Sarkopenik Yaşlı Hastalarda Ultrasonografik Olarak Kas Mimarisinin Değerlendirilmesi

Sarcopenia is a geriatric syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, falls, poor quality of life and death. The prevalence of sarcopenia in 60- to 70-year-olds is in the range of 5–13%, for the population aged 80 years or older is 11–50%. The current diagnosis of sarcopenia depends on the measurement of muscle mass and strength. However, assessment of muscle architecture with ultrasound (USG) has not been studied in sarcopenic elderly before. The aim of this study was to assess the muscle architecture in sarcopenic elderly patients with USG and to assess the reliability of muscle USG for the diagnosis of sarcopenia. In this cross-sectional study, 100 elderly patients (41 men and 59 women) admitted to the outpatient clinic of the Geriatric Medicine were enrolled. Comprehensive geriatrics assessment tests, anthropometric measurements, bioelectrical impedance analysis (BIA), handgrip strength and muscle ultrasound were performed. Fat-free mass index (FFMI) and handgrip strength tests were used for diagnosis of sarcopenia. Mean± SD age of study population was 73.08 ± 6.18 year. The prevalence of sarcopenia was 16% (19.5% in male, 13.6% in female). The median age was significantly higher, body weight, BMI, handgrip, bilateral mid-arm (MAC) and calf circumferences (CC) were significantly lower in patients with sarcopenia. The prevalence of osteoporosis was significantly higher and Tinetti balance test score was significantly lower in sarcopenic patients. There were no significant differences regarding other co-morbidities and geriatric assessment tests. Thickness (T) and fascicle length (FL) of bilateral muscle gastrocnemius (MG) were significantly lower in patients with sarcopenia. FFMI was significantly and positively correlated with skeletal muscle mass index (SMI), handgrip, T and FL of bilateral MG and bilateral dermis T. Handgrip strength was significantly and positively correlated with T and FL of bilateral MG and significantly and negatively correlated with subcutan tissue T. ROC curve analysis suggested optimal cut-off points for sarcopenia; right CC:35.3 cm, left CC:33 cm, bilateral MAC:26.5 cm, right MG T: 1.69 cm, left MG T: 1.71 cm, right MG FL: 3.62 cm, left MG FL: 3.47 cm. USG imaging was found to be a reliable measurement tool to assess the changes of muscle architecture in sarcopenic patients and can be used for the diagnosis of sarcopenia.Sarkopeni ilerleyici ve yaygın olarak kas gücü ve kuvvetinin kaybı ile karakterize olan fiziksel bağımlılık, düşmeler, kötü yaşam kalitesi ve mortalite gibi olumsuz sonuçlara neden olabilen bir geriatrik sendromdur. Sarkopeni prevelansı 60-70 yaşları arasında %5-13 iken, 80 yaş ve üzerinde %11-50'lere çıkmaktadır. Güncel sarkopeni tanısında hem kas kitlesi hem kas gücü değerlendirilmektedir. Bununla beraber, sarkopenik yaşlılarda kas ultrasonu (USG) ile kas mikromimarisi değerlendirilmesi daha önce çalışılmamıştır. Bu çalışmanın amacı sarkopenik yaşlı hastalarda USG ile kas mikromimarisinin değerlendirilmesi ve sarkopeni tanısında kas USG'nin güvenilirliğinin değerlendirilmesidir. Bu kesitsel çalışmada geriatri polikliniğine ayaktan başvuran 41 erkek, 59 kadın olmak üzere 100 yaşlı hasta alındı. Hastaların antropometrik ölçümleri alındı, kapsamlı geriatri değerlendirme testleri, biyoelektrik-empedans analiz yöntemi (BIA), el sıkma kuvvet ölçümü ve kas ultrasonu uygulandı. Sarkopeni tanısında yağsız kitle indeksi (FFMI) ve el sıkma kuvvet ölçümü kullanıldı. Çalışmaya alınan hastaların ortalama±SD yaşları 73.08 ± 6.18 idi. Sarkopeni prevelansı %16 (erkeklerde %19,5, kadınlarda %13,6) saptandı. Sarkopenik hastaların istatistiksel açıdan anlamlı olarak yaşları daha fazla, kilo, VKİ, el sıkma kuvvetleri, bilateral üst-orta kol (MAC) ve baldır çevreleri (CC) daha düşüktü. Sarkopenik hastalarda anlamlı olarak osteoporoz daha sık ve Tinetti denge testi puanları daha düşük iken diğer ko-morbiditeler ve kapsamlı geriatrik değerlendirme testleri arasında anlamlı fark saptanmadı. Bilateral gastroknemius kası (MG) kalınlıkları (T) ve fasikül uzunlukları (FL) sarkopenik hastalarda olmayanlara göre anlamlı olarak daha düşük saptandı. FFMI, iskelet kas kitle indeksi (SMI), el sıkma kuvveti, bilateral MG T ve FL ile ve bilateral dermis T ile anlamlı ve pozitif yönde korele, el sıkma kuvveti ise bilateral MG T ve FL ile pozitif yönde, subkutan doku T ile negatif yönde korele saptandı. ROC eğrisi analizine göre sarkopeniyi öngörmede optimal cut-off değerler; sağ CC için: 35,3 cm, sol CC:33 cm, bilateral MAC:26,5 cm, sağ MG T: 1,69 cm, sol MG T: 1,71 cm, sağ MG FL: 3,62 cm, sol MG FL: 3,47 cm olarak saptandı. USG sarkopenik yaşlı hastalarda kas mikromimarisinde oluşan değişiklikleri değerlendirmek için uygun bir yöntemdir ve sarkopeni tanısında kullanılabilir

Assessment of the Appropriateness of Prescriptions in a Geriatric Outpatient Clinic Geriatri Polikliniğinde Reçete Uygunluğunun Değerlendirilmesi

Objectives: Appropriateness of the geriatric outpatients’ medications needs special attention due to risks of falls, fractures, depression, hospital admissions and mortality. This study aimed to identify current practice on medication usage by using the 2nd version of “Screening Tool of Older People’s Potentially Inappropriate Prescriptions” and “Screening Tool to Alert Doctors to Right Treatment” criteria and affecting factors for the Turkish population. Materials and Methods: This cross-sectional study was conducted between September 2015 and May 2016 at a university research and training hospital’s geriatric outpatient clinic. Patients aged ≥65 years and had ≥5 different prescribed medications (considered as polypharmacy) were recruited. The main outcome measure was the frequency of inappropriate medications identified by clinical pharmacist in the outpatient clinic according to the 2nd version of the criterion sets. Results: A total of 700 patients (440 female) were included in this study. According to the results, 316 patients (45.1%) with at least one potentially inappropriate medication and 668 patients (98.3%) with at least one potential prescription omission were detected. Potentially inappropriate medications were associated with the number of medications used per patient [odds ratio (OR): 1.20 p<0.001], living alone (OR: 4.12 p=0.02), and having congestive heart failure (OR: 2.41 p<0.001). Twenty-two (27.5%) out of 80 criteria and 4 (11.8%) out of 34 criteria did not apply to the study population. Conclusion: Detecting inappropriate medications to maintain treatment effectiveness is necessary to provide the optimum therapy. Despite the awareness of polypharmacy in outpatient clinics it is still one of the important causes of inappropriate prescription followed by vaccination rate. Therefore, with the contribution of clinical pharmacist using these available criteria is important, moreover modification of these criteria according to the local needs to be considered to achieve better outcomes

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research