Latest & greatest articles for geriatrics

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Top results for geriatrics

201. Resiliency Interventions for Adverse Childhood Experiences in All Ages: Clinical Effectiveness and Guidelines

Resiliency Interventions for Adverse Childhood Experiences in All Ages: Clinical Effectiveness and Guidelines Resiliency Interventions for Adverse Childhood Experiences in All Ages: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Resiliency Interventions for Adverse Childhood Experiences in All Ages: Clinical Effectiveness and Guidelines Resiliency Interventions for Adverse Childhood Experiences in All Ages: Clinical Effectiveness and Guidelines Last updated (...) : January 18, 2019 Project Number: RA1002-000 Product Line: Research Type: Devices and Systems Report Type: Reference List Result type: Report Question What is the clinical effectiveness of psychological resilience-building interventions for patients (any age) exposed to adverse childhood experiences (ACEs) or trauma? What are the evidence-based guidelines regarding psychological resilience-building interventions for patients (any age) with ACEs or trauma? Key Message Four systematic reviews, four

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

202. The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: a multicentre randomised controlled trial (Abstract)

, multicentre clinical trial in 145 elderly patients (≥70 years old) with confirmed moderate OSA (apnoea-hypopnoea index 15-29.9 events·h-1) randomised to receive CPAP (n=73) or no CPAP (n=72) for 3 months. The primary end-point was the Epworth Sleepiness Scale (ESS) score, and the secondary end-points included quality of life (Quebec Sleep Questionnaire (QSQ) domain scores), sleep-related symptoms, presence of anxiety/depression, office-based blood pressure measurements and some neurocognitive tests (...) The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: a multicentre randomised controlled trial The efficacy of continuous positive airway pressure (CPAP) treatment in elderly patients with nonsevere obstructive sleep apnoea (OSA) is controversial. The objective of this study was to assess the effect of CPAP treatment in elderly patients with moderate OSA in terms of clinical, quality-of-life and neurocognitive measures.This was an open-label, randomised

2019 EvidenceUpdates

203. Lumacaftor/ivacaftor (cystic fibrosis in children aged 2 to 5 years) - Benefit assessment according to §35a Social Code Book V

the results of the VX15-809-115 study. It justified this with the transferability of the added benefit of lumacaftor/ ivacaftor determined by the G-BA for children aged 6 to 11 years and patients aged 12 years and older due to the same underlying genetic disease and advantages of the earliest possible start of causal treatment. For this purpose, the company presented the results from the single- arm study as proportions of patients with events or as the number of events per patient years (outcomes (...) with binary data) or as a before-after comparison (outcomes with continuous data). The company’s approach to transfer study results from older patients to the population to be assessed is comprehensible due to the lack of comparative data in children aged 2 to 5 years. The concrete approach adopted by the company was unsuitable, however. An added benefit of lumacaftor/ivacaftor versus the ACT in children aged 2 to 5 years cannot be derived from the data presented by the company for the following reasons

2019 Institute for Quality and Efficiency in Healthcare (IQWiG)

204. Common clinical conditions in aged care (Silver Book)

recommendations therefore cannot be provided as the inclusion and exclusion criteria from available systematic reviews and research literature are often too restrictive and unhelpful. Often, the clinical recommendations are single-disease specific, and fail to consider comorbidities, patient needs and polypharmacy that most (if not all) older people experience. Some clinical practice points and general principles are provided in each chapter. A ‘Consensus-based recommendation’ denotes a practice point (...) Common clinical conditions in aged care (Silver Book) RACGP - Silver Book - Part A Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship Fellowship International

2019 The Royal Australian College of General Practitioners

205. Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial. Full Text available with Trip Pro

clinical centers (Arcadia University, University of Connecticut Health Center, and University of Maryland, Baltimore). Randomization began on September 16, 2013, and ended on June 20, 2017; follow-up ended on October 17, 2017. Patients aged 60 years and older were enrolled after nonpathologic, minimal trauma hip fracture, if they were living in the community and walking without human assistance before the fracture, were assessed within 26 weeks of hospitalization, and were not able to walk during daily (...) Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial. Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community.To compare a multicomponent home-based physical therapy intervention (training) with an active control on ability to walk in the community.Parallel, 2-group randomized clinical trial conducted at 3 US

