Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study

Introduction Low levels of vitamin D have been associated with increased mortality in patients that are critically ill. This study explored whether vitamin D levels were associated with 90-day mortality in severe sepsis or septic shock.

Methods Plasma vitamin D levels were measured on admission to the intensive care unit (ICU) in a prospective multicentre observational study.

Results 610 patients with severe sepsis were included; of these, 178 (29%) had septic shock. Vitamin D deficiency (<50?nmol/L) was present in 333 (55%) patients. The 90-day mortality did not differ among patients with or without vitamin D deficiency (28.3% vs. 28.5%, p?=?0.789). Diabetes was more common among patients deficient compared to those not deficient in vitamin D (30% vs. 18%, p?p?p?>?0.9; and <25?nmol/L: HR 0.44 (95% CI: 0.22–0.87), p?=?0.018).

Conclusions Vitamin D deficiency detected upon ICU admission was not associated with 90-day mortality in patients with severe sepsis or septic shock.

• Key messages

• In severe sepsis and septic shock, a vitamin D deficiency upon ICU admission was not associated with increased mortality.

• Compared to patients with sufficient vitamin D, patients with deficient vitamin D more frequently exhibited diabetes, elevated C-reactive protein levels, and hospital-acquired infections upon ICU admission, and they more frequently developed acute kidney injury.

     

The validation of smartphone applications for heart rate measurement

Abstract

Background: The smartphone apps provide a user-friendly option for measurement of heart rate (HR) by detecting pulsatile photoplethysmographic signals with built-in cameras from the fingertips, however, the validation study is limited.

Methods: We compared HR detected by the smartphone apps (App1?=?Instant HR, App2?=?Cardiio: HR Monitor and App3?=?Runtastic HR Monitor) with simultaneous standard ECG monitoring in the adult patients at the critical care unit.

Results: HR measurements were obtained from 140 patients with mean age 67.6?±?15.3 years. Mean baseline HR was 89.1?±?19.1 bpm (range, 32–136 bpm). Sinus rhythm was presented in 111 patients (79.3%), atrial fibrillation in 25 patients (17.9%), pacemaker rhythm in 3 patients (2.1%), and high-grade AV block in 1 patient (0.7%). The ECG-derived HR correlated well with App1 (r?=?0.98), App2 (r?=?0.97), and App3 (r?=?0.92). In patients with regular rhythm, mean absolute deviation was 0.8?±?1, 0.7?±?0.9, 1.0?±?1.3 bpm on App1, App2 and App3, respectively. In the patients with irregular rhythm, median absolute deviation (IQR) was 3 (2–5.5), 4 (1.5–11.5), and 6 (2–13) bpm. Skin colour did not affect with the HR measurement.

Conclusions: HR measurements from all applications were correlated well with ECG monitoring. However, it was less accurate in case of irregular rhythm such as atrial fibrillation.

• Key messages

• Several reports on inaccuracy of mobile health apps have been published. We conducted the validation study in the real patients by using popular mobile apps.

• Heart rate measurements from mobile apps were correlated well with standard ECG. The accuracy of HR from apps was worse at irregular rate and tachycardia.

     

Combination of low blood pressure response,low exercise capacity and slow heart rate recovery during an exercise test significantly increases mortality risk

Abstract

Aims: We investigated the combination of low systolic blood pressure (SBP) response, low exercise capacity (EC) and slow heart rate recovery (HRR) during an exercise test in mortality prediction.

Patients and methods: Our population consisted of 3456 patients from the Finnish Cardiovascular Study. A failure of SBP to increase >42?mmHg was defined as a low response. Low EC was defined as <?8 metabolic equivalents. 1-minute HRR ≤18 bpm from maximum was defined as slow HRR.

Results: During a median follow up of 10.0?years, 537 participants died. Reduced SBP response, low EC and slow HRR were independent predictors of all-cause and CV mortality (p?<?.001 for all). Patients with reduced SBP response, low EC and slow HRR had a very high mortality rate of 42.1% during follow up compared to only 4.5% of the patients without any of these risk factors. The hazard ratios for all-cause mortality in patients with one, two or three of the studied risk factors were 3.2, 6.0, and 10.6, respectively (p?<?.001 for all).

