Derivation of a Nomogram to Estimate Probability of Revisit in at-Risk Older Adults Discharged From the Emergency Department.

Derivation of a nomogram to estimate probability of revisit in at-risk older adults discharged from the emergency department.

Intern Emerg Med. 2013 Mar 5;
Arendts G, Fitzhardinge S, Pronk K, Hutton M, Nagree Y, Donaldson M

Estimation of the risk of revisit to the emergency department (ED) soon after discharge in the older population may assist discharge planning and targeting of post discharge intervention in high risk patients. In this study we sought to derive a risk prediction calculator for this purpose. In a prospective observational study in two tertiary ED, we conducted a comprehensive assessment of people aged 65 and over, and followed them for a minimum of 28 days post discharge. Cox proportional hazard models relating any unplanned ED revisit in the follow up period to observed risk factors were used to compute a probability nomogram. From 1,439 patients, 189 (13.1 %) had at least one unplanned revisit within 28 days. Revisit probability was weighted towards chronic and difficult to modify risk factors such as depression, malignancy and cognitive impairment. We conclude that the risk of revisit post discharge is calculable using a probability nomogram. However, revisit is largely related to immutable factors reflecting chronic illness burden, and does not necessarily reflect poor ED care during the initial index presentation. HubMed – depression

Quality of life in relation to social and disease factors in patients with type 2 diabetes in Lithuania.

Med Sci Monit. 2013; 19: 165-74
Mikaili?kštien? A, Juozulynas A, Narkauskait? L, Zagminas K, S?lyga J, Stukas R

Background Diabetic patients are more than twice as costly to manage as non-diabetic patients, due mainly to the high costs associated with management of diabetic complications. As in most nations of the world, the number of patients with DM is increasing every year in Lithuania. The aim of this study was to determine relation between quality of the life and disease and social factors of patients with type 2 diabetes in Lithuania. Material and Methods Independently prepared questions about the subjects of the survey were: gender; age; weight; education; social and marital status; duration of the disease (in years); treatment method; complications; morbidity with arterial hypertension; change in dietary habits after diagnosis of diabetes (started to eat accordingly to recommendations of the therapist); how often nourishment is taken accordingly to recommendations of the therapist; if beginning to exercise after diagnosis of the diabetes; and if exercising, exercises at least 2-3 times per week. Body mass index was calculated as the relation between body mass in kg and height m square (BMI=kg/m2). The hospital anxiety and depression (HAD) scale was used for the evaluation of depression and anxiety. Quality of life of patients was evaluated with the SF-36 questionnaire. We surveyed 1022 patients with type 2 diabetes (372 men and 650 women). Association between quality of the life and explanatory parameters (disease and social factors) were analyzed using the logistic regression analysis model. Results We found that women had lower scores than men in all fields of quality of life (p<0.001). Peroral treatment had a positive impact on the quality of life (QL) fields of the role limitations due to emotional problems (ORa 0.16. 95% CI 0.07-0.34; p<0.001). Treatment with insulin had a positive effect on restriction of activity because of emotional problems (ORa - 0.23. 95% CI 0.11-0.49; p<0.001) and mental health (ORa - 0.38. 95% CI 0.19-0.78; p=0.008), but had a negative impact on bodily pain (ORa - 3.95. 95% CI 1.41-11.09; p=0.009) and physical health (ORa - 4.14. 95% CI 2.03-8.47; p<0.001). Conclusions Age and BMI are less important factors that can influence quality of life. Peroral treatment positively acted on the role limitations due to emotional problems, bodily pain, and mental health, but had a strong negative effect on emotional state. HubMed – depression

A cross-sectional multicenter study of cognitive and behavioural features in multiple system atrophy patients of the parkinsonian and cerebellar type.

J Neural Transm. 2013 Mar 6;
Siri C, Duerr S, Canesi M, Delazer M, Esselink R, Bloem BR, Gurevich T, Balas M, Giladi N, Santacruz P, Marti F, Tolosa E, Rubino A, Meco G, Poewe W, Pezzoli G, Wenning G, Antonini A

Imaging and neuropathology studies have demonstrated significant abnormalities not only in subcortical, but also in cortical regions of patients with multiple system atrophy (MSA). This raises the possibility that cognitive dysfunction may contribute to the clinical spectrum of this disorder to a greater extent than it is currently not widely appreciated. In this cross-sectional multicenter study from the European multiple system atrophy study group ( http://www.emsa-sg.org ), we applied an extensive neuropsychological test battery in a series of 61 clinically diagnosed probable MSA patients. The results demonstrated that general cognitive decline as assessed by MMSE was uncommon (2 out of 61 patients <24). In contrast, frontal lobe-related functions (as measured by FAB) were impaired in 41 % of patients, with abstract reasoning and sustained attention less compromised. This pattern was similar to our control group of 20 patients with Parkinson's disease (matched for disease duration and age at onset). There was no difference in cognitive performance between MSA patients with the parkinsonian versus the cerebellar variant. Behaviourally, MSA patients had greater depression than PD and in the case of MSA of the cerebellar variant significantly lower anxiety. Our data show that cognitive abnormalities are relatively frequent in multiple system atrophy and this involves primarily frontal-executive functions. Their contribution to clinical disability and disease progression needs to be addressed in larger prospective studies. HubMed – depression

Short-term psychological impact of the BRCA1/2 test result in women with breast cancer according to their perceived probability of genetic predisposition to cancer.

Br J Cancer. 2013 Mar 5; 108:
Brédart A, Kop JL, Depauw A, Caron O, Sultan S, Leblond D, Fajac A, Buecher B, Gauthier-Villars M, Noguès C, Flahault C, Stoppa-Lyonnet D, Dolbeault S

Background:The effect of BRCA1/2 gene test result on anxiety, depression, cancer-related thought intrusion or avoidance and perceived control over cancer risk was assessed in breast cancer (BC) patients, according to their perceived probability of genetic predisposition to cancer.Methods:Two hundred and forty-three (89% response rate) women with BC completed questionnaires after an initial genetic counselling visit (T1), of which 180 (66%) completed questionnaires again after receiving the BRCA1/2 results (T2). The discrepancy between women’s perceived probability of cancer genetic predisposition at T1 and the geneticist’s computed estimates was assessed.Results:In all, 74% of women received a negative uninformative (NU), 11% a positive BRCA1/2 and 15% an unclassified variant (UV) result. On hierarchical regression analysis, in women with a positive BRCA1/2 result (vs NU or UV), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted lower levels of anxiety at T2 (?=-0.28; P<0.01), whereas in women receiving a UV result (vs NU or positive BRCA1/2), a lower perceived probability of cancer genetic predisposition than objective estimates at T1 predicted higher levels of anxiety (?=0.20; P<0.01), depression (?=0.19; P<0.05) and intrusion (?=0.18; P<0.05) at T2.Conclusion:The type of BRCA1/2 test result differently affects distress according to women's perceived probability of genetic predisposition before testing.British Journal of Cancer advance online publication, 5 March 2013; doi:10.1038/bjc.2012.599 www.bjcancer.com. HubMed – depression