2019 JAMA

206. Local Area Variation in Morbidity Among Low-Income, Older Adults in the United States: A Cross-sectional Study. (Abstract)

of receipt of Medicare Part D low-income subsidies and not capturing persons not enrolled in Medicare Part D.Low-income, older adults living in more affluent areas of the country are healthier, and areas with poor health in the low-income, older adult population tend to have a high prevalence of most chronic conditions.National Institute on Aging. (...) Local Area Variation in Morbidity Among Low-Income, Older Adults in the United States: A Cross-sectional Study. Recent studies have reported that low-income adults living in more affluent areas of the United States have longer life expectancies. Less is known about the relationship between the affluence of a geographic area and morbidity of the low-income population.To evaluate the association between the prevalence of chronic conditions among low-income, older adults and the economic affluence

2019 Annals of Internal Medicine

207. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. (Abstract)

Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our (...) analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches.The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were

2019 Lancet

208. Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope Full Text available with Trip Pro

.A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate-lowering drugs (RLDs) and/or anti-arrhythmic drugs (AADs) were included. We compared the use of rate-lowering monotherapy with rate-lowering dual therapy, AAD monotherapy, and AAD combined with rate-lowering therapy.Outcomes were fall-related injuries and syncope as a composite end point (primary) or separate end point (secondary).In this population, the median age was 78 years (interquartile range [IQR] = 72-84 y (...) with rate-lowering therapy. When stratifying by individual drugs, amiodarone significantly increased the risk of fall-related injuries and syncope (IRR = 1.40 [1.26-1.55]). Compared with more than 180 days of rate-lowering monotherapy, a higher risk of all outcomes was seen in the first 90 days of any treatment; however, the greatest risk was in the first 14 days for those treated with AADs.In AF patients aged 65 years and older, AAD use was associated with a higher risk of fall-related injuries

2019 EvidenceUpdates

209. Melatonin (Slenyto) - Treatment of insomnia in children and adolescents aged 2 to 18 years with autism spectrum disorder and / or Smith-Magenis syndrome

on a complete discontinuation of treatment. 1 Product availability date April 2019. Summary of evidence on comparative efficacy The activity of melatonin at the melatonin receptors (MT1, MT2 and MT3) is believed to contribute to its sleep-promoting properties, as these receptors (mainly MT1 and MT2) are involved in the regulation of circadian rhythms and sleep regulation. 1 A double-blind phase III study recruited children and young people aged 2 to 17.5 years with an autism spectrum disorder diagnosed (...) Melatonin (Slenyto) - Treatment of insomnia in children and adolescents aged 2 to 18 years with autism spectrum disorder and / or Smith-Magenis syndrome 1 Published 9 September 2019 1 SMC2168 melatonin 1mg and 5mg prolonged-release tablets (Slenyto®) Flynn Pharma Ltd 9 August 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 NHSScotland. The advice is summarised

2019 Scottish Medicines Consortium

210. Efficacy and safety of linagliptin to improve glucose control in older people with type 2 diabetes on stable insulin therapy: A randomized trial (Abstract)

Efficacy and safety of linagliptin to improve glucose control in older people with type 2 diabetes on stable insulin therapy: A randomized trial To assess the addition of linagliptin as an alternative to insulin uptitration in older people with type 2 diabetes on stable insulin therapy.This phase 4, randomized, multicentre, double-blinded, placebo-controlled, 24-week study recruited individuals on stable insulin, with baseline HbA1c 7.0%-10.0%, aged ≥60 years and body mass index ≤45 kg/m2 (...) . HbA1c and fasting plasma glucose were measured at study visits, and participants assessed glycaemic control with a self-monitoring blood glucose device. Adverse events (AEs) were reported during the study.Three hundred and two participants were randomized 1:1 to linagliptin 5 mg qd and placebo, with one third of patients from Japan. Study population age and HbA1c (baseline mean ± SD) were 72.4 ± 5.4 years and 8.2 ± 0.8%, respectively; ~80% of participants were aged ≥70 years; 80% had macrovascular