Conclusion: The combination of reduced SBP response, low exercise capacity, and reduced HRR in an exercise test is associated with very high mortality and can be used in risk stratification.

• Key messages

• The combination of low blood pressure response, low exercise capacity and slow heart rate recovery in an exercise test is able to identify a group of patients in a very high mortality risk.

• These parameters are easily derived from an exercise test.

• All parameters are commonly available in clinical practice.

     

Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an acute coronary syndrome event

Abstract

Background: Acute coronary syndrome (ACS) patients are widely treated with long-term beta-blocker therapy after cardiac event. Especially for low-risk patients, the benefits of beta-blockers on survival and the optimal therapy duration remain unclear. We investigated the effect of adherence to beta-blockers on long-term survival of ACS patients.

Methods and results: A total of 1855 consecutive ACS patients who underwent angiography and survived 30?days after were followed for a median of 8.6?years. During follow-up, 30.1% (n?=?558) of patients died. Adherence was assessed as yearly periods covered by medication purchases and investigated as a dynamic time-dependent variable in Cox proportional hazards models. In a univariable model, non-adherence to beta-blockers was associated with higher all-cause mortality (Hazard ratio [HR] 2.99, 95% confidence interval [CI] 2.50?3.57; p?<?.001). Results were similar in multivariable models on both overall survival (HR 1.84, 95% CI 1.51?2.24; p?<?.001) and on 1-year landmark survival (HR 1.74, 95% CI 1.41?2.14; p?<?.001). In subgroup analyses, the increase in all-cause mortality was consistent among low-risk patients (HR 1.60, 95% CI 1.16?2.21; p?=?.004).

Conclusion: Poor adherence to beta-blockers is associated with increased long-term mortality among ACS patients. Even low-risk patients seem to benefit from long-term beta-blocker therapy.

• Key messages

• Adherence to secondary prevention medications diminishes drastically over the years after an ACS event.

• Non-adherence to β-blockers is associated with increased long-term mortality of ACS patients, and the effect on survival extends beyond the first year after an ACS event.

• Our follow-up was exceptionally lengthy with median follow-up period of 8.6 years.

     

Prognostic utility of combination of NT-proBNP with high sensitive cTn I in patients with heart failure: Results from retrospective study in an emergency department

Background: N-terminal proBNP (NT-proBNP) and cardiac troponin I (cTn I) are widely used for the diagnosis of myocardial injury, but have not been used for routine evaluation in heart failure (HF) population.

Aims: To evaluate the prognostic utility of combination of NT-proBNP and cTn I in patients with HF, including serial NT-proBNP/cTn I measurements and discharge NT-proBNP/cTn I levels.

Patients and methods: A total of 610 patients presenting in our emergency department for acute HF were studied. The mortality and HF-related readmission were endpoints in the study. NT-proBNP and cTn I were tested on admission including first 5 consecutive days, and on discharge.

Results: A discharge cTn I cut-off value at 24?ng/L and discharge NT-proBNP cut-off value at 350?ng/L were determined. The cTn I level more than 24?ng/L and NT-proBNP level more than 350?ng/L are associated with increased risk for mortality and readmission (p?p?p?p?p?Conclusion: This study demonstrates that elevations of discharge cTn I and NT-proBNP are associated with increased 1-year mortality and HF-related readmission. Patients with increasing serial cTnI and NT-proBNP had increased risk for 60-day HF-related events. The two markers can act as independent predicators, and complete each other in prognostic utility of HF patients.     

The influence of the crutch setup on stability and weight-bearing parameters in post total hip replacement surgery patients during quiet standing

Purpose: The purpose of this study is to evaluate the influence of the crutch setup on standing, in post total hip replacement (THR) surgery patients.

Materials and methods: Thirty patients after THR were randomly assigned to walking with the elbow flexed (EF) or elbow straight (ES) crutch setup. Subjects were asked to stand on a force platform in a comfortable position with the crutch positioned on the unaffected side, facing forward for 10?seconds. Centre of pressure total path and maximal excursion were evaluated in both medio-lateral and anterior–posterior planes. Difference in the asymmetry of left/right acromial height, measured with and without the crutch, was calculated (ACdiff). Percentage of body weight borne by the crutch (Fcr), symmetry (SIload) between operated and healthy limbs loading during the trial, together with shoulder forces and moments were measured.

