Comprehensive geriatric assessment

Geriatric conditions such as functional impairment and dementia are common and frequently unrecognized or inadequately addressed in older adults. Identifying geriatric conditions by performing a geriatric assessment can help clinicians manage these conditions and prevent or delay their complications. "Geriatric syndrome" is a term that is often used to refer to common health conditions in older adults that do not fit into distinct organ-based disease categories and often have multifactorial causes. The list includes conditions such as cognitive impairment, delirium, incontinence, malnutrition, falls, gait disorders, pressure ulcers, sleep disorders, sensory deficits, fatigue, and dizziness. These conditions are common in older adults, and they may have a major impact on quality of life and disability. Geriatric syndromes can best be identified by a geriatric assessment. Although the geriatric assessment is a diagnostic process, the term is often used to include both evaluation and management. Geriatric assessment is sometimes used to refer to evaluation by the individual clinician (usually a primary care clinician or a geriatrician) and at other times is used to refer to a more intensive multidisciplinary program, also known as a comprehensive geriatric assessment (CGA). This topic will review the indications for CGA, as well as its major components and evidence of its efficacy. General issues of geriatric health maintenance and the assessment of specific geriatric populations are discussed elsewhere.måsjekke

Suitability of linear quadrupole ion traps for large Coulomb crystals

Growing and studying large Coulomb crystals, composed of tens to hundreds of thousands of ions, in linear quadrupole ion traps presents new challenges for trap implementation. We consider several trap designs, first comparing the total driven micromotion amplitude as a function of location within the trapping volume; total micromotion is an important point of comparison since it can limit crystal size by transfer of radiofrequency drive energy into thermal energy. We also compare the axial component of micromotion, which leads to first-order Doppler shifts along the preferred spectroscopy axis in precision measurements on large Coulomb crystals. Finally, we compare trapping potential anharmonicity, which can induce nonlinear resonance heating by shifting normal mode frequencies onto resonance as a crystal grows. We apply a non-deforming crystal approximation for simple calculation of these anharmonicity-induced shifts, allowing a straightforward estimation of when crystal growth can lead to excitation of different nonlinear heating resonances. In the axial micromotion and anharmonicity points of comparison, we find significant differences between the compared trap designs, with an original rotated-endcap trap performing slightly better than the conventional in-line endcap trap

Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

BACKGROUND: Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS: Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS: A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS: Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER: NCT04354701