Charles Phelps

Bio: Charles Phelps is an academic researcher. The author has contributed to research in topics: MEDLINE & Geriatrics. The author has an hindex of 2, co-authored 2 publications receiving 1397 citations.

National Institutes of Health Consensus Development Conference Statement: Geriatric Assessment Methods for Clinical Decision‐making

Abstract: he population of elderly persons in the developed nations is growing with extraordinary rapidity. Although the majority enjoy good T health, many older people suffer from multiple illnesses and significant disability. Comprehensive assessment methodologies, while not solely applicable to frail elderly persons, are believed to be particularly suited to their situation. These individuals tend to exhibit great medical complexity and vulnerability; have illnesses with atypical and obscure presentations; suffer major cognitive, affective, and functional problems; are especially vulnerable to iatrogenesis; are often socially isolated and economically deprived; and are at high risk for premature or inappropriate institutionalization. To deal with the exceedingly difficult health care issues posed by frail elderly persons, health professionals need to collect, organize, and use a vast array of clinically relevant information. This process, compre-

Best Paper of the 1980s: National Institutes of Health Consensus Development Conference Statement: Geriatric Assessment Methods for Clinical Decision‐Making

Abstract: The population of elderly persons in developed nations is growing with extraordinary rapidity. Although the majority enjoy good health, many older people suffer from multiple illnesses and significant disability. Comprehensive assessment methodologies, while not solely applicable to frail elderly persons, are believed to be particularly suited for their situation. These individuals tend to exhibit great medical complexity in vulnerability; have illnesses with atypical and obscure presentations; suffer major cognitive, affective, and functional problems; are especially vulnerable to iatrogenesis; are often socially isolated and economically deprived; and are at high risk for premature or inappropriate institutionalization. To deal with exceedingly difficult health care issues posed by frail elderly persons, health professionals need to collect, organize, and use a vast array of clinically relevant information. The process, comprehensive geriatric assessment, is defined as a multidisciplinary evaluation in which the multiple problems of older persons are uncovered, described, and explained, if possible, and in which the resources and strengths of the person are catalogued, need for services assessed, and a coordinated care plan developed to focus interventions on the person’s problems. Comprehensive geriatric assessment generally includes evaluation of the patient in several domains, most commonly the physical, mental, social, economic, functional, and environmental. The term ‘‘functional’’ is used here in a narrow sense: It means the ability to function in the arena of everyday living. The panel recognizes that the same word has been used in the much broader sense of the whole range of functions we have listed just above. In other words, some use ‘‘functional assessment’’ to mean what we have termed ‘‘comprehensive geriatric assessment’’. When applied to clinical decisionmaking, comprehensive geriatric assessment involves clinicians from the many healthcare professions who are necessarily involved in good geriatric care. Comprehensive geriatric assessment is only one component of general geriatric care. Appropriate geriatric care involves some level of assessment of the multiple domains just cited, but comprehensive geriatric assessment tends to be applied only to a subset of older persons who are frail and considered most likely to benefit (see question 3). It has been suggested that a new form of comprehensive assessment could be developed to evaluate physical fitness for purposes of monitoring health promotion and disease prevention in well older persons and another form to guide the humane care of irreversibly disabled and terminally ill older persons. Between 1973 and 1987, reports have appeared on a significant number of true experiments exploring the elements and effectiveness of various approaches to geriatric assessment. The data from these studies, coupled with the growing numbers of frail elderly individuals, the high cost of their health care, the intensity of their distress and discomfort, and the great uncertainty as to the best route to wise clinical decision-making, led to the current conference. The National Institute on Aging and Office of Medical Applications of Research of the National Institutes of Health, in conjunction with the National Institute of Mental Health, the Veterans Administration, and the Henry J. Kaiser Family Foundation, convened the Consensus Development Conference on Geriatric Assessment Methods for Clinical Decision-making on October 19–21, 1987.

The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons

Abstract: This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.

A Gene-Expression Signature as a Predictor of Survival in Breast Cancer

Abstract: Background A more accurate means of prognostication in breast cancer will improve the selection of patients for adjuvant systemic therapy. Methods Using microarray analysis to evaluate our previously established 70-gene prognosis profile, we classified a series of 295 consecutive patients with primary breast carcinomas as having a gene-expression signature associated with either a poor prognosis or a good prognosis. All patients had stage I or II breast cancer and were younger than 53 years old; 151 had lymph-node–negative disease, and 144 had lymph-node–positive disease. We evaluated the predictive power of the prognosis profile using univariable and multivariable statistical analyses. Results Among the 295 patients, 180 had a poor-prognosis signature and 115 had a good-prognosis signature, and the mean (±SE) overall 10-year survival rates were 54.6±4.4 percent and 94.5±2.6 percent, respectively. At 10 years, the probability of remaining free of distant metastases was 50.6±4.5 percent in the group with a...

A Multigene Assay to Predict Recurrence of Tamoxifen-Treated, Node-Negative Breast Cancer

Abstract: background The likelihood of distant recurrence in patients with breast cancer who have no involved lymph nodes and estrogen-receptor–positive tumors is poorly defined by clinical and histopathological measures. methods We tested whether the results of a reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay of 21 prospectively selected genes in paraffin-embedded tumor tissue would correlate with the likelihood of distant recurrence in patients with node-negative, tamoxifen-treated breast cancer who were enrolled in the National Surgical Adjuvant Breast and Bowel Project clinical trial B-14. The levels of expression of 16 cancerrelated genes and 5 reference genes were used in a prospectively defined algorithm to calculate a recurrence score and to determine a risk group (low, intermediate, or high) for each patient. results Adequate RT-PCR profiles were obtained in 668 of 675 tumor blocks. The proportions of patients categorized as having a low, intermediate, or high risk by the RT-PCR assay were 51, 22, and 27 percent, respectively. The Kaplan–Meier estimates of the rates of distant recurrence at 10 years in the low-risk, intermediate-risk, and high-risk groups were 6.8 percent (95 percent confidence interval, 4.0 to 9.6), 14.3 percent (95 percent confidence interval, 8.3 to 20.3), and 30.5 percent (95 percent confidence interval, 23.6 to 37.4). The rate in the low-risk group was significantly lower than that in the high-risk group (P<0.001). In a multivariate Cox model, the recurrence score provided significant predictive power that was independent of age and tumor size (P<0.001). The recurrence score was also predictive of overall survival (P<0.001) and could be used as a continuous function to predict distant recurrence in individual patients. conclusions The recurrence score has been validated as quantifying the likelihood of distant recurrence in tamoxifen-treated patients with node-negative, estrogen-receptor–positive breast cancer.