Multifactorial assessment and targeted intervention in nutritional status among the older adults: a randomized controlled trial: the Octabaix study

Background: Malnutrition is frequent among older people and is associated with morbi-mortality.he aim of the study is to assess the effectiveness of a multifactorial and multidisciplinary intervention in the nutritional status among the elderly. Methods: Randomized, single-blind, parallel-group, clinical trial conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people, born in 1924, 328 subjects were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both the patients and their primary care providers. The main outcome was improvement in nutritional status assessed by Mini Nutritional Assessment (MNA). Data analyses were done by intention-to-treat. Results: Two-year assessment was completed for 127 patients (77.4%) in the intervention group and 98 patients (59.7%) in the control group. In the adjusted linear mixed models for MNA, intervention showed no significant effect during all follow-up period with −0.21 (CI: − 0.96; 0.26). In subjects with nutritional risk (MNA ≤ 23.5 / 30) existed a tendency towards improvement in MNA score 1.13 (95% CI −0.48; 2.74) after 2 years. Conclusion: A universal multifactorial assessment and target intervention over a two year period in subjects at nutritional risk showed a tendency to improve nutrition but not in the rest of community-dwelling studied subjects. Cognitive impairment was an independent factor strongly associated with a decline in nutritional status

Low co-morbidity, low levels of malnutrition, and low risk of falls in a community-dwelling sample of 85-year-old are associated with succesful aging: the Octabaix study

The population is aging throughout the world. Preserving physical and cognitive functions is crucial to successful aging. The aim of this study was to determine the proportion of 85-year-old community-dwelling subjects aging successfully, applying a quantitative approach, and assessing the association of successful aging with sociodemographic data, global geriatric assessment, and co-morbidity. This was a community-based survey of inhabitants aged 85 years, with 328 out of 487 subjects born in 1924 assigned to seven primary health-care teams, representing a participation rate of 67.5%. Sociodemographic variables, Barthel index (BI), the Spanish version of the Mini-Mental State Examination (MEC), Mini Nutritional Assessment (MNA), Charlson Index, Gait Rating Scale, social risk, quality of life (QoL), and prevalent chronic diseases were assessed. Subjects scoring higher than 90 on the BI and higher than 24 on the MEC were compared with the rest. Multiple regression analysis was performed. Using these criteria, successful aging status was defined in 162 (49.3%) subjects. Using multiple logistic regression analysis, successful agers had significantly lower co-morbidity scores (p 0.0001). Almost half of the individuals presented successful aging. Successful agers had less co-morbidity and a lower risk of falls or malnutrition, and they had higher scores on the QoL scale

Falls in nonagenarians living in their own homes; the Nonasantfeliu study

Objectives: To evaluate the prevalence of falls and their circumstances in non-institutionalized people older than 89 years and living in an urban community. Design: Cross-sectional cohort study. Setting: Community-based study. Participants: 137 nonagenarians living at home. Measurements: We evaluated sociodemographic data, capacity to perform basic activities according to the Barthel Index (BI) and instrumental activities on the Lawton-Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC), near visual acuity by the Snellen test, and auditory acuity with the whisper test. Results: Ninety-nine women (72%) and 38 men with an average age of 93.07 years (0.7) were included. 48.1% of them had suffered a fall during the last year, and in 20% of cases this had happened on more than one occasion. In 5.7% of cases, falls led to fractures. Factors associated with falls were a lower LI and a greater number of prescribed drugs. In the multivariate analysis the only factor related to falls was the number of drugs taken (p>0.001, odds ratio 0.785, 95% confidence interval 0.676-0.912). Conclusions: Measures to prevent falls among nonagenarians should be intensified due to their high frequency. In this age group the increase in the percentage of falls is mainly related to the higher number of drugs taken

Implementació d'un Laboratori d'Habilitats Clíniques

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524L’ensenyament en Ciències de la Salut complementa la formació teòrica amb la realització de pràctiques clíniques. Els nous plans d’estudis contemplen les competències i habilitats obligatòries a adquirir. El seu aprenentatge es complexa, intens i perllongat en el temps, integrant coneixements teòrics i habilitat en el maneig de les diferents tècniques. Els maniquins simuladors permeten l’ensenyament i entrenament sense estres per l’alumne i el professorat i sense riscos ple malalt. L’any 2005 es va crear al nostre Campus un Laboratori d’habilitats Clíniques (LHC)..

