Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

The photography and Henri- Cartier Bresson

Η συγκεκριμένη πτυχιακή εργασία αναφέρεται στη φωτογραφία και στον "πατέρα" της φωτογραφίας, τον Henri- Cartier Bresson. Στο πρώτο κεφάλαιο υπάρχουν πληροφορίες για το πως ξεκίνησε η φωτογραφία, ποιος ήταν ο δημιουργός της εφεύρεσης, καθώς και ποιος έβγαλε την πρώτη φωτογραφία του κόσμου. Ακολουθούν τα κινήματα της ζωγραφικής, επειδή οι φωτογράφοι επηρεάστηκαν από αυτά, αλλά και τη μετέπειτα εξέλιξη τους με την παρουσία της φωτογραφίας. Τέλος, ακολουθεί η ζωή του Henri- Cartier Bresson, τα έργα του, το περιοδικό Magnum, αλλά και η συνεργασία του με τον μεγάλο Έλληνα τεχνοκριτικό Στρατή Ελευθεριάδη- Teriade

Synthesis of Dacus Pheromone, 1,7-Dioxaspiro[5.5]Undecane and Its Encapsulation in PLLA Microspheres for Their Potential Use as Controlled Release Devices

Olive fruit fly Dacus oleae is a well-known pest infecting the bark of olive fruit, leading to reduction of extracted olive oil properties. Among chemicals proposed for Dacus oleae population control, pheromone 1,7-dioxaspiro(5.5)undecane (DSU), Dacus pheromone, is considered as a promising agent, which is added in several traps. However, all proposed systems manage to sufficiently deliver DSU for only two weeks. Furthermore, an additional problem is the limited available amount of pheromone to use in such systems. To overcome this, in the present study, a novel synthetic procedure of DSU is described, including only five steps. Intermediate products were studied by High Resolution Mass Spectroscopy Electrospray Ionization (HRMS-ESI) (m/z), while the resulting DSU was further characterized by 1H and 13C-NMR. Synthesized DSU was further encapsulated in poly(L-lactic acid) (PLLA) microparticles in three different concentrations; 5, 10 and 20% w/w. Its successful incorporation was studied by FT-IR, XRD and differential scanning calorimeter (DSC) while two procedures, liquid extraction and solid phase microextraction, followed by GC-MS analysis, was used for quantification of pheromone to microparticles. It was found that microparticles loading was over 85% for all three formulations. Its release showed a prolonged profile for microparticles containing 20% w/w DSU, lasting four weeks, while the quantity of DSU released reached 100%. These microparticles could be appropriate to control Dacus oleae population

The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807)

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807)