Background: The number of geriatric cancer patients is progressively increasing. The evaluation of cognitive functions is important. Loneliness is an emotional experience that results from unmet personal or social requirements. The association between loneliness and cognitive dysfunction has been well documented in elderly patients. However, there is no data in elderly cancer patients. The purpose of this study is to evaluate the association between loneliness and cognitive dysfunction in geriatric cancer patients. Methods: Patients, more than 65 years of age, in departments of medical oncology and geriatrics were included. Patients were evaluated with structured questionnaires to define sociodemographic and clinical characteristics. In addition, patients were tested with multidimensional Scale of Perceived Social Support (PSC), UCLA loneliness Scale (ULS), standardized mini mental state examination (SMMSE), Clock drawing test and geriatric depression scale (GDS). Results: 314 elderly patients (214 with a diagnosis of cancer and 120 without cancer) were evaluated. Scores of PSC, ULS, SMMSE were higher in patients without cancer. Median score of GDS in cancer patients was higher than non-cancer patients (4 vs 2, p < 0.001). The analysis of ULS and SMMSE showed a negative correlation between loneliness and cognitive functions (r= -0.185, p = <0.001). The negative correlation was observed both in cancer patients (r= -0.206, p = 0.001) and non-cancer patients (r= -0.262, p = 0.002). In multivariate analysis; presence of depression, low PSC scores and low educational status were associated with high ULS scores. In the multivariate analysis of factors associated with cognitive dysfunction concluded that depression was associated with increased risk of cognitive dysfunction. (RR: 2.64 (1.3-5.1), 95% CI), p = 0.004) (Table).Table1423PRisk FactorHigh Loneliness ScoreCognitive ImpairmentRR(95%CI)pRR(95%CI)pPresence of depression1.98(1.0- 3.6)0.022.64(1.3-5.1)0.004Low social support2.01(1.1-3.4)0.011.1(0.5-2.1)0.75Educational status- low3.0(1.3-6.6)0.0071.93(0.8-4.4)0.12>75 years old1.46(0.8-2.6)0.211.36(0.6-2.7)0.36Female1.24(0.5-2.6)0.560.88(0.3-2.3)0.81High income1.36(0.7-2.4)0.271.1(0.6-2.2)0.63Retired0.64(0.2-1.4)0.300.54(0.2-1.4)0.22Cancer diagnosis0.93(0.5-1.6)0.811.79(0.8-3.6)0.11Live in Rural1.61(0.7-3.3)0.201.5(0.6-3.3)0.29Comorbidity1.38(0.68-2.8)0.36High Loneliness score1.18(0.6-2.2)0.61 Open table in a new tab Conclusions: In elderly cancer patients, cognitive functions are negatively effected by increased loneliness. However, the association between cancer diagnosis, loneliness and cognitive dysfunction couldn’t be demonstrated in multivariate analysis. Legal entity responsible for the study: Ali Alkan Funding: None Disclosure: All authors have declared no conflicts of interest.

In this prospective trial, we aimed to study the effects of cardiac rehabilitation on functional capacity, depression and quality of life, in patients with a left ventricular assist device (LVAD). We also aimed to compare the effectiveness of home and hospital based exercise programs. 42 patients who had received LVAD implants in our university hospital were included in the study. After the subjects were randomized into hospital exercise group (n=20) and home exercise group (n=22), they were enrolled in a cardiac rehabilitation program for 8 weeks, which lasted for one hour, three times per week in hospital and at home respectively. All subjects were assessed at baseline and 8th week. In our study we detected a significant improvement in peak VO2, six minute walk test values, Minnesota living with heart failure quentionnaire and state-trait anxiety inventory in the hospital exercise group (p<0,05). When we compared the changes seen in the parameters over time, hospital group showed significantly more improvement than the home exercise group in peak VO2, six-minute walk test, Minnesota living with heart failure questionnaire and trait anxiety subscore of the state trait anxiety inventory (p<0,01) and FEV1(r=0,14, p>0,05) scores. End stage heart failure is increasingly being treated with LVAD implantation. Safety of cardiac rehabilitation in patients with LVAD have been proven in other studies. In this study we detected a positive effect of supervised hospital exercise program on functional capacity, quality of life and anxiety in patients with implanted LVADs. Previous studies have shown similar results regarding the efficacy of cardiac rehabilitation in both hospital and home exercise groups. But patients enrolled in these studies were mainly New York Heart Association grade 1 patients who had better functional status. In our study, exercise adherence was worse in the home exercise group. There is still need for more studies focusing on patients with LVAD and comparing the effects of home and hospital exercise programs. There is also need for more long term follow-up to show the long term efficacy of cardiac rehabilitation in LVAD patients.

