordering habits for adjunct nonopioid pain medication for opioid-naïve patients who require intravenous (IV) morphine or hydromorphone for acute pain. Secondary objectives were to assess initial and total opioid consumption in morphine equivalent units (MEU), pain scores, and ED length of stay (LOS) between groups. Methods A retrospective chart review of adult patients who presented to the ED at a large academic medical center and received IV morphine or hydromorphone for acute pain was conducted. Patients were analyzed according to initial opioid received and presence or absence of adjunct nonopioid analgesics. Results A total of 102 patient charts were analyzed. Adjunctive nonopioid analgesics were ordered on 38% of patients. Patients who received an adjunct nonopioid analgesic received a smaller mean initial opioid dose than those who did not (4.73 vs 5.48 MEU, p = .08). Initial pain score reduction on the 11-point Numeric Rating Scale (NRS) did not differ between patients who received adjunct analgesics versus those who did not (3 vs 4, p = .75). Patients who received adjunct analgesics were associated with a decreased ED LOS (294 vs 342 minutes, p = .04). Conclusion A small proportion of patients with acute pain received a nonopioid analgesic in conjunction to IV opioids. Further studies are warranted to assess the impact of adjunct analgesics for patients with acute pain.

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Perioperative antibiotic prophylaxis: improved compliance and impact on infection rates

Epidemiology and Infection ◽

10.1017/s0950268810002505 ◽

2010 ◽

Vol 139 (9) ◽

pp. 1326-1331 ◽

Cited By ~ 25

Author(s):

E. PROSPERO ◽

P. BARBADORO ◽

A. MARIGLIANO ◽

E. MARTINI ◽

M. M. D'ERRICO

Keyword(s):

Antibiotic Prophylaxis ◽

Significant Risk ◽

Quality Improvement Initiative ◽

Perioperative Antibiotic Prophylaxis ◽

Urgent Surgery ◽

Antimicrobial Utilization ◽

Duration Of Surgery ◽

Prolonged Duration ◽

American Society ◽

The Impact

SUMMARYThe aims of this study were to determine adherence to the perioperative antibiotic prophylaxis (PAP) protocol used at a large Italian teaching hospital during a 6-year period, to assess the variables associated with inappropriate administration, and to measure the impact on surgical site infection (SSI) rates. There were 28 621 patients surveyed of which 74·6% received PAP. An improvement in adherence to the PAP protocol was registered for 58·8% of patients. Significant risk factors were an American Society of Anesthesiologists (ASA) score ⩾2 [odds ratios (OR) from 1·28 (95% confidence interval (CI) 1·19–1·37) to 1·87 (95% CI 1·43–2·44)], prolonged duration of surgery (OR 1·68, 95% CI 1·56–1·82) and urgent surgery (OR 2·16, 95% CI 1·96–2·37). During the study period, a significant reduction in SSIs rates was detected. We concluded that the global reduction of inadequate PAP administration signifies the efficacy of a multidisciplinary quality improvement initiative on antimicrobial utilization, and this is supported by the observed reduction of the SSI rate.

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Monocyte count and the risk for acute exacerbation of fibrosing interstitial lung disease: A retrospective cohort study

Chronic Respiratory Disease ◽

10.1177/1479973120909840 ◽

2020 ◽

Vol 17 ◽

pp. 147997312090984 ◽

Cited By ~ 2

Author(s):

Kodai Kawamura ◽

Kazuya Ichikado ◽

Keisuke Anan ◽

Yuko Yasuda ◽

Yuko Sekido ◽

...

Keyword(s):

Cohort Study ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Retrospective Cohort Study ◽

