Gait Speed vs. VES-13: A Pilot Study Comparing Screening Tools to Determine the Need for a Comprehensive Geriatric Assessment in Senior Women with Breast Cancer.

BACKGROUND/OBJECTIVES: Patients aged 70 years and older may be suboptimally treated with cancer therapy because of the lack of clinical trial data in this population. The Comprehensive Geriatric Assessment can be time consuming, and access to geriatricians is limited. This study aims to determine whether gait speed (GS) analysis is equivalent to the widely accepted Vulnerable Elders Survey 13 (VES-13) in identifying vulnerable or frail patients in need of a Comprehensive Geriatric Assessment. METHODS: A pilot prospective cohort study was carried out at a tertiary cancer centre in Toronto, Canada, in a radiation oncology breast follow-up clinic. GS analysis and VES-13 were completed by each patient at the same clinic visit. GS of <1 meter/second (m/s) and VES-13 score ≥3 were considered abnormal. Sensitivity, specificity, positive and negative predictive values, and Kappa characteristic were calculated for GS compared with VES-13. RESULTS AND DISCUSSION: Twenty-nine participants aged 70 years and older with any stage of breast cancer were included. The GS was 67% sensitive and 95% specific for abnormal VES-13 scores. The GS had an 86% positive predictive value and 86% negative predictive value for abnormal scores on VES-13. Overall, the GS showed a substantial strength of agreement with the VES-13 (kappa 0.66, P < .0001). CONCLUSION: The GS analysis compared very well with VES-13 scores, and this may be a reasonable alternative to VES-13 screening. This pilot data warrant further study in a larger group of patients.

High incidence of concussion, but low knowledge levels among young adults.

Cerebral concussion is a brain injury, that involves a complex pathophysiological process that affects the brain as a result of biomechanical forces. With the increasing prevalence, it is important that the public is knowledgeable about concussion and its symptoms, so that they can bring attention to individuals with concussion symptoms soon after onset, for appropriate care. The aim of this study was to determine the knowledgeability of young adults. Secondary aims were to compare the knowledgeability of young adults of different age, of different countries of residence, of different sex, and of different perceived knowledge about concussions. An online survey was circulated to young adults in Canada, the US and the UK. The survey consisted of three components - a consent form, respondent demographics and eight questions to assess each respondent's knowledgeability of concussions. The knowledgeability of each respondent was determined by the summation of the number of correct responses to the knowledge questions. A total of 307 respondents consented and completed the survey in its entirety. The mean knowledge score was 4.25 out of 8. None of the cohort analyses based on demographics - 19 years old and under vs. 20 years and older; North Americans vs. non-North Americans; females vs. males - suggested that one group was more knowledgeable than the other group. These results suggest that educational programs can be developed to increase awareness of concussions. As each cohort seems to have similar starting knowledge levels, it seems appropriate to develop a uniform program to first try to increase knowledgeability, and then produce specialised programs to raise knowledge of certain cohorts. However, prior to the establishment of programs, further studies should be conducted to verify the results disclosed herein.

Awareness of bicycle light use of young adults.

Helmet use amongst bicyclists has been well documented in recent literature. Helmet use is not the only measure cyclists can take to reduce their chance of crashes. Many places, in addition to mandating helmet use by law for youths, also require bicycle lights to be used under low-light conditions (i.e. during sunrise, during sunset and at night). The aim of this study was to investigate the awareness of bicycle light use amongst young adults, with respect to the legalities and also utility of lights while cycling. An anonymous survey was developed and circulated to young adults in Canada, Ireland and the United States of America. A total of 112 individuals completed the survey. Only 13% of individuals had an unsatisfactory knowledge of bicycle light use. As knowledge is the first step towards advocating for new measures, young adults seem well -versed with respect to bicycle light use and may be able to be targeted to increase bicycle light use. Frequency of commute was related to the knowledge of bicycle light use; those who commuted more regularly were more knowledgeable. This study, however, was composed primarily of young adults residing in Canada. Future studies could investigate knowledge among young adults who reside in a region that more regularly commutes using a bicycle, to see whether this trend holds.

Bicycle and helmet use of adolescents in Markham, Canada.

Bicycle crashes are the second most common sports- or recreation-associated cause of serious injury. While the literature suggests that wearing protective helmets can significantly decrease risks associated with bicycle-related injuries, overall helmet use remains sub-optimal. A recent study by Chow et al. suggested that helmet-wearing rates in adolescent boys are negatively correlated with age. The aim of this study was to determine if similar trends are observed in a co-educational high school setting. A questionnaire was circulated at Unionville High School, a co-ed public high school in Markham, Canada. Of the 144 participants, 27 of them were in Grade 9 or 10, and 117 of them were in Grade 11 or 12. While there was no statistical difference between helmet-wearing rates in Grade 9-10 and Grade 11-12 students, overall usage rates were low (41% and 38%, respectively, for recreational cyclists). This trend is interesting, considering that nearly 90% of all students were aware that wearing a helmet while cycling is required under Ontario law. Further studies should be conducted among the young adult population to determine whether the alarming trends discovered by this study and Chow et al. continue.

