Diagnosing and monitoring pleural effusion using parametric electrical impedance tomography - a computational 3D model and preliminary experimental results.

PURPOSE: Diagnosing and monitoring pleural effusion (PE) is challenging due unsuitability of existing modalities. In the present study, a novel parametric electrical impedance tomography (pEIT) technique, tailored to a clinically feasible system to diagnose PE is presented. METHODS: An electrical impedance tomography (EIT) numeric solver was applied to a 3D realistic normal model and five PE models to simulate sets of surface measurements. Simulations were triggered by a series of eight independent projections using five electrodes positioned around the thorax. The relative changes in the potential between the PE models and the normal model were assessed and the error in the estimated PE volume was examined at varying signal to noise ratio (SNR) levels. For experimental feasibility, measurements were performed in four healthy subjects and were correlated with the potentials that were calculated from the normal model. RESULTS: Relative potential changes were notable (reached until ~55%) and increased with the increasing PE volumes. Maximal error of ± 20 [mL] was obtained for SNR levels >50 [dB]. The feasibility real measurements in healthy subjects showed a strong linear correlation (R2 > 0.85) and a successful diagnosis for all subjects. CONCLUSION: The proposed technique can estimate PE volumes from a redundant set of measurements in a realistic 3D human model and may be utilized for monitoring PE patients.

Parametric electrical impedance tomography for measuring bone mineral density in the pelvis using a computational model.

Osteoporosis is defined as bone microstructure deterioration resulting a decrease of bone's strength. Measured bone mineral density (BMD) constitutes the main tool for Osteoporosis diagnosis, management, and defines patient's fracture risk. In the present study, parametric electrical impedance tomography (pEIT) method was examined for monitoring BMD, using a computerized simulation model and preliminary real measurements. A numerical solver was developed to simulate surface potentials measured over a 3D computerized pelvis model. Varying cortical and cancellous BMD were simulated by changing bone conductivity and permittivity. Up to 35% and 16% change was found in the real and imaginary modules of the calculated potential, respectively, while BMD changes from 100% (normal) to 60% (Osteoporosis). Negligible BMD relative error was obtained with SNR>60 [dB]. Position changes errors indicate that for long term monitoring, measurement should be taken at the same geometrical configuration with great accuracy. The numerical simulations were compared to actual measurements that were acquired from a healthy male subject using a five electrodes belt bioimpedance device. The results suggest that pEIT may provide an inexpensive easy to use tool for frequent monitoring BMD in small clinics during pharmacological treatment, as a complementary method to DEXA test.

Pre-stroke dementia does not affect the post-acute care functional outcome of old patients with ischemic stroke.

AIM: The purpose of the present study was to evaluate whether a diagnosis of dementia before stroke onset (pre-stroke dementia [PSD]) affects the short-term functional outcome of elderly ischemic stroke patients. METHODS: This was a retrospective case-control study comprising of consecutive elderly ischemic stroke patients. Functional outcome was assessed by the Functional Independence Measure scale (FIM) at admission and discharge. Data was analyzed by t-test, χ(2) -test, multiple linear regression analysis and logistic regression. RESULTS: There were 919 patients with acute ischemic stroke, out of whom 11.5% were diagnosed with PSD on index day. Compared with non-PSD patients, those with pre-stroke dementia had a shorter length of stay (P < 0.001), higher rate of female patients (P < 0.001) and lower Mini-Mental State Examination scores (P < 0.001). Both total and motor FIM scores at admission and discharge, and their respective FIM gain scores at discharge were higher in non-PSD compared with PSD patients (P < 0.001). In logistic regression analysis to identify factors predicting successful outcome (defined as total FIM at discharge ≥80), PSD remained as significantly associated with increased risk for adverse outcome on discharge (OR 2.449, CI 1.207-4.970, P = 0.013). CONCLUSIONS: The present findings suggest that a diagnosis of pre-stroke dementia is associated with lower FIM scores at admission and discharge in patients with ischemic stroke. Yet, daily motor FIM gains were similar in PSD and non-PSD patients, suggesting that these patients should not be deprived of a post-acute rehabilitation, based on a diagnosis of dementia before stroke onset. Geriatr Gerontol Int 2016; 16: 928-933.