2019 EvidenceUpdates

211. Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: design and rationale for the DEED FRAIL-AHF trial. (Abstract)

Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: design and rationale for the DEED FRAIL-AHF trial. To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days (...) of emergency department (ED) discharge.We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs

2019 Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias Controlled trial quality: uncertain

212. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. Full Text available with Trip Pro

of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 (...) Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia.Prospective cohort study.Civil service departments in London (Whitehall II study; study inception 1985-88).7899 participants with data on the cardiovascular health score at age 50.The cardiovascular health score included four behavioural (smoking, diet

2019 BMJ

213. The impact of HCG in IVF Treatment: Does it depend on age or on protocol? (Abstract)

The impact of HCG in IVF Treatment: Does it depend on age or on protocol? to evaluate the effect of the addition of low dose human chorionic gonadotropin (hCG) to human menopausal gonadotropin (HMG) throughout the early follicular phase in controlled ovarian stimulation (COS) conducted with two difference regimens. Gonadotropin-releasing hormone (GnRH) antagonist and short GnRH-agonist protocol were applied in two in vitro fertilization (IVF) clinics.Clinical study conducted during the period (...) and group 2, respectively (p=0.004). For patients over 40 years, the number of follicles and oocytes retrieved were significant higher in group 2.The pregnancy rate in group 2 was higher than in group 1 (21, 6% vs 5%, p=0.017).Advanced age women are likely to achievepregnancy using the GnRH Short than GnRH antagonist, when HMG/hCG is used, while HMG-hCG gonadotropins have the same potentialas Recombinant follicle stimulating hormone (rFSH)-hCG used in GnRH short protocol.Copyright © 2019 Elsevier Masson

2019 Journal of gynecology obstetrics and human reproduction Controlled trial quality: uncertain

214. Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45

Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 - ACOG Menu ▼ Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 Page Navigation ▼ Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 On October 5, 2018 the FDA approved the use of the 9-valent HPV vaccine in women and men aged 27 (...) through 45 years (1). The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) reviewed the available data at its February 2019 and June 2019 in-person meetings. On June 26, 2019, ACIP voted to recommend shared clinical decision making for persons aged 27 through 45 years when considering the 9-valent HPV vaccine. This recommendation is for women who have not previously received an HPV vaccine series and who are at risk for acquisition of HPV. HPV

2019 American College of Obstetricians and Gynecologists

215. Choosing Wisely Canada recommendation - Don’t routinely do screening mammography for average risk women aged 40 – 49. Individual assessment of each woman’s preferences and risk should guide the discussion and decision regarding mammography screening in th

at time intervals recommended by guidelines, such as those noted by the Canadian Task Force on the Periodic Health Examination. Don’t order DEXA (Dual-Energy X-ray Absorptiometry) screening for osteoporosis on low risk patients. While all patients aged 50 years and older should be evaluated for risk factors for osteoporosis using tools such as the osteoporosis self-assessment screening tool (OST), bone mineral density screening via DEXA is not warranted on women under 65 or men under 70 at low risk (...) Choosing Wisely Canada recommendation - Don’t routinely do screening mammography for average risk women aged 40 – 49. Individual assessment of each woman’s preferences and risk should guide the discussion and decision regarding mammography screening in th Don’t do imaging for lower-back pain unless red flags are present. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging

2019 CPG Infobase

216. Effects of vitamin D supplementation on cognitive function and blood Abeta-related biomarkers in older adults with Alzheimer`s disease: a randomised, double-blind, placebo-controlled trial (Abstract)

Effects of vitamin D supplementation on cognitive function and blood Abeta-related biomarkers in older adults with Alzheimer`s disease: a randomised, double-blind, placebo-controlled trial Our study aimed to assess the effect of a 12-month vitamin D supplementation on cognitive function and amyloid beta (Aβ)-related biomarkers in subjects with Alzheimer's disease (AD). METHODS : This was a randomised, double-blind, placebo-controlled trial. 210 AD patients were randomly divided (...) the control group. According to mixed-model analysis, vitamin D group had significant increase in full scale IQ during follow-up period (p<0.001).Daily oral vitamin D supplementation (800 IU/day) for 12 months may improve cognitive function and decrease Aβ-related biomarkers in elderly patients with AD. Larger scale longer term randomised trials of vitamin D are needed.ChiCTR-IIR-16009549.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

