Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study.

BACKGROUND: Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. METHODS: Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. DISCUSSION: Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.

Prevalence of falls in noninstitutionalized people aged 65-80 and associations with sex and functional tests: A multicenter observational study.

Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65-80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk-specific fall prevention programs to prevent disabilities in older people.

Information and communication technologies for the improvement of cognitive function in healthy older adults: a systematic review protocol.

INTRODUCTION: Mild cognitive impairment is one of the consequences of ageing, causing functional disability, a poor quality of life and an increased socioeconomic expenditure. Evidence shows that patients go through a long preclinical stage in which cognitive deficits appear subtly until they reach the threshold of dementia. Non-pharmacological interventions have been gaining ground as prevention of modifiable factors of cognitive decline such as obesity, diabetes, physical inactivity or social isolation. Along these lines, Information and Communication Technologies (ICTs) can be a tool for cognitive stimulation, cognitive training and cognitive rehabilitation. The main objective of the systematic review will be to review and analyse the use of ICTs for the improvement of cognitive functions in healthy older adult population aged 50 and over, for the prevention of cognitive impairment METHODS: A systematic review will be conducted including randomised clinical trials in adults without diseases or accidents associated with cognitive impairment, and whom have used ICTs for the improvement of cognitive functions between 2010 and 2020 in English or Spanish. The articles that report data on cognitive function by domain, for example, memory or executive functions, or by test will be included. The databases Medline (PubMed), CinahlPlus, Scopus, ISI WoS, CENTRAL and IEEE Xplore will be searched. Studies that meet the inclusion criteria will be analysed according to the Cochrane RoB2 tool for risk of bias assessment. ETHICS AND DISSEMINATION: Ethical approval is not necessary as this is a systematic review. The results will be published in scientific journals, as well as in specialised congresses on the subject of study.

Effectiveness of technology-based interventions in detection, prevention, monitoring and treatment of patients at risk or diagnosed with mild cognitive impairment: protocol for a systematic review.

INTRODUCTION: The gradual changes over the decades in the longevity and ageing of European society as a whole can be directly related to the prolonged decline in the birth rate and increase in the life expectancy. According to the WHO, there is an increased risk of dementia or other cognitive disorders as the population ages, which have a major impact on public health. Mild cognitive impairment (MCI) is described as a greater than expected cognitive decline for an individual's age and level of education, but that does not significantly interfere with activities of daily living. Patients with MCI exhibit a higher risk of dementia compared with others in the same age group, but without a cognitive decline, have impaired walking and a 50% greater risk of falling.The urban lifestyle and advent of smartphones, mobility and immediate access to all information via the internet, including health information, has led to a totally disruptive change in most general aspects.This systematic review protocol is aimed at evaluating the effectiveness of technology-based interventions in the detection, prevention, monitoring and treatment of patients at risk or diagnosed with MCI. METHODS AND ANALYSIS: This review protocol follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols reporting guidelines. The search will be performed on MEDLINE (PubMed), CENTRAL, CINAHL Plus, ISI Web of Science and Scopus databases from 2010 to 2020. Studies of interventions either randomised clinical trials or pre-post non-randomised quasi-experimental designs, published in English and Spanish will be included. Articles that provide relevant information on the use of technology and its effectiveness in interventions that assess improvements in early detection, prevention, follow-up and treatment of the patients at risk or diagnosed with MCI will be included. ETHICS AND DISSEMINATION: Ethics committee approval not required. The results will be disseminated in publications and congresses.

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Evaluation of the Ex-PRESS(®) P-50 implant under scleral flap in combined cataract and glaucoma surgery.

AIM: To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS(®) P-50 for combined cataract surgery and glaucoma. METHODS: Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS(®) P-50 model placed under scleral flap was performed. RESULTS: Out of 40 eyes of 40 patients (55% male and 45% female) completed the study during one-year follow-up. The mean of age was 76.6±11.02y. The intraocular pressure (IOP) decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg (Wilcoxon signed ranks test, P<0.001). A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control (<21 mm Hg). CONCLUSION: Combined surgery of phacoemulsification with ExPRESS(®) P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.

Microangiopathy of common carotid vasa vasorum in type 1 diabetes mellitus.

