The state of frailty in research: A mapping review of its clinical applicability to practice

Research on frailty has expanded in the last decade, but direct evidence supporting its implementation in clinical practice may be limited. This mapping review synthesizes the contexts-of-use and overall clinical applicability of recent pre-COVID frailty research. We sampled 476 articles from articles published on frailty in PubMed and EMBASE in 2017–2018, of which 150 articles were fully appraised for the contexts-of-use, definitions, and interventions. A clinical applicability framework was used to classify articles as practice-changing, practice-informing, or not practice-informing. Of the 476 sampled articles, 31% (n = 150) used frailty in functions that could inform a clinical indication: predictor or mediator (26%, n = 125), selection criterion (3%, n = 15), and effect modifier (2%, n = 10). Articles spanned all health disciplines, and cohort studies comprised 91% (n = 137) of studies and trials 9% (n = 13). Thirty-eight frailty definitions using varied cut-offs and a wide range of interventions were identified. Among all articles, 13% (n = 63) of articles were practice-informing, 2% (n = 11) potentially practice-changing, and 0.2% (n = 1) clearly practice-changing. Lack of well-defined intervention and identifiable effect (96%) or originality (83%) were predominant reasons reducing applicability. Only a minority of recent frailty research provides direct evidence of applicability to practice. Future research on frailty should focus on translating frailty, as a risk factor, into a clinical indication and address definition ambiguity.     

婴幼儿体外循环心脏手术后急性肾损伤

本文对婴幼儿心脏术后急性肾损伤(AKI)的高危因素与致病机制、AKI分级及常用诊断标准、防治措施以及相关研究进展进行综述,旨在通过对婴幼儿心脏术后AKI的合理认识,为临床诊疗提供依据,改善心脏手术患儿的近期及远期预后。     

Awareness and risk factors of autism spectrum disorder in an Egyptian population

BackgroundThe aim of the present study was to determine the type and percentage of referral situations, risk factors, associated syndromes, and parental awareness of autism spectrum disorder (ASD) children who visited the Medical Research Centre of Excellence, National Research Centre in Cairo, specialized in ASD diagnosis and management.MethodsThe study included 530 children who were diagnosed with ASD. For those, full medical history, clinical examination, severity evaluation, and testing the language and cognitive development were performed. The process of diagnosis and assessment of parents’ awareness and knowledge about ASD was investigated using questionnaires.ResultsThe clinic was mainly visited by self-referral. About half of the participants (51.4 %) had previously visited other doctors (1–5 physicians) who were mostly pediatricians. The parents’ awareness was mostly limited to the term “autism”, but not the nature of ASD. Caesarean section was the most common risk factor (57.4 %), followed by jaundice (30.1 %). The most common presenting symptoms were language (81.5 %) and social (60.4 %) deficits. ASD severity was found to be high in association with attention deficit hyperactivity disorder (ADHD) and electroencephalogram (EEG) changes (p = 0.001).ConclusionThe risk factors and associated syndromes in the Egyptian population studied were similar to those reported in previous studies performed in other populations, but their percentage was different. Perinatal problems were the most common risk factors, which may relate to the influence of gene-environmental interaction on the factors which could play a role in developing ASD or increasing its severity. The process of ASD diagnosis was commonly delayed among the participants. Increasing awareness and knowledge among health care professionals and parents is urgently needed to facilitate early diagnosis and intervention services, which will lead to improvement of the developmental outcomes for ASD children. The associated syndromes could be the driving force to seek medical advice and could influence the ASD severity.     

基于风险识别的群组管理对冠状动脉CT血管成像检查依从性及图像质量的影响

目的探究基于风险识别的群组管理对冠状动脉CT血管成像(CTA)检查依从性及图像质量的影响。方法选取2019年1—12月收治的冠心病、均至少接受1次64层CT冠状动脉血管检查患者114例为研究对象,按照两组患者一般资料均衡可比的原则分为观察组和对照组,每组57例。采用问卷调查与量表评估形式,比较两组患者检查依从性及图像质量。结果观察组检查依从性明显优于对照组;观察组检查图像质量优良率高于对照组;观察组平均检查耗时低于对照组,碘对比剂外渗率低于对照组;差异均有统计学意义(P<0.05)。结论基于风险识别的群组管理运用于冠状动脉CTA患者检查过程中,可提高患者检查依从性,提升图像质量,值得临床参考借鉴。     

