Electronic Rapid Fitness Assessment: A Novel Tool for Preoperative Evaluation of the Geriatric Oncology Patient.

Background: The American College of Surgeons and American Geriatrics Society recommend performing a geriatric assessment (GA) in the preoperative evaluation of older patients. To address this, we developed an electronic GA, the Electronic Rapid Fitness Assessment (eRFA). We reviewed the feasibility and clinical utility of the eRFA in the preoperative evaluation of geriatric patients. Methods: We performed a retrospective review of our experience using the eRFA in the preoperative assessment of geriatric patients. The rate and time to completion of the eRFA were recorded. The first 50 patients who completed the assessment were asked additional questions to assess their satisfaction. Descriptive statistics of patient-reported geriatric-related data were used for analysis. Results: In 2015, 636 older patients with cancer (median age, 80 years) completed the eRFA during preoperative evaluation. The median time to completion was 11 minutes (95% CI, 11-12 minutes). Only 13% of patients needed someone else to complete the assessment for them. Of the first 50 patients, 88% (95% CI, 75%-95%) responded that answering questions using the eRFA was easy. Geriatric syndromes were commonly identified through the performance of the GA: 16% of patients had a positive screening for cognitive impairment, 22% (95% CI, 19%-26%) needed a cane to ambulate, and 26% (95% CI, 23%-30%) had fallen at least once during the previous year. Conclusions: Implementation of the eRFA was feasible. The eRFA identified relevant geriatric syndromes in the preoperative setting that, if addressed, could lead to improved outcomes.

Older People with Access to Hand-Held Devices: Who Are They?

INTRODUCTION: Multiple comorbid conditions among older patients require frequent physician office and emergency room visits, at times leading to hospitalization. In recent years, mobile health (m-health) systems utilizing hand-held devices (e.g., smartphones) have been developed, which could be used for health-related interventions. This study investigates sociodemographic and clinical characteristics of individuals who have or have not accessed Internet via hand-held devices. MATERIALS AND METHODS: Adults older than 65 years of age who participated in the Health Tracking survey of the Pew Internet and American Life Project in 2012 were included in the analysis. Data were analyzed for prevalence of Internet access via hand-held devices and differences in sociodemographic and clinical characteristics. Different online health information seeking behavior is also reported. RESULTS: In the weighted sample size of 3,116 responses, 472 (15.1%) had access to Internet via hand-held devices. Those with such an access were younger and had higher income and education and better overall quality of life and quality of life at the time of answering the survey. They were more likely to be female and married or living as married. Those with diabetes or significant change in physical condition in the prior year were less likely to have such an access. In the multivariate analysis, older or diabetic individuals had lower probability of such access. Higher likelihood of access was associated with higher income and education, being married, female gender, better quality of life, higher number of comorbid illnesses, and emergency room visit or hospital admission in the last 12 months. CONCLUSIONS: Investigators should pay attention to sociodemographic and clinical disparities of older adults to develop feasible m-health interventions.

In whom do cancer survivors trust online and offline?

BACKGROUND: In order to design effective educational intervention for cancer survivors, it is necessary to identify most-trusted sources for health-related information and the amount of attention paid to each source. OBJECTIVE: The objective of our study was to explore the sources of health information used by cancer survivors according to their access to the internet and levels of trust in and attention to those information sources. MATERIALS AND METHODS: We analyzed sources of health information among cancer survivors using selected questions adapted from the 2012 Health Information National Trends Survey (HINTS). RESULTS: Of 357 participants, 239 (67%) had internet access (online survivors) while 118 (33%) did not (offline survivors). Online survivors were younger (p<0.001), more educated (p<0.001), more non-Hispanic whites (p<0.001), had higher income (p<0.001), had more populated households (p<0.001) and better quality of life (p<0.001) compared to offline survivors. Prevalence of some disabilities was higher among offline survivors including serious difficulties with walking or climbing stairs (p<0.001), being blind or having severe visual impairment (p=0.001), problems with making decisions (p<0.001), doing errands alone (p=0.001) and dressing or bathing (p=0.001). After adjusting for socio- demographic status, cancer survivors who were non-Hispanic whites (OR=3.49, p<0.01), younger (OR=4.10, p<0.01), more educated (OR=2.29, p=0.02), with greater income (OR=4.43, p<0.01), and with very good to excellent quality of life (OR=2.60, p=0.01) had higher probability of having access to the internet, while those living in Midwest were less likely to have access (OR=0.177, p<0.01). Doctors (95.5%) were the most and radio (27.8%) was the least trusted health related information source among all cancer survivors. Online survivors trusted internet much more compared to those without access (p<0.001) while offline cancer survivors trusted health-related information from religious groups and radio more than those with internet access (p<0.001 and p=0.008). Cancer survivors paid the most attention to health information on newsletters (63.8%) and internet (60.2%) and the least to radio (19.6%). More online survivors paid attention to internet than those without access (68.5% vs 39.1%, p<0.001) while more offline survivors paid attention to radio compared to those with access (26.8% vs 16.5%, p=0.03). CONCLUSIONS: Our findings emphasize the importance of improving the access and empowering the different sources of information. Considering that the internet and web technologies are continuing to develop, more attention should be paid to improve access to the internet, provide guidance and maintain the quality of accredited health information websites. Those without internet access should continue to receive health-related information via their most trusted sources.

Multiple brain abscesses due to nocardia in an immunocompetent patient.

Nocardia cerebral abscesses are rare intracranial lesions. They account for only 1% to 2% of all brain abscesses. They are important in immunocompromised patients, but rarely occur in immunocompetent hosts. Here, we present a case of multiple primary brain abscesses with Nocardia in an immunocompetent patient, who was treated successfully with oral antibiotic therapy.

A survey of complementary and alternative medicine in Iran.

OBJECTIVE: To survey the use, capability and satisfaction of complementary and alternative medicine (CAM) in comparison with conventional medicine in Iran. METHODS: In this national survey, a cross-sectional study was designed, 5,000 people were surveyed to identify predictors of Iranian traditional medicine (ITM) use compared with conventional medicine. Data were collected through a questionnaire that covered three different predictor categories: demographic information, patient's viewpoint, and patients' experiences. RESULTS: Most of the participants preferred government owned hospitals rather than other places. Praying for one's own health was the most frequent and favorable ITM domain (P=0.017) based on patients' interests, both in low- (P=0.08) and high-level (P=0.011) educated subjects. Among the participants, 97.8% had previous conventional medicine history due to their chronic diseases CONCLUSIONS: Iranian patients resort to ITM as a choice at the late stage of the disease. Current deficiency in integration of CAM and conventional medicine is in contrast to the increasing demand on patients' side. Health care organizers should be facilitating the CAM services by tuition of CAM practitioners and supporting eligible CAM centers for diagnosis and treatment of patients.