OBJECTIVE: We hypothesize that in type 1 diabetes vasa vasorum (VV) are affected by microangiopathic changes. For this purpose, we assessed the status of the VV signal in patients with type 1 diabetes. METHODS: The VV signal at the arterial adventitia of the common carotid artery was evaluated by contrast-enhanced ultrasound imaging. The VV contrast agent signal was quantified in an plaque-free arterial segment as the ratio of the adventitial signal and that of the lumen of the artery. We studied 113 type 1 diabetic patients, 60 with and 53 without retinopathy and without known cardiovascular disease, and a group of 78 non-diabetic subjects free of cardiovascular risk factors. All study subjects underwent a clinical evaluation. RESULTS: The mean ± standard deviation VV signal of healthy subjects was 0.562 ± 0.135. Type 1 diabetic patients showed a higher adventitial VV signal (0.723 ± 0.128) than non-diabetic subjects (P < 0.0001). After adjustment for cardiovascular risk confounders, this difference remained significant. No differences in VV signal, or common carotid intima-media thickness, between subjects with and without retinopathy were found. CONCLUSIONS: Type 1 diabetic patients, independently of their retinopathy status, show an increased angiogenesis of the VV of the common carotid artery compared with non-diabetic subjects. Diabetic microangiopathy, that according to our results would also affect the wall of the large arteries, could be a factor contributing to atherosclerosis in type 1 diabetes mellitus.

Late postoperative capsular block syndrome: a case series studied before and after Nd:YAG laser posterior capsulotomy.

PURPOSE: To evaluate the clinical characteristics of the unusual late postoperative capsular block syndrome (CBS) and the effect of Nd:YAG laser posterior capsulotomy on visual acuity and refractive error as well as its possible complications. METHODS: In this retrospective cohort study, 12 eyes of 11 patients with late CBS who had undergone Nd:YAG laser posterior capsulotomy were reviewed. A complete ophthalmic examination including Scheimpflug camera and anterior segment optical coherence tomography (AS-OCT) imaging had been performed before and after posterior capsulotomy. RESULTS: The mean time between cataract surgery and posterior capsulotomy was 4.7 ± 1.5 years (range 3-9 years). Best-corrected visual acuity increased in 11 cases (91.7%). Only one eye showed a 0.5-D hyperopic shift following posterior capsulotomy. There were no postlaser complications such as increased intraocular pressure (IOP), severe inflammation, cystoid macular edema, or retinal detachment. In all patients, the posterior capsule was vaulted posteriorly and could not be seen clearly. The AS-OCT confirmed CBS in the studied cases, demonstrating a distended capsular bag. Rotating Scheimpflug imaging examination showed the white substance located behind the intraocular lens (IOL). CONCLUSIONS: Late CBS is usually not accompanied by shallow anterior chamber, forward IOL displacement, or raised IOP. Nd:YAG laser posterior capsulotomy is a useful treatment and the prognosis of patients with this complication appears favorable. Furthermore, although AS-OCT measurements are easier to obtain than rotating Scheimpflug imaging examination, both are useful to visualize the distended capsular bag containing the white material and the IOL position.

Comparison of anterior segment measurements with optical low-coherence reflectometry and rotating dual Scheimpflug analysis.

PURPOSE: To compare the anterior segment measurements obtained with optical low-coherence reflectometry (OLCR) (Lenstar LS 900, version 2.1.1) and rotating dual Scheimpflug analysis (Galilei G1, version 3). SETTING: Private practice, Policlinic Lleida, Lleida, Spain. DESIGN: Prospective comparative observational study. METHODS: The following measurements were performed in patients requiring a preoperative study for a refractive procedure or cataract surgery and healthy volunteers from the clinic's staff: central corneal thickness (CCT), anterior chamber depth (ACD), horizontal limbal distance (white-to-white distance [WTW]), pupil diameter, keratometry (K) readings at the steepest meridian (steep K) and the flattest meridian (flat K), corneal astigmatism power, and plus astigmatic cylinder. Measurements were taken using the OLCR device and rotating dual Scheimpflug analyzer. The main outcome measure was the degree of agreement between steep K, flat K, astigmatism power, cylinder axis, CCT, ACD, WTW, and pupil diameter measurements. RESULTS: The study enrolled 100 eyes of 100 subjects. Steep K, flat K, corneal astigmatism power, cylinder axis, and WTW measurements with the OLCR device and Scheimpflug analyzer showed narrow 95% limits of agreement (LoA), which implies good agreement (P>.05, Bland-Altman plot analysis). In contrast, the range and 95% LoA for CCT, ACD, and pupil diameter values were statistically significantly different (P<.05, Bland-Altman plot analysis). CONCLUSION: In clinical practice, the OLCR device and the rotating dual Scheimpflug analyzer system can be used interchangeably for WTW measurements and K readings but not for CCT, ACD, and pupil diameter values. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.