Reliability of Proxy-reported Patient-reported Outcomes Measurement Information System Physical Function and Pain Interference Responses for Elderly Patients With Musculoskeletal Injury.

BACKGROUND: Patient-reported Outcomes Measurement Information System (PROMIS) instruments are useful to evaluate health status, but its use can be challenging for some vulnerable elderly patients, requiring aid from their proxies. Whether the proxies could be accurate informants is unknown. The goal of this study was to compare elderly patients' and their proxies' answers with PROMIS physical function (PF) and pain interference (PI) computer adaptive test for the evaluation of patients' outcomes after musculoskeletal injury. In addition, to correlate patients' reported PF with the Timed Up and Go (TUG) test. METHODS: This prospective cohort study, from February to September 2016, in the Orthopaedic trauma clinic of two level I Trauma centers, included 273 patients aged 65 years or older, ambulatory, cognitively intact, with a discernible proxy. PROMIS PF and PI, TUG, and the "FRAIL" Questionnaire screening tool were performed. The correlation of PROMIS scores between patients and proxies, and also with the TUG score, was assessed using Spearman rank correlation. The Bland-Altman analysis served to check agreement and bias. Subgroup comparison was tested using probit transformations. RESULTS: The mean age of patients was 75.7 years, SD 7.5 (62.2 years; SD, 13.8 for proxies), 66.7% women, 57.1% married, and 34% with femoral fractures. A significant correlation and agreement of PROMIS PF and PI scores were found between patients and proxies (Spearman rho for both, PF and PI = 0.73), although proxies tended to overestimate the interference of pain on patient's performance (median difference, -1.7; P < 0.001). The correlation was markedly stronger in nonfrail patients and in those with faster TUG scores. There was also a correlation between patients' PROMIS PF and TUG test (Spearman rho = - 0.58). CONCLUSIONS: Proxies are good informants of the PF of ambulatory, cognitively intact elderly patients, as evaluated by the PROMIS PF instrument, after musculoskeletal injury, although they tend to slightly overestimate PI. The use of proxy-reported PROs might better characterize functional impairment and pain in a vulnerable patient population, and it could decrease selection bias in outcomes research. LEVEL OF EVIDENCE: Diagnostic level II.

FRAIL Questionnaire Screening Tool and Short-Term Outcomes in Geriatric Fracture Patients.

OBJECTIVES: There are limited screening tools to predict adverse postoperative outcomes for the geriatric surgical fracture population. Frailty is increasingly recognized as a risk assessment to capture complexity. The goal of this study was to use a short screening tool, the FRAIL scale, to categorize the level of frailty of older adults admitted with a fracture to determine the association of each frailty category with postoperative and 30-day outcomes. DESIGN: Retrospective cohort study. SETTING: Level 1 trauma center. PARTICIPANTS: A total of 175 consecutive patients over age 70 years admitted to co-managed orthopedic trauma and geriatrics services. MEASUREMENTS: The FRAIL scale (short 5-question assessment of fatigue, resistance, aerobic capacity, illnesses, and loss of weight) classified the patients into 3 categories: robust (score = 0), prefrail (score = 1-2), and frail (score = 3-5). Postoperative outcome variables collected were postoperative complications, unplanned intensive care unit admission, length of stay (LOS), discharge disposition, and orthopedic follow-up after surgery. Thirty-day outcomes measured were 30-day readmission and 30-day mortality. Analysis of variance (1-way) and Kruskal-Wallis tests were used to compare continuous variables across the 3 FRAIL categories. Fisher exact tests were used to compare categorical variables. Multiple regression analysis, adjusted by age, sex, and Charlson index, was conducted to study the association between frailty category and outcomes. RESULTS: FRAIL scale categorized the patients into 3 groups: robust (n = 29), prefrail (n = 73), and frail (n = 73). There were statistically significant differences between groups in terms of age, comorbidity, dementia, functional dependency, polypharmacy, and rate of institutionalization, being higher in the frailest patients. Hip fracture was the most frequent fracture, and it was more frequent as the frailty of the patient increased (48%, 61%, and 75% in robust, prefrail, and frail groups, respectively). The American Society of Anesthesiologists preoperative risk significantly correlated with the frailty of the patient (American Society of Anesthesiologists score 3-4: 41%, 82% and 86%, in robust, prefrail, and frail groups, P < .001). After adjustment by age, sex, and comorbidity, there was a statistically significant association between frailty and both LOS and the development of any complication after surgery (LOS: 4.2, 5.0, and 7.1 days, P = .002; any complication: 3.4%, 26%, and 39.7%, P = .03; in robust, prefrail, and frail groups). There were also significant differences in discharge disposition (31% of robust vs 4.1% frail, P = .008) and follow-up completion (97% of robust vs 69% of the frail ones). Differences in time to surgery, unplanned intensive care unit admission, and 30-day readmission and mortality, although showing a trend, did not reach statistical significance. CONCLUSIONS: Frailty, measured by the FRAIL scale, was associated with increase LOS, complications after surgery, and discharge to rehabilitation facility in geriatric fracture patients. The FRAIL scale is a promising short screen to stratify and help operationalize the perioperative care of older surgical patients.

