Weak Handgrip at Index Admission for Acute Exacerbation of COPD Predicts All-Cause 30-Day Readmission

Rationale: Identifying patients hospitalized for acute exacerbations of COPD (AECOPD) who are at high risk for readmission is challenging. Traditional markers of disease severity such as pulmonary function have limited utility in predicting readmission. Handgrip strength, a component of the physical frailty phenotype, may be a simple tool to help predict readmission.Objective(s): To investigate if handgrip strength, a component of the physical frailty phenotype and surrogate for weakness, is a predictive biomarker of COPD readmission.Methods: This was a prospective, observational study of patients admitted to the inpatient general medicine unit at the University of Chicago Medicine, US. This study evaluated age, sex, ethnicity, degree of obstructive lung disease by spirometry (FEV1 percent predicted), and physical frailty phenotype (components include handgrip strength and walk speed). The primary outcome was all-cause hospital readmission within 30 days of discharge.Results: Of 381 eligible patients with AECOPD, 70 participants agreed to consent to participate in this study. Twelve participants (17%) were readmitted within 30 days of discharge. Weak grip at index hospitalization, defined as grip strength lower than previously established cut-points for sex and body mass index (BMI), was predictive of readmission (OR 11.2, 95% CI 1.3, 93.2, p = 0.03). Degree of airway obstruction (FEV1 percent predicted) did not predict readmission (OR 1.0, 95% CI 0.95, 1.1, p = 0.7). No non-frail patients were readmitted.Conclusions: At a single academic center weak grip strength was associated with increased 30-day readmission. Future studies should investigate whether geriatric measures can help risk-stratify patients for likelihood of readmission after admission for AECOPD.

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Reversibility of Frailty after Lung Transplantation

Journal of Transplantation ◽

10.1155/2020/3239495 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Elyn Montgomery ◽

Peter S. Macdonald ◽

Phillip J. Newton ◽

Sungwon Chang ◽

Kay Wilhelm ◽

...

Keyword(s):

Lung Transplantation ◽

Handgrip Strength ◽

Rehabilitation Program ◽

Morbidity And Mortality ◽

Physical Frailty ◽

Frailty Phenotype ◽

Frailty Assessment ◽

Frail Patients ◽

Lung Transplants ◽

Frailty Score

Background. Frailty contributes to increased morbidity and mortality in patients referred for and undergoing lung transplantation (LTX). The study aim was to determine if frailty is reversible after LTX in those classified as frail at LTX evaluation. Methods. Consecutive LTX recipients were included. All patients underwent modified physical frailty assessment during LTX evaluation. For patients assessed as frail, frailty was reassessed on completion of the post-LTX rehabilitation program. Frailty was defined by the presence of ≥ 3 domains of the modified Fried Frailty Phenotype (mFFP). Results. We performed 166 lung transplants (frail patients, n = 27, 16%). Eighteen of the 27 frail patients have undergone frailty reassessment. Eight frail patients died, and one interstate recipient did not return for reassessment. In the 18 (66%) patients reassessed, there was an overall reduction in their frailty score post-LTX ((3.4 ± 0.6 to 1.0 ± 0.7), p<0.001) with 17/18 (94%) no longer classified as frail. Improvements were seen in the following frailty domains: exhaustion, mobility, appetite, and activity. Handgrip strength did not improve posttransplant. Conclusions. Physical frailty was largely reversible following LTX, underscoring the importance of considering frailty a dynamic, not a fixed, entity. Further work is needed to identify those patients whose frailty is modifiable and establish specific interventions to improve frailty.

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Association between physical frailty and inflammation in late-life depression

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.038 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S84-S85

Author(s):

M. Arts ◽

R. Collard ◽

H. Comijs ◽

P. Naudé ◽

R. Risselada ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Gait Speed ◽

Inflammatory Markers ◽

Handgrip Strength ◽

Low Grade ◽

Late Life Depression ◽

Physical Frailty ◽

Frailty Phenotype ◽

Low Grade Inflammation

IntroductionAlthough the criteria for physical frailty and depression partly overlap, both represent unique, but reciprocally related constructs. The association between inflammation and frailty has been reported consistently, in contrast to the association between inflammation and late-life depression (LLD).Aim and objectivesTo determine whether physical frailty is associated with low-grade inflammation in LLD.MethodsThe physical frailty phenotype, defined as three out of five criteria (weight loss, weakness, exhaustion, slowness, low physical activity level), and three inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6), and neutrophil gelatinase–associated lipocalin (NGAL)] were assessed in a sample of individuals aged 60 and older with depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (n = 366).ResultsThe physical frailty phenotype was not associated with inflammatory markers in linear regression models adjusted for sociodemographic characteristics, lifestyle characteristics, and somatic morbidity. Of the individual criteria, handgrip strength was associated with CRP and IL-6, and gait speed was associated with NGAL. Principal component analysis identified two dimensions within the physical frailty phenotype: performance-based physical frailty (encompassing gait speed, handgrip strength, and low physical activity) and vitality-based physical frailty (encompassing weight loss and exhaustion). Only performance-based physical frailty was associated with higher levels of inflammatory markers.ConclusionThe physical frailty phenotype is not a unidimensional construct in individuals with depression. Only performance-based physical frailty is associated with low-grade inflammation in LLD, which might point to a specific depressive subtype.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Frailty, with or without Cognitive Impairment, is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab083 ◽

