Frailty and Prognostication in Geriatric Surgery and Trauma.

Frailty is a predominant predictor of poor outcomes in older populations. This article presents a review of the concept of frailty and its role for prognostication among geriatric trauma and surgery patients. We discuss models of frailty defined in the scientific literature, emphasizing that frailty is a process of biologic aging. We emphasize the importance of screening, assessment, and inclusion of frailty indices for the development and use of prognostication instruments/tools in the population of interest. Finally, we discuss best practices for the delivery of prognostic information in acute care settings and specific recommendations for trauma and surgical care settings.

Community-based interventions for the use and conservation of animal genetic resources: the case of indigenous scavenger chicken production in Benin.

Scavenging chicken production in Africa is important for the livelihood of the poor. In most countries, these low inputs, low output systems employ local breeds making use of the feeding resources available in the household. However, their replacement with introduced exotic breeds with higher productivities represents a risk for their conservation. Here, we present a simulation model to evaluate the impact of community-based interventions aiming to improve the profitability of local chicken breeds and promote their use and conservation. The results indicate that under the current conditions, farmers producing exotic chicken are able to sell more animals in a one year period; however the market price of local chicken makes their production more profitable. Vaccination campaigns significantly reduce the mortality rate of both breeds, having a positive effect on producers' income but its impact on animal off-take is larger for exotic breeds, and the availability of feeding resources is the limiting factor as the flock size increases. The results of the intervention are positive in terms of increasing farmers' income but do not clearly contribute to the conservation of indigenous breeds since after the vaccination campaign, the gap between the profitability of indigenous and exotic breeds is reduced. The simulation model indicates that under the current conditions, the conservation of indigenous chicken breeds in Benin is maintained by the existence of distinct niche markets with consumers able to pay higher prices for indigenous chicken. Policies for the conservation of chicken genetic resources in Benin are discussed.

Pediatric convulsive status epilepticus in Honduras, Central America.

Convulsive status epilepticus (SE) in children is an important public health problem, particularly in low-resource countries. A surveillance study was performed with consecutive enrollment of all children presenting with convulsive SE to Hospital Escuela Materno-Infantil Emergency Department in Tegucigalpa, Honduras over a 13-week period in 2003. In the 47 children with SE, the mean age was 4.5 years and the median seizure duration was 95 min. Mortality and morbidity were higher in children from rural locations, with all six deaths and three cases of new neurologic abnormalities occurring in rural children who had acute symptomatic SE. We conclude that childhood SE is common in the low-resource developing country of Honduras. Given the long delays in obtaining initial treatment in pediatric emergency facilities, availability of prehospital treatment may be of particular importance in this setting.

Adherence and complementary and alternative medicine use among Honduran people with epilepsy.

Adherence to antiepileptic drugs (AEDs) and use of complementary and alternative medicine (CAM) among Hondurans with epilepsy were evaluated. Our epilepsy cohort of 274 outpatients was surveyed to determine demographics, epilepsy treatment history, adherence, and use of CAM. Nonadherence to epilepsy therapy was reported by 121, with unavailability of AEDs (48%) the most common reason. CAM was reportedly used by 141, with prayer, herbs, and potions being common. Forty-nine rural Miskito Hondurans without epilepsy were also interviewed to gain an understanding of their beliefs and longstanding practices regarding epilepsy. Seventeen (34.7%) attributed epilepsy to the supernatural; only three knew of an AED. Widespread nonadherence to evidence-based epilepsy treatments in Honduras can be attributed to inadequate education, AED unavailability, insufficient resources, cultural beliefs, and wide use of CAM. A comprehensive epilepsy education program and improved access to evidence-based AEDs represent initial priorities to improve the Honduran epilepsy treatment gap.

Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) with Puerto Rican elderly.

The Beck Depression Inventory-Second Edition (BDI-II; (1) is one of the most useful measures for depressive symptomatology in many countries (2). The psychometric properties of this inventory, however, have not been reported with Puerto Rican elderly. This paper reports, exploratory psychometric results with a sample of 410 elderly Puerto Rican (65 years and older; men=94, women=316). The assessment of the construct validity of the BDI-II yielded four factors accounting for 52% of total variance and an internal reliability coefficient (alpha Cronbach) of .89. A factor analysis with the 21 items of the BDI-II was performed using principal component analysis as the extraction method and Varimax rotation. This analysis revealed that the BDI-II was a good measure of the dimensions of depressive symptomatology in the present sample, which resembled prior findings reported with the general Puerto Rican Population (3). This study also reports further data supporting the reliability, validity, and practical utility of the BDI-II for the Puerto Rican population including elders. Implications for potential research with minorities and clinical uses of the BDI-II are also discussed.

Phase I dose and sequencing study of pegylated liposomal doxorubicin and docetaxel in patients with advanced malignancies.

BACKGROUND: Pegylated liposomal doxorubicin (PEG-LD) and docetaxel have single-agent activity in several malignancies. The authors conducted a Phase I trial to evaluate the maximum tolerated dose (MTD), toxicities, and effect of dose sequencing of this combination in patients with advanced malignancies. METHODS: Twenty-two patients were enrolled in this two-arm, accelerated, dose escalation trial. Both drugs were administered on Days 1 and 15 of a 28 day cycle. In Arm A, dose escalation proceeded from a sequence and starting dose of 15 mg/m(2) PEG-LD and 30 mg/m(2) docetaxel. In Arm B, dose escalation proceeded from a sequence and starting dose of 30 mg/m(2) docetaxel and 15 mg/m(2)PEG-LD. In both arms, the dose of each drug was increased alternately by 5 mg/m(2) at each dose level. RESULTS: The MTD for Arm A was 20 mg/m(2) PEG-LD and 40 mg/m(2) docetaxel, both of which were administered on Days 1 and 15 of a 28-day cycle. The MTD for Arm B was 35 mg/m(2) docetaxel and 20 mg/m(2) PEG-LD, both of which were administered on Days 1 and 15 of a 28-day cycle. Dose-limiting toxicities were Grade 3 (according to the National Cancer Institute Common Toxicity Criteria) skin toxicity and thrombocytopenia. One partial response was observed and stable disease was documented for three patients. CONCLUSIONS: The recommended sequence and dose is 20 mg/m(2) PEG-LD followed by 40 mg/m(2) docetaxel on Days 1 and 15 of a 28-day cycle in Phase II trials for patients with breast and ovarian carcinoma to establish the efficacy of this well tolerated regimen.