Supportive care needs among older Mexican adults with metastatic cancer.

INTRODUCTION: Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS: We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS: Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION: Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.

Delivering Palliative and Supportive Care for Older Adults with Cancer: Interactions between Palliative Medicine and Geriatrics.

The world's population is aging rapidly, with projections indicating that by 2050 one in six people will be aged ≥65 years. As a result, the number of cancer cases in older people is expected to increase significantly. Palliative care is an essential component of cancer care with a direct impact on quality of life. However, older adults with cancer often suffer from multiple comorbidities, cognitive impairment, and frailty, posing unique challenges in the delivery of palliative care. The complex healthcare needs of older patients with cancer therefore require a comprehensive assessment, including a geriatric evaluation. Collaboration between geriatrics and palliative care can offer a solution to the challenges faced by older people with cancer, since this is a population with overlapping concerns for both disciplines. This review highlights the importance of palliative care for older adults with cancer and the benefits of a multidisciplinary approach. It also addresses the coordination of palliative care and geriatrics for specific symptom management and decision making.

Arthroscopic Calcaneonavicular Coalition and Too-long Anterior Process of the Calcaneus Resection in Children.

Persistent symptomatic calcaneonavicular coalition (CNC) and too-long anterior process of the calcaneus (TLAP) are congenital disorders that can benefit from surgical treatment. The arthroscopic technique for CNC and TLAP resection has previously been described. The aim of this prospective study was to describe outcomes following arthroscopic resection of 12 (38.71%) CNC and 19 (61.29%) TLAP cases in 30 consecutive pediatric patients treated between July 2009 and March 2013. There mean age was 12.4 (range 10 to 15) years, and the mean follow-up was 55.2 (range 24 to 79) months. Radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, AOFAS pain scores, and patient satisfaction were assessed. All final postoperative imaging scans revealed complete synostosis resection without recurrence. The mean overall AOFAS Ankle-Hindfoot Score increased from 78.87 (95% confidence interval [CI] 76.74 to 81.01) to 93.06 (95% CI 91.10 to 95.03) (p < .001). All patients showed pain reduction after surgery; even 1 patient (3.23%) who initially developed complex regional pain syndrome eventually had a successful outcome. The mean AOFAS pain score increased from 23.87 (95% CI 22.05 to 25.69) to 34.84 (95% CI 32.97 to 36.70) (p < .001). All patients were either satisfied (n = 9 [30%]) or very satisfied (n = 21 [70%]) with the intervention at the final follow-up. Although both arthroscopic CNC and TLAP resection are demanding techniques, they allow for precise coalition resection through a less invasive approach, which may ultimately lead to faster recovery and improved outcomes.

Geriatric principles for patients with cancer / Princípios geriátricos para pacientes com câncer

Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.

O câncer é principalmente uma doença de pessoas idosas. Diante da heterogeneidade do envelhecimento, a idade fisiológica expressa, melhor do que a idade cronológica, o efeito cumulativo dos estressores ambientais, médicos e psicossociais que modificam a expectativa de vida. A avaliação geriátrica ampla é uma ferramenta que ajuda a determinar a idade fisiológica de um indivíduo idoso e o padrão ouro para avaliar idosos com câncer. Diversas organizações internacionais recomendam considerar os domínios da avaliação geriátrica a fim de identificar problemas de saúde não reconhecidos capazes de interferir no tratamento, e prever resultados adversos relacionados à saúde, auxiliando na complexa tomada de decisão do tratamento. Mais recentemente, intervenções direcionadas com base na avaliação geriátrica também demonstraram melhorar a qualidade de vida e mitigar a toxicidade do tratamento, sem comprometer a sobrevida. Nesta revisão discutimos o papel da avaliação geriátrica ampla no tratamento do câncer para idosos e fornecemos ao leitor informações úteis para avaliar os riscos e benefícios potenciais do tratamento, antecipar complicações e intervir para melhor cuidar dos idosos com câncer

Early Short-Term Postoperative Mechanical Failures of Current Ceramic-on-Ceramic Bearing Total Hip Arthroplasties.

