scholarly journals Screening for Frailty in Older Emergency Patients and Association with Outcome

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 20 ◽  
Author(s):  
Siobhan Lewis ◽  
Louis Evans ◽  
Timothy Rainer ◽  
Jonathan Hewitt
Keyword(s):  
Older Patients ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Care Home ◽  
Adverse Outcomes ◽  
Urgent Care ◽  
High Incidence ◽  
Screening Questions ◽  
The Mean ◽  
Secondary Outcomes

Older people have a high incidence of adverse outcomes after urgent care presentation. Identifying high-risk older patients early is key to targeting interventions at those patients most likely to benefit. This study used the Frailsafe three-point screening questions amongst older Emergency Department (ED) attendees. Consecutive unplanned ED attendances in patients aged ≥75 were assessed for Frailsafe status. The primary outcome was mortality at 180 days. A Frailsafe screen was completed in 356 patients, of whom 194/356 (54.5%) were Frailsafe positive. The mean age was 85.8 for Frailsafe screen positive and 82.2 for Frailsafe screen negative patients (p < 0.001). A positive Frailsafe screen was a predictor of death within 180 days of presentation to the ED and remained so after adjustment (AOR = 3.23, 95% CI 1.45–7.19, p = 0.004). A positive Frailsafe screen was an independent predictor of a new care home admission at 180 days (AOR = 8.95, 95% CI 2.01–39.83, p = 0.004). A positive Frailsafe screen was also predictive of a number of secondary outcomes, such as length of stay of >28 days (AOR 3.42, 95% CI 1.41–8.31, p = 0.007) and re-attendance within 30 days of discharge after admission (OR = 2.73, 95% CI 1.27–5.88, p = 0.01). Frailsafe screen results independently predict a range of outcomes amongst older ED attendees.

Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

2018 ◽  
Vol 103 (4) ◽  
pp. 494-498 ◽  
Author(s):  
Yichen Bai ◽  
Huanjie Nie ◽  
Shiyu Wei ◽  
Xiaohe Lu ◽  
Xiaoyun Ke ◽  
...  
Keyword(s):  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Primary Outcome ◽  
Safety And Efficacy ◽  
Postmenstrual Age ◽  
Zone Ii ◽  
The Mean ◽  
Secondary Outcomes ◽  
Number Of Injections

BackgroundTo evaluate the safety and efficacy of intravitreal conbercept (IVC) injection in the treatment of retinopathy of prematurity (ROP).MethodsPatients with ROP who underwent IVC injection in Zhujiang Hospital from June 2015 to July 2016 were studied retrospectively. The primary outcome was defined as the regression of plus disease. The secondary outcomes were defined as the presence of recurrence, number of injections and the final regression of disease.ResultsA total of 48 eyes of 24 patients with ROP were included. Among them, 9 eyes of 5 patients had zone I ROP, 35 eyes of 18 patients had zone II ROP and 4 eyes of 2 patients had aggressive posterior ROP. The mean gestational age was 28.5±1.6 weeks, the mean birth weight was 1209.6±228.6 g, the mean postmenstrual age of first injection was 34.2±1.9 weeks and the mean follow-up period was 31.0±4.7 weeks. Forty of 48 eyes (83.3%) received IVC only once, and the regression of plus disease occurred at an average of 3.5±1.5 weeks after the first injection of conbercept. For eight recurrent eyes (16.7%), four eyes received a second IVC and the remaining four eyes received laser photocoagulation, and the regression of plus disease occurred in 3 weeks. No lens opacity, vitreous haemorrhage, entophthalmia or retinal detachment was observed during follow-up.ConclusionIVC injection is an effective treatment for ROP.