Monitoring brain damage using bioimpedance technique in a 3D numerical model of the head.

Disturbance in the blood supply to the brain causes a stroke or cerebrovascular accident. This can be due to ischemia caused by blockage (thrombosis, arterial embolism) or a hemorrhage. In this study, the feasibility of basic electrical impedance technique for monitoring such damage was analyzed using a computerized model. Simulations were conducted on a realistic 3D numerical model of the head. Tissues were assumed to act as linear isotropic volume conductors, and the quasi-static approximation was applied. Electrical potentials were calculated by solving Poisson's equation, using the finite volume method and the successive over relaxation method. Left-right asymmetry was calculated for several conductivities and volumes of the damaged region. The results were compared with the left-right asymmetry in a head model with normal brain. A negative asymmetry was revealed for blockage (i.e. the potential amplitude over the ischemic hemisphere was greater than that over the intact hemisphere). In case of hemorrhage, a positive asymmetry was found. Furthermore, correlation was found between the location of the damaged region and the electrodes with significant asymmetry. The 3D numerical simulations revealed that the electrical conductivity and the size of the damaged tissue have an effect on the left-right asymmetry of the surface potential.

Perioperative urinary retention, short-term functional outcome and mortality rates of elderly hip fracture patients.

AIM: Perioperative urinary retention (POUR) is common among hip fracture patients. The aim of the present study was to compare the prevalence, risk factors, functional outcomes and survival rates of patients with and without POUR. METHODS: This was a retrospective chart review study that was carried out in an orthogeriatric hip fracture unit. A total of 639 consecutive hip fracture patients who had hip surgery followed by a standard rehabilitation course participated in the study. Post-void residual volume (PVRV), Functional Independence Measure (FIM) scores (total and motor FIM, FIM gain) and mortality rates (90 and 365 days, end of follow up) were measured. RESULTS: A total of 328 patients (51.3%) suffered from POUR. Diabetes (OR 1.55, 95% CI 1.04-2.31), urinary infection (OR 3.25, 95% CI 2.16-4.90) and delirium (OR 1.66. 95% CI 1.09-2.52) emerged as the best predictors for POUR. Functional gains were slightly better in patients without POUR (P = 0.037 and P = 0.023, for discharge motor and total FIM gain, respectively). There were no differences in FIM gains at discharge in male patients, whether with or without POUR. However, female patients without POUR showed significantly better motor and total FIM gains on discharge (P = 0.003 and P = 0.003, respectively), compared with females with POUR. In multiple linear regression analyses, POUR in female (but not male) patients was predictive for adverse motor FIM gain (beta = -0.089, P = 0.046). In Cox regression analysis, urinary retention was not associated with mortality rates. CONCLUSIONS: POUR is highly prevalent in elderly hip fracture patients. It adversely affects the functional outcome of female patients, but is not associated with increased mortality rates.

Gender differences in functional outcome of elderly hip fracture patients.

AIM: The purpose of the present study was to investigate whether gender might affect functional outcome of hip fractured patients undergoing in-hospital rehabilitation. METHODS: This was a retrospective chart review study comprising of 759 consecutive elderly patients suffering traumatic hip fracture. All patients underwent a standard orthogeriatric care of surgical hip repair and post-acute rehabilitation care. Functional outcome (female vs male gender) was assessed by motor and total Functional Independence Measurement (FIM) scores on discharge. Data was analyzed by t-tests χ(2) -test and multiple linear regression analyses. RESULTS: A total of 574 (75.6%) out of all patients were females. There were no differences in admission FIM scores; however, male patients had a higher prevalence of comorbidities. FIM scores on discharge were higher in female patients (motor FIM, P=0.007; motor FIM gain, P=0.001; compared with males). A multiple linear regression analysis showed that female gender was independently associated with higher total FIM at discharge (ß coefficient=0.056, P=0.008), higher motor FIM at discharge (ß coefficient=0.071, P=0.007) and higher total FIM gain at discharge (ß coefficient=0.11, P=0.008). CONCLUSION: The findings suggest that absolute discharge FIM scores of females are higher, compared with male patients. After adjusting for possible covariates, female gender still emerged as an independent predictor for higher FIM at discharge, suggesting that male gender should be considered as adversely affecting rehabilitation outcome of hip fracture male patients.

