Ling-Ling Zhu, Yan-Hong Wang, Mei-Juan Lan, Quan Zhou
Abstract: Medication reconciliation (MR) is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking in order to identify and resolve medication discrepancies. It is an effective means of risk management to avoid medication errors (eg, omissions, duplication, dosage errors, or drug interactions). Some guidelines explicitly state that MR is a pharmacist-led transition of care; however, there is a shortage of qualified pharmacists to meet the increasing clinical needs, and clinical nurses’ roles have not been clearly described. This paper aimed to enable nurses to gain confidence in contributing to MR at discharge and to make the industry aware of the potential risks if nurses do not actively intervene in this area. A narrative approach was used to introduce experiences in identifying discrepancies and medication errors through MR at discharge in a geriatric ward of an academic medical center hospital in China. The nurses’ main roles in MR involve chasing, checking, and education. Clinical nurses, an untapped hospital resource, can actively engage in MR at discharge if they receive effective training and motivation. Multidisciplinary collaboration at discharge allowed many discrepancies to be reconciled before harming older patients. It is worth conducting further research in MR when discharging older adults, such as the cost-effectiveness of nurses’ efforts, the value of electronic tools and the impact of MR-targeted education and training for nursing students and nursing staff.
{"title":"Exploring the Roles of Nurses in Medication Reconciliation for Older Adults at Hospital Discharge: A Narrative Approach","authors":"Ling-Ling Zhu, Yan-Hong Wang, Mei-Juan Lan, Quan Zhou","doi":"10.2147/cia.s450319","DOIUrl":"https://doi.org/10.2147/cia.s450319","url":null,"abstract":"<strong>Abstract:</strong> Medication reconciliation (MR) is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking in order to identify and resolve medication discrepancies. It is an effective means of risk management to avoid medication errors (eg, omissions, duplication, dosage errors, or drug interactions). Some guidelines explicitly state that MR is a pharmacist-led transition of care; however, there is a shortage of qualified pharmacists to meet the increasing clinical needs, and clinical nurses’ roles have not been clearly described. This paper aimed to enable nurses to gain confidence in contributing to MR at discharge and to make the industry aware of the potential risks if nurses do not actively intervene in this area. A narrative approach was used to introduce experiences in identifying discrepancies and medication errors through MR at discharge in a geriatric ward of an academic medical center hospital in China. The nurses’ main roles in MR involve chasing, checking, and education. Clinical nurses, an untapped hospital resource, can actively engage in MR at discharge if they receive effective training and motivation. Multidisciplinary collaboration at discharge allowed many discrepancies to be reconciled before harming older patients. It is worth conducting further research in MR when discharging older adults, such as the cost-effectiveness of nurses’ efforts, the value of electronic tools and the impact of MR-targeted education and training for nursing students and nursing staff.<br/><br/><strong>Keywords:</strong> hospital discharge, medication reconciliation, multidisciplinary collaboration, older adults, patient safety<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"30 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140037040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Previous research has consistently shown that self-perception of aging (SPA) is an important predictor of health and longevity, while Chinese rural elderly patients with hypertension had poorer SPA. Whether it was associated with their mortality kept unknown. The objective of this study was to investigate the long-term mortality and analyze the association between SPA and this mortality in the specific context of rural elderly patients with hypertension. Patients and Methods: This study is a longitudinal investigation of the mortality in elderly patients with hypertension in rural Suzhou, China. Sociodemographic and clinical data, SPA, and six-year mortality were investigated. We used binary logistic regression and subgroup analyses to assess the effect of SPA at baseline on six-year mortality. Results: A total of 280 hypertensive patients aged 60 years and older participated in the study, of whom 21 died, with a six-year mortality rate of 7.5%. After controlling for covariates, the “Emotional representation” dimension (OR=2.824, 95% CI:1.034– 7.712) in SPA remained a risk factor for death. In subgroup analyses of the group aged 75 years and older, high scores on the “Timeline cyclical” (OR=14.125, 95% CI: 1.258– 158.593) and “Emotional representations” (OR=2.567, 95% CI:1.066– 6.182) dimensions were associated with a higher risk of death, while weekly nut intake may have mitigated the negative SPA effect on mortality. Conclusion: Poorer self-perception of aging was associated with a high risk of mortality in rural elderly patients with hypertension, while the habit of weekly nut intake might help reduce this risk in the group aged 75 years or older.