2021 ◽

Author(s):

Mei-Ling Ge ◽

Eleanor M Simonsick ◽

Bi-Rong Dong ◽

Judith D Kasper ◽

Qian-Li Xue

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Strong Predictor ◽

Word Recall ◽

Physical Frailty ◽

Frailty Phenotype ◽

Clock Drawing Test ◽

Recurrent Falls ◽

Health Aging ◽

Marginal Means

Abstract Background Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults. Methods The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017). Results Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13). Conclusions Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

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Dairy Product Intake and Long-Term Risk for Frailty among French Elderly Community Dwellers

Nutrients ◽

10.3390/nu13072151 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2151

Author(s):

Berna Rahi ◽

Hermine Pellay ◽

Virginie Chuy ◽

Catherine Helmer ◽

Cecilia Samieri ◽

...

Keyword(s):

Older Adults ◽

Dairy Product ◽

Food Group ◽

Community Dwelling ◽

Physical Frailty ◽

Frailty Phenotype ◽

Cross Sectional ◽

Sectional Analysis ◽

Community Dwelling Older Adults

Dairy products (DP) are part of a food group that may contribute to the prevention of physical frailty. We aimed to investigate DP exposure, including total DP, milk, fresh DP and cheese, and their cross-sectional and prospective associations with physical frailty in community-dwelling older adults. The cross-sectional analysis was carried out on 1490 participants from the Three-City Bordeaux cohort. The 10-year frailty risk was examined in 823 initially non-frail participants. A food frequency questionnaire was used to assess DP exposure. Physical frailty was defined as the presence of at least 3 out of 5 criteria of the frailty phenotype: weight loss, exhaustion, slowness, weakness, and low physical activity. Among others, diet quality and protein intake were considered as confounders. The baseline mean age of participants was 74.1 y and 61% were females. Frailty prevalence and incidence were 4.2% and 18.2%, respectively. No significant associations were observed between consumption of total DP or DP sub-types and frailty prevalence or incidence (OR = 1.40, 95%CI 0.65–3.01 and OR = 1.75, 95%CI 0.42–1.32, for a total DP consumption >4 times/d, respectively). Despite the absence of beneficial associations of higher DP consumption on frailty, older adults are encouraged to follow the national recommendations regarding DP.

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Muscle quantity and function measurements are acceptable to older adults during and post- hospitalisation: results of a questionnaire-based study

BMC Geriatrics ◽

10.1186/s12877-021-02091-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carly Welch ◽

Carolyn Greig ◽

Tahir Masud ◽

Thomas A. Jackson

Keyword(s):

Older Adults ◽

Gait Speed ◽

Bacterial Infections ◽

Handgrip Strength ◽

General Medicine ◽

Research Participation ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Queen Elizabeth Hospital ◽

Elective Colorectal Surgery

Abstract Background To evaluate the acceptability of handgrip strength, gait speed, quadriceps ultrasound, and Bioelectrical Impedance Analysis (BIA) to older adults conducted during and following hospitalisation. Methods Questionnaire-based study conducted upon completion of prospective cohort study, with follow-up in either Queen Elizabeth Hospital Birmingham (QEHB), UK, or participant’s own home following recent admission to QEHB. Outcome measures were acceptability as defined by total multi-domain score for each test (maximum score 35), and by frailty status. Results Forty adults aged 70 years and older admitted for emergency abdominal surgery, elective colorectal surgery, or acute bacterial infections (general medicine) participated. Handgrip strength (median 33, IQR 30–35; p = 0.001), gait speed (median 32, IQR 30–35; p = 0.002), ultrasound quadriceps (median 33, IQR 31–35; p = 0.001), and BIA (median 33.5, IQR 31–35; p = 0.001) were considered highly acceptable. Participants responded positively that they enjoyed participating in these tests, and considered these tests of importance. There was no difference in scores between tests (p = 0.166). Individual total test scores did not differ between patients with and without frailty. Qualitative data are also presented on drivers for research participation. Conclusions Handgrip strength, gait speed, ultrasound quadriceps, and BIA are acceptable tests to older adults during and following hospitalisation. Our results may serve as standards when evaluating acceptability of other tests. Trial registration Prospectively registered February 2019: https://clinicaltrials.gov/ct2/show/NCT03858192

