RESUMEN
BACKGROUND: Postoperative cognitive dysfunction (POCD) manifests as a subtle decline in cognition, potentially leading to unfavourable postoperative outcomes. We explored the impact of POCD on physical function, length of hospital stay (LOS), dementia and mortality outcomes. METHODS: PubMed and Scopus were searched until May 2023. All studies of major surgical patients that assessed POCD and outcomes of interest were included. POCD effects were stratified by surgery type (cardiac and noncardiac) and time of POCD assessment (<30 and ≥30 days postsurgery). RESULTS: Of 2316 studies, 20 met the inclusion criteria. POCD was not associated with functional decline postsurgery. Patients who experienced POCD postcardiac surgery had an increased relative risk (RR) of death of 2.04 [(95% CI: 1.18, 3.50); I2 = 0.00%]. Sensitivity analyses showed associations with intermediate-term mortality among noncardiac surgical patients, with an RR of 1.84 [(95% CI: 1.26, 2.71); I2 = 0.00%]. Patients who developed POCD <30 days postcardiac and noncardiac surgeries experienced longer LOS than those who did not [mean difference (MD) = 1.37 days (95% CI: 0.35, 2.39); I2 = 92.38% and MD = 1.94 days (95% CI: 0.48, 3.40); I2 = 83.29%, respectively]. Postoperative delirium (POD) may contribute to the heterogeneity observed, but limited data were reported within the studies included. CONCLUSIONS: Patients undergoing cardiac and noncardiac surgeries who developed POCD <30 days postsurgery had poorer outcomes and an increased risk of premature death. Early recognition of perioperative neurocognitive disorders in at-risk patients may enable early intervention. However, POD may confound our findings, with further studies necessary to disentangle the effects of POD from POCD on clinical outcomes.
Asunto(s)
Tiempo de Internación , Complicaciones Cognitivas Postoperatorias , Anciano , Humanos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Disfunción Cognitiva/etiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Complicaciones Cognitivas Postoperatorias/etiología , Complicaciones Cognitivas Postoperatorias/epidemiología , Complicaciones Cognitivas Postoperatorias/diagnóstico , Medición de Riesgo , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: As societies age, increasing numbers of older adults undergo surgeries with anesthesia. Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) frequently occur in older surgical patients. Most of these patients already have preoperative mild cognitive impairment (MCI). However, the correlation between MCI and POD remains unclear. This study aimed to determine the incidence of POD in elderly patients with and without preexisting MCI. METHODS: A prospective study enrolled patients aged 60 years and above scheduled for major surgeries between December 2017 and April 2022. Preoperative MCI was determined by a Montreal Cognitive Assessment (MoCA) score between 18 and 24. POD was diagnosed using criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). POCD was characterized by a MoCA score reduction of 2 or more points from the preoperative score. The primary outcome was the incidence of POD within the first 72 h postoperatively. Secondary outcomes encompassed other postoperative complications, including POCD. RESULTS: The study comprised 223 elderly patients with MCI and 56 without MCI. The incidence of POD was 16.6% in the MCI group and 14.3% in the non-MCI group (P = 0.839). POCD occurred in 24.3% of MCI patients and 50% of non-MCI patients (P = 0.001). There were no significant differences in other postoperative complications between the groups. Postoperatively, the MCI group notably declined in visuospatial, attention, and orientation domains, while the non-MCI group declined in all domains except delayed recall. CONCLUSIONS: The incidence of POD was similar in the MCI and non-MCI groups. However, the non-MCI group demonstrated a higher incidence of POCD than the MCI group. This was identified by a reduction in postoperative MoCA scores for the visuospatial, naming, attention, language, abstraction, and orientation domains. These findings underscore the importance of postoperative cognitive assessments for both elderly patients with preexisting MCI and those with previously intact cognitive functions. TRIAL REGISTRATION: This trial was retrospectively registered in the Thai Clinical Trials Registry on 15/01/2019 (registration number: TCTR20190115001).