Results: No significant differences between the two groups (p?>?.05) were found for stability parameters. ACdiff, Fcr and shoulder load increased significantly (p?Conclusions: The present study showed that the ES setup reduced the force borne by the crutch, the load on the shoulder joint and it minimized postural and loading asymmetries when compared to EF setup. Conversely, postural stability was not influenced by the crutch setup.

• Implications for Rehabilitation

• Static posture and weight-bearing parameters are influenced by crutch setup during quiet standing.

• Crutch setup does not influence postural stability.

• Adjusting the crutch according to the elbow straight setup reduces the force borne by the crutch and the asymmetry in lower limbs loading.

• Forces and moments at the shoulder joint were reduced for the elbow straight setup group.

     

The quality of the sickness certificate. A case control study of patients with symptom and disease specific diagnoses in primary health care in Sweden

Abstract

Objective: To compare information in sickness certificates and rehabilitation activities for patients with symptom diagnoses vs patients with disease specific diagnoses.

Design: Retrospective case control study 2013–2014.

Setting: Primary health care, Sweden.

Subjects. Patients with new onset sickness certificates with symptom diagnoses n?=?222, and disease specific diagnoses (controls), n?=?222.

Main outcome measures: Main parameters assessed were: information about body function and activity limitation in certificates, duration of sick leave, certificate renewals by telephone, diagnostic investigations, health care utilisation, contacts between patients, rehabilitation coordinators, social insurance officers, employers and occurrence of rehabilitation plans.

Results: Information about body function and activity limitation was sufficient according to guidelines in half of all certificates, less in patients with symptom diagnoses compared to controls (44% vs. 56%, p?=?0.008). Patients with symptom diagnoses had shorter sick leave than controls (116 vs. 151 days p?=?0.018) and more certificates issued by telephone (23% vs. 15% p?=?0.038). Furthermore, they underwent more diagnostic investigations (32% vs. 18%, p?<?0.001) and the year preceding sick leave they had more visits to health care (82% vs. 68%, p?<?0.001), but less follow-up (16% vs. 26%, p?<?0.008). In both groups contacts related to rehabilitation and with employers were scarce.

Conclusion: Certificates with symptom diagnoses compared to disease specific diagnoses could be used as markers for insufficient certificate quality and for patients with higher health care utilisation. Overall, the information in half of the certificates was insufficient and early contacts with employers and rehabilitation activities were in practice missing.

• KEY POINTS

• Symptom diagnoses are proposed as markers of sickness certification quality. We investigated this by comparing certificates with and without symptom diagnoses.

• Certificates with symptom diagnoses lacked information to a higher degree compared to certificates with disease specific diagnoses.

• Regardless of diagnoses, early contacts between patients, rehabilitation coordinators and social insurance officers were rare and contacts with employers were absent.

     

Quasi-experimental evaluation of a home care model for patients with stroke in China

Purpose: To evaluate the effectiveness of a modified home care model in China.

Methods: First-time stroke survivors were recruited from a comprehensive teaching hospital in China. Subjects in the intervention group (n?=?168) received modified home care involving detailed pre-discharge preparation and post-discharge follow-up lasting one month. The following outcomes were assessed at the end of follow-up: length of hospital stay, satisfaction with acute hospitalisation, medication compliance, complications and stroke-related re-hospitalisation. The outcomes were compared for the intervention group and a historical control group (n?=?173) who received routine care.

Results: Modified home care was associated with shorter acute hospitalisation (11.29?±?2.18 vs. 12.36?±?4.33 d, p?=?0.03), higher compliance [161 (95.83%) vs. 92 (53.18%), p?=?0.004] and ability to perform daily activities (38.25?±?10.22 vs. 32.08?±?10.32, p?=?0.03), and a lower rate of re-hospitalisation [2 (1.19%) vs. 11 (6.36%), p?=?0.02].

Conclusions: Home care may be associated with higher quality of life and reduced dependency among stroke patients in China.

• Implications for Rehabilitation

• Home care can be effective method at improving the physical and psychological well-being of stroke survivors in China.