{"title":"Association Between Self-Perception of Aging and Long-Term Mortality in Elderly Patients with Hypertension in Rural China: A Possible Beneficial Effect of Nut Intake","authors":"Anping Lu, Fangyi Yu, Xiaohan Tan, Xiaohong Jin, Xiaohua Wang, Wenya Wu","doi":"10.2147/cia.s445378","DOIUrl":"https://doi.org/10.2147/cia.s445378","url":null,"abstract":"<strong>Purpose:</strong> Previous research has consistently shown that self-perception of aging (SPA) is an important predictor of health and longevity, while Chinese rural elderly patients with hypertension had poorer SPA. Whether it was associated with their mortality kept unknown. The objective of this study was to investigate the long-term mortality and analyze the association between SPA and this mortality in the specific context of rural elderly patients with hypertension.<br/><strong>Patients and Methods:</strong> This study is a longitudinal investigation of the mortality in elderly patients with hypertension in rural Suzhou, China. Sociodemographic and clinical data, SPA, and six-year mortality were investigated. We used binary logistic regression and subgroup analyses to assess the effect of SPA at baseline on six-year mortality.<br/><strong>Results:</strong> A total of 280 hypertensive patients aged 60 years and older participated in the study, of whom 21 died, with a six-year mortality rate of 7.5%. After controlling for covariates, the “Emotional representation” dimension (<em>OR</em>=2.824, 95% CI:1.034– 7.712) in SPA remained a risk factor for death. In subgroup analyses of the group aged 75 years and older, high scores on the “Timeline cyclical” (<em>OR</em>=14.125, 95% CI: 1.258– 158.593) and “Emotional representations” (<em>OR</em>=2.567, 95% CI:1.066– 6.182) dimensions were associated with a higher risk of death, while weekly nut intake may have mitigated the negative SPA effect on mortality.<br/><strong>Conclusion:</strong> Poorer self-perception of aging was associated with a high risk of mortality in rural elderly patients with hypertension, while the habit of weekly nut intake might help reduce this risk in the group aged 75 years or older.<br/><br/><strong>Keywords:</strong> China, hypertension, mortality, rural population, self-perception<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"42 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140026061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Schwesinger, Li-Tang Tsai, Wei Lang, Noemi Mantegazza, Robert Bauernschmitt, Markus Johannes Wilhelm, Heike Annette Bischoff-Ferrari, Michael Gagesch
Purpose: Postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) is frequent in older adults and associated with multiple negative outcomes including a higher mortality. We aimed to investigate whether a comprehensive geriatric assessment (CGA) prior to TAVI reduces the odds of POD and results in a positive change in self-care ability, intended to lay a foundation for future geriatric comanagement. Patients and methods: We used a retrospective, single-center study with a quasi-experimental design enrolling patients aged 70 years and older undergoing CGA before elective TAVI, and a nonrandomized comparison group without preoperative CGA. Data on POD occurrence during the first 5 days after TAVI (primary outcome) and change in self-care ability index (SPI) between admission and discharge (secondary outcome) were collected from electronic health records and CGA data (exposure) by clinical assessment. To explore associations between (1) CGA and POD, and (2) CGA and SPI, multivariate logistic regression and linear regression models were applied adjusting for age, sex, BMI, and number of medications. Results: Among 435 patients (mean age 81.0 ± 5.6 years, 43.6% women, median [IQR] SPI at baseline 40 [39, 40] points), POD incidence was 14.3% in the CGA group vs 18.8% in the non-CGA group (P 0.219). Undergoing CGA before TAVI was not associated with the odds for POD (OR: 1.15; 95%CI: 0.65– 2.04) or improved SPI (P 0.073). Conclusion: We observed no association of CGA prior to TAVI with POD incidence or postoperative self-care, highlighting the need for additional studies investigating the effect of POD preventive measures in older TAVI patients integrated into a comprehensive geriatric comanagement program.