Primary Use of the TruePath Crossing Device for Infrainguinal Chronic Total Occlusions With Intravascular Ultrasound Evaluation

2018 ◽  
Vol 25 (5) ◽  
pp. 592-598 ◽  
Author(s):  
Yoshimitsu Soga ◽  
Miho Nakamura ◽  
Kaoru Hirose ◽  
Nobuhiro Ito ◽  
Yusuke Tomoi ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Primary Outcome Measure ◽  
High Rate ◽  
Access Site ◽  
Chronic Total Occlusions ◽  
Ultrasound Evaluation ◽  
The Mean ◽  
Severe Calcification

Purpose: To evaluate the use of the TruePath crossing device as the primary recanalization tool for infrainguinal chronic total occlusions (CTO). Methods: A retrospective analysis was conducted of 50 patients (mean age 75 years; 26 men) with 55 infrainguinal CTOs treated with the TruePath between March 2017 and September 2017 at a single center. The mean occlusion length was 138±55 mm, and femoropopliteal lesions accounted for 65% of the 55 lesions. The primary outcome measure was CTO crossing using the TruePath alone; secondary outcomes were assisted success (>50% lumen gain using the TruePath), device-related complications, and intraluminal crossing evaluated by intravascular ultrasound (IVUS). Results: Complete success was achieved in 33 (60%) of 55 lesions having a mean occlusion length of 145±72 mm. Among these, the true lumen crossing rate was 97% according to IVUS evaluation. Assisted success was achieved in 15 (68%) of the 22 failures. Complete/assisted success, in which the TruePath was thought to have contributed to CTO crossing, was attained in 48 (87%) of the 55 lesions. Three (5.5%) complications were observed: a perforation, an access-site hematoma, and acute occlusion; only the perforation was device related (1.8%). Multivariate analysis showed PACCS grade 4 (odds ratio 4.5, 95% confidence interval 1.33 to 15.5, p=0.02) was an independent predictor of TruePath failure. Conclusion: Primary use of the TruePath crossing device for infrainguinal CTOs demonstrated a satisfactory complete success rate and a high rate of IVUS-documented intraluminal crossing with few device-related complications. Severe calcification is an independent predictor of TruePath failure.

Maternal Age and Preeclampsia Outcomes during Delivery Hospitalizations

2019 ◽  
Vol 37 (01) ◽  
pp. 044-052 ◽  
Author(s):  
Jean-Ju Sheen ◽  
Yongmei Huang ◽  
Maria Andrikopoulou ◽  
Jason D. Wright ◽  
Dena Goffman ◽  
...  
Keyword(s):  
Older Women ◽  
Maternal Age ◽  
Primary Outcome ◽  
Temporal Trends ◽  
Adverse Outcomes ◽  
Dependent Manner ◽  
Age Group ◽  
National Inpatient Sample ◽  
Secondary Outcomes ◽  
Dose Dependent

Abstract Objective To characterize risk and temporal trends for preeclampsia and related outcomes by maternal age. Study Design Deliveries to women aged 15 to 54 years in the 1998 to 2014 National Inpatient Sample who had a diagnosis of preeclampsia, eclampsia, or both were included in the analysis. Age was categorized as 15 to 17, 18 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, and 45 to 54 years. The primary outcome was temporal trends in preeclampsia based on maternal age. Secondary outcomes analyzed included risk for severe maternal morbidity. Results The proportion of women with preeclampsia aged 15 to 24 years decreased from 42.3% in 1998 to 30.1% in 2014, while preeclampsia among those 30 to 54 years increased from 32.9 to 43.7%. Preeclampsia risk increased for all groups over the study period. Risk for severe morbidity by age group with and without transfusion was “U-shaped,” with risk highest for women 18 to 24 and 40 to 54 years. The risk for abruption, acute renal failure, acute heart failure or pulmonary edema, and stroke was lowest for women aged 15 to 24 years and increased in a “dose-dependent” manner with increasing maternal age. In contrast, eclampsia risk was highest for women aged 15 to 17 years. Conclusion With a changing demographic profile of preeclampsia, older women accounted for an increasing proportion of preeclampsia and related adverse outcomes.

scholarly journals Evaluation of Levetiracetam for Early Post-Traumatic Seizure Prophylaxis: A Level II Trauma Center Experience

2021 ◽  
Author(s):  
Timothy A. Amin ◽  
Steven F. Nerenberg ◽  
Osama A. Elsawy ◽  
Antai Wang ◽  
Jackie P. Johnston
Keyword(s):  
Trauma Center ◽  
Chart Review ◽  
Primary Outcome ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Level Ii ◽  
Post Traumatic ◽  
The Mean ◽  
Secondary Outcomes

Abstract Background: Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis.Methods: A single-center, retrospective chart review of TBI patients > 18 years who received LEV for early PTS prophylaxis between August 2018 - July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).Results: Of the 137 included, mean age was 59±20 years and 69.3% were male. The mean admission GCS was 13±4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4-10) days and 13.9% met recommended 7-day duration. Those prescribed LEV > 7 days had more than twice the median LEV duration than those prescribed ≤ 7 days (10.25 (8.5-15.5) vs 4 (1.5-4.5) days, p < 0.0001). EEG-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1-7) and 7 (IQR 3-16) days, respectively. Conclusions: The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.