• The home care model in this study can improve health outcomes as well as reduce healthcare resources utilisation.

• Home care models for stroke survivors should be adapted to local healthcare policies and resources.

     

Association between mental health and physical activity in patients with chronic heart failure

Abstract

Purpose: Poor mental health (MH) is common in chronic heart failure (CHF) patients. No studies have reported a relation between MH status and objectively measured physical activity (PA) in CHF patients. The study aim was to determine self-reported MH-related differences associated with PA and target values of PA for improved MH in CHF outpatients. Methods: We divided 243 CHF outpatients (mean age 57.1 years) into two groups according to MH assessed by Short Form-36 score: high-MH (≥68 points) group (n?=?148) and poor-MH (<68 points) group (n?=?95). Average step count (steps) and energy expenditure on PA (EE) (kcal) per day for 1 week of PA were assessed by an accelerometer and compared between groups. PA resulting in high MH was determined by the receiver-operating characteristic (ROC) analysis. Results: PA correlated positively with MH in all patients (steps: r?=?0.46, p?<?0.001; EE: r?=?0.43, p?<?0.001). After adjusting for patient characteristics, steps and EE were significantly lower in the poor-MH versus high-MH group (5020.1?±?280.7 versus 7174.1?±?221.5 steps, p?<?0.001; 133.9?±?10.8 versus 215.9?±?8.4?kcal, p?<?0.001). Cut-off values of 5590.8 steps and 141.1?kcal were determined as PA target values associated with improved MH. Conclusions: Poor MH status may reduce PA. Attaining PA target values may improve MH status of CHF outpatients.

• Implications for Rehabilitation

• Poor mental health may negatively affect physical exercise in CHF outpatients.

• In particular step counts and energy expenditure are lower in those with poor mental health.

• It may be that focused exercise training may impact positively both on mental health and physical well being.

     

Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

Purpose: The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation.

Method: The ADL intervention was early and pre-prosthetic; it was focused on six self-care activities. Fifty-two adults with LLA, who required assistance in self-care, were included. Functional independence (Barthel) was assessed at baseline and after intervention (T2). Successful intervention was defined as independent performance of all self-care activities.

Results: There was a significant improvement in Barthel scores between baseline and T2 in toileting (p?p?p?p?p?=?0.025). The proportion of homes with an unmet need for adaptation decreased significantly in bathroom (p?=?0.008) and other internal areas (p?=?0.031). Intervention was successful for 61.5% of participants. In a multivariate model, age was significantly associated with successful intervention (OR 0.66, 95%CI 0.52–0.83).

Conclusions: A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies.

• Implications for Rehabilitation

• Because basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence.

• A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation.

• Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation.

• A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation.

     

Sex-based influence on clinical outcomes after drug-eluting stent implantation in real-world patients: insight from the FOCUS registry

Objectives: To investigate the impact of sex on clinical outcomes after drug-eluting stent (DES) implantation in real-world patients.

Methods and results: A total number of 4720 patients (3365 males and 1355 females) undergoing the second-generation cobalt-chromium sirolimus-eluting stent (CoCr-SES) implantation from the FOCUS registry were included in this analysis. The cumulative incidences of major adverse cardiovascular event (MACE) (1.5% vs. 2.4%; p?=?.03), cardiovascular death (0.5% vs. 1.0%; p?=?.02) and target vessel revascularization (TVR) (0.3% vs. 0.8%; p?=?.01) within six months were significantly higher in females and the risks of MACE (adjusted hazard ratio [HR] 0.5 (0.3–0.9); p?=?.01) and TVR (adjusted HR 0.1(0.0–0.5); p?=?.001) remained significant in multivariate analysis. Reversely, the cumulative incidences of MACE (5.4% vs. 4.8%; p?=?.04) and any revascularization (5.1% vs. 3.3%; p?=?.01) were significantly higher in males beyond six months and the risks of all-cause death (adjusted HR 1.6 (1.1–2.5); p?=?.03) and cardiovascular death (adjusted HR 1.9 (1.1–3.6); p?=?.03) turned out to be significant in multivariate analysis. Notes: All cumulative incidences were presented as male vs. female; all HRs were calculated as male relative to female.