{"title":"Does Comprehensive Geriatric Assessment Reduce the Incidence of Postoperative Delirium? A Quasi-experimental Study in Older Adults Undergoing Transcatheter Aortic Valve Implantation","authors":"Anna Schwesinger, Li-Tang Tsai, Wei Lang, Noemi Mantegazza, Robert Bauernschmitt, Markus Johannes Wilhelm, Heike Annette Bischoff-Ferrari, Michael Gagesch","doi":"10.2147/cia.s448167","DOIUrl":"https://doi.org/10.2147/cia.s448167","url":null,"abstract":"<strong>Purpose:</strong> Postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) is frequent in older adults and associated with multiple negative outcomes including a higher mortality. We aimed to investigate whether a comprehensive geriatric assessment (CGA) prior to TAVI reduces the odds of POD and results in a positive change in self-care ability, intended to lay a foundation for future geriatric comanagement.<br/><strong>Patients and methods:</strong> We used a retrospective, single-center study with a quasi-experimental design enrolling patients aged 70 years and older undergoing CGA before elective TAVI, and a nonrandomized comparison group without preoperative CGA. Data on POD occurrence during the first 5 days after TAVI (primary outcome) and change in self-care ability index (SPI) between admission and discharge (secondary outcome) were collected from electronic health records and CGA data (exposure) by clinical assessment. To explore associations between (1) CGA and POD, and (2) CGA and SPI, multivariate logistic regression and linear regression models were applied adjusting for age, sex, BMI, and number of medications.<br/><strong>Results:</strong> Among 435 patients (mean age 81.0 ± 5.6 years, 43.6% women, median [IQR] SPI at baseline 40 [39, 40] points), POD incidence was 14.3% in the CGA group vs 18.8% in the non-CGA group (<em>P</em> 0.219). Undergoing CGA before TAVI was not associated with the odds for POD (OR: 1.15; 95%CI: 0.65– 2.04) or improved SPI (<em>P</em> 0.073).<br/><strong>Conclusion:</strong> We observed no association of CGA prior to TAVI with POD incidence or postoperative self-care, highlighting the need for additional studies investigating the effect of POD preventive measures in older TAVI patients integrated into a comprehensive geriatric comanagement program.<br/><br/><strong>Keywords:</strong> POPS, frail older adults, perioperative care, aortic stenosis, TAVI, delirium<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"39 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140008166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Guangcai Shao, Xiang Li, Meiyue Da, Xiaochuan Huo, Shuheng Zhang
Background and Purpose: Studies on outcome comparison after endovascular treatment (EVT) for large vessel occlusion (LVO) between large artery atherosclerosis (LAA) and cardioembolism (CE) in the Asian population are scarce. We aimed to compare the baseline characteristics and clinical outcomes after EVT for anterior circulation LVO with LAA and CE in the Chinese population. Methods: Patients were selected from the ANGEL registry and divided into LAA and CE groups. The primary outcome was the 90-day modified Rankin Scale (mRS) 0– 2. The secondary outcomes were 90-day mRS distribution, 90-day mRS 0– 1, 90-day mRS 0– 3, and early neurological improvement. The safety outcomes included death, symptomatic intracranial hemorrhage, and any intracranial hemorrhage. We conducted logistic regression models with adjustments to compare the outcomes. Results: A total of 632 patients were included, of whom, 488 were in the LAA group and 144 were in the CE group. No significant difference in 90-day mRS 0– 2 was observed between LAA and CE groups (55.7%vs.43.1%, odds ratio[OR] 1.19, 95% confidence interval(CI), 0.92– 1.53, P=0.190). The LAA group exhibited a higher frequency of mRS 0– 3 compared to the CE group (69.1% vs 32.6%, OR1.32, 95% CI 1.02– 1.72, P=0.038). However, the incidence of death within 90 days did not significantly differ between the LAA and CE groups (10.9%vs.24.3%, OR0.91, 95% CI0.66– 1.25, P=0.545), nor did the occurrences of symptomatic intracranial hemorrhage(SICH) (4.5%vs.9.7%,OR1.08, 95% CI 0.65– 1.78, P=0.779) or intracranial hemorrhage(ICH) (21.9%vs.30.6%, OR 0.94, 95% CI0.71– 1.25, P=0.680). Moreover, no significant disparities were detected in other outcomes between the two groups (All P> 0.05). Conclusion: In the ANGEL registry, a higher prevalence of patients undergoing EVT for acute anterior circulation LVO with LAA was found than those with CE. However, our study revealed that the efficacy and safety of EVT remained consistent regardless of the stroke’s etiology such as LAA or CE.
Keywords: large vessel occlusion, endovascular treatment, large artery atherosclerosis, cardioembolism
