Abstract: Disability is associated with lower quality of life and premature death in older people. Therefore, prevention and intervention targeting older people living with a disability is important. Frailty can be considered a major predictor of disability. In this study, we aimed to develop nomograms with items of the Tilburg Frailty Indicator (TFI) as predictors by using cross-sectional and longitudinal data (follow-up of five and nine years), focusing on the prediction of total disability, disability in activities of daily living (ADL), and disability in instrumental activities of daily living (IADL). At baseline, 479 Dutch community-dwelling people aged 75 years participated. They completed a questionnaire that included the TFI and the Groningen Activity Restriction Scale to assess the three disability variables. We showed that the TFI items scored different points, especially over time. Therefore, not every item was equally important in predicting disability. ‘Difficulty in walking’ and ‘unexplained weight loss’ appeared to be important predictors of disability. Healthcare professionals need to focus on these two items to prevent disability. We also conclude that the points given to frailty items differed between total, ADL, and IADL disability and also differed regarding years of follow-up. Creating one monogram that does justice to this seems impossible.
DOCUMENT
In de richtlijnen van het Forensisch Medisch Genootschap is opgenomen dat het schatten van het tijdstip van overlijden onderdeel van de lijkschouw is. Het schatten van het tijdstip dient uitgevoerd te worden door de gemeentelijk lijkschouwer. Hierdoor valt te verwachten dat de forensisch arts als getuige-deskundige gehoord kan worden over het geschatte tijdstip van overlijden, dat in sommige strafzaken een cruciaal punt van discussie kan zijn. Uit ons retrospectieve onderzoek blijkt dat het tijdstip van overlijden, in 2013, in relatief weinig strafzaken een cruciale rol heeft gespeeld en dat in nog minder zaken een op wetenschappelijke literatuur gebaseerde methode aan de schatting ten grondslag lag.
DOCUMENT
Deze voorlichtingspublicatie is bedoeld voor allen die te maken hebben of te maken krijgen met de selectie, toepassing en uitvoering van warmtebehandelingen. Daarbij moet gedacht worden aan constructeurs, lastechnici, werkvoorbereiders, enzovoorts. Deze voorlichtingspublicatie is een update van de bestaande NIL-voorlichtingspublicatie V990906 (september 1999) "Warmtebehandeling van metalen in relatie tot de lastechniek". De updating was noodzakelijk omdat er enerzijds geen document beschikbaar was met een duidelijk overzicht van de (belangrijkste) warmtebehandelingen en anderzijds omdat de ontwikkelingen in onder andere de nieuwe staalsoorten beperkingen (kunnen) stellen aan de uitvoering van warmtebehandelingen. De in deze voorlichtingspublicatie genoemde warmtebehandelingen zijn die, welke veel voorkomen in de staalverwerkende industrie en dus ook in de lastechniek. De meest belangrijke warmtebehandelingen worden in beknopte vorm behandeld. Doel van deze publicatie is voornamelijk basisinformatie te verschaffen over de warmtebehandelingen. Warmtebehandelingen hebben effecten op de metaalkundige aspecten, zoals de structuur en de daaraan gerelateerde mechanische eigenschappen. Daarom wordt in een aantal hoofdstukken aandacht besteed aan de opbouw (kristalstructuur) van de metalen, alsmede de invloed van het opwarmen naar en (snel) afkoelen vanaf een bepaalde warmtebehandelingstemperatuur. Daarnaast wordt ook beknopt ingegaan op de uitvoering van warmtebehandelingen. Het is echter geenszins de bedoeling met deze publicatie volledig te zijn.
DOCUMENT
Objectives : To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). Design : Systematic review with best evidence synthesis. Setting : Primary care. Participants : Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. Review methods: PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. Results : Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. Conclusion :Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
MULTIFILE
Abstract The aim of this cross-sectional study was to develop a Frailty at Risk Scale (FARS) incorporating ten well-known determinants of frailty: age, sex, marital status, ethnicity, education, income, lifestyle, multimorbidity, life events, and home living environment. In addition, a second aim was to develop an online calculator that can easily support healthcare professionals in determining the risk of frailty among community-dwelling older people. The FARS was developed using data of 373 people aged ≥ 75 years. The Tilburg Frailty Indicator (TFI) was used for assessing frailty. Multivariate logistic regression analysis showed that the determinants multimorbidity, unhealthy lifestyle, and ethnicity (ethnic minority) were the most important predictors. The area under the curve (AUC) of the model was 0.811 (optimism 0.019, 95% bootstrap CI = −0.029; 0.064). The FARS is offered on a Web site, so that it can be easily used by healthcare professionals, allowing quick intervention in promoting quality of life among community-dwelling older people.
