A scoping review of the Clinical Frailty Scale.

BACKGROUND: Frailty is increasingly recognized as an important construct which has health implications for older adults. The Clinical Frailty Scale (CFS) is a judgement-based frailty tool that evaluates specific domains including comorbidity, function, and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill). The aim of this scoping review is to identify and document the nature and extent of research evidence related to the CFS. METHODS: We performed a comprehensive literature search to identify original studies that used the Clinical Frailty Scale. Medline OVID, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane Library and Embase were searched from January 2005 to March 2017. Articles were screened by two independent reviewers. Data extracted included publication date, setting, demographics, purpose of CFS assessment, and outcomes associated with CFS score. RESULTS: Our search yielded 1688 articles of which 183 studies were included. Overall, 62% of studies were conducted after 2015 and 63% of the studies measured the CFS in hospitalized patients. The association of the CFS with an outcome was examined 526 times; CFS was predictive in 74% of the cases. Mortality was the most common outcome examined with CFS being predictive 87% of the time. CFS was associated with comorbidity 73% of the time, complications 100%, length of stay 75%, falls 71%, cognition 94%, and function 91%. The CFS was associated with other frailty scores 94% of the time. CONCLUSIONS: This scoping review revealed that the CFS has been widely used in multiple settings. The association of CFS score with clinical outcomes highlights its utility in the care of the aging population.

Cryopreservation of canine cardiosphere-derived cells: Implications for clinical application.

The clinical application of cardiosphere-derived cells (CDCs) to treat cardiac disease has gained increasing interest over the past decade. Recent clinical trials confirm their regenerative capabilities, although much remains to be elucidated about their basic biology. To develop this new treatment modality, in a cost effective and standardized workflow, necessitates the creation of cryopreserved cell lines to facilitate access for cardiac patients requiring urgent therapy. Cryopreservation may however lead to alterations in cell behavior and potency. The aim of this study was to investigate the effect of cryopreservation on canine CDCs. CDCs and mesenchymal stem cells (MSCs) isolated from five dogs were characterized. CDCs demonstrated a population doubling time that was unchanged by cryopreservation (fresh vs. cryopreserved; 57.13 ± 5.27 h vs. 48.94 ± 9.55 h, P = 0.71). This was slower than for MSCs (30.46 h, P < 0.05). The ability to form clones, self-renew, and commit to multiple lineages was unaffected by cryopreservation. Cryopreserved CDCs formed larger cardiospheres compared to fresh cells (P < 0.0001). Fresh CDCs showed a high proportion of CD105+ (89.0% ± 4.98) and CD44+ (99.68% ± 0.13) cells with varying proportions of CD90+ (23.36% ± 9.78), CD34+ (7.18% ± 4.03) and c-Kit+ (13.17% ± 8.67) cells. CD45+ (0.015% ± 0.005) and CD29+ (2.92% ± 2.46) populations were negligible. Increasing passage number of fresh CDCs correlated with an increase in the proportion of CD34+ and a decrease in CD90+ cells (P = 0.003 and 0.03, respectively). Cryopreserved CDCs displayed increased CD34+ (P < 0.001) and decreased CD90+ cells (P = 0.042) when compared to fresh cells. Overall, our study shows that cryopreservation of canine CDCs is feasible without altering their stem characteristics, thereby facilitating their utilization for clinical trials. © 2017 International Society for Advancement of Cytometry.

Prevalence, management, and outcome of problem residents among neurosurgical training programs in the United States.

OBJECTIVE: The challenging nature of neurosurgical residency necessitates that appropriate measures are taken by training programs to ensure that residents are properly progressing through their education. Residents who display a pattern of performance deficiencies must be identified and promptly addressed by faculty and program directors to ensure that resident training and patient care are not affected. While studies have been conducted to characterize these so-called "problem residents" in other specialties, no current data regarding the prevalence and management of such residents in neurosurgery exist. The purpose of this study was to determine the rate and the outcome of problem residents in US neurosurgical residency programs and identify predictive risk factors that portend a resident's departure from the program. METHODS: An anonymous nationwide survey was sent to all 108 neurosurgical training programs in the US to assess a 20-year history of overall attrition as well as the management course of problem residents, including the specific deficiencies of the resident, management strategies used by faculty, and the eventual outcome of each resident's training. RESULTS: Responses were received from 36 centers covering a total of 1573 residents, with the programs providing a mean 17.4 years' worth of data (95% CI 15.3-19.4 years). The mean prevalence of problem residents among training programs was 18.1% (95% CI 14.7%-21.6%). The most common deficiencies recognized by program directors were poor communication skills (59.9%), inefficiency in tasks (40.1%), and poor fund of medical knowledge (39.1%). The most common forms of program intervention were additional meetings to provide detailed feedback (93.9%), verbal warnings (78.7%), and formal written remediation plans (61.4%). Of the identified problem residents whose training status is known, 50% graduated or are on track to graduate, while the remaining 50% ultimately left their residency program for other endeavors. Of the 97 residents who departed their programs, 65% left voluntarily (most commonly for another specialty), and 35% were terminated (often ultimately training in another neurosurgery program). On multivariable logistic regression analysis, the following 3 factors were independently associated with departure of a problem resident from their residency program: dishonesty (OR 3.23, 95% CI 1.67-6.253), poor fund of medical knowledge (OR 2.54, 95% CI 1.47-4.40), and poor technical skill (OR 2.37, 95% CI 1.37-4.12). CONCLUSIONS: The authors' findings represent the first study to characterize the nature of problem residents within neurosurgery. Identification of predictive risk factors, such as dishonesty, poor medical knowledge, and/or technical skill, may enable program directors to preemptively act and address such deficiencies in residents before departure from the program occurs. As half of the problem residents departed their programs, there remains an unmet need for further research regarding effective remediation strategies.