Effectiveness and tolerability of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis

Rheumatology ◽  
2021 ◽  
Author(s):  
Janne Heuvelmans ◽  
Nathan den Broeder ◽  
Geke A H van den Elsen ◽  
Alfons A den Broeder ◽  
Bart J F van den Bemt
Keyword(s):  
Rheumatoid Arthritis ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Real Life ◽  
Treat To Target ◽  
Oral Methotrexate ◽  
Real Life Setting ◽  
Significant Difference ◽  
The Mean ◽  
Secondary Outcomes

Abstract Objectives The aim of this study was to compare the effectiveness and tolerability between oral methotrexate (MTX) and subcutaneous MTX in a large group of rheumatoid arthritis (RA) patients in a real-life setting. Methods In this retrospective cohort study, adult patients with clinical diagnosis of RA who started MTX treatment (monotherapy or combined with hydroxychloroquine), either started with oral or subcutaneous MTX. The primary outcome was superiority testing of between group difference in change in DAS28CRP between baseline and 3–6 months, and subsequent non inferiority testing (NI margin 0.6) analyses in case of non-superiority. Secondary outcomes included MTX dose, side effects, laboratory abnormalities, and use of comedication. Results 640 RA patients were included: 259 started with oral MTX and 381 with subcutaneous. There was no significant difference in ΔDAS28CRP, after adjusting for confounding, 0.13 (95%-CI: -0.14, 0.40), and oral MTX strategy was non inferior to subcutaneous. The mean MTX dose was slightly lower for the oral strategy (18.0 SD6.9 vs 19.9 SD8.2, p= 0.002), which was accompanied by a lower cumulative incidence of adverse events (41% vs 52%, p= 0.005). No differences were seen in use of other comedication. Conclusions Starting with oral MTX in RA in a real-life setting is non inferior to a subcutaneous MTX treatment with regard to disease activity control, at least when used in dosages up to 25 mg and on a background of HCQ cotreatment and a treat-to-target approach. In addition, tolerability was better. This supports the strategy of starting with oral MTX.

Mortality in American Veterans with the HLA-B27 Gene

2015 ◽  
Vol 42 (4) ◽  
pp. 638-644 ◽  
Author(s):  
Jessica A. Walsh ◽  
Xi Zhou ◽  
Daniel O. Clegg ◽  
Chiachen Teng ◽  
Grant W. Cannon ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Primary Outcome ◽  
Hla B27 ◽  
Test Results ◽  
Mortality Difference ◽  
National Cohort ◽  
Inflammatory Bowel ◽  
The Mean ◽  
Secondary Outcomes ◽  
The Difference

Objective.To compare survival in American veterans with and without the HLA-B27 (B27) gene.Methods.Mortality was evaluated in a national cohort of veterans with clinically available B27 test results between October 1, 1999, and December 31, 2011. The primary outcome was the mortality difference between B27-positive and B27-negative veterans, adjusted for age, sex, race, and diagnoses codes for diseases that may have influenced both B27 testing and mortality, including psoriasis, inflammatory bowel disease, spondyloarthritis (SpA), and other types of inflammatory arthritis. The secondary outcomes were the adjusted mortality HR for B27+ and B27− veterans, in subgroups with and without SpA.Results.Among veterans with available B27 test results, 27,652 (84.7%) were B27− and 4978 (15.3%) were B27+. The mean followup time was 4.6 years. Mortality was higher in the B27+ group than in the B27− group (HR 1.15, 95% CI 1.03–1.27). Mortality was also higher in the B27+ subgroups with SpA (HR 1.35, 95% CI 1.06–1.72) and without SpA (HR 1.11, 95% CI 0.99–1.24), but the difference was significant only in the subgroup with SpA.Conclusion.B27 positivity was associated with an increased mortality rate in a cohort of veterans clinically selected for B27 testing, after adjustment for SpA. In the subgroup with SpA, the mortality rate was associated with B27 positivity, and in the subgroup without SpA, there was a nonsignificant association between B27+ and mortality.