Asunto(s)
Disfunción Cognitiva , Delirio del Despertar , Complicaciones Cognitivas Postoperatorias , Anciano , Humanos , Estudios Prospectivos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Complicaciones Cognitivas Postoperatorias/diagnóstico , Complicaciones Cognitivas Postoperatorias/epidemiología , Complicaciones Cognitivas Postoperatorias/etiologíaRESUMEN
Blood pressure (BP) measurement is the mainstay for diagnosing and treating hypertension. Blood pressure screening in the May Measurement Month (MMM) project is helpful for the early detection of hypertension, which is usually asymptomatic. This study aimed to investigate the epidemiology of hypertension from data in the MMM21 project in Thailand. A cross-sectional study was conducted according to the MMM clinical study protocol for MMM21 in all regions of Thailand from August to November 2021. We included adults aged ≥18 years. Baseline characteristics, history of hypertension diagnosis, and treatment were collected through the questionnaires followed by three standardized BP measurements, 1 min apart. We included 10 940 participants with a mean age of 41.3 (SD ± 13.5) years. Only 6% never had their BP measured before. Of all participants, 30.2% had hypertension, and among this hypertensive population, 50.3% were aware, and 46.2% were taking antihypertensive medications. Of participants with hypertension, 31.6% had controlled BP (<140/90â mmHg), and BP control was 68.5% among those taking antihypertensive medication. The proportion of participants who had diabetes, were on aspirin, and were on statin were 6, 7.2, and 11.4%, respectively. Almost all participants (93.7%) had received at least one COVID-19 vaccination, and 8.0% reported a previous COVID-19 positive test. Most of the participants (97.4%) received hypertension care at no cost. Hypertension awareness and overall BP control rate were relatively low, while most subjects had previously had their BP checked. The widespread use of BP measurement may improve the diagnosis and treatment of hypertension to improve the care of those with hypertension in Thailand.
RESUMEN
Alzheimer's disease is a type of neurodegenerative disorder that is characterized by the progressive degeneration of brain cells, leading to cognitive decline and memory loss. It is the most common cause of dementia and affects millions of people worldwide. While there is currently no cure for Alzheimer's disease, early detection and treatment can help to slow the progression of symptoms and improve quality of life. This research presents a diagnostic tool for classifying mild cognitive impairment and Alzheimer's diseases using feature-based machine learning applied to optical coherence tomographic angiography images (OCT-A). Several features are extracted from the OCT-A image, including vessel density in five sectors, the area of the foveal avascular zone, retinal thickness, and novel features based on the histogram of the range-filtered OCT-A image. To ensure effectiveness for a diverse population, a large local database for our study was collected. The promising results of our study, with the best accuracy of 92.17,% will provide an efficient diagnostic tool for early detection of Alzheimer's disease.
Asunto(s)
Enfermedad de Alzheimer , Disfunción Cognitiva , Tomografía de Coherencia Óptica , Humanos , Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/patología , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico , Tomografía de Coherencia Óptica/métodos , Angiografía/métodos , Aprendizaje Automático , Masculino , Anciano , FemeninoRESUMEN
BACKGROUND: Perioperative neurocognitive disorder includes postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). Concerning inconclusive consequences of POCD compared with POD, we explored the association between either POCD or POD and functional decline as well as healthcare utilization. METHODS: Patients aged at least 60 years who underwent a major operation were enrolled. POCD was defined as a decrease in the Montreal Cognitive Assessment (MoCA) score (≥ 2) 1 week after surgery. Postoperative delirium (POD) was defined according to the criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The primary outcome was instrumental activities of daily living (IADLs) 3 months after discharge. Secondary outcomes were the length of stay (LOS), hospital cost, and factors that affected functional decline 3 months after surgery. The multivariate model, including potential confounding factors, namely age, gender, surgery type, and postoperative complications, was used to analyze possible factors that influenced a reduction in function, and the results were expressed by using adjusted relative risk (RR) and 95%CI. RESULTS: Two hundred eighty-nine patients with a mean age of 72 years were enrolled. The incidence of POCD at 1 week was 28.5%. At their 3-month follow-ups, the patients with POCD were not associated with IADL decline. Nevertheless, patients with POCD were more likely to need a prolonged LOS (11 days [1, 46] vs. 8 days [2, 42]; P = 0.01), and incur higher hospital costs (8973.43 USD [3481.69, 11 763.74] vs. 5913.62 USD [332.43, 19 567.33]; P < 0.001). Additionally, the patients experiencing POD demonstrated increased risks of reducing their IADLs (adjusted RR 2.33; 95% CI, 1.15-4.71; P = 0.02). CONCLUSIONS: POCD at 1 week leaded to increase healthcare utilization in a middle-income country. POD during hospitalization was associated with a decline in function after surgery and increased health care utilization. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20190115001 .
