Comprehensive Geriatric Assessment for Trauma: Operationalizing the Trauma Quality Improvement Program Directive.

Elderly patients are the fastest growing trauma demographic and present some of the most complicated clinical challenges. This feasibility study employed observational data from a geriatric cohort. Comprehensive geriatric assessments (CGAs) were performed biweekly on eligible patients, 65 years or older, who met screening criteria. Mobility, activities of daily living impairment, frailty, and depression were screened and documented, and along with summative recommendations, were entered into the medical record, communicated to the patient's primary care provider, and discussed with family. From September 1, 2015, to February 1, 2016, 65 comprehensive geriatric assessments were performed, with 2 repeats. Thirty-two (49%) were men. Mean age was 76.9 (range, 65-97) years. Motor vehicle collisions and falls accounted for the majority of trauma mechanisms (52% and 40%, respectively). New action items from the CGA were in 2 main categories: (1) home or inpatient medication changes and (2) additional physical therapist/occupational therapist intervention. Comprehensive geriatric assessment can be successfully organized and performed in centers without a designated geriatric service using standard trauma team members. Objective assessments for functional mobility, activities of daily living, frailty, and depression can be performed easily using current staff and the data easily incorporated into the CGA. Advanced practice providers can feasibly serve as clinical leads even if faculty/residents are unavailable.

Association between alcohol consumption patterns and metabolic syndrome.

AIMS: Examine associations between self-reported alcohol consumption patterns and metabolic syndrome. MATERIALS AND METHODS: Sample (N=7432) included adult (≥20 years) participants in the 1999-2006 National Health and Nutrition Examination Survey. RESULTS: Above moderate alcohol consumption (AMAC) was negatively associated with waist circumference among those in the 20-29, 40-49, and 70-79 age groups (ß=-6.21, ß=-8.34, and ß=-6.60, respectively) and moderate alcohol consumption (MAC) was negatively associated with waist circumference among those in the 30-39, 40-49, and 70-79 age groups (ß=-4.60, ß=-5.69, and ß=-2.88, respectively). AMAC was negatively associated with triglycerides among those in the 70-79 and 80+ age groups (ß=-23.62 and ß=-34.18, respectively) and positively associated with HDL-C levels in all groups (ß range 8.96-18.25). MAC was positively associated with HDL-C in the age groups spanning 20-69 years (ß range 3.05-5.34) and those over 80 (ß=5.26). AMAC and MAC were negatively associated with fasting glucose levels in the 20-29 and 70-79 age groups (ß=-3.38 and -15.61, respectively). MAC was negatively associated with fasting glucose levels among those 70-79 and those over 80 years of age (ß=-7.06 and ß=-5.00, respectively). CONCLUSION: MAC and AMAC may favorably impact metabolic health.

A multidisciplinary clinical program is effective in stabilizing BMI and reducing transaminase levels in pediatric patients with NAFLD.

BACKGROUND AND AIM: Weight loss is an effective treatment for children with nonalcoholic fatty liver disease (NAFLD), but it is extremely difficult to achieve outside of an intensive weight management program. We hypothesized that one can achieve success in improving NAFLD and weight-related outcomes in a structured and focused multidisciplinary clinical program feasible to implement in a gastroenterology clinic. METHODS: We prospectively tracked the clinical status of our patients enrolled in a multidisciplinary program of dietary and exercise advice through an institutional review board-approved NAFLD registry. Each patient met with a gastroenterologist and dietitian every 3 months for 30 minutes to set individualized goals and monitor progress. RESULTS: A total of 108 children have been enrolled in the registry, and of the 83 that were eligible for 1-year follow-up and included in the analysis, 39 patients returned, resulting in a 47% follow-up rate. These 39 patients showed statistically significant improvements in mean BMI z score (-0.1 U, P < 0.05), total (-11 mg/dL, P < 0.05) and low-density lipoprotein (9 mg/dL, P < 0.05) cholesterol, and serum alanine aminotransferase levels (-36 U/L) and aspartate aminotransferase levels (-22 U/L) levels. CONCLUSIONS: A clinically feasible multidisciplinary program for obese pediatric patients with NAFLD stabilized BMI z score and significantly improved aminotransferase levels at 1-year follow-up.