Frailty assessment in primary health care and its association with unplanned secondary care use: a rapid review.

BACKGROUND: The growing frail, older population is increasing pressure on hospital services. This is directing the attention of clinical commissioning groups towards more comprehensive approaches to managing frailty in the primary healthcare environment. AIM: To review the literature on whether assessment of frailty in primary health care leads to a reduction in unplanned secondary care use. DESIGN & SETTING: A rapid review involving a systematic search of Medline and Medline In-Process. METHOD: Relevant data were extracted following the iterative screening of titles, abstracts, and full texts to identify studies in the primary or community healthcare setting which assessed the effect of frailty on unplanned secondary care use between January 2005-June 2016. RESULTS: The review included 11 primary studies: nine observational studies; one randomised controlled trial (RCT); and one non-randomised controlled trial (nRCT). Eight out of nine observational studies reported a positive association between frailty and secondary care utilisation. The RCT and nRCT reported conflicting findings. CONCLUSION: Older people identified as frail in a primary healthcare setting were more likely to be admitted to hospital. Based on the limited and equivocal trial evidence, it is not possible to draw firm conclusions regarding appropriate tools for the identification and management of frail older people at risk of hospital admission.

Production of Highly Monolayer Enriched Dispersions of Liquid-Exfoliated Nanosheets by Liquid Cascade Centrifugation.

While liquid exfoliation is a powerful technique to produce defect-free nanosheets in large quantities, its usefulness is limited by broad nanosheet thickness distributions and low monolayer contents. Here we demonstrate liquid processing techniques, based on iterative centrifugation cascades, which can be designed to achieve either highly efficient nanosheet size-selection and/or monolayer enrichment. The resultant size-selected dispersions were used to establish quantitative metrics to determine monolayer volume fraction, as well as mean nanosheet size and thickness, from standard spectroscopic measurements. Such metrics allowed us to design and optimize centrifugation cascades to enrich liquid exfoliated WS2 dispersions up to monolayer contents of 75%. Monolayer-rich dispersions show relatively bright photoluminescence with narrow line widths (<35 meV) indicating the high quality of the nanosheets. The enriched dispersions display extinction spectra with distinct features, which also allow the direct estimation of monolayer contents.

The triglyceride to high-density lipoprotein ratio identifies children who may be at risk of developing cardiometabolic disease.

AIM: It is important to develop simple, reliable methods to identify high-risk individuals who may benefit from intervention. This study investigated the association between the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio and cardiometabolic risk, cardiorespiratory fitness and physical activity in children. METHODS: Anthropometric, biochemical parameters, cardiorespiratory fitness and accelerometry determined physical activity were assessed in 155 children (80 girls) from 10 to 14 years of age from Bedfordshire, UK. Participants were grouped into high and low TG/HDL ratio groups, according to published thresholds. MANCOVA and logistic regression were used in the analysis. RESULTS: Cardiometabolic risk factor levels were significantly higher in participants with a high TG/HDL ratio (p < 0.05). The odds of having high waist circumference (OR = 13.99; 95% CI 2.93, 69.25), elevated systolic blood pressure (5.27; 1.39, 20.01), high non-HDL cholesterol (19.47; 4.42, 85.81) and ≥2 cardiometabolic risk factors (15.32; 3.10, 75.79) were higher in participants with a high TG/HDL ratio. The TG/HDL ratio values were significantly lower in those with high cardiorespiratory fitness (p = 0.01), but there was no association with physical activity. CONCLUSION: These findings support the use of the TG/HDL ratio to identify children with cardiometabolic risk factors who may be at risk of developing cardiometabolic disease.

The hypertriglyceridemic waist, waist-to-height ratio, and cardiometabolic risk.

OBJECTIVE: To investigate whether the hypertriglyceridemic waist (HW) phenotype and waist-to-height ratio (WHTR) are associated with cardiometabolic disorders in children and adolescents. STUDY DESIGN: This was a cross-sectional design study. Anthropometry, biochemical variables, and cardiorespiratory fitness were assessed in 234 participants (122 girls) aged 10-19 years from Bedfordshire, United Kingdom. The HW phenotype was defined as a waist circumference ≥90(th) percentile for age and sex, and triglyceride concentrations ≥1.24 mmol/L, and a high WHTR defined as >0.5. ANCOVA and logistic regression were used in the analysis. RESULT: In participants with the HW phenotype, the odds of having high cardiorespiratory fitness (mL/kg/min) were lower (0.045; 95% CI 0.01, 0.42), and the odds of having low high-density lipoprotein cholesterol (4.41; 1.50, 12.91), impaired fasting glucose (3.37; 1.06, 10.72), and ≥1 (4.78; 1.32, 17.29) and ≥2 risk factors (7.16; 2.38, 21.54) were higher than those without the phenotype. Those with a high WHTR had higher odds of having low high-density lipoprotein cholesterol (2.57; 1.11, 5.95), high diastolic blood pressure (3.21; 1.25, 8.25), and ≥2 risk factors (5.57; 2.05, 15.17) than those with normal WHTR. CONCLUSION: The HW phenotype may be a better simple marker than WHTR for identifying children and adolescents at risk for cardiometabolic disorders.