背景和目的：关于亚洲人群大动脉粥样硬化（LAA）和心栓塞（CE）大血管闭塞（LVO）血管内治疗（EVT）后疗效比较的研究很少。我们旨在比较中国人群前循环 LVO 伴 LAA 和 CE EVT 的基线特征和临床结果：方法：从ANGEL登记处选取患者，分为LAA组和CE组。主要结果为90天改良Rankin量表（mRS）0- 2。次要结局为 90 天 mRS 分布、90 天 mRS 0- 1、90 天 mRS 0- 3 和早期神经功能改善。安全性结果包括死亡、症状性颅内出血和任何颅内出血。我们采用调整后的逻辑回归模型对结果进行了比较：共纳入632名患者，其中LAA组488人，CE组144人。LAA 组和 CE 组 90 天 mRS 0- 2 无明显差异（55.7%vs.43.1%，比值比[OR]1.19，95% 置信区间(CI)，0.92- 1.53，P=0.190）。与CE组相比，LAA组出现mRS 0- 3的频率更高（69.1%对32.6%，OR1.32，95% CI 1.02- 1.72，P=0.038）。然而，LAA 组和 CE 组 90 天内死亡的发生率没有明显差异（10.9% 对 24.3%，OR0.91，95% CI0.66-1.25，P=0.545），症状性颅内出血（SICH）的发生率也没有明显差异（4.5% 对 9..7%，OR1.08，95% CI 0.65-1.78，P=0.779）或颅内出血（ICH）（21.9% 对 30.6%，OR 0.94，95% CI 0.71-1.25，P=0.680）。此外，两组患者在其他结果方面没有发现明显差异（所有P> 0.05）：结论：在ANGEL登记中发现，因急性前循环LVO合并LAA而接受EVT治疗的患者发病率高于合并CE的患者。然而，我们的研究显示，无论卒中的病因是 LAA 还是 CE，EVT 的有效性和安全性都是一致的。
{"title":"Outcome Comparison of Endovascular Treatment for Acute Large Vessel Occlusion Due to Large Artery Atherosclerosis and Cardioembolism in the Chinese Population: Data from the ANGEL Registry","authors":"Guangcai Shao, Xiang Li, Meiyue Da, Xiaochuan Huo, Shuheng Zhang","doi":"10.2147/cia.s442339","DOIUrl":"https://doi.org/10.2147/cia.s442339","url":null,"abstract":"<strong>Background and Purpose:</strong> Studies on outcome comparison after endovascular treatment (EVT) for large vessel occlusion (LVO) between large artery atherosclerosis (LAA) and cardioembolism (CE) in the Asian population are scarce. We aimed to compare the baseline characteristics and clinical outcomes after EVT for anterior circulation LVO with LAA and CE in the Chinese population.<br/><strong>Methods:</strong> Patients were selected from the ANGEL registry and divided into LAA and CE groups. The primary outcome was the 90-day modified Rankin Scale (mRS) 0– 2. The secondary outcomes were 90-day mRS distribution, 90-day mRS 0– 1, 90-day mRS 0– 3, and early neurological improvement. The safety outcomes included death, symptomatic intracranial hemorrhage, and any intracranial hemorrhage. We conducted logistic regression models with adjustments to compare the outcomes.<br/><strong>Results:</strong> A total of 632 patients were included, of whom, 488 were in the LAA group and 144 were in the CE group. No significant difference in 90-day mRS 0– 2 was observed between LAA and CE groups (55.7%vs.43.1%, odds ratio[OR] 1.19, 95% confidence interval(CI), 0.92– 1.53, P=0.190). The LAA group exhibited a higher frequency of mRS 0– 3 compared to the CE group (69.1% vs 32.6%, OR1.32, 95% CI 1.02– 1.72, P=0.038). However, the incidence of death within 90 days did not significantly differ between the LAA and CE groups (10.9%vs.24.3%, OR0.91, 95% CI0.66– 1.25, P=0.545), nor did the occurrences of symptomatic intracranial hemorrhage(SICH) (4.5%vs.9.7%,OR1.08, 95% CI 0.65– 1.78, P=0.779) or intracranial hemorrhage(ICH) (21.9%vs.30.6%, OR 0.94, 95% CI0.71– 1.25, P=0.680). Moreover, no significant disparities were detected in other outcomes between the two groups (All P> 0.05).<br/><strong>Conclusion:</strong> In the ANGEL registry, a higher prevalence of patients undergoing EVT for acute anterior circulation LVO with LAA was found than those with CE. However, our study revealed that the efficacy and safety of EVT remained consistent regardless of the stroke’s etiology such as LAA or CE.<br/><br/><strong>Keywords:</strong> large vessel occlusion, endovascular treatment, large artery atherosclerosis, cardioembolism<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"48 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139967471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chenyu Tang, Ping Lin, Yige Zhao, Panpan Wang, Ping Wang
Purpose: To summarize the clinical, histopathological and therapeutic features of senile gluteal dermatosis. Patients and Methods: Retrospective analysis of 230 cases who visited the outpatient clinic of Hangzhou No. 3 People’s Hospital for skin lesions on the buttocks and hips from 2018.8– 2023.8 were included in the study, basic clinical information was collected, and they were subjected to physical examination of the buttocks and hips, and 36 cases were senile gluteal dermatosis, of which 7 underwent histopathological biopsy. Results: A total of 230 patients were included, of which 36 were diagnosed with geriatric buttock dermatosis, with a mean age of (84.2± 12.6) years, mean body mass index of (21.7± 3.8) kg/m2, and a male to female ratio of 2:1. There was a significant correlation between the occurrence of the disease and age, gender, body mass index, sedentary time, type of chair used, and hypertension (P< 0.05). The severity of the lesions may be associated with longer sitting time and prolonged use of bamboo chairs (P< 0.05). Histopathologic changes were not specific. The skin lesions could subside after general treatment such as improvement of lifestyle, use of pressure-reducing air mattresses, salicylic acid cream, and moisturizing creams. Conclusion: Senile gluteal dermatosis is a common senile physical dermatosis, mainly manifested as brownish scaly plaques, erythema and crusted ulcers, which can often be cured under reasonable treatment.