Scoring System ◽

Retrospective Cohort ◽

Significant Risk ◽

Monocyte Count ◽

Peripheral Monocyte ◽

The Impact

Recent studies have suggested that an increased peripheral monocyte count predicts a poor outcome in fibrosing interstitial lung disease (ILD). However, the association between an increased monocyte count and acute exacerbations (AEs) of fibrosing ILD remains to be elucidated. Our retrospective cohort study aimed to assess the impact of peripheral monocyte count on AEs of fibrosing ILD. We analyzed the electronic medical records of 122 consecutive patients with fibrosing ILD and no prior history of an AE, who were treated with anti-fibrotic agents from August 2015 to December 2018. We determined their peripheral monocyte counts at anti-fibrotic agent initiation and performed univariate and multivariate Cox regression analyses of time-to-first AE after anti-fibrotic agent initiation to assess the impact of monocyte count on AEs of fibrosing ILD. Twenty-six patients developed an AE during the follow-up period, and there was an increased monocyte count at anti-fibrotic agent initiation in these patients compared to those who did not develop an AE. There was also a significantly shorter time-to-first AE of fibrosing ILD in patients with a higher absolute monocyte count. Subgroup analyses indicated similar results regardless of the idiopathic pulmonary fibrosis diagnoses. This association was independently significant after adjusting for the severity of the fibrosing ILD. Using our results, we developed a simple scoring system consisting of two factors—monocyte count (<>380 µL−1) and ILD-gender, age, physiology score (<>4 points). Our findings suggest that the absolute monocyte count is an independent significant risk factor for AE in patients with fibrosing ILD. Our simple scoring system may be a predictor for AEs of fibrosing ILD, although further studies are needed to verify our findings.

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Outcomes and Risks With Age in Spondylolisthesis: A Comparison of the Elderly From the Quality Outcomes Database

Neurosurgery ◽

10.1093/neuros/nyz310_621 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Michael Karsy ◽

Andrew Kai-Hong Chan ◽

Michael S Virk ◽

Praveen V Mummaneni ◽

Mohamad Bydon ◽

...

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Rating Scale ◽

Age Groups ◽

The Elderly ◽

Quality Outcomes ◽

Degenerative Lumbar Spondylolisthesis ◽

Patient Reported ◽

Lumbar Spondylolisthesis ◽

The Impact

Abstract INTRODUCTION Degenerative lumbar spondylolisthesis affects 3% to 20% of the population with an increasing incidence of up to 30% in the elderly. The impact of age on surgical complication and patient reported outcomes (PRO) have yet to be evaluated in a modern, multicenter study. METHODS The Quality Outcomes Database (QOD) multicenter, prospective registry was used to evaluate patients from 12 US centers, including academic and private institutions, between July 2014 and June 2016 who underwent surgical treatment for grade 1 lumbar spondylolisthesis. All patients received at least 12 mo of follow-up RESULTS A total of 608 patients were divided into < 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and > 80 (n = 32) categories. Older patients showed lower body mass index (BMI) (P = .00001), increased diabetes (P = .007), coronary artery disease (P = .0001), and osteoporosis (P = .005). A lower likelihood for home disposition was seen with the elderly (89.1% in < 60 yr olds vs 75% in > 80 yr olds), with more elderly patients discharged to skilled nursing facilities or rehabilitation (P = .002). No baseline differences in PROs (Oswestry Disability Index [ODI], EQ-5D [EuroQol healthy survey], Numeric Rating Scale for leg pain [NRS-LP] and back pain [NRS-BP]) were seen among age categories. A significant improvement for all QOLs was seen regardless of age (P < .05). Minimal clinically important differences (MCID) in QOLs were seen after surgery for all age groups. No differences in hospital readmissions (30-d, 3-mo) or reoperations (30-d, 1-yr, 2-yr, and 3-yr) were seen among age groups (P < .05). CONCLUSION Despite increased presurgical comorbidities and risk, well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes without increases in complications or readmission. However, PRO do not improve to the same degree in the elderly as in younger adults. This modern, multicenter US study reflects the current use and limitation of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.

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The Impact of Patient Education on the Quality of Inpatient Bowel Preparation for Colonoscopy

Canadian Journal of Gastroenterology ◽

10.1155/2010/718628 ◽

2010 ◽

Vol 24 (9) ◽

pp. 543-546 ◽

Cited By ~ 48

Author(s):

Greg Rosenfeld ◽

Darin Krygier ◽

Robert A Enns ◽

Janakie Singham ◽

Holly Wiesinger ◽

...

Keyword(s):

Patient Education ◽

Bowel Preparation ◽

Rating Scale ◽

Tertiary Care ◽

Intervention Group ◽

Control Group ◽

Inpatient Setting ◽

Care Hospital ◽

Patient Counselling ◽

The Impact

BACKGROUND: For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.OBJECTIVES: To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy.METHODS: A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale.RESULTS: The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001).CONCLUSION: Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.

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