Conclusions: Females were associated with higher risk of early adverse events, while, males were associated with higher risk of late adverse events.

• Key messages

• Females undergoing PCI are typically older, have more cardiovascular risk factors, while, males in need of PCI are more frequently associated with complex lesions.

• The overall three-year cumulative incidences of adverse events are not significantly different between males and females but numerically higher in males.

• Females are associated with significantly higher risks of MACE and TVR within six months, while, males are associated with significantly higher risk of all-cause mortality and cardiac mortality beyond 6 months.

     

Effectiveness of botulinum toxin injection with and without needle electromyographic guidance for the treatment of spasticity in hemiplegic patients: a randomized controlled trial

Abstract

Purpose: To compare the effects of botulinum toxin injection with and without needle electromyographic guidance for the treatment of spasticity. Method: A randomized controlled study was conducted in a tertiary university hospital. Twenty-seven adult hemiplegic patients with spasticity due to brain or spinal cord damage were included. Spastic muscles were injected with botulinum toxin with or without EMG guidance. The modified Ashworth scale and modified Barthel index in each patient pre- and post-injection were documented. Results: In group A, which consisted of 15 patients (55.55%), the injection was administered with needle electromyographic guidance, while in 12 patients (44.44%) of group B without electromyographic guidance with the use of anatomic landmarks only. The follow-up period was 3 months. At 3 weeks post-injection, spasticity was decreased (p?<?0.05) in all patients and the mean (SD) reduction of spasticity was higher (p?<?0.05) in group A (1.67 (0.5)) than group B (1.25 (0.46)). Similarly, the mean (SD) functional modified Barthel index improved statistically significantly (p?<?0.001) post-injection (45.37 (8.43)) than pre-injection (54.07 (9.610), especially in group A (p?<?0.05). Conclusion: The effectiveness of intramuscular botulinum toxin injection for the treatment of spasticity in hemiplegic patients is superior when performed with needle electromyographic guidance than without electromyography.

• Implications for Rehabilitation

• It is recommended that botulinum toxin muscle injections of hemiplegic limbs be performed with EMG guidance

• More spasticity reduction and functional improvement at 3 months post-injection was observed in patients injected with botulinum toxin by the use of combined EMG guidance and anatomic landmarks

• EMG guidance might also save amount of botulinum toxin due to less spasticity observed during injection than when injection is performed with anatomic landmarks only

     

The validity and reliability of the Thai version of the Kujala score for patients with patellofemoral pain syndrome

Purpose: To develop a Thai version of the Kujala score and show the evaluation of the validity and reliability of the score.

Method: The Thai version of the Kujala score was developed using the forward–backward translation protocol. The 49 PFPS patients answered the Thai version of questionnaires including the Kujala score, Short Form-36 (SF-36) and International Knee Documentation Committee (IKDC) Subjective Knee Form. The validity between the scores has been tested. The reliability was assessed using test–retest reliability and internal consistency.

Results: The Thai version of the Kujala score showed a good correlation with Thai IKDC Subjective Knee Form (Pearson’s correlation coefficient; r?=?0.74: p?r?=?0.586, 0.571 and 0.524, respectively: p?p?p?Conclusion: The Thai version of the Kujala score has shown good validity and reliability. This score can be effectively used for evaluating Thai patients with patellofemoral pain syndrome.

• Implications for Rehabilitation

• The Kujala score is a self-administered questionnaire for patients with patellofemoral pain syndrome (PFPS).

• The validity and reliability of the Thai version of Kujala are compatible with other versions (Turkish, Chinese and Persian version).

• The Thai version of Kujala has been shown to have validity and reliability in Thai PFPS patients and can be used for clinical evaluation and also in the research work.

     

Effects of modified constraint-induced movement therapy on the lower extremities in patients with stroke: a pilot study

Purpose: This study aimed to qualify the improvements of modified constraint-induced movement therapy (m-CIMT) on the lower limb of stroke patients via assessing the centre of mass (COM) displacement and the basic gait parameters.

Methods: A total of 22 hemiplegic patients after stroke with first-time clinical cerebral infarction or haemorrhagic cerebrovascular accident were included in this study from May to December, 2014. The patients were randomly divided into m-CIMT group and the conventional therapy group (control group), and received corresponding training for five days/week for four weeks. The COM displacement and gait parameters were assessed by three-dimensional segmental kinematics method in pre-intervention and post- intervention therapy.