Eating management and functional outcome of elderly patients with symptomatic ischemic stroke undergoing inpatient rehabilitation.

AIM: The purpose of this study was to investigate whether, and to what extent, post-stroke eating management (EM) at admission to a rehabilitation ward is associated with functional outcome. METHODS: This was a retrospective study comprising 716 consecutive elderly patients with first ever symptomatic ischemic stroke. Level of eating management was determined by Functional Independence Measurement (FIM) subscale scores relevant to eating management, where scores ≤ 5 points define low-eating management (Low-EM) ability and scores >5 indicate independent eating management. Data was analyzed by t-test, χ(2) -test, Pearson's correlation and by multiple linear regression analysis. RESULTS: A total of 418 and 298 Low-EM and High-EM patients, respectively, were eligible for final analysis. Compared with High-EM, Low-EM patients were slightly older (P=0.04), had longer rehabilitation stays (P<0.001) and lower Mini-Mental State Examination (MMSE) scores (P<0.001). Total FIM at admission and discharge were lower in Low-EMS, yet there was no statistically significant difference in total FIM gain on discharge between the two groups. Multiple linear regression analyses showed that total FIM at discharge was inversely associated with Low-EM at admission (ß-coefficient= -0.389, P<0.001). Low-EM scores were independently predictive for higher total FIM gain at discharge (ß-coefficient=0.125, P=0.005). CONCLUSION: The findings suggest that impaired eating management on admission is associated with adverse functional outcome. However, patients presenting to rehabilitation with impaired eating management do obtain significant functional gains and should not be deprived of rehabilitation.

Increased 1-year mortality rates among elderly hip fracture patients with atrial fibrillation.

BACKGROUND AND AIMS: Prediction of factors associated with survival following hip fracture is important. We studied crude and adjusted survival rates in elderly hip fracture patients with and without atrial fibrillation (AF) to assess possible risk of death associated with AF. METHODS: A historical prospective cohort study, comprising 1114 consecutive patients with hip fractures. Subjects were divided into three groups: patients with sinus rhythm (SR), paroxysmal atrial fibrillation (PAF) or chronic atrial fibrillation (CAF). The main outcome measures were crude and adjusted survival rates at 30, 90 and 365 days, and end of follow-up. RESULTS: AF patients differed from SR patients by gender (p=0.0018), age (p=0.008), heart failure (p<0.001), ischemic heart disease (p<0.001) and history of a stroke (p<0.001). The lowest death rates were observed among SR and PAF patients, whereas CAF patients had the highest rates at each follow-up time point. CAF (but not PAF or SR) patients were at a significantly higher risk of death at both 365 days and at the end of the study (HR 1.786, CI 1.011- 3.155 and HR 1.835, CI 1.302-2.585, respectively). Older age (HR 1.301, CI 1.135-1.491 and HR 1.321, CI 1.321-1.415) and male gender (HR 1.879, CI 1.271- 2.779 and HR 1.545, CI 1.251-1.909) also predicted higher risk of death at both 365 days and at the end of the study. CONCLUSIONS: Atrial fibrillation cannot be considered to adversely affect short-term survival of hip fracture patients. After 365 day, CAF was associated with a significantly higher risk of death.

Atrial fibrillation is not associated with rehabilitation outcomes of elderly hip fracture patients.