2019 EvidenceUpdates

217. The dose of physical activity to minimise functional decline in older general medical patients receiving 24-hr acute care: A systematic scoping review Full Text available with Trip Pro

were included. Study contexts were general medical wards (n = 11, 73.3%), Acute care of the elderly unit (n = 3, 20%) and a nursing unit (n = 1, 6.7%) located in tertiary referral acute hospitals. Most participants were aged 75-84 years (n = 10, 66%), had variable medical diagnoses and samples were either physically capable (n = 4, 26.7%) of limited physical capability (n = 1, 6.7%) or of mixed capability to mobilise independently (n = 10, 66.7%). Walking at least twice a day for approximately 20 (...)  min in total appeared to be associated with less functional decline in older patients of variable physical capabilities, and the overall efficacy of twice-daily exercise to reduce functional decline was supported.The evidence tentatively supported walking for hospitalised elders, irrespective of physical capability, and based on one RCT, suggested likely benefits of graduated exercise in dependent elders. Insufficient evidence limits prescription of optimal doses of physical activity to minimise

2019 EvidenceUpdates

218. Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly: A Randomized Controlled Trial Full Text available with Trip Pro

Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly: A Randomized Controlled Trial The usage of volar locking plate fixation for distal radial fractures has increased in older patient populations, despite the fact that surgical treatment in the elderly population has not clearly been proven to be superior to nonoperative treatment. The purpose of the present study was to compare nonoperative treatment with volar locking (...) plate fixation with regard to clinical outcome for elderly patients with dorsally displaced distal radial fractures.In this study, 140 patients were randomly allocated to nonoperative treatment with a plaster splint (n = 72) or volar locking plate fixation (n = 68). The outcome variables were the Patient-Rated Wrist Evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, EuroQol-5 Dimensions (EQ-5D) score, range of motion, grip strength, radiographic outcomes

2019 EvidenceUpdates

219. Perampanel (Fycompa) - for the adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in adult and adolescent patients from 12 years of age with epilepsy.

perampanel tablets. Treatment should be initiated only by physicians who have appropriate experience in the treatment of epilepsy. SMC has previously accepted perampanel tablets for restricted use as adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in patients with epilepsy aged 12 years and older. The oral suspension provides an alternative formulation for patients who have difficulty swallowing tablets. Depending on the dose, it may be more expensive than (...) Perampanel (Fycompa) - for the adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in adult and adolescent patients from 12 years of age with epilepsy. Published 12 August 2019 1 Product update SMC2172 perampanel 0.5mg/mL oral suspension (Fycompa®) Eisai Ltd 5 July 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 Scottish Medicines Consortium

220. Perampanel (Fycompa) - for the adjunctive treatment of primary generalised tonic-clonic seizures in adult and adolescent patients from 12 years of age with idiopathic generalised epilepsy.

Perampanel (Fycompa) - for the adjunctive treatment of primary generalised tonic-clonic seizures in adult and adolescent patients from 12 years of age with idiopathic generalised epilepsy. Published 12 August 2019 www.scottishmedicines.org.uk Statement of advice SMC2218 perampanel 0.5mg/mL oral suspension (Fycompa®) Eisai Ltd 5 July 2019 Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish (...) with the patient and/or guardian or carer. Chairman Scottish Medicines Consortium ADVICE: in the absence of a submission from the holder of the marketing authorisation perampanel (Fycompa®) is not recommended for use within NHSScotland. Indication under review: for the adjunctive treatment of primary generalised tonic-clonic seizures in adult and adolescent patients from 12 years of age with idiopathic generalised epilepsy. The holder of the marketing authorisation has not made a submission to SMC regarding

2019 Scottish Medicines Consortium