Tendencias en la incidencia de hospitalizaciones por cáncer de pulmón en España entre 2001 y 2011 / Trends in the incidence of lung cancer ospitalizations in Spain, 2001-2011

OBJETIVO: Analizar los cambios en incidencia, características clínicas, procedimientos diagnósticos, comorbilidad, estancia hospitalaria y coste en los pacientes hospitalizados por cáncer de pulmón (CP) en España entre 2001 y 2011. PACIENTES Y MÉTODOS: Estudio retrospectivo mediante la utilización del registro nacional de hospitalizaciones conjunto mínimo básico de datos (CMBD). Se reclutaron todos los pacientes hospitalizados por CP en España durante el periodo de estudio. Se analizaron variables sociodemográficas, económicas y relacionadas con la salud. RESULTADOS: Se detectaron 298.435 hospitalizaciones, cuya tasa global aumentó desde 61,18 hasta 65,08 por 100.000 habitantes desde 2001 a 2011 (p < 0,05), evidenciándose una disminución progresiva en hombres y un aumento en mujeres. El intervalo de edad con mayor incidencia fue el registrado entre los 70 a 79años. El porcentaje de pacientes con un índice de comorbilidad de Charlson > 2 se incrementó desde el 4,5 al 9,1% (p < 0,05). El procedimiento diagnóstico más realizado fue la tomografía computarizada (TC) torácica. La estancia media disminuyó a lo largo del periodo de estudio, pero el coste por hospitalización aumentó desde 4.471,22 € en 2001 hasta 5.562,54 € en 2011 (p < 0,05). Los factores asociados con la incidencia de ingresos hospitalarios en el análisis multivariado fueron: edad, sexo y año de estudio. CONCLUSIONES: Observamos una disminución en la tasa de ingresos en hombres y un aumento en mujeres, con incremento concomitante de comorbilidad y coste y disminución de la estancia hospitalaria media. Los factores asociados con la incidencia de ingresos por CP son la edad, el sexo y el año del estudio

OBJECTIVE. To analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay and costs of patients hospitalized for lung cancer in Spain between 2001 and 2011. PATIENTS AND METHODS: Retrospective study including all patients hospitalised with a primary diagnosis of lung cancer between 2001 and 2011. Data were collected from the National Hospital Discharge Database, encompassing the entire Spanish population. Economic and sociodemographic characteristics and health-related variables were analyzed. RESULTS: A total of 298,435 hospitalizations occurred. The overall crude incidence increased from 61.18 per 100,000 inhabitants in 2001 to 65.08 per 100,000 in 2011 (P < .05), with a decrease in men and a proportionate increase in women. The age group with the highest incidence was 70 to 79 years. In 2001, 4.5% of patients had a Charlson comorbidity index (CCI) > 2, and in 2011, prevalence of CCI > 2 increased to 9.1% (P < .05). Mean length of hospital stay decreased during the study period. Computed tomography was the most common procedure. Mean cost per patient increased from €4,471.22 in 2001 to €5,562.54 (P < .05) in 2011. Factors related to the incidence of hospitalizations were age, sex and year of study in the multivariate analysis. CONCLUSIONS: We found a decrease in the rate of hospitalizations in men and an increase in women, with a concomitant increase in comorbidities and cost; however, length of hospital stay decreased. Factors related to incidence of hospitalizations were age, sex and year of study

Trends in the Incidence of Lung Cancer Hospitalizations in Spain, 2001-2011. / Tendencias en la incidencia de hospitalizaciones por cáncer de pulmón en España entre 2001 y 2011.