DOCUMENT
OBJECTIVE: To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published prediction models for peak oxygen consumption (Vo2peak) and peak power output (Wpeak).DESIGN: Cross-sectional study.SETTING: Multicenter.PARTICIPANTS: Cancer survivors (N=283) in 2 randomized controlled exercise trials.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions.RESULTS: ICCs of SRT-predicted Vo2peak and Wpeak with these values as obtained by the cardiopulmonary exercise test were .61 and .73, respectively, using the previously published prediction models. 95% LOA were ±705mL/min with a bias of 190mL/min for Vo2peak and ±59W with a bias of 5W for Wpeak. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of Vo2peak (ICC, .73; 95% LOA, ±608mL/min) and by adding age, height, and sex for the prediction of Wpeak (ICC, .81; 95% LOA, ±48W). Accuracy of endurance exercise prescription improved from 57% accurate prescriptions to 68% accurate prescriptions with the new prediction model for Wpeak.CONCLUSIONS: Predictions of Vo2peak and Wpeak based on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeak can be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.
DOCUMENT
Wetenschappelijke publicatie
MULTIFILE
Het schatten van het tijdstip van overlijden is een van de taken van een forensisch arts. De mate van ontbinding, het proces van verval van het lichaam, is een van de methoden die wordt gebruikt om het tijdstip van overlijden te bepalen. Het is echter onbekend hoe betrouwbaar deze methode is. Om dit te toetsen zijn vijftien casussen geselecteerd uit in totaal 1534 lijkschouwingen op basis van vooropgestelde criteria. Deze vijftien casussen zijn voorgelegd aan tien ervaren forensisch artsen met de vraag om het postmortale interval te schatten. Dit onderzoek toont aan dat er weinig overeenstemming is tussen de forensisch artsen. Het gebruik van ontbinding alleen om het tijdstip van overlijden te bepalen wordt daarom ontraden.
DOCUMENT
Background/Aims: This study examines the feasibility of a preoperative exercise program to improve the physical fitness of a patient before gastrointestinal surgery. Methods: An outpatient exercise program was developed to increase preoperative aerobic capacity, peripheral muscle endurance and respiratory muscle function in patients with pancreatic, liver, intestinal, gastric or esophageal cancer. During a consult at the outpatient clinic, patients were invited to participate in the exercise program when their surgery was not scheduled within 2 weeks. Results: The 115 participants followed on average 5.7 (3.5) training sessions. Adherence to the exercise program was high: 82% of the planned training sessions were attended, and no adverse events occurred. Mixed model analyses showed a significant increase of maximal inspiratory muscle strength (84.1-104.7 cm H2O; p = 0.00) and inspiratory muscle endurance (35.0-39.5 cm H2O; p = 0.00). No significant changes were found in aerobic capacity and peripheral muscle strength. Conclusion: This exercise program in patients awaiting oncological surgery is feasible in terms of participation and adherence. Inspiratory muscle function improved significantly as a result of inspiratory muscle training. The exercise program however failed to result in improved aerobic capacity and peripheral muscle strength, probably due to the limited number of training sessions as a result of the restricted time interval between screening and surgery.
DOCUMENT
Children with Marfan (MFS) and Loeys-Dietz syndrome (LDS) report limitations in physical activities, sports, school, leisure, and work participation in daily life. This observational, cross-sectional, multicenter study explores associations between physical fitness and cardiovascular parameters, systemic manifestations, fatigue, and pain in children with MFS and LDS. Forty-two participants, aged 6–18 years (mean (SD) 11.5(3.7)), diagnosed with MFS (n = 36) or LDS (n = 6), were enrolled. Physical fitness was evaluated using the Fitkids Treadmill Test’s time to exhaustion (TTE) outcome measure. Cardiovascular parameters (e.g., echocardiographic parameters, aortic surgery, cardiovascular medication) and systemic manifestations (systemic score of the revised Ghent criteria) were collected. Pain was obtained by visual analog scale. Fatigue was evaluated by PROMIS® Fatigue-10a-Pediatric-v2.0-short-form and PROMIS® Fatigue-10a-Parent-Proxy-v2.0-short-form. Multivariate linear regression analyses explored associations between physical fitness (dependent variable) and independent variables that emerged from the univariate linear regression analyses (criterion p <.05). The total group (MFS and LDS) and the MFS subgroup scored below norms on physical fitness TTE Z-score (mean (SD) −3.1 (2.9); −3.0 (3.0), respectively). Univariate analyses showed associations between TTE Z-score aortic surgery, fatigue, and pain (criterion p <.05). Multivariate analyses showed an association between physical fitness and pediatric self-reported fatigue that explained 48%; 49%, respectively, of TTE Z-score variance (F (1,18) = 18.6, p ≤.001, r2 =.48; F (1,15) = 16,3, p =.01, r2 =.49, respectively). Conclusions: Physical fitness is low in children with MFS or LDS and associated with self-reported fatigue. Our findings emphasize the potential of standardized and tailored exercise programs to improve physical fitness and reduce fatigue, ultimately enhancing the physical activity and sports, school, leisure, and work participation of children with MFS and LDS. (Table presented.)
DOCUMENT