scholarly journals Cardiovascular Characteristics and Outcomes of Young Patients with COVID-19

2021 ◽  
Vol 8 (12) ◽  
pp. 165
Author(s):  
Antonin Trimaille ◽  
Sophie Ribeyrolles ◽  
Charles Fauvel ◽  
Corentin Chaumont ◽  
Orianne Weizman ◽  
...  
Keyword(s):  
Older Patients ◽  
Primary Outcome ◽  
Significant Proportion ◽  
Young Patients ◽  
Hospital Death ◽  
Composite Outcome ◽  
Young Population ◽  
Thrombotic Complications ◽  
Secondary Outcomes ◽  
Primary Composite Outcome

Although 18–45-year-old (y-o) patients represent a significant proportion of patients hospitalized for COVID-19, data concerning the young population remain scarce. The Critical COVID France (CCF) study was an observational study including consecutive patients hospitalized for COVID-19 in 24 centers between 26 February and 20 April 2020. The primary composite outcome included transfer to the intensive care unit (ICU) or in-hospital death. Secondary outcomes were cardiovascular (CV) complications. Among 2868 patients, 321 (11.2%) patients were in the 18–45-y-o range. In comparison with older patients, young patients were more likely to have class 2 obesity and less likely to have hypertension, diabetes and dyslipidemia. The primary outcome occurred less frequently in 18–45-y-o patients in comparison with patients > 45 years old (y/o) (16.8% vs. 30.7%, p < 0.001). The 18–45-y-o patients presented with pericarditis (2.2% vs. 0.5%, p = 0.003) and myocarditis (2.5% vs. 0.6%, p = 0.002) more frequently than patients >45 y/o. Acute heart failure occurred less frequently in 18–45-y-o patients (0.9% vs. 7.2%, p < 0.001), while thrombotic complications were similar in young and older patients. Whereas both transfer to the ICU and in-hospital death occurred less frequently in young patients, COVID-19 seemed to have a particular CV impact in this population.

scholarly journals Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness

BMJ ◽  
2018 ◽  
pp. k1332 ◽  
Author(s):  
Miriam Santer ◽  
Matthew J Ridd ◽  
Nick A Francis ◽  
Beth Stuart ◽  
Kate Rumsby ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Topical Corticosteroid ◽  
Primary Outcome ◽  
Control Group ◽  
Significant Difference ◽  
The Mean ◽  
Secondary Outcomes ◽  
Bath Additives

AbstractObjectivesTo determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children.DesignPragmatic randomised open label superiority trial with two parallel groups.Setting96 general practices in Wales and western and southern England.Participants483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded.InterventionsParticipants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants.Main outcome measuresThe primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed.Results483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score over the 16 week period was 7.5 (SD. 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group (95% confidence interval −0.27 to 1.10), below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects.ConclusionsThis trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes.Trial registrationCurrent Controlled Trials ISRCTN84102309.

Effects of Chronic Proton-Pump Inhibitor Use on Kidney Function in Older Adults

2019 ◽  
Vol 34 (5) ◽  
pp. 325-333
Author(s):  
Ashley M. Huntsberry ◽  
Sunny A. Linnebur ◽  
Danielle R. Fixen ◽  
Laura M. Saba ◽  
Joseph J. Saseen
Keyword(s):  
Diabetes Mellitus ◽  
Older Adults ◽  
Kidney Function ◽  
Proton Pump ◽  
Primary Outcome ◽  
University Of Colorado ◽  
Primary Care Patients ◽  
Observational Cohort ◽  
The Mean ◽  
Secondary Outcomes