{"title":"A Retrospective Study: Clinical Characteristics and Lifestyle Analysis of Chinese Senile Gluteal Dermatosis Patients","authors":"Chenyu Tang, Ping Lin, Yige Zhao, Panpan Wang, Ping Wang","doi":"10.2147/cia.s448026","DOIUrl":"https://doi.org/10.2147/cia.s448026","url":null,"abstract":"<strong>Purpose:</strong> To summarize the clinical, histopathological and therapeutic features of senile gluteal dermatosis.<br/><strong>Patients and Methods:</strong> Retrospective analysis of 230 cases who visited the outpatient clinic of Hangzhou No. 3 People’s Hospital for skin lesions on the buttocks and hips from 2018.8– 2023.8 were included in the study, basic clinical information was collected, and they were subjected to physical examination of the buttocks and hips, and 36 cases were senile gluteal dermatosis, of which 7 underwent histopathological biopsy.<br/><strong>Results:</strong> A total of 230 patients were included, of which 36 were diagnosed with geriatric buttock dermatosis, with a mean age of (84.2± 12.6) years, mean body mass index of (21.7± 3.8) kg/m2, and a male to female ratio of 2:1. There was a significant correlation between the occurrence of the disease and age, gender, body mass index, sedentary time, type of chair used, and hypertension (P< 0.05). The severity of the lesions may be associated with longer sitting time and prolonged use of bamboo chairs (P< 0.05). Histopathologic changes were not specific. The skin lesions could subside after general treatment such as improvement of lifestyle, use of pressure-reducing air mattresses, salicylic acid cream, and moisturizing creams.<br/><strong>Conclusion:</strong> Senile gluteal dermatosis is a common senile physical dermatosis, mainly manifested as brownish scaly plaques, erythema and crusted ulcers, which can often be cured under reasonable treatment.<br/><br/><strong>Keywords:</strong> skin diseases, physical, gluteal dermatosis, pressure injury, friction<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"51 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139967740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Research in sarcopenia has grown exponentially over the last 15 years in geriatrics and gerontology, as well as other specialties, including oncology and hepatology. There is now strong evidence for the role of resistance exercise to prevent declines in muscle strength and function, especially when combined with nutritional optimization with protein supplementation. However, there remains a disparity between research evidence and clinical practice. There are multiple factors for this, which relate to the current diagnostic criteria for sarcopenia, practical and logistical aspects of diagnosis of sarcopenia, clinician knowledge of both diagnosis and management, and the availability of pathways for interventions. Sarcopenia is currently defined based on the identification of muscle strength, in combination with muscle size or quality, below cut-off thresholds at a single timepoint. This defines sarcopenia as a binary process of either present or not present, thus early diagnosis can be challenging. In this article, we summarize current obstacles to early diagnosis and management of sarcopenia in clinical practice, and make recommendations to how these might be overcome. This includes our recommendation of incorporation of handgrip strength measurement into standard care, to enable dynamic assessment and identification of early declines in handgrip strength, so that interventions can be implemented to prevent disability.
{"title":"Obstacles to the Early Diagnosis and Management of Sarcopenia: Current Perspectives","authors":"Hoyli Ooi, Carly Welch","doi":"10.2147/cia.s438144","DOIUrl":"https://doi.org/10.2147/cia.s438144","url":null,"abstract":"<strong>Abstract:</strong> Research in sarcopenia has grown exponentially over the last 15 years in geriatrics and gerontology, as well as other specialties, including oncology and hepatology. There is now strong evidence for the role of resistance exercise to prevent declines in muscle strength and function, especially when combined with nutritional optimization with protein supplementation. However, there remains a disparity between research evidence and clinical practice. There are multiple factors for this, which relate to the current diagnostic criteria for sarcopenia, practical and logistical aspects of diagnosis of sarcopenia, clinician knowledge of both diagnosis and management, and the availability of pathways for interventions. Sarcopenia is currently defined based on the identification of muscle strength, in combination with muscle size or quality, below cut-off thresholds at a single timepoint. This defines sarcopenia as a binary process of either present or not present, thus early diagnosis can be challenging. In this article, we summarize current obstacles to early diagnosis and management of sarcopenia in clinical practice, and make recommendations to how these might be overcome. This includes our recommendation of incorporation of handgrip strength measurement into standard care, to enable dynamic assessment and identification of early declines in handgrip strength, so that interventions can be implemented to prevent disability.<br/><br/><strong>Keywords:</strong> EWGSOP2, dynamic change, handgrip strength, implementation, exercise<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"10 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139909831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Contrast-associated acute kidney injury (CA-AKI) is a prevalent complication following coronary angiography (CAG). However, there is ongoing controversy surrounding its precise definition. Although previous studies have demonstrated the successful application of appropriate definitions in managing high-risk CA-AKI patients, there remains limited research on the association between different definitions and prognosis specifically in patients with chronic kidney disease (CKD). Methods: A total of 4197 CKD patients undergoing coronary angiography (CAG) were included in this study. Two definitions of contrast-associated acute kidney injury (CA-AKI) were used: CA-AKIA, which was defined as an increase of ≥ 0.5 mg/dL or > 25% in serum creatinine (SCr) from baseline within 72 hours after CAG, and CA-AKIB, which was defined as an increase of ≥ 0.3 mg/dL or > 50% in SCr from baseline within 48 hours after CAG. Cox regression analysis was employed to assess the association between these two definitions and long-term mortality. Additionally, population attributable risks (PARs) were calculated to evaluate the impact of CA-AKI definitions on long-term prognosis. Results: During the median follow-up period of 4.70 (2.50– 7.78) years, the overall long-term mortality was 23.6%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 33.5% and 33.8%, respectively. We found that CA-AKIA (HR: 1.45, 95% CI: 1.23– 1.70, p< 0.001) and CA-AKIB (HR: 1.44, 95% CI: 1.23– 1.69, p< 0.001) were associated with long-term mortality. The PARs were the highest for CA-AKIA (5.87%), followed by CA-AKIB (5.70%). Conclusion: Contrast-associated acute kidney injury (CA-AKI) is a frequently observed complication in CKD patients undergoing coronary angiography (CAG), and both definitions of CA-AKI are significantly correlated with a poor long-term prognosis. Consequently, in the clinical management of CKD patients, it is crucial to prioritize CA-AKI, irrespective of the specific CA-AKI definition used.