OBJECTIVE: To analyze changes in the incidence, diagnostic procedures, comorbidity, length of hospital stay and costs of patients hospitalized for lung cancer in Spain between 2001 and 2011. PATIENTS AND METHODS: Retrospective study including all patients hospitalised with a primary diagnosis of lung cancer between 2001 and 2011. Data were collected from the National Hospital Discharge Database, encompassing the entire Spanish population. Economic and sociodemographic characteristics and health-related variables were analyzed. RESULTS: A total of 298,435 hospitalizations occurred. The overall crude incidence increased from 61.18 per 100,000 inhabitants in 2001 to 65.08 per 100,000 in 2011 (P <.05), with a decrease in men and a proportionate increase in women. The age group with the highest incidence was 70 to 79 years. In 2001, 4.5% of patients had a Charlson comorbidity index (CCI) >2, and in 2011, prevalence of CCI >2 increased to 9.1% (P<.05). Mean length of hospital stay decreased during the study period. Computed tomography was the most common procedure. Mean cost per patient increased from €4,471.22 in 2001 to €5,562.54 (P<.05) in 2011. Factors related to the incidence of hospitalizations were age, sex and year of study in the multivariate analysis. CONCLUSIONS: We found a decrease in the rate of hospitalizations in men and an increase in women, with a concomitant increase in comorbidities and cost; however, length of hospital stay decreased. Factors related to incidence of hospitalizations were age, sex and year of study.

A short-form version of the Boston Naming Test for language screening in dementia in a bilingual rural community in Galicia (Spain).

BACKGROUND: Aphasia, one of the core symptoms of cortical dementia, is routinely evaluated using graded naming tests like the Boston Naming Test (BNT). However, the application of this 60-item test is time-consuming and shortened versions have been devised for screening. The hypothesis of this research is that a specifically designed shortened version of the BNT could replace the original 60-item BNT as part of a mini-battery for screening for dementia. The objective of this study was to design a short version of the BNT for a rural population in Galicia (Spain). METHODS: A clinic group of 102 patients including 43 with dementia was recruited along with 78 healthy volunteers. The clinic and control groups were scored on the Spanish version of the Mini-mental State Examination (MMSE) and BNT. In addition, the clinic group was tested with standard neuropsychological instruments and underwent brain investigations and routine neurological examination. BNT items with specificity and sensitivity above 0.5 were selected to compose a short battery of 11 pictures named BNTOu11. ANOVA and mean comparisons were made for MMSE and BNT versions. Receiver operating characteristics (ROC) curves and internal consistency were calculated. RESULTS: Areas under ROC curves (AUC) did not show statistically significant differences; therefore BNTOu11's AUC (0.814) was similar to the 60-item BNT versions (0.785 and 0.779), to the short versions from Argentina (0.772) and Andalusia (0.799) and to the Spanish MMSE (0.866). BNTOu11 had higher internal consistency than the other short versions. CONCLUSIONS: BNTOu11 is a useful and time-saving method as part of a battery for screening for dementia in a psychogeriatric outpatient unit.

Epidemiology of hip fracture in the elderly in Spain.