The challenge of maintaining successful aging at 87 years old: the Octabaix study two-year follow-up

Preserving physical and cognitive function is crucial to successful aging. The objective of this study is to determine how many 87-year-old community-dwelling subjects continued to age successfully, according to a definition using a quantitative approach, and to assess the predictive value of certain factors evaluated 2 years previously. A total of 162 participants were assessed. Sociodemographic variables, the Barthel Index (BI), the Spanish version of the Mini-Mental State Examination (MEC), the Mini Nutritional Assessment (MNA), the Charlson Index, the Gait Rating Scale, social risk, quality of life, prevalent chronic diseases, and chronic drug prescription were collected. All subjects with scores over 90 points on the BI and above 23 points on the MEC were compared with the rest of the participants. A multiple regression analysis was performed. With the selected criteria, 90 (61.6%) community-dwelling subjects continued to age successfully. The multiple logistic regression analysis showed that the following were significantly associated with continued successful aging: A higher level of studies (p<0.02, odds ratio [OR] 3.223, 95% confidence interval [CI] 1.158-8.975), better MEC scores (p<0.01, OR 1.204, 95% CI 1.046-1.386) and Tinetti gait scale scores (p<0.01, OR 1.433, 95% CI 1.013-2.027), and fewer chronic drug prescriptions (p<0.001, OR 0.768, 95% CI 0.655-0.899). In conclusion, more than half of the individuals continued to age successfully. In subjects aged 87 years, the factors associated with continued successful aging were longer schooling, better cognition scores, lower risk of falls, and fewer chronic drug prescriptions at baseline evaluation

Utility of geriatric assessment to predict mortality in the oldest old: the Octabaix Study 3-year follow-up

Objective: Few studies have prospectively evaluated the utility of geriatric assessment tools as predictors of mortality in the oldest population. We investigated predictors of death in an oldest-old cohort after 3 years of follow-up. Methods: The Octabaix study is a prospective, community-based study with a follow-up period of 3 years involving 328 subjects aged 85 at baseline. Data were collected on functional and cognitive status, co-morbidity, nutritional and falls risk, quality of life, social risk, and long-term drug prescription. Vital status for the total cohort was evaluated after 3 years of follow-up. Results: Mortality after 3 years was 17.3%. Patients who did not survive had significantly poorer baseline functional status for basic and instrumental activities of daily living (Barthel and Lawton Index), higher co-morbidity (Charlson), higher nutritional risk (Mini Nutritional Assessment), higher risk of falls (Tinetti Gait Scale), poor quality of life (visual analog scale of the Quality of Life Test), and higher number of chronic drugs prescribed. Cox regression analysis identified the Lawton Index (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.73-0.89) and the number of chronic drugs prescribed (HR 1.09, 95% CI 1.01-1.18) as independent predictors of mortality at 3 years. Conclusions: Among the variables studied, the ability to perform instrumental activities of daily living and using few drugs on a chronic basis at baseline are the best predictors of which oldest-old community-dwelling subjects survive after a 3-year follow-up period

Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial

Background: The purpose of this study was to assess the effectiveness of a multifactorial intervention to reduce falls among the oldest-old people, including individuals with cognitive impairment or comorbidities. Methods: A randomized, single-blind, parallel-group clinical trial was conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people who were born in 1924, 328 were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both patients and their primary care providers. Primary outcomes were risk of falling and time until falls. Data analyses were by intention-to-treat. Results: Sixty-five (39.6%) subjects in the intervention group and 48 (29.3%) in the control group fell during follow-up. The difference in the risk of falls was not significant (relative risk 1.28, 95% confidence interval [CI] 0.94-1.75). Cox regression models with time from randomization to the first fall were not significant. Cox models for recurrent falls showed that intervention had a negative effect (hazard ratio [HR] 1.46, 95% CI 1.03-2.09) and that functional impairment (HR 1.42, 95% CI 0.97-2.12), previous falls (HR 1.09, 95% CI 0.74-1.60), and cognitive impairment (HR 1.08, 95% CI 0.72-1.60) had no effect on the assessment. Conclusion: This multifactorial intervention among octogenarians, including individuals with cognitive impairment or comorbidities, did not result in a reduction in falls. A history of previous falls, disability, and cognitive impairment had no effect on the program among the community-dwelling subjects in this study