Asunto(s)
Disfunción Cognitiva , Delirio , Complicaciones Cognitivas Postoperatorias , Actividades Cotidianas , Anciano , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Delirio/diagnóstico , Humanos , Aceptación de la Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios ProspectivosRESUMEN
BACKGROUND: Several methods are available for identifying frailty, but limited tools have been validated in Thai context. Our objective was to evaluate the validity and reliability of the Thai version of the Simple Frailty Questionnaire (T- FRAIL) compared to the Thai Frailty Index (TFI) and to explore modifications to improve its diagnostic properties. METHODS: The T-FRAIL was translated with permission using a standardized protocol, that included forward and back-translation. Content validity analysis was performed using input from 5 geriatricians. Test-retest reliability, concurrent validity, diagnostic properties, and options to increase the sensitivity of the questionnaire were explored. A cross-sectional study for evaluation validity and reliability was carried out among 3 hundred patients aged 60 or more undergoing elective surgery at a university hospital. RESULTS: The item content validity index (I-CVI) showed 1.0 for each questionnaire item. Test-retest reliability within a 7-day interval was done in 30 patients with a good intraclass correlation coefficient of 0.880. Compared with the TFI, the T-FRAIL yielded an excellent accuracy (area under the curve = 0.882). The identification of frailty using a score of 2 points or more provided the best Youden's index at 63.1 with a sensitivity of 77.5% (95% CI 69.0-84.6) and a specificity of 85.6% (95% CI 79.6-90.3). A cutoff point of 1 out of 5 items for original T-FRAIL provided a sensitivity of 93.3% and a specificity of 61.1%. The modified T-FRAIL (T-FRAIL_M1), by reducing the "illnesses" criterion to 4 or more diseases, at a cutoff point at 1 had a sensitivity of 94.2% and a specificity of 57.8%. Another modified T-FRAIL (T-FRAIL_M2), by combining three components, at a cutoff point at 1 yielded a sensitivity of 85.8% and a specificity of 80.6%. CONCLUSION: The T-FRAIL and its modification demonstrated satisfactory validity and reliability to identify frailty in elderly patients. The cutoff score of 1 point from 5 items from the original version of T-FRAIL and T-FRAIL_M1 provides a highly sensitive screening tool. T-FRAIL_M1 with a cutoff point of 2 and T-FRAIL_M2 yields reasonable sensitivity and specificity for practical use.
Asunto(s)
Fragilidad , Anciano , Estudios Transversales , Anciano Frágil , Fragilidad/diagnóstico , Evaluación Geriátrica/métodos , Humanos , Vida Independiente , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Tailandia/epidemiologíaRESUMEN
BACKGROUND: Limited studies exist on the factors associated with a complete cure of onychomycosis in older adults. OBJECTIVES: To determine the age and factors associated with a complete cure among older adults diagnosed with toenail onychomycosis. METHODS: A retrospective cohort study was conducted of 95 older adult patients (aged ≥ 60 years) diagnosed with toenail onychomycosis between January 2016 and December 2017. Demographic data, mycological findings, treatments and durations to a complete cure were reviewed. RESULTS: The complete cure rates of the patients aged < 70 years and ≥70 years were 67.4% and 44.9%, respectively (P = 0.027). Patients aged ≥ 70 years were significantly higher in male gender, had higher history of smoking, peripheral arterial disease, impaired renal function, antihypertensive drug and amorolfine nail lacquer usage, and polypharmacy. A multivariate analysis revealed that being aged ≥70 years and having a nail thickness >2 mm were associated with failure to achieve a complete cure. The median times to a complete cure for older adults aged <70 years and ≥70 years were 20 months and 47 months, respectively (P = 0.007). CONCLUSIONS: An age ≥ 70 years was related to a lower cure rate and delays in achieving a complete cure. A nail thickness > 2 mm was a poor prognostic factor for a complete cure. Moreover, very old adults were more likely to suffer side effects arising from the use of systemic antifungal medications.