We evaluated corneal endothelial cell (EC) damage after vitreoretinal surgery and compared the results using different tamponades. This prospective controlled study included 45 eyes of 45 patients (24 females, 21 males) who underwent pars plana vitrectomy with gas (sulphur hexafluoride, SF6, 20%) or silicone oil (SO) tamponade. Patients were assigned to one of the three groups: group 1 (phakic, 20% SF6 gas), group 2 (pseudophakic, 20% SF6 gas), and group 3 (phakic, SO). Mean endothelial cell density (MCD), mean cell area (MCA), coefficient of variation in cell size (CV), and percentage of hexagonal cells (HC) values were measured using a non-contact specular microscope (SP-2000P; Topcon, Japan) at baseline and at 3 months after surgery. The fellow eye of each patient was used as a control. Group 2, which had the lowest baseline MCD and MCA values, was found to be different than groups 1 and 3 (P=0.028 and 0.022, respectively). At 3 months postoperatively, all groups showed significantly lower MCD, HC and CV values than at baseline (all P<0.05). The mean changes in MCD at 3 months after surgery were 3.8±2.8% (mean±SD), 8.0±7.5%, and 4.6±5.4% in groups 1–3, respectively. The mean MCD changes in the fellow eyes were 0.31±1.41% in group 1, −0.63±1.90% in group 2, and 0.14±0.52 in group 3 at 3 months postoperatively (P>0.05 for all). Our findings revealed that corneal EC damage may occur after vitreoretinal surgery with gas or SO tamponade. Eyes that had undergone previous cataract surgery were more vulnerable to EC loss than phakic eyes, supporting the protective effect of an intact lens.

Purpose: Urinary incontinence (UI) is very common problem in older problem. This study evaluates the prevalence of UI, and associated factors with UI in community dwelling older people in Turkey.Materials and methods: This was a cross-sectional study as part of a health survey conducted with community dwelling older people. Demographic, clinical data, UI and its types were obtained by interview. Post-void residual (PVR) volume was measured with ultrasound.Results: The prevalence of UI was 43.9%. The most common type was urge UI (23.7%). Associated factors with UI were gender, low income, low education level, chronic diseases, chronic constipation, chronic cough, number of deliveries, benign prostatic hyperplasia, past genitourinary surgery and lower urinary tract symptoms. PVR volume was not related with UI.Conclusions: UI is very common in older people in Turkey. PVR volume is not related to the presence of UI in our study due to the lower prevalence of significantly high PVR volumes and lack of individuals with overflow UI. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

OBJECTIVES:The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction.METHODS:Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC.RESULTS:In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (P<0.05). Worries patients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals.CONCLUSION:In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization.

Study design: Multi-center, cross-sectional study. Objectives: Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire. Setting: Turkey. Methods: Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management. Results: The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization (IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation ( P >0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders ( P >0.05). The most common anticholinergic drug used was oxybutynin (40.3%), followed by trospium (32.6%), tolterodine (19.3%) darifenacin (3.3%), propiverine (3.3%) and solifenacin (1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists (76.2%), urologists (22.1%) and neurologists (1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients (77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital (15.3%) and monetary problems (7.7%). Of the patients, 42.7% did not experience urinary tract infections (UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ⩾3 clinical UTIs. The clinical characteristics of patients with and without UTI (at least one symptomatic UTI during 1 year) were similar ( P >0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques ( P >0.05). Conclusion: The most frequently used technique for bladder rehabilitation in patients with SCI was IC (77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs.

Background Ankylosing spondylitis causes progressive postural deformities [1]. Objectives We aimed to assess the impact of postural deformities on balance. Methods In this cross-sectional study, 29 AS patients and 21 healthy controls were included. For assessing exercise capacity and dynamic balance, timed up-and-go test, 5 times sit-to-stand test, gait speed and six-minute walk test were performed. Romberg tests were used to assess static balance and proprioception, while Dynamic Gait Index (DGI), Functional Gait Assessment (FGA), Berg Balance Scale (BBS), Activity Specific Balance Confidence Scale (ABC), Dizziness Handicap Inventory (DHI) and functional reach test were used to assess dynamic balance and risk of falling. Using Bath Ankylosing Spondylitis Metrology Index (BASMI) scores, AS patients with scores 0-4 were assigned to subgroup AS1, while those with scores 5-10 were assigned to subgroup AS2. Results In the whole group of AS patients, 5 times sit-to-stand test, tandem Romberg test with eyes closed, BDI, BBS and ABC scores were significantly worse than the healthy controls (p<0.05). In the AS2 subgroup, five additional parameters including timed up and go test, 6 minute walk test, functional reach test, FGA and DHI scores were also significantly worse than the healthy controls (p<0.05). Only BBS scores were significantly worse in AS2 subgroup compared to AS1 subgroup. Conclusions Patients with AS have poorer static and dynamic balance compared to healthy subjects [2-4]. Although significantly worse BBS scores in the AS2 subgroup, compared to AS1 subgroup may suggest the presence of more severe dynamic balance problems in advanced disease, future studies including larger number of patients are necessary to confirm this assumption. References Khan MA, (2002) Ankylosing spondylitis: introductory comments on its diagnosis and treatment. Ann Rheum Dis 61 Suppl 3: p. iii3-7. doi:10.1136/ard.61.suppl_3.iii3 Aydog E, Depedibi R, Bal A,Eksioglu E, Unlu E,Cakci A, Dynamic postural balance in ankylosing spondylitis patients. Rheumatology (Oxford), 45(4): p. 445-8. doi:10.1093/rheumatology/kei192 Durmus B, Altay Z, Ersoy Y, Baysal O,Dogan E, (2010) Postural stability in patients with ankylosing spondylitis. Disabil Rehabil, 2010. 32(14): p. 1156-62. doi: 10.3109/0963828090342831 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1087