OBJECTIVE: To describe the incidence and epidemiological characteristics of hip fracture (HF) in patients aged 65 years or over in the various autonomous regions (AR) of Spain from the year 2000 to 2002 and to determine which factors affect in-hospital mortality. METHODS: Retrospective, observational study including all patients aged >65 years with acute hip fracture in the 19 AR of Spain from 2000 to 2002. Data were obtained from the National Record of the Minimum Basic Data Set of the Ministry of Health. We analyzed the following: incidence rates (crude and age- and gender-adjusted rates) and incidence of hospital admission by season, length of hospital stay and in-hospital mortality. We used regression analysis to identify the factors that influenced in-hospital mortality. RESULTS: There were 107,718 cases of HF in patients aged >65 years; of these, 74% were women, with a mean age of 79 years (SD 14). The crude incidence rate for HF was 511 cases per 100,000 >65-year-old patients per year (265 cases per 100,000 men and 688 per 100,000 women and year). Incidence adjusted for age and gender was 503 cases per 100,000 inhabitants per year. Catalonia had the highest age-adjusted incidence and Galicia the lowest (623 and 317 cases per 100,000 inhabitants per year, respectively). Incidence rates increased from spring (24.1%) to winter (25.8%). The mean length of hospital stay was 15 days (SD 13). Seasonal influence and length of stay varied greatly between autonomous regions. While the overall in-hospital mortality rate was 5.3%, the rate for males was double that of females (8.9% and 4.8%, respectively), and in-hospital mortality increased with comorbidity (each point on the Charlson index increased mortality by 34.5%) was higher in winter (11% more risk compared to warmer seasons) and in cold climate regions (15% more risk compared to regions with a warm climate, i.e.: Catalonia, Valencia, Murcia, Andalusia, Balearic Islands and Canary Islands). CONCLUSIONS: Hip fracture mainly affects elderly women and presents great variability in incidence, seasonality, length of hospital stay and mortality between the different autonomous regions in Spain. Elderly male patients with severe comorbid conditions, who are admitted in winter and in cold climate regions are more at risk of in-hospital mortality.

Unusual duodenal presentation of leishmaniasis.

This case report describes an atypical case of duodenal leishmaniasis in an elderly patient not infected with human immunodeficiency virus. Investigation of this 84 year old woman with a constitutional syndrome and dysphagia revealed anaemia of chronic disorder, a high erythrocyte sedimentation rate, and polyclonal hypergammaglobulinaemia. Abdominal ultrasonography revealed thickening of the stomach wall, which was seen to be inflamed during gastroscopy. Duodenal histology revealed numerous leishmania amastigotes within macrophages. This was confirmed by bone marrow biopsy and leishmania serology. This case report stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, but also in elderly immunocompetent patients.

Activity of aphids associated with lettuce and broccoli in Spain and their efficiency as vectors of Lettuce mosaic virus.

This research sought to identify the aphid virus vector species associated with lettuce and broccoli crops in Spain, and to determine their population dynamics and ability to transmit Lettuce mosaic virus (LMV). Green tile traps and Moericke yellow water-pan traps were used to monitor aphid flights during the spring and autumn growing seasons of 2001. Aphid species feeding on lettuce were counted weekly. The transmission efficiencies of LMV were determined for the aphid species caught most frequently. The Moericke traps generally caught more aphid species than the tile trap, but the latter was the most suitable to estimate flight activity of species involved in virus spread. Spring aphid catches indicated that the main aphid species landing on lettuce in the regions of Madrid and Murcia was Hyperomyzus lactucae, but Brachycaudus helichrysi was also abundant in both regions. In broccoli in the Navarra region, the most abundant species in spring were Aphis fabae, B. helichrysi and H. lactucae. In autumn-sown crops, the main species landing on lettuce in the Madrid region were Hyadaphis coriandri and Aphis spiraecola. In Murcia, A. spiraecola and Myzus persicae were the most abundant, while in Navarra, Therioaphis trifolii, and various Aphis spp. were the most numerous landing on broccoli. The main aphid species colonising lettuce was Nasonovia ribisnigri, but other less abundant colonising species were Aulacorthum solani and Macrosiphum euphorbiae. The most efficient vectors of LMV were M. persicae, Aphis gossypii and M. euphorbiae, while A. fabae and H. lactucae transmitted with low efficiency, and Rhopalosiphum padi and N. ribisnigri did not transmit. Occurrence of LMV epidemics in central Spain in relation to aphid flights and the role of weeds as virus reservoirs is discussed.