Asunto(s)
Dermatosis del Pie/epidemiología , Onicomicosis/epidemiología , Anciano , Antifúngicos/uso terapéutico , Antihipertensivos/uso terapéutico , Estudios de Cohortes , Femenino , Dermatosis del Pie/tratamiento farmacológico , Humanos , Enfermedades Renales/epidemiología , Masculino , Persona de Mediana Edad , Morfolinas/uso terapéutico , Onicomicosis/tratamiento farmacológico , Enfermedad Arterial Periférica/epidemiología , Polifarmacia , Estudios Retrospectivos , Factores Sexuales , Fumar/epidemiología , Tailandia/epidemiologíaRESUMEN
BACKGROUND: The data on the immunogenicity and efficacy of heterologous primary series COVID-19 vaccination are still limited. OBJECTIVE: To investigate the immunogenicity and vaccine efficacy/effectiveness compared between heterologous and homologous primary series COVID-19 vaccination. METHODS: We conducted a multi-source search for randomized controlled trials, prospective cohort, and case-control studies that investigated the immunogenicity or vaccine efficacy/effectiveness (VE) of heterologous primary series vaccination. Six online databases were searched from inception to June 2022. The primary outcome was the levels of binding antibodies and neutralizing antibodies (NAbs), and the secondary outcomes were VE against COVID-19 infection, hospitalization, and death. RESULTS: Among the 28 included studies, 21 and 7 were included to investigate immunogenicity and VE outcome, respectively. Heterologous CoronaVac (CV)/ChAdOx1 (ChAd) induced higher anti-RBD IgG and NAbs against wild type and delta variants compared to homologous CV or ChAd. However, risk of documented infection of CV/ChAd was similar to homologous CV, but higher than homologous ChAd (odds ratio: 2.56, 95% CI: 1.02-6.37). Heterologous ChAd/BNT162b2 (BNT) elicited a higher anti-spike level than homologous ChAd or BNT, and induced a higher NAbs level against delta variants compared to homologous ChAd. The VE of ChAd/BNT and homologous ChAd or BNT against hospitalization were similar. CONCLUSIONS: Heterologous CV/ChAd induced higher binding and neutralizing antibody levels than homologous CV or ChAd; and, ChAd/BNT induced higher binding and neutralizing antibody levels than homologous ChAd. However, CV/ChAd demonstrated increased risk of infection compared to homologous ChAd. Therefore, immunogenicity findings and real-world vaccine efficacy/effectiveness should be integrated in clinical practice.
Asunto(s)
Anticuerpos Neutralizantes , COVID-19 , Humanos , Eficacia de las Vacunas , Vacunas contra la COVID-19 , Vacuna BNT162 , Estudios Prospectivos , COVID-19/prevención & control , SARS-CoV-2 , Vacunación , Anticuerpos AntiviralesRESUMEN
BACKGROUND: Hip fractures are common among frail, older people and associated with multiple adverse outcomes, including death. Timely and appropriate care by a multidisciplinary team may improve outcomes. Implementing a team to jointly deliver the service in resource-limited settings is challenging, particularly on the effectiveness of patient outcomes. METHODS: A retrospective cohort study to compare outcomes of hip fracture patients aged 65 or older admitted at Siriraj hospital before and after implementation of the Fast-track program for Acute Geriatric Hip Fractures. The primary outcome was the incidence of medical complications. The secondary outcomes were time to surgery, factors related to the occurrence of various complications, in-hospital mortality, and mortality at month 3, month 6 and month 12 after the operation. RESULTS: Three hundred two patients were enrolled from the Siriraj hospital's database from October 2016 to October 2018; 151 patients in each group with a mean age of 80 years were analyzed. Clinical parameters were similar between groups except the Fast-track group comprising more patients with dementia (37.1% VS 23.8%, p < 0.012). In the Fast-track group, there was a significantly higher proportion of patients underwent surgery within 72-h (80.3% VS 44.7%, p < 0.001) and the length of stay was significantly shorter (11 days (8-17) VS 13 days (9-18), p = 0.017). There was no significant difference in medical complications. Stratified analysis by dementia status showed a trend in delirium reduction in both patients with dementia and without dementia groups, and a pressure injury reduction among patients with dementia after the program was implemented but without statistical significance. There was no significant difference in mortality. CONCLUSIONS: The implementation of a multidisciplinary team for hip fracture patients is feasible in resource-limited setting. In the Fast-track program, time to surgery was reduced and the length of stay was shortened. Other outcome benefits were not shown, which may be due to incomplete uptake of all involved disciplines.
Asunto(s)
Fracturas de Cadera , Anciano , Anciano de 80 o más Años , Fracturas de Cadera/diagnóstico , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Mortalidad Hospitalaria , Hospitalización , Hospitales Universitarios , Humanos , Tiempo de Internación , Estudios RetrospectivosRESUMEN
OBJECTIVE: To investigate the prevalence of and factors associated with metabolic syndrome (MetS) in patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS). METHODS: This cross-sectional study included PsA or AS patients who attended Siriraj Hospital (Bangkok, Thailand) during March 2014 to October 2017. The Harmonized MetS definition was used to diagnose MetS. Demographic, clinical, and spinal radiographic data were collected. Logistic regression was used to identify factors associated with MetS. RESULTS: Among 319 patients, 153 had AS and 166 had PsA. MetS was present in 43% of PsA and 19% of AS (p < 0.001). Multiple regression analysis identified body mass index (BMI) > 23 (odds ratio [OR]: 3.7), female gender (OR range: 3.8-3.9), and the number of syndesmophytes or ankylosis [SynAnk] (OR: 1.1) were associated with MetS among PsA patients. For AS patients, BMI > 23 (OR: 9.1) and age > 40 (OR: 4.3) were associated with MetS. Disease activity index was not associated with MetS. CONCLUSIONS: MetS was significantly more prevalent in PsA than in AS. Structural change of the spine was associated with MetS in PsA. PsA patients with being female, BMI > 23 or evidence of spinal change should be informed to screen for MetS. AS patients with age > 40 or BMI > 23 should be informed to screen for MetS.