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Prevalence of sarcopenia in patients with gastroesophageal and lung malignancies undergoing surgical resection and its impact on immediate postoperative outcomes: A prospective observational study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18617 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18617-e18617

Author(s):

Sudhakar Gunasekar ◽

SVS Deo ◽

Sunil Kumar ◽

Ekta Dhamija ◽

Sandeep Kumar Bhoriwal

Keyword(s):

Lung Cancer ◽

Weight Loss ◽

Grip Strength ◽

Handgrip Strength ◽

Ct Images ◽

Control Group ◽

Gastroesophageal Cancer ◽

Combined Method ◽

Skeletal Muscle Index ◽

Strength Based

e18617 Background: The study evaluated the prevalence & impact of sarcopenia in gastroesophageal cancer (GC) & lung cancer (LC) patients undergoing resection. Methods: An observational prospective study was conducted in department of surgical oncology, AIIMS, New Delhi. All patients aged under 65 years with resectable GC & LC were included. Skeletal muscle index (SMI) using cross-sectional CT images at the level of L3 & Hand grip strength (dynamometer) were used to assess sarcopenia. Random benign patients with CT images were used as control group. Patients were categorized into sarcopenic and non-sarcopenic and outcome parameters were compared. Results: In the study population (n = 66), GC & LC constituted 44 (66.67%) & 22(33.33%) respectively. Mean age was 53.4 years. The prevalence of sarcopenia based on the combined method (CT imaging & handgrip strength) was 57.58%, CT based sarcopenia was 33.34% & handgrip strength-based sarcopenia was 43.93%. Mild and moderate sarcopenia was seen in 37.88% (n = 25) & 19.7 % (n = 13) respectively. Among patients with GC, prevalence of sarcopenia was 59.09% by combined method, 36.36% and 43.18% by CT based method alone & handgrip strength-based method alone respectively. Among LC prevalence of sarcopenia was 54.54% by combined method, 27.27% and 45.45% by CT based & handgrip-based method. The concordance between CT muscle mass & grip strength was 62.12%. Most female patients had weak handgrip strength despite having normal SMI. In control group (n = 44) mean age was 54.5 years, the prevalence of CT based sarcopenia was 34.09%. Weight loss history & BMI correlated with the degree of sarcopenia. Out of 66 patients 13% (n = 9) patients were unresectable. Moderate sarcopenia group had more statistically significant (P -0.02) unresectable disease compared to mild and non-sarcopenic groups. In postoperative period, sarcopenic group (64.51% vs 38.36 %) had more grade 2 complications though statistically insignificant. There was no difference in hospital stay between the two groups. In patients with GC , postoperative respiratory complication occurred in 11.53% (n = 3) of sarcopenic patients and 5.5%(n = 1) of non-sarcopenic patients, anastomotic leak occurred in 7.69% (n = 2) of sarcopenic patients and 5.5% (n = 1) of nonsarcopenic patients. Conclusions: The prevalence of sarcopenia is higher in patients with gastroesophageal cancer compared to lung cancer. The important factors that affect the sarcopenia include age and body mass index and weight loss history. The study has showed a trend towards increased post-operative complications and increased unresectable cases in patients with mild to moderate sarcopenia. Further larger studies are required to validate if sarcopenia can be used as an adjunct to predict resectability and post-operative outcomes.

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Impact of Two-Step Testing Algorithm on Reducing Hospital-Onset Clostridioides difficile Infections

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.78 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s42-s43

Author(s):

Bhagyashri Navalkele ◽

Wendy Winn ◽

Sheila Fletcher ◽

Regina Galloway ◽

Jason Parham ◽

...

Keyword(s):