Results: After four weeks of m-CIMT, the COM displacement on sagittal plane of paretic leg during stance phase was increased (pre: 91.04?±?4.39?cm, post: 92.38?±?4.58?cm, p?p?p?Conclusion: The m-CIMT intervention improves the COM displacement in sagittal and frontal plane, as well as gait parameters. These suggest that m-CIMT intervention may be feasible and effective for the rehabilitation of hemiplegic gait.

• Implications for Rehabilitation

• Segmental kinematics method was used to estimate the displacement of the COM.

• m-CIMT interventions improved the COM displacement of patients after stroke.

• m-CIMT interventions improved the hemiplegic gait parameters.

     

Fixed multibracket dental therapy has challenges but can be successfully performed in young persons with Down syndrome

Purpose The objective of this study was to analyze the feasibility of orthodontic treatment with fixed multibracket dental appliances (FMAs) in patients with Down syndrome (DS). Methods The study sample was formed of 25 patients with DS who underwent orthodontic treatment with FMAs. Dental and skeletal characteristics, aspects of FMA treatment, retainer use and recurrences were analyzed. Results were compared with a control group of healthy, age-, sex- and PAR index-matched individuals. Results All the controls underwent a single desensitization session, whereas 2–3 sessions were necessary in 11 patients with DS (p?p?p?=?0.004). Complications were more common in patients with DS than in controls (p?=?0.003), due particularly to traumatic ulcers development. There were more failures during the maintenance phase in patients with DS than in controls (p?=?0.001). The mean duration of treatment was 37 months in patients with DS and 23 months in controls. More cemented retainers were used in the controls than in patients with DS (p?=?0.050). Conclusions It is possible to perform orthodontic treatment with FMAs in patients with DS, although treatment may take longer than usual and the frequency of complications is higher than in controls.

• Implications for Rehabilitation

• Certain dental characteristics of Down syndrome (DS) make these children firm candidates for orthodontic intervention.

• There is little literature available on orthodontic treatment in patients with DS, particularly with regard to the use of fixed appliances.

• This case–control study shows that it is possible to perform orthodontic treatment with fixed appliances in adequately selected patients with DS.

• However, in patients with DS orthodontic treatment may take longer than usual and the frequency of complications is higher than in the general population.

     

Effects of 12-week supervised treadmill training on spatio-temporal gait parameters in patients with claudication

The purpose of the study was to evaluate selected temporal and spatial gait parameters in patients with intermittent claudication after completion of 12-week supervised treadmill walking training. The study included 36 patients (26 males and 10 females) aged: mean 64 (SD 7.7) with intermittent claudication. All patients were tested on treadmill (Gait Trainer, Biodex). Before the programme and after its completion, the following gait biomechanical parameters were tested: step length (cm), step cycle (cycle/s), leg support time (%), coefficient of step variation (%) as well as pain-free walking time (PFWT) and maximal walking time (MWT) were measured. Training was conducted in accordance with the current TASC II guidelines. After 12 weeks of training, patients showed significant change in gait biomechanics consisting in decreased frequency of step cycle (p?p?p?p?p?p?>?0.05).

• Implications for Rehabilitation

• Twelve-week treadmill walking training programme may lead to significant improvement of temporal and spatial gait parameters in patients with intermittent claudication.

• Twelve-week treadmill walking training programme may lead to significant improvement of pain-free walking time and maximum walking time in patients with intermittent claudication.

     

Inclusion of populations at risk of advanced melanoma in an opportunistic targeted screening project involving general practitioners

Objective: The study objective was to measure the rates of inclusion of populations at risk of advanced melanoma in a pilot targeted screening project involving general practitioners.

Design: This cross-sectional database study compared the inclusion rates of patients who signed inclusion in a targeted screening project with those of patients who did not, during a period in which both groups of patients consulted investigators.

Setting: Data were extracted from the national healthcare insurance records in western France from 11 April to 30 October 2011.

Patients: Patients, older than 18, considered for the data extraction had consulted one of the 78 participating GPs during the study period, and were affiliated with the national healthcare insurance.