Asunto(s)
Artritis Psoriásica , Síndrome Metabólico , Espondilitis Anquilosante , Artritis Psoriásica/diagnóstico por imagen , Artritis Psoriásica/epidemiología , Estudios Transversales , Femenino , Humanos , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/epidemiología , Espondilitis Anquilosante/diagnóstico por imagen , Espondilitis Anquilosante/epidemiología , TailandiaRESUMEN
BACKGROUND: Various patterns of dementia care have been developed in different settings, depending on the availability of healthcare resources and facilities. The purpose of this study was to examine the epidemiology and characteristics of dementia care at a geriatric clinic, a field that has been subject to little prior evaluation. METHODS: A retrospective chart review was undertaken of cohort patients with cognitive impairment who had received a diagnosis and were still on active follow-up at a geriatric clinic. A total of 892 patients were included. In addition, 203 geriatric patients with no cognitive impairment who attended the clinic during the study period were sampled as a control. RESULTS: The main diagnoses of dementia were Alzheimer's disease (AD) (40.1%), vascular dementia (16.9%), unspecified dementia (16.3%), mixed dementia (9.0%), AD with cerebrovascular disease (8.7%), and Parkinson's disease dementia (6.1%). Atypical dementia was presented in 3.0% of cases. There were 178 patients with mild cognitive impairment, 20 with vascular cognitive impairment, and 18 with subjective cognitive decline. Other comorbidities were found in 97% of the subjects. Patients with cognitive impairment had a higher total number of other geriatric syndromes and higher percentages for delirium, falls, immobility, loss of appetite, and incontinence. Potentially reversible causes of dementia were found in 11.3% of the cases. Acetylcholinesterase inhibitors were administered to 61%, whereas 23.5% received an NMDA receptor antagonist. The need for a change in the antidementia medication was identified for 10.7% of the subjects; the major cause was adverse drug side effects. Nonpharmacological therapy only was administered to 52.4% of the people with dementia who had behavioral and psychological symptoms. CONCLUSIONS: Mixed brain pathologies, comorbidities, and the coexistence of other geriatric syndromes are common at geriatric clinics. Holistic, integrated, and continuous care are needed to improve the outcomes of patients with more complicated comorbidities.
Asunto(s)
Envejecimiento , Enfermedad de Alzheimer , Cognición/fisiología , Disfunción Cognitiva/diagnóstico , Demencia , Servicios de Salud para Ancianos/estadística & datos numéricos , Anciano , Envejecimiento/fisiología , Envejecimiento/psicología , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/epidemiología , Inhibidores de la Colinesterasa/uso terapéutico , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/psicología , Estudios de Cohortes , Comorbilidad , Demencia/clasificación , Demencia/epidemiología , Demencia/psicología , Demencia/terapia , Femenino , Evaluación Geriátrica/métodos , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Masculino , Rendimiento Físico Funcional , Estudios Retrospectivos , Tailandia/epidemiologíaRESUMEN
PURPOSE: The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF). METHODS: This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥ 65 years) patients with NVAF. RESULTS: Among the 3218 participants that were enrolled, 61.0% were aged older than 65 years. Mean HRQoL was lower in older than in younger patients (0.72 ± 0.26 vs. 0.84 ± 0.20; p < 0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p = 0.006) and taking warfarin (p = 0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p < 0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p < 0.001). CONCLUSIONS: Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.