AIM: To study possible differences in rehabilitation outcomes of patients with hip fracture, with and without atrial fibrillation. METHODS: A retrospective cohort study comprising 1114 patients, divided into three groups: patients with sinus rhythm, paroxysmal atrial fibrillation or chronic atrial fibrillation. All patients underwent a standard orthogeriatric care comprising surgical hip repair and a rehabilitation course. Main outcome measures included functional status at discharge by the Functional Independence Measure, post-fracture functional status category and type of postdischarge living arrangement. RESULTS: Patients with atrial fibrillation differed from patients in sinus rhythm by female sex (P = 0.018), older age (P = 0.008) and higher rates of heart failure (P < 0.001), ischemic heart disease (P < 0.001), previous stroke (P < 0.001), and American Society of Anesthesiologists score (P < 0.001). No differences were observed among the three groups regarding Functional Independence Measure motor and total scores. In regression analysis, Mini-Mental State Examination (P < 0.001), prefracture status (P < 0.001), postsurgery motor Functional Independence Measure (P < 0.0001) and Parkinson's disease (P = 0.009) were predictive of higher motor Functional Independence Measure at discharge, whereas atrial fibrillation had no predictive value whatsoever. There were no differences among groups in magnitude of postfracture change of functional status category or type of postdischarge living arrangement. CONCLUSIONS: Discharge motor Functional Independence Measure scores, postfracture changes in functional status and in discharge placement are similar in hip fracture patients with sinus rhythm, compared with those with atrial fibrillation. Atrial fibrillation should not be considered to adversely affect the rehabilitation outcome of these patients.

Functional outcome of elderly survivors of ischemic stroke: a retrospective study comparing nonhypercholesterolemic and hypercholesterolemic patients.

BACKGROUND: Total cholesterol is significantly associated with increased risk of ischemic stroke. Patients with ischemic stroke and high cholesterol levels may show better functional outcome after rehabilitation. OBJECTIVES: To study the possible interrelations between hypercholesterolemia and functional outcome in elderly survivors of ischemic stroke. METHODS: We conducted a retrospective chart review study of consecutive patients (age > or = 60 years) with acute stroke admitted to a geriatric rehabilitation ward in a university-affiliated hospital. The presence or absence of hypercholesterolemia was based on registry data positive for hypercholesterolemia, defined as total cholesterol > or = 200 mg/dl (5.17 mmol/L). Functional outcome of patients with hypercholesterolemia (Hchol) and without (NHchol) was assessed by the Functional Independence Measurement scale (FIM) at admission and discharge. Data were analyzed by t-test and chi-square test, as well as linear regression analysis. RESULTS: The complete data for 551 patients (age range 60-96 years) were available for final analysis; 26.7% were diagnosed as having hypercholesterolemia. Admission total FIM scores were significantly higher in patients with Hchol (72.1 +/- 24.8) compared with NHchol patients (62.2 +/- 24.7) (P < 0.001). A similar difference was found at discharge (Hchol 90.8 +/- 27.9 vs. NHchol 79.7 +/- 29.2, P < 0.001). However, total FIM change upon discharge was similar in both groups (18.7 +/- 13.7 vs. 17.6 +/- 13.7, P = 0.4). Regression analyses showed that high Mini Mental State Examination scores (beta = 0.13, P = 0.01) and younger age (beta = -0.12, P = 0.02) were associated with higher total FIM change scores upon discharge. Total cholesterol was not associated with better total FIM change on discharge (beta = -0.012, P = 0.82). CONCLUSIONS: Elderly survivors of stroke with Hchol who were admitted for rehabilitation showed higher admission and discharge FIM scores but similar functional FIM gains as compared to NHchol patients. High cholesterol levels may be useful in identifying older individuals with a better rehabilitation potential.

Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment.