{"title":"A Comparison Between Two Different Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Patients with Chronic Kidney Disease Undergoing Coronary Angiography","authors":"Wenwei Feng, Jiancong Zhou, Zhubin Lun, Dianhua Zhou, Peiwen Li, Jianfeng Ye","doi":"10.2147/cia.s452882","DOIUrl":"https://doi.org/10.2147/cia.s452882","url":null,"abstract":"<strong>Background:</strong> Contrast-associated acute kidney injury (CA-AKI) is a prevalent complication following coronary angiography (CAG). However, there is ongoing controversy surrounding its precise definition. Although previous studies have demonstrated the successful application of appropriate definitions in managing high-risk CA-AKI patients, there remains limited research on the association between different definitions and prognosis specifically in patients with chronic kidney disease (CKD).<br/><strong>Methods:</strong> A total of 4197 CKD patients undergoing coronary angiography (CAG) were included in this study. Two definitions of contrast-associated acute kidney injury (CA-AKI) were used: CA-AKI<sub>A</sub>, which was defined as an increase of ≥ 0.5 mg/dL or > 25% in serum creatinine (SCr) from baseline within 72 hours after CAG, and CA-AKI<sub>B</sub>, which was defined as an increase of ≥ 0.3 mg/dL or > 50% in SCr from baseline within 48 hours after CAG. Cox regression analysis was employed to assess the association between these two definitions and long-term mortality. Additionally, population attributable risks (PARs) were calculated to evaluate the impact of CA-AKI definitions on long-term prognosis.<br/><strong>Results:</strong> During the median follow-up period of 4.70 (2.50– 7.78) years, the overall long-term mortality was 23.6%, and the long-term mortality in patients with CA-AKI according to both CA-AKI<sub>A</sub> and CA-AKI<sub>B</sub> criteria were 33.5% and 33.8%, respectively. We found that CA-AKI<sub>A</sub> (HR: 1.45, 95% CI: 1.23– 1.70, p< 0.001) and CA-AKI<sub>B</sub> (HR: 1.44, 95% CI: 1.23– 1.69, p< 0.001) were associated with long-term mortality. The PARs were the highest for CA-AKI<sub>A</sub> (5.87%), followed by CA-AKI<sub>B</sub> (5.70%).<br/><strong>Conclusion:</strong> Contrast-associated acute kidney injury (CA-AKI) is a frequently observed complication in CKD patients undergoing coronary angiography (CAG), and both definitions of CA-AKI are significantly correlated with a poor long-term prognosis. Consequently, in the clinical management of CKD patients, it is crucial to prioritize CA-AKI, irrespective of the specific CA-AKI definition used.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"177 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139922775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ying Wang, Yu Yi, Fan Zhang, Yuan-Yuan Yao, Yue-Xiu Chen, Chao-Min Wu, Rui-Yu Wang, Min Yan
Background: The lung ultrasound score was developed for rapidly assessing the extent of lung ventilation, and it can predict failure to wean various types of patients off mechanical ventilation. Whether it is also effective for COVID-19 patients is unclear. Methods: This single-center, prospective, observational study was conducted to assess the ability of the 12-region lung ultrasound score to predict failure to wean COVID-19 patients off ventilation. In parallel, we assessed whether right hemidiaphragmatic excursion or previously published predictors of weaning failure can apply to these patients. Predictive ability was assessed in terms of the area under the receiver operating characteristic curve (AUC). Results: The mean age of the 35 patients in the study was (75 ± 9) years and 12 patients (37%) could not be weaned off mechanical ventilation. The lung ultrasound score predicted these failures with an AUC of 0.885 (95% CI 0.770– 0.999, p < 0.001), and a threshold score of 10 provided specificity of 72.7% and sensitivity of 92.3%. AUCs were lower for previously published predictors of weaning failure, and right hemidiaphragmatic excursion did not differ significantly between the two groups. Conclusion: The lung ultrasound score can accurately predict failure to wean critically ill COVID-19 patients off mechanical ventilation, whereas assessment of right hemidiaphragmatic excursion does not appear helpful in this regard. Trial Registration:https://clinicaltrials.gov/ct2/show/NCT05706441.