Background and aims We aimed to evaluate the association of subfoveal choroidal thickness (SFCT) with age and to determine its relationship with axial length (AL) and ocular biometric parameters, in children and young adults during growth period. Methods One hundred and sixty patients (80 male, 80 female) aged between 4 and 23 years were included. Patients were classified into five groups according to their ages as group 1 (4–7 years of age), group 2 (8–11 years), group 3 (12–15 years), group 4 (16–19 years), and group 5 (20–23 years). SFCT was assessed using spectral-domain optical coherence tomography (3D OCT-2000). The measurements were taken at the same daytime (1000–1200 hours) to avoid diurnal fluctuation. Ocular AL and anterior segment parameters were measured using optical biometry (Lenstar LS900)). Results The average SFCT was 308.1±47.6 μ m, ranging from 206 to 410 μ m. The mean SFCT values in group 1 to 5 were measured as 306.8±42.0, 297.8±48.1, 283.2±38.9, 326.9±57.4, and 325.8±35.9 μ m, respectively. The mean CT of group 3 was significantly thinner than group 4 and 5 ( P <0.05 for two groups), however, there was no statistical significance compared with group 1 ( P =0.227) and group 2 ( P =0.693). On stepwise regression analysis, age exhibited a positive association with SFCT ( B =2.8, P <0.001) and AL exhibited a negative association with choroidal thickness ( B =−16.7, P <0.001). Conclusions We found that SFCT shows no age-related difference until age of 15, whereas 16–23-year old participants had thicker SFCT compared with the younger ones. In that aspect, a thicker choroid associated with age in certain age groups suggests an age period of SFCT increase to a plateau in young adulthood. Larger studies are warranted to elucidate the age-related changes in SFCT in childhood, as improved evaluation of normal choroidal thicknesses during eye growth should assist in the diagnosis of choroidal abnormalities associated with eye disease.

Background Plantar heel pain in adulthood is a common, disabling and chronic foot problem. Most cases have a biomechanical etiology however various systemic arthritis also causes heel pain. Plantar fasciitis which is caused by secondary degenerative changes in the plantar fascia, is the most common cause of plantar heel pain. Despite the common use of low intensity laser therapy (LILT) and extracorporeal shock wave therapy(ESWT)inmusculoskeletal problems such as plantar fasciitis there is no randomized controlled study comparing the efficacy of these treatment modalities. Objectives To compare the efficacy of LILT and ESWT in the treatment of plantar fasciitis. Methods Fifty-five patients with plantar fasciitis were randomly allocated into the laser group(29 patients) who received Gallium-Aluminum-Arsenide laser therapy with 850nm wavelength for 10 sessions 3 times a week and ESWTgroup (26 patients) who received 2000 shock waves with 0.02 mJ/mm2 for three sessions once a week. Foot Function Index,12 minutes walk test and VAS were used for evaluation. Results In the laser group pre-post treatment values showed a significant difference in favor of post treatment values in all measured parameters whereas in the ESWT group no difference was found in gait velocity or pain. Intergroup comparisons showed that LILT was more effective in reducing pain, increasing the speed of walking and in increasing perceived quality of life. Conclusions The results of this study suggest that LILT is more effective than ESWT in the treatment of heel pain. References Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med 2004; 350: 2159-2166. Yalcin E. Akca Keskin A. Secuk B. Kurtaran A. Akyuz M. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes. Rhematol Int. 2012;32: 343-347. Johal KS, Milner SA. Plantar fasciit and the calcaneal spur: Fact or function? Foot Ankle surg. 2012; 18(1):39-41. Disclosure of Interest None Declared