OBJECTIVES: To compare survival rates of hip fracture patients treated within a comprehensive geriatric hip fracture unit (CGHFU) with those undergoing a standard of care treatment (SOCT) in general orthopedic wards. DESIGN: Retrospective chart review. SETTING: A geriatric hip fracture unit of a division of geriatric medicine and rehabilitation and departments of general orthopedic surgery of a tertiary hospital. PARTICIPANTS: Participants were 3114 consecutive hip fracture patients: 847 were admitted to CGHFU and 2267 to wards of general orthopedics. INTERVENTION: Surgical repair followed by standard rehabilitation course MEASUREMENT: Mortality rates at 30 days, 90 days, and 1 year. RESULTS: CGHFU population was older (P < .0001), comprised more women (P < .0001), and suffered a greater number of comorbidities (P < .0001). Crude 30-day mortality rates were 1.9% and 3.0% for CGHFU and SOCT, respectively. At 90 days, crude rates were 6.5% and 8.1%, respectively, and 14.8% and 17.3%, at 1 year, respectively. Cox proportional hazard models adjusted for sociodemographics, Comorbidity, and surgery characteristics showed borderline significant lower mortality hazard ratios for CGHFU in comparison with SOCT, for 1-month and 3-month intervals. The adjusted Cox model favored the CGHFU modality of care with regard to 1-year cumulative mortality (hazard ratios 0.78, 95% confidence interval 0.63-0.96, P = .016). Male gender, age, diabetes, and number of operations were predictive of increased 1-year mortality risk in the separate regression models by gender and age group (<85, 85+). CONCLUSION: Crude and adjusted mortality rates are lower in a geriatric hip fracture unit, as compared with the common standard of care model of general orthopedic wards. Combined with earlier data on improved functional outcomes of CGHFU, these findings further support the implementation of similar comprehensive orthogeriatric models of care.

Elevated blood urea, independent of glomerular filtration rate (GFR), confers increased risk of adverse functional outcome in elderly hip fracture patients.

This retrospective cohort study investigated the possible interrelations of GFR and functional outcome in elderly hip fracture patients. The final analyses comprised 499 consecutive patients undergoing standard medical, surgical and rehabilitation treatment in an orthogeriatric unit of a tertiary care hospital. Functional outcomes were assessed by Functional Independence Measurement (FIM™) scores. Kidney function was assessed by blood urea and creatinine, as well as by GFR according to the modification diet of renal disease study (MDRDS) formula. Mean age was 83.60 ± 5.14 and mean GFR 61.07 ± 17.22 ml/min. GFR was <60 ml/min in 91.8% out of all patients. FIM admission and discharge scores, and gains, were not associated with GFR values, except for discharge motor FIM which was significantly higher in patients with GFR greater than 30 ml/min (p = 0.043). In regression analysis, GFR was associated with motor FIM at discharge (ß = 0.028, p = 0.022). Neither GFR nor creatinine was associated with discharge total FIM. In contrast, lower admission urea levels were predictive of higher motor (correlation coefficient (CC) = 0.151, odds ratio (OR) 0.132, 95% confidence interval (CI) = 0.027-0.237, p = 0.013) and total FIM scores (CC = -0.022, OR = 0.978, 95%CI = 0.960-0.997, p = 0.022) at discharge. We suggest that GFR and creatinine are poorly associated with functional outcome. Instead, urea is more likely to predict functional outcome, and may serve as more reliable biomarker for the prognostication of functional outcome.

Atrial fibrillation predicts cognitive impairment in patients with ischemic stroke.

BACKGROUND: Atrial fibrillation (AF) is considered as a risk factor for cognitive impairment. METHODS: This retrospective chart review study was conducted in a patient stroke rehabilitation ward of a university-affiliated referral hospital. The participants were 707 patients admitted for a standard rehabilitation course after an ischemic stroke. Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. RESULTS: Atrial fibrillation, age, gender, diabetes, and dementia emerged as the only statistically significant parameters differing between those with MMSE score lower than 24 or higher. In a multiple logistic regression analysis, AF (odds ratio 1.6, 95% confidence interval 1.03-2.47, P = .03) was associated with an increased risk of cognitive impairment. CONCLUSIONS: Our findings suggest that atrial fibrillation upon admission is independently associated with lower MMSE scores in patients with ischemic stroke.

[The bacteriological profile of bacteriuria in residents of a long-term geriatric facility].

