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Latest & greatest articles for elderly
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Adjustment of the multi-biomarker disease activity score to account for age, sex and adiposity in patients with rheumatoid arthritis To develop and evaluate an adjusted score for the multi-biomarker disease activity (MBDA) test to account for the effects of age, sex and adiposity in patients with RA.Two models were developed to adjust MBDA score for age, sex and adiposity, using either serum leptin concentration or BMI as proxies for adiposity. Two cohorts were studied. A cohort of 325 781 RA (...) patients who had undergone commercial MBDA testing and had data for age, sex and serum leptin concentration was used for both models. A cohort of 1411 patients from five studies/registries with BMI data was used only for the BMI-adjusted MBDA score. Univariate and multivariate linear regression analyses evaluated the adjusted MBDA scores and conventional clinical measures as predictors of radiographic progression, assessed in terms of modified total Sharp score (ΔmTSS).Two models were developed, based
Repeat thyroid function tests for healthy olderpeople are not needed. The studyRoberts L, McCahon D, Johnson O, Haque MS, Parle J, Hobbs FR. Stability of thyroid function in older adults: the Birmingham Elderly Thyroid Study. Published on 28 August 2018 Br J Gen Pract 2018;68:e718-26.This study was funded by the National Institute for Health Research School for Primary Care Research (SPCR).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000703/repeat-thyroid (...) -function-tests-for-healthy-older-people-are-not-needed.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Interventions using social networking sites to promote contraception in women of reproductive age. Social networking sites (SNSs) have great potential as a platform for public health interventions to address the unmet need for contraception.To evaluate the effectiveness of interventions using SNSs to promote the uptake of and adherence to contraception in reproductive-age women.We searched CENTRAL, MEDLINE, Embase, and six other databases on January 2018. We also searched Google Scholar, key (...) conference proceedings, checked the reference lists of included studies, and contacted study authors to identify additional studies.We considered randomised controlled trials (RCTs) and non-randomised interventional studies (NRS) in women of reproductive age. SNSs requiring a social profile within a bounded or restricted-access system of shared connections were included. We also included trials that utilised SNSs only or as an adjunct to an intervention. Studies had to have a follow-up outcome assessment
and death records in England.157 264 adults aged 65 years or older presenting to a general practitioner with at least one diagnosis of suspected or confirmed lower UTI from November 2007 to May 2015.Bloodstream infection, hospital admission, and all cause mortality within 60 days after the index UTI diagnosis.Among 312 896 UTI episodes (157 264 unique patients), 7.2% (n=22 534) did not have a record of antibiotics being prescribed and 6.2% (n=19 292) showed a delay in antibiotic prescribing. 1539 (...) at risk for both bloodstream infection and 60 day all cause mortality.In elderly patients with a diagnosis of UTI in primary care, no antibiotics and deferred antibiotics were associated with a significant increase in bloodstream infection and all cause mortality compared with immediate antibiotics. In the context of an increase of Escherichia coli bloodstream infections in England, early initiation of recommended first line antibiotics for UTI in the older population is advocated.Published by the BMJ
patients undergoing cardiac surgery.Randomized, placebo-controlled, factorial clinical trial among 120 patients aged 60 years or older undergoing on-pump coronary artery bypass graft (CABG) surgery or combined CABG/valve surgeries at a US center. Enrollment was September 2015 to April 2018, with follow-up ending in April 2019.Patients were randomized to 1 of 4 groups receiving postoperative analgesia with IV acetaminophen or placebo every 6 hours for 48 hours and postoperative sedation (...) Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. Postoperative delirium is common following cardiac surgery and may be affected by choice of analgesic and sedative.To evaluate the effect of postoperative intravenous (IV) acetaminophen (paracetamol) vs placebo combined with IV propofol vs dexmedetomidine on postoperative delirium among older
Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits (...) , but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes.In this international, assessor-masked, equivalence, randomised, controlled trial conducted at 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand, we recruited infants of less than 60 weeks' postmenstrual age who were born at more than 26 weeks' gestation and were undergoing inguinal
2019LancetControlled trial quality: predicted high
Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial. Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium.To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium.Randomized clinical trial of 1232 adults aged 60 years (...) and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis. Recruitment was from January 2015 to May 2018, with follow-up until July 2018.Patients were randomized 1:1 (stratified by cardiac vs noncardiac surgery and positive vs negative recent fall history) to receive EEG-guided anesthetic administration (n = 614) or usual anesthetic care (n = 618).The primary outcome was incident delirium during postoperative days 1 through 5. Intraoperative measures
) of interest for this review (Table 1). Table 1. Inclusion and exclusion criteria PICOTS Inclusion/Exclusion Criteria Population Include: Older adults (Medicare or retirement age [60 years or older]), community dwelling Exclude: People less than 60 years of age, exclusively focused on a single health condition (physical or sensory disability, specific mental illness, etc.), non-community dwelling (nursing home, institutional setting, etc.), exclusively focused on a specific subpopulation (indigenous (...) isolation and low support are particularly concerning for older adults. The population of the United States is aging, with the number of adults aged 65 and older growing from 35 million in 2000 to 49.2 million in 2016. 4 Older adults are at higher risk for being socially isolated due to age-related changes in health and social connections, such as limitations to hearing and vision, reduced mobility, and loss of family and friends. 1 These changes can contribute to social isolation and loneliness
Eslicarbazepine acetate (Zebinix) - as adjunctive therapy in adolescents and children aged above 6 years with partial-onset seizures Published 11 February 2019 Product Update: eslicarbazepine acetate 200mg and 800mg tablets and oral suspension 50mg/mL (Zebinix ® ) SMC2087 Eisai Ltd 10 August 2018 (Issued 11 January 2019) The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use (...) in NHS Scotland. The advice is summarised as follows: ADVICE: following an abbreviated submission eslicarbazepine acetate (Zebinix ® ) is accepted for restricted use within NHSScotland. Indication under review: as adjunctive therapy in adolescents and children aged above 6 years with partial-onset seizures with or without secondary generalisation. SMC restriction: patients with highly refractory epilepsy who have been heavily pre-treated and remain uncontrolled with existing anti-epileptic drugs. SMC
of blood cancer with around 60% of cases occurring in patients under 20 years old. 2 Cure rates are related to the age of the patient and can be 80% to 90% in children. 3 For patients who have relapsed or refractory B-cell ALL, there is no standard treatment approach and outcomes are poor. 1, 2 Treatment options are limited for these patients and include: salvage chemotherapy (potentially with fludarabine- and anthracycline-containing regimens or clofarabine-based regimens); subsequent allogeneic stem (...) Tisagenlecleucel (Kymriah) - treatment of paediatric and young adult patients up to 25 years of age with B-cell acute lymphoblastic leukaemia (ALL) Published 11 February 2019 1 SMC2129 tisagenlecleucel 1.2 x 10 6 – 6 x 10 8 cells dispersion for infusion (Kymriah®) Novartis Pharmaceuticals UK Ltd 11 January 2019 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use
, 2019 The depressing evidence for antidepressants in the elderly Clinical Question: How effective are antidepressants for treating depression in the elderly? Bottom Line: The efficacy of antidepressants in the elderly is inconsistent and may decrease as patients age. From 80% to 40% of elderly patients will recover with antidepressants, with some studies showing no difference from placebo response rates. Harms of antidepressants are common, with ~20% stopping due to adverse effects. Evidence: • 5 (...) Post-hoc analysis: no difference from placebo when limited to studies over age 65. o SSRIs only: 12 RCTs, mean ages 70-79, followed for mostly 8 weeks: 4 ? Response or remission: no difference compared to placebo. o Limitations: Often based on secondary analysis. Context: • Likely no difference in efficacy between TCAs and SSRIs, but adverse-effect withdrawals higher with TCAs (24% versus 17%). 5 • Elderly patients may respond to antidepressants slower than adults, possibly requiring 10-12 weeks
Controlling Nutritional Status (CONUT) Score Predicts Outcomes of Curative Resection for Gastric Cancer in the Elderly Preoperative nutritional status is considered to affect the short-term and long-term outcomes of cancer patients. The clinical value of the controlling nutritional status (CONUT) score in elderly patients undergoing gastrectomy for gastric cancer remains unknown.This study reviewed 211 elderly patients aged 75 years or over who underwent curative resection for gastric cancer (...) from 2000 to 2015. Patients were grouped according to the preoperative CONUT score into those with normal nutrition (75 patients), light malnutrition (100 patients) and moderate or severe malnutrition (36 patients). The predictive value of the CONUT score for postoperative morbidity and survival was assessed.Impaired nutrition was associated with cardiovascular disease (P = 0.012) and chronic kidney disease (P = 0.014), and worsened malnutrition was linked to advanced age (P = 0.004), decreased