The value of repeat biopsy in lupus nephritis flares

Whether a repeat renal biopsy is helpful during lupus nephritis (LN) flares remains debatable. In order to analyze the clinical utility of repeat renal biopsy in this complex situation, we retrospectively reviewed our series of 54 LN patients who had one or more repeat biopsies performed only on clinical indications. Additionally, we reviewed 686 well-documented similar cases previously reported (PubMed 1990-2015). The analysis of all patients reviewed showed that histological transformations are common during a LN flare, ranging from 40% to 76% of cases. However, the prevalence of transformations and the clinical value of repeat biopsy vary when they are analyzed according to proliferative or nonproliferative lesions. The great majority of patients with class II (78% in our series and 77.5% in the literature review) progressed to a higher grade of nephritis (classes III, IV, or V), resulting in worse renal prognosis. The frequency of pathological conversion in class V is lower (33% and 43%, respectively) but equally clinically relevant, since almost all cases switched to a proliferative class. Therefore, repeat biopsy is highly advisable in patients with nonproliferative LN at baseline biopsy, because these patients have a reasonable likelihood of switch to a proliferative LN that may require more aggressive immunosuppression. In contrast, the majority of patients (82% and 73%) with proliferative classes in the reference biopsy (III, IV or mixed III/IV + V), remained into proliferative classes on repeat biopsy. Although rebiopsy in this group does not seem as necessary, it is still advisable since it will allow us to identify the 18% to 20% of patients that switch to a nonproliferative class. In addition, consistent with the reported clinical experience, repeat biopsy might also be helpful to identify selected cases with clear progression of proliferative lesions despite the initial treatment, for whom it is advisable to intensify inmunosuppression. Thus, our experience and the literature data support that repeat biopsy also brings more advantges than threats in this group. The results of the repeat biopsy led to a change in the immunosuppresive treatment in more than half of the patients on average, intensifying it in the majority of the cases, but also reducing it in 5% to 30%

Involvement of the parenchyma of the central nervous system in Behçet disease

Introducción: la enfermedad de Behçet es una vasculitis sistémica que presenta clínica neurológica con una frecuencia que varía entre el 16 y el 40%. Se ha relacionado la afectación parenquimatosa con un peor pronóstico en los pacientes con neurobehçet (NB). Objetivo: revisar la clínica y evolución de los pacientes con NB y afectación parenquimatosa del sistema nervioso central (SNC). Casos clínicos. Siete pacientes con enfermedad de Behçet y focalidad neurológica fueron atendidos en nuestro centro entre 1989 y 1996. El diagnóstico inicial fue de ictus isquémico en cinco de los siete pacientes. Tanto los estudios de neuroimagen como los del líquido cefalorraquídeo resultaron siempre patológicos. Los estudios vasculares (arteriografía y eco-Doppler de troncos supraórticos) fueron normales. Un enfermo fue éxitus letalis. Cuatro pacientes presentaron secuelas tras el tratamiento. Conclusión: el NB ha de formar parte del diagnóstico diferencial del ictus. La afectación parenquimatosa del SNC se acompaña de meningitis linfocitaria y puede, además, condicionar un peor pronóstico funcional

El portafoli electrònic com a complement docent d'habilitats clíniques en ciències de la salut

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524[cast] Introducción: El portafolio es una herramienta docente útil para la enseñanza y evaluación, de amplia difusión en los últimos años. Su objetivo es mejorar el aprendizaje mediante la reflexión del alumno y el feed-back continuado de las evaluaciones. En Ciencias de la Salud ha de mostrado ser útil para la evaluación de competencias trasversales y técnicas realizadas mediante prácticas clínicas y talleres. La implantación de la informática ha facilitado la introducción del portafolio electrónico (e-portafolio). Nuestra experiencia previa en portafolio en papel, nos decidió a implantarlo en alguna asignatura de nuestro Departamento. Objetivos: 1. Valorar la realización del e-portafolio. 2. Evaluar la satisfacción del alumnado. 3 Determinar la carga del proceso en el profesorado..