Tratamiento de la trombosis venosa profunda en pacientes mayores de 60 años en una unidad de hospitalización a domicilio / Therapeutic approach to home treatment of deep venous thrombosis in the elderly

OBJETIVO: Comparar la evolución de los pacientes mayores de 60 años con trombosis venosa profunda (TVP), tratados con heparinas de bajo peso molecular (HBPM) en una unidad de hospitalización a domicilio con los que reciben tratamiento hospitalario.MÉTODO: Estudio observacional retrospectivo con grupo control, de pacientes mayores de 60 años, con TVP proximal o distal, diagnosticada en el servicio de urgencias mediante flebografía o eco-Doppler. El grupo estudio estaba constituido por aquellos pacientes tratados en el servicio de hospitalización a domicilio y el grupo control por los que realizaron tratamiento hospitalario.Ambos grupos recibieron HBPM durante unos 5 días y posteriormente dicumarínicos durante 6 meses. Recogimos sus características basales, factores de riesgo de TVP, tratamiento y complicaciones. Tras el alta, realizamos una entrevista telefónica a los 3 y 6 meses. Comparamos la incidencia de reingresos, retrombosis, tromboembolismo pulmonar y sangrado.RESULTADOS: Se incluyeron 96 pacientes, 70 tratados en domicilio (grupo de estudio) y 26 en hospital (grupo control). La edad media fue 74 ñ 7 años en el grupo de estudio y de 79 ñ 9 años en el grupo control. El factor de riesgo más frecuente fue la TVP previa (29 y 15 per cent en los grupos de estudio y control, respectivamente) seguido de neoplasia (19 y 27 per cent, respectivamente). La TVP fue sobre todo proximal (81 y 75 per cent en los grupos de estudio y control). El método de diagnóstico más utilizado fue flebografía isotópica en el grupo de estudio (61 per cent) y eco-Doppler en el grupo control (61 per cent). En este último grupo, 2 pacientes (10 per cent) presentaron recurrencia de la TVP y hubo un caso de tromboembolismo pulmonar (5 per cent). Se produjo un episodio de sangrado mayor en el grupo de estudio (1,6 per cent) y dos en el grupo control (10 per cent). Dos pacientes (3,2 per cent) del grupo de estudio y en 2 (10 per cent) del grupo control fueron reingresados. El tratamiento Tratamiento de la trombosis venosa profunda en pacientes mayores de 60 años en una unidad de hospitalización a domicilio domiciliario redujo el número de días de tratamiento de 16,6 en el grupo control a 9,6 en el grupo de estudio, es decir, un 58 per cent.CONCLUSIÓN: El tratamiento domiciliario de la TVP con heparinas de bajo peso molecular en pacientes mayores de 60 años es una alternativa eficaz y segura, evitando el ingreso en hospitalización convencional (AU)

Rapid serotyping of enteropathogenic Yersinia enterocolitica strains by co-agglutination.

A rapid co-agglutination test using monospecific antisera was developed for the serological typing of enteropathogenic strains of Yersinia enterocolitica. A total of 70 bacterial strains (17 reference strains and 53 clinical isolates) were examined. Absorption of immune sera against serotypes O:3, O:8 and O:9 with their heterologous antigens (S-LPS) was necessary to avoid the appearance of different cross-reactions, as observed by co-agglutination. The proteins present in the S-LPS preparations obtained from each serotype seemed to be responsible for such cross-reactions. Results obtained with a total of 57 clinical isolates belonging to other members of the family Enterobacteriaceae indicate a high specificity of the assay.

Transient occlusion of the left anterior descending coronary artery in pigs.

The purpose of this study was to define a model of transient coronary occlusion (CO) in the open-chest pig. The left anterior descending (LAD) coronary artery was occluded at its mid-length in 45 white pigs and reperfusion was performed after 30, 45, 60 or 90 min. One group of 9 animals with permanent CO served as control. During the occlusion period only slight hemodynamic changes were observed, but a period of ventricular arrhythmias was consistently observed between 15 and 30 min after CO, with an incidence of ventricular fibrillation (VF) in 8 cases (18%). All but 1 of the animals with VF could be defibrillated in less than 1 min or 3 electrical countershocks. Complex arrhythmias with marked hypotension were consistently observed after reperfusion. Histological examination showed a patent coronary artery lumen and minor changes in the LAD coronary artery at the site of occlusion in the reperfused animals and completely occluded arteries in the control group. Two pigs (4.4%) died during the night following CO. Transient CO can be performed safely in pigs with a very low complication rate and a high 24-hour survival rate.