-
Advances in Gerontology = Uspekhi... 2024A review of the use of comprehensive geriatric assessment and its components in oncology is introduced. The evidence base for the increasing incidence of cancer in the... (Review)
Review
A review of the use of comprehensive geriatric assessment and its components in oncology is introduced. The evidence base for the increasing incidence of cancer in the elderly worldwide also presented. The management of older adults with cancer is challenging. Comprehensive Geriatric Assessment (CGA) has been shown by many authors to be a strong predictor of adverse events in geriatric oncology patients. CGA is recommended in oncology practice for many reasons: to identify health problems not usually detected in routine oncologic screening, to perform non-oncologic interventions, and to modify the cancer treatment plan. Comprehensive geriatric assessment is the gold standard in geriatric oncology for identifying patients at high risk for adverse outcomes and optimizing cancer treatment and overall management. Nevertheless, it can be stated that the final point in the search for evidence-based and effective frailty assessment tools in the practice of geriatric oncology has not yet been reached. It is concluded that the development of new scales and index scores, as well as the application of the CGA model in general, can provide adequate care for elderly cancer patients.
Topics: Humans; Geriatric Assessment; Aged; Neoplasms; Medical Oncology; Frailty; Frail Elderly; Geriatrics
PubMed: 38944778
DOI: No ID Found -
Advances in Gerontology = Uspekhi... 2024One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to... (Review)
Review
One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to age-related physiological changes, high frequency of multimorbidity. The age of patients no longer precludes surgical intervention, and surgical procedures are often performed on elderly patients with complex comorbidities. Over the past 15 years, the number of emergency hospitalizations has increased significantly worldwide.
Topics: Humans; Aged; Geriatric Assessment; Frail Elderly; Frailty; Syndrome; Hospitalization; Aged, 80 and over; Comorbidity; Multimorbidity
PubMed: 38944777
DOI: No ID Found -
Advances in Gerontology = Uspekhi... 2024The aim of the study was to investigate the peculiarities of morphometric parameters of peripheral blood lymphocytes in chronic pyelonephritis in elderly patients in...
The aim of the study was to investigate the peculiarities of morphometric parameters of peripheral blood lymphocytes in chronic pyelonephritis in elderly patients in comparison with young and middle-aged patients. A total of 81 patients with chronic pyelonephritis in the exacerbation phase were examined. All patients were divided into three age groups according to WHO recommendations: the 1st - 42patients of young age (18-44 years); the 2nd - 17 patients of middle age (45-59 years); the 3rd - 22 elderly patients (60-74 years). Computer morphometry of lymphocytes was performed in all examined patients. In elderly patients with chronic pyelonephritis the size and сytoplasmic-nuclear ratio of lymphocytes increase. This indicates the preservation of lymphocyte defense responses at this age. In male patients with chronic pyelonephritis in the 1st and 2nd age groups the size of lymphocytes increases, and in female patients - decreases. The сytoplasmic-nuclear ratio increases in males of these age groups, while it remains unchanged or decreases in females. Indirect indications of reduced immunity in young and middle-aged women with chronic inflammation in the kidneys have been obtained.
Topics: Humans; Pyelonephritis; Middle Aged; Female; Male; Lymphocytes; Aged; Adult; Chronic Disease; Age Factors
PubMed: 38944771
DOI: No ID Found -
Inflammatory Bowel Diseases Jun 2024The patient perspective is essential for assessing disease severity, but it is not always adequately considered. We describe how a comprehensive clinical disease...
BACKGROUND
The patient perspective is essential for assessing disease severity, but it is not always adequately considered. We describe how a comprehensive clinical disease severity index (DSI) for inflammatory bowel disease (IBD) correlates with patient global self-assessment (PGSA).
METHODS
In an individually linked parallel online survey, physicians provided the DSI, and patients provided self-assessed severity using a global question and visual analog scale (0-100) (PGSA). Mean DSI values by PGSA were calculated with 95% confidence intervals. Pearson correlation (r) and the intraclass correlation coefficient were calculated for PGSA vs DSI. Positive predictive values for identifying severe disease with PGSA categories as a reference were based on a threshold >22 points.
RESULTS
The primary analysis included 89 pairs (46 Crohn's disease [CD], 43 ulcerative colitis [UC]) with strict criteria and 147 pairs when less stringent. Common reasons for exclusion were missing values for albumin or colonoscopy. Mean DSI values showed no clear trend with increasing PGSA in CD but good discrimination between moderate, severe, and very severe PGSA in UC. For PGSA on the visual analog scale, r was 0.54 for CD and 0.59 for UC (difference in means: CD 27.7, UC 13.8; intraclass correlation coefficient: CD 0.48, UC 0.58). A high DSI predicted severe disease in 76.2% of CD and 65.2% of UC.