Although ceramic-on-ceramic (CoC) bearings have been shown to produce the smallest amount of wear volume in vitro as well as in vivo studies when used for total hip arthroplasties (THA), concerns about the failure of these bearing surfaces persist due to early failures observed after short postoperative time. In this study, an exhaustive analysis of the early failure occurred on the new generation of ceramic bearings, consisting of a composite alumina matrix-based material reinforced with yttria-stabilized tetragonal zirconia (Y-TZP) particles, chromium dioxide, and strontium crystals, was performed. For this study, 118 CoC bearings from 117 patients were revised. This article describes a group of mechanical failure CoC-bearing BIOLOX THA hip prosthesis patients without trauma history. The retrieved samples were observed under scanning electron microscopy (SEM), composition was analyzed with energy dispersive X-ray spectroscopy (EDX), and damaged surfaces were analyzed by grazing-incidence X-ray diffraction (GI-XRD) and white light interferometry. In the short term, CoC articulations provided similar mechanical behavior and functional outcome to those in XLPE cases. However, 5% more early mechanical failures cases were observed for the ceramic components. Although the fracture rate of third generation CoC couples is low, the present study shows the need to further improve the third generation of CoC-bearing couples for THA. Despite the improved wear compared to other materials, stress concentrators are sources of initial crack propagation, such as those found in the bore-trunnion areas. Moreover, in view of the evidence observed in this study, the chipping observed was due to the presence of monoclinic phase of the Y-TZP instead of tetragonal, which presents better mechanical properties. The results showed that total safety after receiving a THA is still a goal to be pursued.

Evolución histórica de las ideas en el tratamiento de fracturas trocantéricas / Historical development of trochanteric fracture treatment ideas

Se realiza una revisión de los distintos conceptos, estrategias de tratamiento y dispositivos de osteosíntesis, desde que se comienza a conocer en los primeros tratados las fracturas del fémur en el siglo XVI hasta nuestros días. Mal conocida al principio, es confundida con luxaciones de cadera hasta incluso avanzado el siglo XVIII. En el siguiente siglo los cirujanos ponen su empeño en tipifi car los distintos trazos de fractura y relacionarlas con su pronóstico. Los tratamientos ortopédicos que defi enden las diversas escuelas, a veces incluso encontrados, y que abarcan hasta principios del siglo XX, provocan una alta incidencia de secuelas y un porcentaje muy preocupante de mortalidad sobre todo ligado al prolongado encamamiento. En el siglo XX y fruto de la mejora en técnicas asépticas y anestésicas se comienza a propugnar la cirugía, pero no es hasta la década de los 60 cuando nace la propuesta de que el tratamiento quirúrgico y de urgencia de estas fracturas, debe ser la regla. Se desarrollan diversos tipos de osteosíntesis pudiéndose establecer cuatro diferentes etapas: Sus inicios, el clavo-placa monobloque, las osteosíntesis dinámicas y por último los clavos trocantéricos. Todo progreso en el desarrollo de nuevas osteosíntesis, aunque sea mínimo es de gran utilidad y de importancia considerable, dada la gran repercusión de las fracturas de cadera en nuestro medio (AU)

A review was performed of the various concepts, treatment strategies and osteosynthesis devices, since the fi rst treaties about femoral fractures were published in the 16th Century, until today. Initially, it was poorly known and often confused with hip dislocations even until well into the 18th Century. In the following century surgeons strove into typifying the different fracture lines, thus relating these with their prognoses. The orthopedic treatment that the various schools defend, sometimes contradictory, and that was carried out until the onset of the 20th Century, caused a high incidence of secondary effects, and a very worrying percentage of mortality due to prolonged bed rest. In the 20th Century and thanks to improved aseptic and anesthetic techniques, surgical intervention was more widespread; nevertheless, it was not until the 1960s when surgical and emergency treatment of such fractures became the gold standard. Diverse types of osteosynthesis were developed, with four different stages being established: its beginnings, the monoblock nail-panel, dynamic osteosynthesis and lastly trochanteric nails. Progress in the development of new osteosynthesis—even minimum—is of great use and considerable importance, given the important repercussion of hip fractures (AU)

Evaluation of autologous platelet concentrate for intertransverse lumbar fusion.

INTRODUCTION: The aim of the study was to analyze if the adding of autologous platelet concentrate (APC) to a mixture of local autograft plus tricalcium phosphate and hidroxiapatite (TCP/HA) would improve the fusion rate in posterolateral lumbar fusion. MATERIALS AND METHODS: A prospective, controlled, blinded, non-randomized clinical trial was carried out in 107 patients affected by degenerative lumbar pathology. The study group consisted of 67 patients, in which autologous platelet concentration was added to a mixture of autologous local bone graft and TCP/HA. A control group of 40 patients with same pathology and surgical technique but without APC addition was used to compare the fusion mass obtained. By means of plain X-rays, a blinded evaluation of the intertransverse fusion mass quality at twelve and twenty-four months was made according to type A (bilateral uniform mass), type B (unilateral uniform mass) and type C (irregular or lack bilateral mass). Patients with type C were regarded as pseudoarthrosis. RESULTS: In the study group 17 patients had lack or irregular fusion mass (25.4%) versus three patients in the control group (7.5%), which was statistically significant. CONCLUSIONS: This study shows that the adding of autologous platelet concentration to a mixture of autologous bone graft plus TCP/HA has decreased our rates of posterolateral lumbar fusion.