Asunto(s)
Fibrilación Atrial/psicología , Demencia/psicología , Insuficiencia Cardíaca/psicología , Calidad de Vida/psicología , Accidente Cerebrovascular/psicología , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Estudios Transversales , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Accidente Cerebrovascular/tratamiento farmacológico , Tailandia , Warfarina/uso terapéuticoRESUMEN
BACKGROUND: Few studies exist regarding the perception of medical students toward older adults' wishes during their end-of-life period. Better understanding of students' perceptions regarding this topic could help improve palliative education. The purposes of this study were to examine the perceptions of medical students regarding what constitutes a "good death" and to demonstrate the factors associated with the necessary care decisions in older patients. METHODS: This is a cross-sectional study. A questionnaire was developed and given to all of the medical students at two medical schools in Thailand (Siriraj and Srinagarind Hospital) from September 2017 to February 2018. They were asked to response to the questions by imagining how older people would think, and their preferences regarding care at the end-of-life period. The anonymous questionnaires were collected and analyzed. RESULTS: A total of 1029 out of 2990 surveys were returned (34.4%). A minority of the sixth-year medical students rated themselves as being knowledgeable about palliative care (11.3%). According to the survey, desire to have spiritual needs met and have their loved ones present were the most important conditions that contributed to a "good death". Factors associated with reluctance to receive prolonged treatment were female sex (adjusted odds ratio (AOR 1.39), being in the clinical years of training (AOR 1.92), self-rated good health (AOR 1.45), and prior experience of watching someone dying (AOR 1.61). Enrollment in Srinagarind medical school (AOR 2.05), being a clinical student (AOR1.91), and being dissatisfied with life (AOR 1.78) were independent factors related to preference for home death. CONCLUSIONS: Most medical students signified understanding of concepts of geriatric palliative care but felt that they had insufficient knowledge in this area. Multiple factors related to decision regarding the care that was required were identified. Medical schools should consider this information to improve geriatric palliative medical education in undergraduate training.
Asunto(s)
Educación de Pregrado en Medicina/normas , Ética Médica/educación , Cuidados Paliativos/normas , Mejoramiento de la Calidad/normas , Estudiantes de Medicina/psicología , Actitud del Personal de Salud , Estudios Transversales , Curriculum , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Cuidados Paliativos/psicología , Encuestas y Cuestionarios , Tailandia/epidemiología , Adulto JovenRESUMEN
Palliative care is a crucial component in improving peoples' end-of-life period. It is important to understand the wishes of people at the end of life and the perceptions of their healthcare providers regarding these wishes. As nurses play a key role in patient care, in this study we set out to determine nurses' perceptions regarding what constitutes a "good death", comparing what they thought their older patients would prefer to their own preferences for their own end-of-life care. Questionnaires asking about various options of end-of-life care were distributed to nurses, and they were asked how they thought older people would respond to each of the questions and what their own preferences would be if they were terminally ill. In total, 656 participants were enrolled and they rated relief from suffering as the most important component, both for themselves and for those in their care. More than 80% of nurses agreed with all of the statements on the questionnaire. However, some of the nurses' preferences for their own end of life differed from those they expected their patients to value.
Asunto(s)
Actitud Frente a la Muerte , Enfermeras y Enfermeros/psicología , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/estadística & datos numéricos , Cuidados Paliativos/métodos , Cuidados Paliativos/psicología , Encuestas y Cuestionarios , TailandiaRESUMEN
OBJECTIVE: This study aimed to identify factors associated with EuroQoL-5 Dimensions, 5 Levels and Patient Acceptable Symptom State (PASS) and health utility (HU) in Thai patients with ankylosing spondylitis (AS). METHODS: This was a cross-sectional study of consecutive AS patients visiting Siriraj Hospital between May 31, 2012, and March 31, 2016. Demographic data and outcomes related to HU (Thai version of EuroQoL-5 Dimensions, 5 Levels), disease activity (Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score-erythrocyte sedimentation rate or Ankylosing Spondylitis Disease Activity Score-C-reactive protein, number of tender and swollen joints, and enthesitis), and functional status (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire) were collected. Regression analysis was used to explore factors associated with each EuroQOL-5 Dimensions (EQ-5D) domain, HU, and PASS. RESULTS: Among 119 AS patients, the mean age was 40.4 years; 61.3% were male. The mean EQ-5D was 0.75. In univariate analysis, lower disease activity and less impaired function were significantly associated with higher HU and not to mild problems in each EQ-5D domain. In multivariate regression analysis, Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and Health Assessment Questionnaire adjusting for age explained 77.4% of the HU variance. Patients answering yes to PASS were significantly older, had higher HU, and lower disease activity compared with those answering no to PASS. Usual activity and pain problems were importantly related to PASS after adjusting for other domains and age. CONCLUSIONS: Disease activity and functional status in AS patients were significant factors related to HU and PASS. To improve quality of life, treatment goals should be achieving remission, improving function, and controlling pain.