Medical Center ◽

Molecular Testing ◽

Toxin A ◽

Clostridioides Difficile ◽

Contact Isolation ◽

Academic Center ◽

Mississippi Medical ◽

True Infection ◽

Testing Algorithm ◽

The University

Clostridioides difficile infection (CDI) is one of the leading causes of hospital–onset infections. Clinically distinguishing true CDI versus colonization with C. difficile is challenging and often requires reliable and rapid molecular testing methods. At our academic center, we implemented a 2-step testing algorithm to help identify true CDI cases. The University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, Mississippi. Hospital-onset (HO) CDI was defined based on NHSN Laboratory Identified (LabID) event as the last positive C. difficile test result performed on a specimen using a multistep testing algorithm collected >3 calendar days after admission to the facility. HO-CDI data were collected from all inpatient units except the NICU and newborn nursery. HO-CDI outcomes were assessed based on standardized infection ratio (SIR) data. In May 2020, we implemented a 2-step testing algorithm (Figure 1). All patients with diarrhea underwent C. difficile PCR testing. Those with positive C. difficile PCR test were reflexed to undergo enzyme immunoassay (EIA) glutamate dehydrogenase antigen (Ag) testing and toxin A and B testing. The final results were reported as colonization (C. difficile PCR+/EIA Ag+/Toxin A/B−) or true CDI case (C. difficile PCR+/EIA +/Toxin A/B +) or negative (C. difficile PCR−). All patients with colonization or true infection were placed under contact isolation precautions until diarrhea resolution for 48 hours. During the preintervention period (October 2019–April 2020), 25 HO-CDI cases were reported compared to 8 cases in the postintervention period (June 2020–December 2020). A reduction in CDI SIR occurred in the postintervention period (Q3 2020–Q4 2020, SIR 0.265) compared to preintervention period (Q4 2019–Q1 2020, SIR 0.338) (Figure 2). We successfully reduced our NHSN HO-CDI SIR below the national average after implementing a 2-step testing algorithm for CDI. The 2-step testing algorithm was useful for antimicrobial stewardship to guide appropriate CDI treatment for true cases and for infection prevention to continue isolation of infected and colonized cases to reduce the spread of C. difficile spores.Funding: NoDisclosures: None

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The libraries in students’ and undergraduates’ educational reading

Scientific and Technical Libraries ◽

10.33186/1027-3689-2021-1-77-98 ◽

2021 ◽

Vol 1 (1) ◽

pp. 77-98

Author(s):

T. Yu. Cherkashina ◽

E. A. Chernyshova ◽

S. N. Lyutov

Keyword(s):

Social Relationship ◽

Organizational Context ◽

Academic Research ◽

Educational Process ◽

Reading Practices ◽

Structured Interviews ◽

Internet Resources ◽

Academic Center ◽

The University

The goal of the study was to reveal distinction between the reading practices at different educational levels and to specify the libraries’ place in these practices. The reading practices are determined not only by the new technological (digital) environment but also by the institutional and organizational context and social relationship within the educational environment. The case study of educa-tional institutions of Novosibirsk Academic Center (namely Novosibirsk State Uni-versity and the University’s specialized Academic Research Center) was accom-plished. The data was acquired through structured interviews, questionnaire-based survey supplemented with the statistical data of RAS SB State Public Scien-tific and Technological Library. The majority of high-graders use the library for textbooks and/or if recommended by the teacher. The university library is less involved in the educational process; the students visit the library occasionally (e.g. searching for rare publications or lacking alternatives). The university is not their source of digital documents or full texts either; the students prefer not to scruti-nize the specificity of every database and access procedure and turn to searchable Internet-resources. The library, in student’s opinion, needs modernization for less formal and disciplinary regulations, for more comfort, and polyfunctional envi-ronment of reading rooms.

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Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study

F1000Research ◽

10.12688/f1000research.16040.2 ◽

2019 ◽

Vol 8 ◽

pp. 417 ◽

Cited By ~ 1

Author(s):

Faezeh Jaafari ◽

Somayeh Delavari ◽

Leila Bazrafkan

Keyword(s):

Medical Students ◽

Clinical Education ◽

Group Discussion ◽

Geriatric Medicine ◽

General Medicine ◽

Ambulatory Setting ◽

Field Observations ◽

Medical Sciences ◽

Structured Interviews ◽

The University

Background: Recently, there has been an increase in life expectancy due to improvements in nutrition, health, and sanitation. The aim of this study was to evaluate the geriatric curriculum in the field of general medicine at Shiraz University of Medical Sciences (SUMS), Iran to improve the quality of services provided to this population in the community. Methods: This was a qualitative study. Six educational hospitals and ambulatory centers of Shiraz University of Medical Sciences participated in this study. Within these centers, 15 medical education faculty members and educational experts, 6 medical students, 6 elderly patients and 6 nurses working in the university related to the geriatric field were selected using purposive sampling. Data were gathered through semi-structured interviews, focus group discussion and field observations in the teaching hospital and ambulatory setting of SUMS from June 2017 to May 2018. Based on the qualitative research, the data underwent conventional content analysis and the main themes were developed from this. Results: Three main themes were extracted from the data: effective clinical education, geriatrics curriculum challenges and promotion strategies for geriatric medicine. Subcategories that emerged were a competent curriculum teacher, a challenging program, management of resources, promotion of the program, and the revision required in the curriculum, which were related to other concepts and described in the real-world situation of the geriatric curriculum in the university, as observed in field observations. Conclusions: This study identified three concepts as main themes that can be used to explain how to implement a geriatric curriculum in a medical university. The main contributing factor to different views of the participants was identified as the revision required to the curriculum for integrative care in a geriatric patient. This should be taken into consideration while planning any programs and decisions aimed at education of medical students on this topic.

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