BACKGROUND: Little is known on the bacteriological profile of consecutive urine samples in elderly patients institutionalized in nursing homes. AIM: This retrospective study aims to characterize urinary pathogens, rates of isolation of the same pathogen in subsequent urine samples and predicting factors associated with such repeated isolations. Data were retrospectively retrieved from medical charts of nursing home patients during a four-year period. The authors looked for changes in rates of positive cultures, changes in urine flora, in rates of repeated isolation of the same pathogens and the possible interrelations with the use of antibiotics. METHODS: A total number of 3229 urine cultures were studied, 1311 of which (43%) were positive and 493 out of these positive cultures (37.6%) were treated with antibiotics. The rates of positive cultures increased consistently during the study period (p=0.003). E. coli (68.1%), Klebsiella pneumoniae and Proteus mirabilis accounted for more than 90% of positive cultures. RESULTS: There was no difference with regard to pathogen types isolated from symptomatic or asymptomatic cases. The rates of recurrent bacteriuria, by the same pathogen isolated at baseline urine culture, were similar in treated and untreated cases. A regression analysis aiming to predict factors associated with subsequent positive cultures had negative results, except for cases of untreated bacteriuria with pseudomonas (CI 1.36-7.09, O.R. 3.11, p=0.006). CONCLUSION: Our data support earlier studies underscoring the need to carefully consider the role of antibiotics and for better clinical guidelines for the treatment of bacteriuria in this population.

Diabetes mellitus predicts cognitive impairment in patients with ischemic stroke.

BACKGROUND: Non-insulin-dependent diabetes mellitus (NIDDM) is associated with an increased incidence of cognitive impairment. METHODS: A retrospective chart review study involving 707 patients admitted for rehabilitation after an ischemic stroke. Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered suggestive of cognitive impairment. RESULTS: Age, gender, NIDDM, dementia, and previous stroke emerged as the only statistically significant parameters differing between those with MMSE score lower than 24 or higher. After adjusting for confounding variables, NIDDM (odds ratio 1.46, 95% CI 1.05-2.05, P = .02) was associated with an increased risk of cognitive impairment. CONCLUSIONS: Our findings suggest that NIDDM is independently associated with lower MMSE scores in ischemic stroke patients. It identifies individuals in need of specifically targeted interventions and may assist in selecting and developing resources for cognitively impaired diabetic patients.

Body mass index (BMI), body composition and mortality of nursing home elderly residents.

The body mass index (BMI) is a key marker of nutritional status among older patients, but does not reflect changes in body composition, The aim of the present study was to investigate BMI levels and body composition in a sample of disabled nursing home residents, and to study possible interrelations between BMI, fat-free body mass (FFM), body fat mass (BFM), skeletal muscle mass (SMM) and 1-year mortality rates. FFM and SMM were assessed by 24-h urine creatinine excretion and BFM as the difference between BMI and FFM. We calculated relative risk (RR) and odds ratio (OR) of 1-year mortality, associated with different levels of BMI, FFM index (where index=value/height(2)), SMM index and BFM index in 82 disabled institutionalized elderly patients. One-year mortality rate was 29.3%. Adjusted relative risk of mortality of low BMI patients was 1.45 (95% CI=0.73-2.89; OR=1.73) and 0.63 (95% CI=0.33-1.60; OR=0.72) in high BMI. Risk of mortality was higher in those having low FMM index or SMM index (RR=2.42, 95% CI=0.36-16.18; OR=2.55 and RR=3.22, 95% CI=0.78-13.32; OR=3.67, respectively). It is concluded that low FFM and SMM indexes among disabled nursing home residents are far better predictors than BMI for 1-year mortality estimation.

Estimating pulmonary congestion in elderly patients using bio-impedance technique: correlation with clinical examination and X-ray results.