{"title":"Lung Ultrasound Score as a Predictor of Failure to Wean COVID-19 Elderly Patients off Mechanical Ventilation: A Prospective Observational Study","authors":"Ying Wang, Yu Yi, Fan Zhang, Yuan-Yuan Yao, Yue-Xiu Chen, Chao-Min Wu, Rui-Yu Wang, Min Yan","doi":"10.2147/cia.s438714","DOIUrl":"https://doi.org/10.2147/cia.s438714","url":null,"abstract":"<strong>Background:</strong> The lung ultrasound score was developed for rapidly assessing the extent of lung ventilation, and it can predict failure to wean various types of patients off mechanical ventilation. Whether it is also effective for COVID-19 patients is unclear.<br/><strong>Methods:</strong> This single-center, prospective, observational study was conducted to assess the ability of the 12-region lung ultrasound score to predict failure to wean COVID-19 patients off ventilation. In parallel, we assessed whether right hemidiaphragmatic excursion or previously published predictors of weaning failure can apply to these patients. Predictive ability was assessed in terms of the area under the receiver operating characteristic curve (AUC).<br/><strong>Results:</strong> The mean age of the 35 patients in the study was (75 ± 9) years and 12 patients (37%) could not be weaned off mechanical ventilation. The lung ultrasound score predicted these failures with an AUC of 0.885 (95% CI 0.770– 0.999, <em>p</em> < 0.001), and a threshold score of 10 provided specificity of 72.7% and sensitivity of 92.3%. AUCs were lower for previously published predictors of weaning failure, and right hemidiaphragmatic excursion did not differ significantly between the two groups.<br/><strong>Conclusion:</strong> The lung ultrasound score can accurately predict failure to wean critically ill COVID-19 patients off mechanical ventilation, whereas assessment of right hemidiaphragmatic excursion does not appear helpful in this regard.<br/><strong>Trial Registration:</strong> <u>https://clinicaltrials.gov/ct2/show/NCT05706441</u>.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"235 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139922722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiang Zhou, Yanlin Wan, Le Ma, Liang Dong, Weijian Yuan
Purpose: The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded. Results: The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p< 0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p< 0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p< 0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p< 0.01). Conclusion: Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
目的：本研究旨在比较经皮弧形椎体成形术（PCVP）和双侧经皮椎体后凸成形术（PKP）在治疗骨质疏松性椎体压缩骨折（OVCF）中的骨水泥椎体再骨折率：将94例单节段胸腰椎OVCF患者随机分为两组（每组47例），分别接受PCVP或双侧PKP手术。记录骨水泥椎体折断、骨水泥注射量和骨水泥形态、骨水泥渗漏率、手术总时间、术中透视时间、术前术后 Cobb 角和椎体前高度、Oswestry 残疾指数问卷（ODI）和视觉模拟量表（VAS）：结果：PCVP 组的骨水泥椎体骨折发生率明显低于双侧 PKP 组（p< 0.05）。两组术后 VAS 评分和 ODI 均有明显改善（P< 0.01），两组间无明显差异。PCVP 组的手术时间和术中透视时间明显少于双侧 PKP 组（p< 0.01）。PCVP组的平均后凸角矫正和椎体高度恢复明显少于双侧PKP组（p< 0.01）：PCVP和PKP都是治疗OVCF安全有效的方法。关键词：骨质疏松症；骨质疏松性椎体压缩骨折；经皮弧形椎体成形术；经皮椎体后凸成形术
{"title":"Percutaneous Curved Vertebroplasty Decrease the Risk of Cemented Vertebra Refracture Compared with Bilateral Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures","authors":"Qiang Zhou, Yanlin Wan, Le Ma, Liang Dong, Weijian Yuan","doi":"10.2147/cia.s438036","DOIUrl":"https://doi.org/10.2147/cia.s438036","url":null,"abstract":"<strong>Purpose:</strong> The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF).<br/><strong>Methods:</strong> Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded.<br/><strong>Results:</strong> The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p< 0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p< 0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p< 0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p< 0.01).<br/><strong>Conclusion:</strong> Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.<br/><br/><strong>Keywords:</strong> osteoporosis, osteoporotic vertebral compression fractures, percutaneous curved vertebroplasty, percutaneous kyphoplasty<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"36 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139761716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xin Xue, Li-Bo Zhao, Zhe Zhao, Wei-Hao Xu, Wei-Meng Cai, Shao-Hua Chen, Tian-Jiao Li, Ting-Yu Nie, Dong Rui, Xiao-Shun Qian, Lin Liu
Background: The concomitant rise in the prevalence of obstructive sleep apnea (OSA) and frailty among the elderly population has been linked to an increase in mortality rates. Despite continuous positive airway pressure (CPAP) being the gold standard treatment for OSA, its impact on incident frailty remains inadequately explored. Methods: In this cohort study, we analyzed data from 1290 patients diagnosed with OSA, aged 60 years and older. A subset of 71 patients who demonstrated high adherence to CPAP therapy were categorized as the CPAP group. Propensity score matching (PSM) was employed at a 1:4 ratio, matching for variables such as age, gender, body mass index (BMI), and sleep apnea-hypopnea index (AHI), to establish a non-CPAP group for comparison. The FRAIL scale was utilized to evaluate the frailty status of participants. Logistic regression analysis examined the relationship between CPAP therapy and incident frailty, as well as its individual components, in elderly patients with OSA. Results: During a median follow-up period of 52 months, incident frailty was observed in 70 patients (19.7%). Patients with OSA receiving CPAP therapy exhibited a lower incidence of frailty compared to those not receiving CPAP (11.26% vs 21.83%, P=0.045). In the multivariate model, CPAP therapy was significantly correlated with a reduced risk of incident frailty (OR = 0.36, 95% CI, 0.15– 0.88; P = 0.025). Subcomponent analyses revealed that CPAP was associated with a lower risk of fatigue (OR=0.35, 95% CI, 0.19– 0.63; P < 0.001), resistance (OR = 0.32, 95% CI, 0.14– 0.74; P=0.008), and weight loss (OR = 0.38, 95% CI, 0.19– 0.75; P = 0.007). Conclusion: CPAP therapy was associated with a reduced risk of incident frailty among elderly patients with OSA.