Asunto(s)
Estado de Salud , Calidad de Vida , Espondilitis Anquilosante/psicología , Adulto , Sedimentación Sanguínea , Proteína C-Reactiva , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/fisiopatología , Encuestas y Cuestionarios , Evaluación de Síntomas , TailandiaRESUMEN
BACKGROUND: Achieving a "good death" is a major goal of palliative care. Nurses play a key role in the end-of-life care of older patients. Understanding the perceptions of both older patients and nurses in this area could help improve care during this period. OBJECTIVES: To examine and compare the preferences and perceptions of older patients and nurses with regard to what they feel constitutes a "good death." RESEARCH DESIGN: A cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT: This study employed a self-report questionnaire that asked about various options for end-of-life care. It was distributed to older patients who attended the outpatient clinic of internal medicine and nurses who worked at two medical schools in Thailand from September 2017 to February 2018. Patients were asked to respond to the questions as if they were terminally ill, and nurses were asked to imagine how older patients would answer the questions. ETHICAL CONSIDERATION: Approval from Institutional Review Board was obtained. FINDINGS: A total of 608 patients and 665 nurses responded to the survey. Nurses agreed with concepts of palliative care, but they rated themselves as having poor knowledge. The patient respondents felt that it was most important that they receive the full truth about their illnesses (29.2%). The nurses thought the most important issue was relief of uncomfortable symptoms (25.2%). On seven out of the 13 questions, nurses overestimated the importance of the relevant issue to patients and underestimated the importance on one question (p < 0.05). DISCUSSION: Both nurses and older patients signified concepts of palliative care, but nurses felt that they lacked adequate knowledge. Nurses estimated that patients would have positive attitudes toward autonomy and the closure of life affairs to a significantly greater degree than the patient respondents. CONCLUSIONS: We recommend that palliative care education be improved and that steps be taken to allow for more effective nurse-patient communication with regard to the patients' end-of-life wishes.
Asunto(s)
Enfermeras y Enfermeros/psicología , Percepción , Cuidado Terminal/normas , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Geriatría/métodos , Humanos , Masculino , Relaciones Enfermero-Paciente , Enfermeras y Enfermeros/estadística & datos numéricos , Encuestas y Cuestionarios , Cuidado Terminal/métodos , Cuidado Terminal/estadística & datos numéricos , TailandiaRESUMEN
OBJECTIVES: To assess factors predisposing to severe chemotherapy-related toxicity and adverse events (AEs) and dose modification in aging cancer patients. METHODS: Cancer patients aged ≥70 years scheduled to receive the first cycle of a new chemotherapy regimen were enrolled. On the day of starting chemotherapy, demographic data, performance status (PS), and geriatric parameters were recorded. AEs and chemotherapy modification were recorded. Quality of life (QOL) was assessed at baseline and 3 months after starting chemotherapy or at the end of chemotherapy. RESULTS: We included 151 patients (mean age, 76.4 years) with gastrointestinal (47%), lung (24%), breast (9%), or genitourinary (6%) cancer. All-grade and severe AEs occurred in 83 and 42% of patients, respectively; 51.6% of patients required chemotherapy modification due to toxicities. A higher incidence of severe AEs (71% vs. 39%, p = 0.01) and poorer QOL was found in patients with PS 2 than in those with PS 0-1. Patients with PS 2 or who received palliative-intent chemotherapy or had multiple comorbidities were more likely to discontinue chemotherapy because of toxicity. CONCLUSIONS: PS remains a key predictor of chemotherapy-related toxicity in elderly patients. PS 2 was correlated with higher incidence of severe AEs, premature treatment discontinuation, and worsening QOL after treatment.
Asunto(s)
Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Neoplasias/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Estudios Prospectivos , Calidad de Vida , Factores de Riesgo , TailandiaRESUMEN
To validate the Thai language version of the Psoriasis Epidemiology Screening Tool (PEST) and the Early Arthritis for Psoriatic Patients Questionnaire (EARP), as well as also to develop a new tool for screening psoriatic arthritis (PsA) among psoriasis (Ps) patients. This was a cross-sectional study. Ps patients visiting the psoriasis clinic at Siriraj Hospital were recruited. They completed the EARP and PEST. Full musculoskeletal history, examination, and radiography were evaluated. PsA was diagnosed by a rheumatologist's evaluation and fulfillment of the classification criteria for psoriatic arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to evaluate the performances of the tools. The Siriraj Psoriatic Arthritis Screening Tool (SiPAT) contained questions most relevant to peripheral arthritis, axial inflammation, and enthesitis, selected from multivariate analysis. Of a total of 159 patients, the prevalence of PsA was 78.6 %. The ROC curve analyses of Thai EARP, PEST, and SiPAT were 0.90 (95 % CI 0.84, 0.96), 0.85 (0.78, 0.92), and 0.89 (0.83, 0.95), respectively. The sensitivities of SiPAT, Thai EARP, and PEST were 91.0, 83.0, and 72.0 %, respectively, while the specificities were 69.0, 79.3, and 89.7 %, respectively. All screening questionnaires showed good diagnostic performances. SiPAT could be considered as a screening tool with its desirable properties: higher sensitivity and taking less time. Thai PEST and EARP could possibly be sequentially administered for people with a positive test from SiPAT to reduce the number of false positives.