The bio-impedance technique provides a safe, low-cost and non-invasive alternative for lung fluid level monitoring. Here we have investigated the feasibility of a novel bio-impedance system in measuring pulmonary congestion in elderly patients suffering from congestive heart failure (CHF). The system employed a parametric reconstruction algorithm to assess mean lung resistivity. Fourteen patients were studied before and following treatment to reduce lung congestion. Significant correlation was found between the changes of radiographic scores and resistivity values following treatment (R=0.57, p<0.04). A significant difference in resistivity values between patients having low and high congestion degrees was also demonstrated (p<0.01). Moreover, the bio-impedance technique successfully diagnosed an improvement of congestion level in 10 out of 14 patients, while the radiographic score indicated such an improvement in only 5 out of the 14 patients. These results, along with our previous validation studies, suggest that the bio-impedance technique is a feasible bedside system for monitoring of pulmonary congested patients, thus facilitating effective treatment strategies.

A novel telemedicine system for monitoring congestive heart failure patients.

Congestive heart failure is a widespread cardiac disease in western countries. At present, the main measure for monitoring the level of pulmonary edema in telemedicine systems is weight, which is not a reliable indicator. The authors propose a novel bioimpedance telemedical system to monitor these patients. The system measures the resistivity of each lung using optimization methods and transmits the measurements via a modem to a call center. Preliminary results show that the measured resistivity values among healthy young patients are consistent and reproducible within 48 hours. The mean resistivity values in patients with pulmonary congestion were lower than those of the healthy patients: 887 [Omega*cm]+/-117 vs 1244 [Omega*cm]+/-87 (P<.01). The system is noninvasive, safe, and portable. It retrieves unique information correlated with the amount of fluid in the lungs and transmits the data to a medical call center in order to improve the diagnostics and treatment of congestive heart failure.

Serum albumin levels predict cognitive impairment in elderly hip fracture patients.

The aim of this study was to investigate the possible interrelation of serum albumin levels and cognitive function of elderly hip fracture patients. The study involved 331 elderly patients with hip fractures, admitted for rehabilitation. Cognition was assessed by Mini-Mental State Examination (MMSE). MMSE scores less than 24 points were considered suggestive of cognitive impairment. Age, serum albumin levels, and previous stroke emerged as the only statistically significant parameters differing between those with MMSE score less than 24 or higher. After adjusting for confounding variables, the middle and lowest tertiles of serum albumin levels were associated with an increased risk of cognitive impairment (odds ratio 1.97, 95% confidence interval 1.15-3.38, P < .01 vs 3.06 and 1.79-5.23, P < .001, respectively). This study shows that lower serum albumin levels are independently associated with lower MMSE scores in hip fractured elderly patients, supporting the possible role of chronic low-grade inflammation in age-related cognitive decline.

Aortic stenosis in elderly hip fractured patients.

Aortic stenosis (AS) and hip fractures are unrarely seen in elderly patients. The decision whether to operate these patients or not remains difficult. The present study examined the characteristics of such patients and the possible interrelations with management and outcome. This retrospective chart review study was conducted in a tertiary hospital during a 10-year period. We looked for demographic, clinical and echocardiographic characteristics of the patients, as well as their in-hospital course, compared with 100 hip fracture patients without AS. We identified 71 patients with AS hospitalized for acute hip fractures, 62 out of whom were included in the final analysis. Mean age of AS patients was 85.9+/-7.4. Mean and peak AV gradient were 35.8+/-16.3 and 59.0+/-26.7 mmHg, respectively. Mean valve area was 0.97+/-0.64. Fifty-six AS patients (91%) were operated. Rate of major in-hospital complications was 8% compared with 3.6% in non-AS patients. In-hospital mortality was 6.5% compared with 3.3% in non-AS patients (p=0.01), respectively. One-year mortality was 17.7% (11/62) among AS patients and 16.1% in non-AS patients. Death of AS patients was not interrelated with age, gender, pre-fracture function or echocardiographic data (mean and peak AV gradients, ejection fraction and valve area). We conclude that surgery of hip fractured elderly with AS was associated with increased rate of major complications and in-hospital mortality rates, compared with controls; however, 1-year mortality rate was similar in both groups. It remains to be determined whether a more careful medical and surgical management of such patients will result in less eventful hospital course.