OBJECTIVE: Proton-pump inhibitors (PPIs) have been associated with adverse renal outcomes in older adults; however, there are little data regarding the magnitude of the change in renal function in this population. The objective of this study was to quantify the change in kidney function associated with chronic PPI therapy at two years in older adults using estimated glomerular filtration rate (eGFR).<br/> DESIGN: The study was a retrospective, pre/post, observational cohort.<br/> SETTING/PATIENTS/INTERVENTIONS/MAIN OUTCOME MEASURE(S): The study included University of Colorado Health primary care patients 60 to 89 years of age who were newly initiated on a PPI between August 1, 2012, and March 1, 2015, and remained on therapy for at least two years. The primary outcome was the change in kidney function, measured by eGFR, two years after starting PPI therapy. Secondary outcomes included change in kidney function and incidence of reduction in eGFR to < 60 mL/min/1.73 m2 two years post-index date between patients with and without diabetes mellitus.<br/> RESULTS: Of 877 electronic health records reviewed, 100 patients met inclusion criteria. The mean change in eGFR was -6.15 mL/min/1.73 m2 (standard error of the mean = 1.03) at two years compared with baseline<br/> (95% confidence interval -8.20 to -4.10; P < 0.0001). There were no differences in the secondary outcomes based on concomitant diabetes mellitus.<br/> CONCLUSIONS: Chronic PPI use was associated with a significant reduction in eGFR in ambulatory older adults at two years, beyond that expected based on increased age alone. Prescribers should be aware of the potential adverse renal effects of chronic PPI use.

scholarly journals Endoscope-assisted (with robotic guidance and using a hybrid technique) interhemispheric transcallosal hemispherotomy: a comparative study with open hemispherotomy to evaluate efficacy, complications, and outcome

2019 ◽  
Vol 23 (2) ◽  
pp. 187-197 ◽  
Author(s):  
P. Sarat Chandra ◽  
Heri Subianto ◽  
Jitin Bajaj ◽  
Shabari Girishan ◽  
Ramesh Doddamani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Loss ◽  
Hospital Stay ◽  
Primary Outcome ◽  
Operating Time ◽  
First Episode ◽  
Hybrid Technique ◽  
The Mean ◽  
Secondary Outcomes

OBJECTIVEEndoscope-assisted hemispherotomy (EH) has emerged as a good alternative option for hemispheric pathologies with drug-resistant epilepsy.METHODSThis was a prospective observational study. Parameters measured included primary outcome measures (frequency, severity of seizures) and secondary outcomes (cognition, behavior, and quality of life). Blood loss, operating time, complications, and hospital stay were also taken into account. A comparison was made between the open hemispherotomy (OH) and endoscopic techniques performed by the senior author.RESULTSOf 59 cases (42 males), 27 underwent OH (8 periinsular, the rest vertical) and 32 received EH. The mean age was 8.65 ± 5.41 years (EH: 8.6 ± 5.3 years; OH: 8.6 ± 5.7 years). Seizure frequency per day was 7 ± 5.9 (EH: 7.3 ± 4.6; OH: 15.0 ± 6.2). Duration of disease (years since first episode) was 3.92 ± 1.24 years (EH: 5.2 ± 4.3; OH: 5.8 ± 4.5 years). Number of antiepileptic drugs per patient was 3.9 ± 1.2 (EH: 4.2 ± 1.2; OH: 3.8 ± 0.98). Values for the foregoing variables are expressed as the mean ± SD. Pathologies included the following: postinfarct encephalomalacia in 19 (EH: 11); Rasmussen’s syndrome in 14 (EH: 7); hemimegalencephaly in 12 (EH: 7); hemispheric cortical dysplasia in 7 (EH: 4); postencephalitis sequelae in 6 (EH: 2); and Sturge-Weber syndrome in 1 (EH: 1). The mean follow-up was 40.16 ± 17.3 months. Thirty-nine of 49 (79.6%) had favorable outcomes (International League Against Epilepsy class I and II): in EH the total was 19/23 (82.6%) and in OH it was 20/26 (76.9%). There was no difference in the primary outcome between EH and OH (p = 0.15). Significant improvement was seen in the behavioral/quality of life performance, but not in IQ scores in both EH and OH (p < 0.01, no intergroup difference). Blood loss (p = 0.02) and hospital stay (p = 0.049) were less in EH.CONCLUSIONSEH was as effective as the open procedure in terms of primary and secondary outcomes. It also resulted in less blood loss and a shorter postoperative hospital stay.

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