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Nature Medicine Feb 2024Alzheimer's disease (AD) is characterized pathologically by amyloid-beta (Aβ) deposition in brain parenchyma and blood vessels (as cerebral amyloid angiopathy (CAA))...
Alzheimer's disease (AD) is characterized pathologically by amyloid-beta (Aβ) deposition in brain parenchyma and blood vessels (as cerebral amyloid angiopathy (CAA)) and by neurofibrillary tangles of hyperphosphorylated tau. Compelling genetic and biomarker evidence supports Aβ as the root cause of AD. We previously reported human transmission of Aβ pathology and CAA in relatively young adults who had died of iatrogenic Creutzfeldt-Jakob disease (iCJD) after childhood treatment with cadaver-derived pituitary growth hormone (c-hGH) contaminated with both CJD prions and Aβ seeds. This raised the possibility that c-hGH recipients who did not die from iCJD may eventually develop AD. Here we describe recipients who developed dementia and biomarker changes within the phenotypic spectrum of AD, suggesting that AD, like CJD, has environmentally acquired (iatrogenic) forms as well as late-onset sporadic and early-onset inherited forms. Although iatrogenic AD may be rare, and there is no suggestion that Aβ can be transmitted between individuals in activities of daily life, its recognition emphasizes the need to review measures to prevent accidental transmissions via other medical and surgical procedures. As propagating Aβ assemblies may exhibit structural diversity akin to conventional prions, it is possible that therapeutic strategies targeting disease-related assemblies may lead to selection of minor components and development of resistance.
Topics: Young Adult; Humans; Child; Alzheimer Disease; Growth Hormone; Amyloid beta-Peptides; Creutzfeldt-Jakob Syndrome; Cerebral Amyloid Angiopathy; Brain; Prions; Cadaver; Iatrogenic Disease; Biomarkers
PubMed: 38287166
DOI: 10.1038/s41591-023-02729-2 -
JAMA Apr 2024Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures. (Review)
Review
IMPORTANCE
Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.
OBSERVATIONS
Falls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.
CONCLUSIONS AND RELEVANCE
More than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.
Topics: Aged; Aged, 80 and over; Humans; Accidental Falls; Exercise; Independent Living; Postural Balance; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Meta-Analysis as Topic; United States; Male; Female; Middle Aged
PubMed: 38536167
DOI: 10.1001/jama.2024.1416 -
Ugeskrift For Laeger Oct 2023According to the International Life Saving Federation (ILS), integrating lifeguards in the local or regional emergency medical service (EMS) is a necessity to prevent... (Review)
Review
According to the International Life Saving Federation (ILS), integrating lifeguards in the local or regional emergency medical service (EMS) is a necessity to prevent drowning and improve prehospital treatment in selected situations. This review describes the organisation of lifeguards in Denmark, focusing on essential skills and equipment to assist prehospital EMS in drowning, out-of-hospital cardiac arrest, and search and rescue operations. Standardised requirements for the medical education of lifeguards are warranted to improve prehospital treatment and integration in the EMS.
Topics: Humans; Drowning; Emergency Medical Services; Cardiopulmonary Resuscitation; Out-of-Hospital Cardiac Arrest; Denmark
PubMed: 37873984
DOI: No ID Found -
National Vital Statistics Reports :... Dec 2023Objectives-This report presents final 2020 data on the 10 leading causes of death in the United States by age, race and Hispanic origin, and sex. Leading causes of...
Objectives-This report presents final 2020 data on the 10 leading causes of death in the United States by age, race and Hispanic origin, and sex. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2020," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2020. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths. Cause-of-death statistics are based on the underlying cause of death. Race and Hispanicorigin data are based on the Office of Management and Budget's 1997 standards for reporting race and Hispanic origin. Results-In 2020, many of the 10 leading causes of death changed rank order due to the emergence of COVID-19 as a leading cause of death in the United States. The 10 leading causes of death in 2020 were, in rank order: Diseases of heart; Malignant neoplasms; COVID-19; Accidents (unintentional injuries); Cerebrovascular diseases; Chronic lower respiratory diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; and Nephritis, nephrotic syndrome and nephrosis. They accounted for 74.1% of all deaths occurring in the United States. Differences in the rankings are evident by age, race and Hispanic origin, and sex. Leading causes of infant death for 2020 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage.
Topics: Infant; Infant, Newborn; Pregnancy; Female; Humans; United States; Cause of Death; Death Certificates; Infant Mortality; Accidental Injuries; Sudden Infant Death; Nephrotic Syndrome; COVID-19
PubMed: 38085308
DOI: No ID Found -
The Veterinary Clinics of North... Sep 2023Perinatal deaths including abortions, stillbirths, and neonatal deaths are an important economic and emotional challenge for companion animal owners, breeders, and... (Review)
Review
Perinatal deaths including abortions, stillbirths, and neonatal deaths are an important economic and emotional challenge for companion animal owners, breeders, and veterinarians. A protocol for the investigation of perinatal deaths in dogs and cats is described, including examination of the placenta. Specific lesions of common infectious diseases leading to perinatal death are presented, as well as the more prevalent noninfectious causes. These include viruses, bacteria, protozoa, metabolic causes, "accidents of pregnancy," nutritional deficiencies, intoxications, hormonal causes, and heritable and nonheritable congenital defects.
Topics: Pregnancy; Female; Animals; Cats; Dogs; Humans; Perinatal Death; Cat Diseases; Abortion, Veterinary; Dog Diseases; Stillbirth
PubMed: 37221102
DOI: 10.1016/j.cvsm.2023.04.008 -
The American Journal of Nursing Aug 2023The aim of this quality improvement (QI) project was to explore prevention strategies to reduce tubing and device misconnections that cause patient harm and death.... (Review)
Review
PURPOSE
The aim of this quality improvement (QI) project was to explore prevention strategies to reduce tubing and device misconnections that cause patient harm and death. Practicing evidence-based techniques can improve rates of nursing-sensitive indicators, such as central line-associated bloodstream infections, and increase patient safety.
METHODS
Our nursing quality management team reviewed internal quality data and found 11 reported misconnections. A literature review was performed to identify recommended prevention strategies that have been used to improve patient outcomes. Recommended strategies included promoting environmental safety, providing adequate education to clinicians on adverse events, performing line tracing and line reconciliation, and reporting all errors in real time.The nursing quality management team provided education on recommended best practices to prevent misconnection to various stakeholders. Nursing policies and standards of care were revised to include the practice of line tracing and line reconciliation during handoff, admission, transfers, and clinical tests and procedures.
RESULTS
The nursing quality management team gathered postimplementation data on education and policy changes. Two incidents of misconnection occurred within four months. In their reports, clinicians adopted the language of line tracing and line reconciliation when describing the events and actions performed.
CONCLUSION
Implementation of prevention strategies, including adequate education, enabled staff to identify the risk of misconnections and potential adverse events. Clinical staff incorporated line tracing and reconciliation into their practice, improving patient outcomes.
Topics: Humans; Safety Management; Equipment Failure
PubMed: 37498038
DOI: 10.1097/01.NAJ.0000947468.89142.03