Main outcome measures: Inclusion in the screening was the main outcome measure. Patients at risk of advanced melanoma were characterized by male gender, age over 50, low income, rural residence, farmer, and presence of chronic disease.

Results: A total of 57,279 patients consulted GPs during the inclusion period and 2711 (4.73%) were included in the targeted screening. Populations at risk of advanced melanoma were less included: men (OR?=?0.67; 95%CI [0.61–0.73]; p?p?p?p?p?Conclusion: This study demonstrated inequalities in the inclusion of patients in a melanoma screening. Patients at risk of advanced cancer were screened less often. Further studies should focus on GPs ability to identify and screen these patients.

• KEY POINTS

• Advanced melanoma is more frequently diagnosed in men, older patients and socioeconomically disadvantaged populations, which leads to survival inequalities.

• ??Despite the involvement of general practitioners, the implementation of targeted melanoma screening did not avoid inclusion inequalities.

• ??Men, older patients, patients suffering from chronic diseases, and low-income patients were less likely to benefit from screening.

• ??The display of a conventional or an alarmist poster in the waiting room did not statistically reduce these inclusion inequalities.

     

Effects of line dancing on physical function and perceived limitation in older adults with self-reported mobility limitations

Introduction: Older adults with mobility limitations are at greater risk for aging-related declines in physical function. Line dancing is a popular form of exercise that can be modified, and is thus feasible for older adults with mobility limitations.

Purpose: The purpose of this study was to assess the effects of 8 weeks of line dancing on balance, muscle strength, lower extremity function, endurance, gait speed, and perceived mobility limitations.

Methods: An experimental design randomly assigned older adults to either an 8-week line dancing or usual care group. The convenience sample consisted of 23 participants with mobility limitations (age range: 65–93?years). The intervention used simple routines from novice line dance classes. At baseline and at 8 weeks, balance, knee muscle strength, lower extremity function, endurance, gait speed, and mobility limitations were measured. ANCOVA tests were conducted on each dependent variable to assess the effects of the intervention over time.

Results: Results found significant positive differences for the intervention group in lower extremity function (p?p?p?p?Conclusions: Eight weeks of line dancing significantly improved physical function and reduced self-reported mobility limitations in these individuals. Line dancing could be recommended by clinicians as a potential adjunct therapy that addresses mobility limitations.

• Implications for Rehabilitation

• Line dancing may be an alternative exercise for older adults who need modifications due to mobility limitations.

• Line dancing incorporates cognitive and motor control.

• Line dancing can be performed alone or in a group setting.

• Dancing improves balance which can reduce risk of falls.

     

Relevance of nerve conduction velocity in the assessment of balance performance in older adults with diabetes mellitus

Purpose This study investigated the relationship between peripheral nerve conduction velocity (NCV) and balance performance in older adults with diabetes. Methods Twenty older adults with diabetes were recruited to evaluate the NCV of their lower limbs and balance performance. The balance assessments comprised the timed up and go (TUG) test, Berg balance scale (BBS), unipedal stance test (UST), multidirectional reach test (MDRT), maximum step length (MSL) test and quiet standing with eyes open and closed. The relationship between NCV and balance performance was evaluated by Pearson’s correlation coefficients, and the balance performances of the diabetic patients with and without peripheral neuropathy were compared by using Mann–Whitney U tests. Results The NCV in the lower limbs exhibited a moderate to strong correlation with most of the balance tests including the TUG (r?=??0.435 to??0.520, p?r?=?0.406–0.554, p?r?=?0.409–0.647, p?P?p?p?p?p?p?Conclusion Our findings revealed that a decline in peripheral nerve conduction in the lower limb is not only an indication of nerve dysfunction, but may also be related to the impairment of balance performance in patients with diabetes.

• Implications for Rehabilitation

• Nerve conduction velocity in the lower limbs of diabetic older adults showed moderate to strong correlations with most of the results of balance tests, which are commonly used in clinics.

• Decline in nerve conduction velocity of the lower limbs may be related to the impairment of balance control in patients with diabetes.

• Diabetic older adults with peripheral neuropathy exhibited greater postural instability than those without peripheral neuropathy.