External validation and clinical usefulness of first-trimester prediction models for small- and large-for-gestational-age infants: a prospective cohort study To assess the external validity of all published first-trimester prediction models based on routinely collected maternal predictors for the risk of small- and large-for-gestational-age (SGA and LGA) infants. Furthermore, the clinical potential of the best-performing models was evaluated.Multicentre prospective cohort.Thirty-six midwifery (...) practices and six hospitals (in the Netherlands).Pregnant women were recruited at <16 weeks of gestation between 1 July 2013 and 31 December 2015.Prediction models were systematically selected from the literature. Information on predictors was obtained by a web-based questionnaire. Birthweight centiles were corrected for gestational age, parity, fetal sex, and ethnicity.Predictive performance was assessed by means of discrimination (C-statistic) and calibration.The validation cohort consisted of 2582
Does Systemic Administration of Parathyroid Hormone After Noninstrumented Spinal Fusion Surgery Improve Fusion Rates and Fusion Mass in Elderly Patients Compared to Placebo in Patients With Degenerative Lumbar Spondylolisthesis? Prospective, randomized, double-blinded, placebo-controlled clinical trial.To evaluate whether 90-day subcutaneous injections with 20 μg teriparatide increases the volume and quality of the fusion mass compared to placebo based on 12-month postop fine cut computed (...) randomized to receive 90-day subcutaneous injections with 20 μg teriparatide (N = 41) or placebo (N = 46) in a 1:1 fashion. Fusion volume and quality was evaluated using 12-month postoperative fine cut computed tomography scans.The two groups were comparable in terms of age, sex, and numbers of levels operated. PTH treatment was well tolerated but provided no additional benefit versus placebo. Fusion rates, the mean volume, and robustness of the fusion mass were similar between the PTH and placebo
Video-Game-Based Exercises for OlderPeople With Chronic Low Back Pain: A Randomized Controlledtable Trial (GAMEBACK) Video game technology increases adherence to home exercise and could support self-management for olderpeople with chronic low back pain (LBP).The objective was to investigate the effects of home-based video game exercises on pain self-efficacy and care-seeking in olderpeople with chronic LBP.The study was a randomized controlled trial.The setting was a community and waiting (...) with the control group, participants completing Wii Fit U exercises demonstrated significantly greater improvements in pain and function at 8 weeks and were more likely to engage in flexibility exercises at 6 months. There were no significant between-group differences for the remaining outcomes.Participants and therapists were not blinded.Wii Fit U exercises improved pain self-efficacy at 6 months, and pain and function immediately postintervention in olderpeople with chronic LBP, but the clinical importance
Effect of a Biobehavioral Environmental Approach on Disability Among Low-Income Older Adults: A Randomized Clinical Trial Disability among older adults is a strong predictor of health outcomes, health service use, and health care costs. Few interventions have reduced disability among older adults.To determine whether a 10-session, home-based, multidisciplinary program reduces disability.In this randomized clinical trial of 300 low-income community-dwelling adults with a disability in Baltimore (...) , Maryland, between March 18, 2012, and April 29, 2016, 65 years or older, cognitively intact, and with self-reported difficulty with 1 or more activities of daily living (ADLs) or 2 or more instrumental ADLs (IADLs), participants were interviewed in their home at baseline, 5 months (end point), and 12 months (follow-up) by trained research assistants who were masked to the group allocation. Participants were randomized to either the intervention (CAPABLE) group (n = 152) or the attention control group
The electronic frailty index as an indicator of community healthcare service utilisation in the older population olderpeople with frailty are particularly high users of healthcare services, however a lack of standardised recording of frailty in different healthcare electronic datasets has limited investigations into healthcare service usage and demand of the older frail population.to investigate the community service demand of frail patients using the electronic frailty index (eFI (...) ) as a measure of frailty.a retrospective cohort study using anonymised linked healthcare patient data from primary care, community services and acute hospitals in Norfolk.patients aged 65 and over who had an eFI assessment score established in their primary care electronic patient record in Norwich based General Practices.we include data from 22,859 patients with an eFI score. Frailty severity increased with age and was associated with increased acute hospital admission within a 6-month window. Patients