背景：阻塞性睡眠呼吸暂停（OSA）发病率和老年人体质虚弱的同时上升与死亡率的上升有关。尽管持续气道正压（CPAP）是治疗 OSA 的金标准，但其对体弱事件的影响仍未得到充分探讨：在这项队列研究中，我们分析了 1290 名 60 岁及以上确诊为 OSA 患者的数据。其中，71 名高度坚持使用 CPAP 治疗的患者被归入 CPAP 组。我们采用倾向得分匹配法（PSM），将年龄、性别、体重指数（BMI）和睡眠呼吸暂停-低通气指数（AHI）等变量按 1:4 的比例进行匹配，以建立非 CPAP 组进行比较。FRAIL 量表用于评估参与者的虚弱状况。逻辑回归分析检验了 CPAP 治疗与老年 OSA 患者的虚弱状况及其各个组成部分之间的关系：结果：在中位 52 个月的随访期间，70 名患者（19.7%）出现了虚弱症状。接受 CPAP 治疗的 OSA 患者与未接受 CPAP 治疗的患者相比，虚弱发生率较低（11.26% vs 21.83%，P=0.045）。在多变量模型中，CPAP 治疗与虚弱发生风险的降低显著相关（OR = 0.36，95% CI，0.15- 0.88；P = 0.025）。子成分分析显示，CPAP 与疲劳（OR=0.35，95% CI，0.19- 0.63；P <；0.001）、抵抗（OR=0.32，95% CI，0.14- 0.74；P=0.008）和体重减轻（OR=0.38，95% CI，0.19- 0.75；P=0.007）的风险降低相关：CPAP疗法可降低老年OSA患者出现虚弱的风险。
{"title":"Effect of Continuous Positive Airway Pressure on Incident Frailty in Elderly Patients with Obstructive Sleep Apnea: A Study Based on Propensity Score Matching","authors":"Xin Xue, Li-Bo Zhao, Zhe Zhao, Wei-Hao Xu, Wei-Meng Cai, Shao-Hua Chen, Tian-Jiao Li, Ting-Yu Nie, Dong Rui, Xiao-Shun Qian, Lin Liu","doi":"10.2147/cia.s446129","DOIUrl":"https://doi.org/10.2147/cia.s446129","url":null,"abstract":"<strong>Background:</strong> The concomitant rise in the prevalence of obstructive sleep apnea (OSA) and frailty among the elderly population has been linked to an increase in mortality rates. Despite continuous positive airway pressure (CPAP) being the gold standard treatment for OSA, its impact on incident frailty remains inadequately explored.<br/><strong>Methods:</strong> In this cohort study, we analyzed data from 1290 patients diagnosed with OSA, aged 60 years and older. A subset of 71 patients who demonstrated high adherence to CPAP therapy were categorized as the CPAP group. Propensity score matching (PSM) was employed at a 1:4 ratio, matching for variables such as age, gender, body mass index (BMI), and sleep apnea-hypopnea index (AHI), to establish a non-CPAP group for comparison. The FRAIL scale was utilized to evaluate the frailty status of participants. Logistic regression analysis examined the relationship between CPAP therapy and incident frailty, as well as its individual components, in elderly patients with OSA.<br/><strong>Results:</strong> During a median follow-up period of 52 months, incident frailty was observed in 70 patients (19.7%). Patients with OSA receiving CPAP therapy exhibited a lower incidence of frailty compared to those not receiving CPAP (11.26% vs 21.83%, <em>P</em>=0.045). In the multivariate model, CPAP therapy was significantly correlated with a reduced risk of incident frailty (OR = 0.36, 95% CI, 0.15– 0.88; <em>P</em> = 0.025). Subcomponent analyses revealed that CPAP was associated with a lower risk of fatigue (OR=0.35, 95% CI, 0.19– 0.63; <em>P</em> < 0.001), resistance (OR = 0.32, 95% CI, 0.14– 0.74; <em>P</em>=0.008), and weight loss (OR = 0.38, 95% CI, 0.19– 0.75; <em>P</em> = 0.007).<br/><strong>Conclusion:</strong> CPAP therapy was associated with a reduced risk of incident frailty among elderly patients with OSA.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139761710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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