Efficacy of single fraction conventional radiation therapy for painful uncomplicated bone metastases: a systematic review and meta-analysis.

BACKGROUND: Single fraction radiotherapy (SFRT) and multiple fraction radiotherapy (MFRT) are effective for painful uncomplicated bone metastases and have been shown to be of similar efficacy. The optimal conventional external beam SFRT dose for maximum pain relief remains uncertain. The aim of this systematic review was to comprehensively review and synthesize overall pain response rates by dose. METHODS: A literature search was conducted in Ovid MEDLINE(R) (1946 to June 2016 week 3), Embase Classic & Embase (1947 to 2016 week 26) and Cochrane Central Register of Controlled Trials (May 2016) using keywords such as bone metastases, radiotherapy and single fraction (SF). RESULTS: The 635 results from the search were screened, and ultimately 27 were included for quantitative synthesis. The review indicated that 10 and 6 Gy may produce superior overall response (OR) and complete response (CR) rates compared to 8 Gy, and 6 Gy may result in better partial response (PR) than 8 Gy. However, only a few studies documented doses other than 8 Gy. In trials that directly compared 8 Gy to 4 Gy or 6 Gy, 8 Gy was deemed statistically superior. CONCLUSIONS: 8 Gy SFRT was the most commonly administered dose for palliation of bone metastases supporting its efficacy and safety. Future studies should explore the efficacy of 10 Gy while minimizing its side effects.

Efficacy of multiple fraction conventional radiation therapy for painful uncomplicated bone metastases: A systematic review.

BACKGROUND: Radiation therapy is effective for painful uncomplicated bone metastases, with multiple fraction radiation therapy (MFRT) administered frequently. The optimal dose for MFRT to yield maximum pain relief remains unclear. The aim of this systematic review was to determine pain response across MFRT doses. METHODS: A literature search was conducted in Ovid MEDLINE(R) <1946 to July Week 3 2016>, Embase Classic & Embase <1947 to 2016Week 30> and Cochrane Central Register of Controlled Trials . Pain response rates and the side effects for MFRT doses were extracted. RESULTS: From the 3719 articles identified from the search, 17 were included for quantitative synthesis. 22.5Gy/5 had the highest overall response (OR) rate, 30Gy/15 had better complete response (CR) rate and 20Gy/2 had better partial response (PR) rate. Only 4 of the 17 included studies directly compared MFRT doses with each other - one reported marginally-better OR for 24Gy/6 over 20Gy/2; another found 20Gy/10 to be slightly more efficacious than 30Gy/15 and 22.5Gy/5 for OR. Two randomized trials compared 20Gy/5 and 30Gy/10 - one favored 20Gy/5 while the other concluded 30Gy/10 to be the better option. The overall rate of GI toxicities, nausea, and vomiting did not differ greatly between MFRT doses. CONCLUSION: No major difference exists between the schedules and toxic events studied in these trials. This is consistent with the wealth of randomized data which show no dose response for pain relief after radiotherapy for metastatic bone pain.

Pain assessment tools for older adults with dementia in long-term care facilities: a systematic review.

AIM: The aim of this review is to document pain assessment tools used primarily for older adults in long-term care facilities and compare self-report and observer-rated tools. METHODS: A literature search was conducted in Ovid MEDLINE®, Embase, Cochrane and PsycINFO. Keywords included 'dementia', 'pain management' and 'managing pain'. RESULTS: Of 1033 references, 23 articles were selected for inclusion. Six tools were self-rated and 18 tools were administered by an observer. 13 studies evaluated the reliability/validity of their scales; four studies compared different scales against each other. CONCLUSION: Self-report should be the first-line approach when possible, with observational assessment used as a supplementary tool. Reliable observational tools have been shortened, and shown to maintain high reliability/validity, and positive psychometric properties.

Helmet use of adolescent cyclists at Crescent School in Toronto, Canada.

Numerous studies have highlighted that bicycle helmets reduce the risk of head injury; the purpose of this study was to determine the helmet-wearing rate of adolescent boys and the reasons for those who do not wear helmets. A questionnaire was developed and completed by 257 students. A higher percentage of older students reported a long bike commute to school (over 20 min). The frequency of helmet use and awareness of helmet legislation was lower amongst the older students. Common reasons for not using a helmet across all ages included its uncomfortable nature, the confidence of the rider's cycling ability to not crash, and negligence. Further reminders and educational sessions regarding the importance of helmets could help to increase the helmet use of students across the grades.