Asunto(s)
Artritis Psoriásica/diagnóstico , Adulto , Artritis Psoriásica/epidemiología , Estudios Transversales , Diagnóstico Precoz , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Psoriasis/epidemiología , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Tailandia , TraduccionesRESUMEN
OBJECTIVE: To assess recognition and management of inflammatory back pain (IBP) and spondyloarthritis (SpA) among non-rheumatologists (NRs) and rheumatologists in Thailand. MATERIAL AND METHOD: A cross-sectional survey was conducted among physicians in Thailand A questionnaire designed to evaluate knowledge regarding IBP and SpA was sent to 1,336 NRs. A different questionnaire regarding SpA management in practice was sent to 112 rheumatologists. RESULTS: Of 1,448 questionnaires distributed, 367 (25.3%) questionnaires were returned (NRs: 321 [24.0%] and included rheumatologists, 46 [41.1%]). Among NRs, 26.6%, 20.9%, and 9.4% recognized all features of IBP according to Calin, Assessment of SpondyloArthritis International Society, and Berlin criteria, respectively. In the presence of typical features of ankylosing spondylitis, 57.8% of NRs made the correct diagnosis. Regarding related clinical skills and involvement, 43.8%, 53.6%, and 37.3% of NRs lacked confidence in distinguishing IBP from mechanical back pain, performing musculoskeletal examination, and interpretation of plain radiography, respectively. Expensive biologic agents (31.2%) and advanced disease stage at diagnosis (27.1%) were the main problems reported by rheumatologists. CONCLUSION: Problems in diagnosis and management of SpA patients among NRs in Thailand included lack of knowledge and lack of associated clinical skills. Issues reported by rheumatologists centered on case management limitations. In order to improve overall quality of care for SpA patients, focused strategies should be implemented for both NRs and rheumatologists that consider the needs of patients, clinicians, and policy makers.
Asunto(s)
Competencia Clínica , Pautas de la Práctica en Medicina , Columna Vertebral/diagnóstico por imagen , Espondilitis Anquilosante/diagnóstico , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Dolor de Espalda/diagnóstico , Dolor de Espalda/terapia , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , Estudios Transversales , Manejo de la Enfermedad , Antígeno HLA-B27/genética , Humanos , Medicina Interna , Imagen por Resonancia Magnética , Anamnesis , Ortopedia , Examen Físico , Modalidades de Fisioterapia , Medicina Física y Rehabilitación , Médicos , Radiografía , Reumatología , Columna Vertebral/patología , Espondiloartritis/diagnóstico , Espondiloartritis/terapia , Espondilitis Anquilosante/terapia , Encuestas y Cuestionarios , TailandiaRESUMEN
Objective: Delirium is a syndrome associated with high mortality that often goes undetected by healthcare providers. There has been limited evidence regarding the consequences of under-recognition of delirium on patient outcomes. The present study aimed to investigate the rate of under-recognized delirium and explore the effect of unrecognized delirium on patient mortality. Material and Method: A cohort of older patients aged 70 years or more who developed delirium during admittance to general medical wards at Siriraj Hospital between January and March 2009 was retrospectively investigated. A diagnosis of delirium was made by geriatricians applying DSM-IV criteria. Medical records were reviewed to identify recognition of delirium by physicians and nurses. Factors affecting mortality were investigated using univariate and multivariate logistic regression models. Results: Of 110 patients who developed delirium, 57.3% of cases were identified as delirium by physicians, with only 14.5% of cases having their delirium documented in the discharge summary. Rate of delirium recognition among nurses was 61.8%, with a comprehensive nursing care plan developed in only 13.6% of cases. Patients with delirium that went unrecognized by attending physicians had a mortality rate of 38.3%, compared to 15.9% for the recognized delirium group (p = 0.008). In multivariate analysis, unrecognized delirium was identified as an independent risk factor for death with adjusted OR of 5.16 (95% CI 1.45-18.29). Conclusion: Rate of unrecognized delirium by healthcare providers in this study was high, but comparable to previous studies. Moreover, under-recognition of delirium was found to lead to higher mortality. Routine screening for delirium and implementation of a proactive care plan by nurses for older patients admitted to general medical wards might be a strategy for improving this common and preventable medical condition and for lowering delirium-related mortality rates.