Stanford A型主动脉夹层术后肾脏功能损伤的危险因素

目的调查分析Stanford A型主动脉夹层术后肾脏功能损伤(AKI)的危险因素,为临床降低肾脏功能损伤并发率对策提供支持。方法收集2017年1月—2019年12月医院心血管外科确诊且顺利行A型主动脉夹层手术的179例患者为研究对象,均由同组外科医师和麻醉医师实施手术,术后进入ICU监测治疗。根据术后早期是否存在AKI,将发生AKI 60例设为病例组,未发生AKI 119例设为对照组。分析发生AKI高危因素。结果经过多因素Logistics回归分析显示,年龄(OR=2.396)、双侧肾脏灌注欠佳(OR=8.725)、BMI值(OR=3.454)、监测膀胱温度(OR=4.180)、CPB时长(OR=2.165)、术中红细胞输注(OR=2.291)均为此类手术患者发生AKI独立危险因素(P<0.05)。结论年龄、BMI值、双侧肾脏灌注欠佳、CPB、监测膀胱温度、术中红细胞输注均为影响A型主动脉夹层术后AKI的独立相关因素,临床护士应针对上述分析制定个体化针对方案以降低术后AKI发生风险。     

Risk Factors of Outcomes of COVID-19 Patients in Korea: Focus on Early Symptoms

BackgroundCoronavirus disease 2019 (COVID-19) has spread around the globe, and it is important to determine the risk factors of death in the general population. Our study aimed to determine the risk factors of death and severe illness requiring supplemental oxygen therapy based on the demographic and clinical characteristics of COVID-19 patients in Korea.MethodsIn this study, we used data provided by the Korea Disease Control and Prevention Agency (KDCA) and analyzed a total of 5,068 patients with COVID-19, excluding 19 pregnant women and 544 individuals with missing data. We performed logistic regression analysis to determine the impact of early symptoms on survival and severe disease. Logistic regression models included sex, age, number of comorbidities, symptoms on admission, blood pressure, heart rate, and body temperature as explanatory variables, and death and oxygen therapy as outcome variables.ResultsLogistic regression analyses revealed that the male sex, older age (≥ 60 years), higher number of comorbidities, presence of symptoms on admission, heart rate ≥ 120 bpm, and body temperature ≥ 37.5°C presented with higher risk of in-hospital death and oxygen therapy requirement. Conversely, rhinorrhea and headache were associated with a low risk of death and oxygen therapy requirement. The findings showed that cough, sputum, and fever were the most common symptoms on admission, while 25.3% of patients with COVID-19 were asymptomatic.ConclusionCOVID-19 patients with high-risk early symptoms on admission, such as dyspnea and altered mental status, and those without low-risk symptoms of rhinorrhea and headache should be included in priority treatment groups.     

A modality-specific somatosensory evoked potential test protocol for clinical evaluation: A feasibility study

ObjectiveWe aimed to establish an objective neurophysiological test protocol that can be used to assess the somatosensory nervous system.MethodsIn order to assess most fiber subtypes of the somatosensory nervous system, repetitive stimuli of seven different modalities (touch, vibration, pinprick, cold, contact heat, laser, and warmth) were synchronized with the electroencephalogram (EEG) and applied on the cheek and dorsum of the hand and dorsum of the foot in 21 healthy subjects and three polyneuropathy (PNP) patients. Latencies and amplitudes of the modalities were assessed and compared. Patients received quantitative sensory testing (QST) as reference.ResultsWe found reproducible evoked potentials recordings for touch, vibration, pinprick, contact-heat, and laser stimuli. The recording of warm-evoked potentials was challenging in young healthy subjects and not applicable in patients. Latencies were shortest within Aβ-fiber-mediated signals and longest within C-fibers. The test protocol detected function loss within the Aβ-fiber and Aδ-fiber-range in PNP patients. This function loss corresponded with QST findings.ConclusionIn this pilot study, we developed a neurophysiological test protocol that can specifically assess most of the somatosensory modalities. Despite technical challenges, initial patient data appear promising regarding a possible future clinical application.SignificanceEstablished and custom-made stimulators were combined to assess different fiber subtypes of the somatosensory nervous system using modality-specific evoked potentials.