CONCLUSIONS
The DSI showed good discrimination for patient-reported disease severity in UC but performed unsatisfactorily in CD. Correlations were moderate. Further refinement of the DSI is suggested to better reflect the patient perspective.
PubMed: 38944765
DOI: 10.1093/ibd/izae127 -
JAMA Health Forum Jun 2024The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned...
IMPORTANCE
The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.
OBJECTIVE
To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model's implementation.
EXPOSURE
Receiving dialysis treatment in a region randomly assigned to the ETC model.
MAIN OUTCOMES AND MEASURES
Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions.
RESULTS
The study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of -0.2 percentage points (pp; 95% CI, -0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, -0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.
Topics: Humans; Kidney Transplantation; Female; Male; Cross-Sectional Studies; Hemodialysis, Home; United States; Reimbursement, Incentive; Retrospective Studies; Kidney Failure, Chronic; Aged; Middle Aged; Medicare
PubMed: 38944762
DOI: 10.1001/jamahealthforum.2024.2055 -
American Journal of Epidemiology Jun 2024Evidence is limited regarding the effect of prenatal benzodiazepine and z-hypnotic exposure and long-term neurodevelopment in childhood. The objective of this study was...
Prenatal exposure to benzodiazepine and z-hypnotics and fifth-grade scholastic skills - emulating target trials using data from the Norwegian Mother, Father and Child Cohort Study.
Evidence is limited regarding the effect of prenatal benzodiazepine and z-hypnotic exposure and long-term neurodevelopment in childhood. The objective of this study was to investigate the effects of initiating benzodiazepine or z-hypnotic treatment in early, mid and late pregnancy on fifth-grade numeracy and literacy scholastic skills in children, by emulating three target trials. The trials are identical except for the timing of enrollment and the number of eligible individuals. Eligibility to the trials required a history of anxiety and/or depression prior to pregnancy. We used data from the Norwegian Mother, Father and Child Cohort Study, linked to the Medical Birth Registry of Norway, to emulate the trials. We adjusted for baseline covariates that were available at time 0 for each trial by inverse probability of treatment weighting using the propensity score. The findings of this study did not show any effect of mothers' initiation of treatment with benzodiazepines or z-hypnotics in early, mid or late pregnancy on the children's 5th grade test scores in numeracy and literacy. The study results provide reassurance for patients in need of benzodiazepines and z-hypnotics during pregnancy; however, these findings need to be interpreted with caution due to low study power in some of the analyses.
PubMed: 38944758
DOI: 10.1093/aje/kwae159 -
The Plant Journal : For Cell and... Jun 2024Female willows exhibit greater drought tolerance and benefit more from exogenous acetic acid (AA)-improved drought tolerance than males. However, the potential...
Female willows exhibit greater drought tolerance and benefit more from exogenous acetic acid (AA)-improved drought tolerance than males. However, the potential mechanisms driving these sex-specific responses remain unclear. To comprehensively investigate the sexually dimorphic responsive mechanisms of willows to drought and exogenous AA, here, we performed physiological, proteomic, Lys-acetylproteomic, and transgenic analyses in female and male Salix myrtillacea exposed to drought and AA-applicated drought treatments, focusing on protein abundance and lysine acetylation (LysAc) changes. Drought-tolerant females suffered less drought-induced photosynthetic and oxidative damage, did not activate AA and acetyl-CoA biosynthesis, TCA cycle, fatty acid metabolism, and jasmonic acid signaling as strongly as drought-sensitive males. Exogenous AA caused overaccumulation of endogenous AA and inhibition of acetyl-CoA biosynthesis and utilization in males. However, exogenous AA greatly enhanced acetyl-CoA biosynthesis and utilization and further enhanced drought performance of females, possibly determining that AA improved drought tolerance more in females than in males. Interestingly, overexpression of acetyl-CoA synthetase (ACS) could reprogram fatty acids, increase LysAc levels, and improve drought tolerance, highlighting the involvement of ACS-derived acetyl-CoA in drought responses. In addition, drought and exogenous AA induced sexually dimorphic LysAc associated with histones, transcription factors, and metabolic enzymes in willows. Especially, exogenous AA may greatly improve the photosynthetic capacity of S. myrtillacea males by decreasing LysAc levels and increasing the abundances of photosynthetic proteins. While hyperacetylation in glycolysis, TCA cycle, and fatty acid biosynthesis potentially possibly serve as negative feedback to acclimate acetyl-CoA biosynthesis and utilization in drought-stressed males and AA-applicated females. Thus, acetyl-CoA biosynthesis and utilization determine the sexually dimorphic responses of S. myrtillacea to drought and exogenous AA.
PubMed: 38944754
DOI: 10.1111/tpj.16901 -
International Journal of Gynaecology... Jun 2024To evaluate the effectiveness of ChatGPT in providing insights into common urinary incontinence concerns within urogynecology. By analyzing the model's responses against...
OBJECTIVE
To evaluate the effectiveness of ChatGPT in providing insights into common urinary incontinence concerns within urogynecology. By analyzing the model's responses against established benchmarks of accuracy, completeness, and safety, the study aimed to quantify its usefulness for informing patients and aiding healthcare providers.
METHODS
An expert-driven questionnaire was developed, inviting urogynecologists worldwide to assess ChatGPT's answers to 10 carefully selected questions on urinary incontinence (UI). These assessments focused on the accuracy of the responses, their comprehensiveness, and whether they raised any safety issues. Subsequent statistical analyses determined the average consensus among experts and identified the proportion of responses receiving favorable evaluations (a score of 4 or higher).
RESULTS
Of 50 urogynecologists that were approached worldwide, 37 responded, offering insights into ChatGPT's responses on UI. The overall feedback averaged a score of 4.0, indicating a positive acceptance. Accuracy scores averaged 3.9 with 71% rated favorably, whereas comprehensiveness scored slightly higher at 4 with 74% favorable ratings. Safety assessments also averaged 4 with 74% favorable responses.
CONCLUSION
This investigation underlines ChatGPT's favorable performance across the evaluated domains of accuracy, comprehensiveness, and safety within the context of UI queries. However, despite this broadly positive reception, the study also signals a clear avenue for improvement, particularly in the precision of the provided information. Refining ChatGPT's accuracy and ensuring the delivery of more pinpointed responses are essential steps forward, aiming to bolster its utility as a comprehensive educational resource for patients and a supportive tool for healthcare practitioners.
PubMed: 38944693
DOI: 10.1002/ijgo.15751 -
Journal of Psychoactive Drugs Jun 2024Cannabis is one of the most commonly utilized recreational drugs. However, increasing evidence from the literature suggests harmful implications on cognition. Thus, the... (Review)
Review
Cannabis is one of the most commonly utilized recreational drugs. However, increasing evidence from the literature suggests harmful implications on cognition. Thus, the main aim of the current review is to summarize literature findings pertaining to the impact of cannabis on neurocognitive skills, focusing on the imaging biomarkers provided by MRI. Two reviewers navigated the literature independently using four main search engines including PubMed and Cochrane. Articles were first evaluated through their title and abstract, followed by full-text assessment. Study characteristics and findings were extracted, and the studies' quality was appraised. 47 articles were included. The majority of the studies were of a case-control design (66%), and the most studied neurocognitive skill was memory (40.4%). With task-based fMRI being the most commonly utilized MRI technique, findings have shown significantly varying decreased and increased neuronal activity within brain regions associated with the cognitive tasks performed. Results suggest that cannabis users are significantly suffering from cognitive deficits. The major significance of this review is attributed to highlighting the role of MRI. Future research needs to delve more into validating the negative effects of cannabis, to enable stakeholders to take action to limit cannabis usage, to foster public health and wellbeing.
PubMed: 38944688
DOI: 10.1080/02791072.2024.2372377 -
The American Journal of Case Reports Jun 2024BACKGROUND Heparin-induced thrombocytopenia (HIT) is a disease in which the immune response elicited by heparin results in a state of hypercoagulability and platelet...
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a disease in which the immune response elicited by heparin results in a state of hypercoagulability and platelet activation, leading to thrombocytopenia and thromboembolism. Gustilo-Anderson type IIIC open fractures of the extremities are defined as open fractures presenting with arterial injuries that require repair and result in treatment challenges and complications. The diagnosis of HIT can be difficult in patients with severe trauma with consumptive thrombocytopenia associated with heavy bleeding and the use of heparin after vascular anastomosis. CASE REPORT A 48-year-old man was injured in a car accident, pinching his right lower leg and sustaining a Gustilo-Anderson type IIIc open fracture, for which he underwent emergency revascularization surgery. Heparin was administered continuously immediately after the surgery. On postoperative day 9, ischemic changes were observed in the right foot, and we performed suture re-anastomosis; however, the blood circulation in the right lower leg did not resume, and right lower leg amputation was performed due to ischemic necrosis with the onset of HIT. Postoperatively, the patient was switched to edoxaban after the recovery of his platelet count. Thereafter, the patient experienced no new thrombus occlusion or wound trouble, and was able to walk on a prosthetic leg and return to daily life. CONCLUSIONS It is important to consider the possibility of HIT as soon as thrombocytopenia appears in patients with Gustilo-Anderson type IIIC open fracture who are receiving heparin after vascular anastomosis, as a delayed diagnosis of HIT can make it difficult to save the limb.
Topics: Humans; Male; Middle Aged; Heparin; Thrombocytopenia; Fractures, Open; Limb Salvage; Anticoagulants; Ischemia
PubMed: 38944681
DOI: 10.12659/AJCR.944121