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Symposia Report of The Annual Biological Sciences Section Meeting of the Gerontological Society of America 2023, Tampa, Florida.
No full textThe aging process is universal, and it is characterized by a progressive deterioration and decrease in physiological function leading to decline on the organismal level. Nevertheless, a number of genetic and non-genetic interventions have been described, which successfully extend healthspan and lifespan in different species. Furthermore, a number of clinical trials have been evaluating the feasibility of different interventions to promote human health. The goal of the annual Biological Sciences Section of the Gerontological Society of America meeting was to share current knowledge of different topics in aging research and provide a vision of the future of aging research. The meeting gathered international experts in diverse areas of aging research including basic biology, demography, and clinical and translational studies. Specific topics included metabolism, inflammaging, epigenetic clocks, frailty, senescence, neuroscience, stem cells, reproductive aging, inter-organelle crosstalk, comparative transcriptomics of longevity, circadian clock, metabolomics, and biodemography
Cochlear Implant Outcomes: A Focused Way of Looking at Speech Perception and Health-Related Quality of Life.
No full textINTRODUCTION: The relationship between health-related quality of life (HRQoL) and speech perception in cochlear implant (CI) users is inconsistent across existing research. To investigate this relationship, we assessed HRQoL using the Glasgow Benefit Inventory (GBI) and speech perception using the Minimum Speech Test Battery (MSTB). The present study proposes an additional subscore to the GBI: CI global outcomes.
METHODS: Seventeen bimodal CI users between the ages of 55 and 85 years participated in the study. All participants completed the GBI as well as the MSTB (e.g., AzBio sentence test in quiet and noise, the Bamford-Kowal-Bench Speech-in-Noise test [BKB-SIN], and the Consonant-Nucleus-Consonant test [CNC]). Correlations were calculated between HRQoL and speech perception measures.
RESULTS: Improvement in QoL as measured by the GBI CI global outcomes subscore significantly related to better performance on the AzBio in noise. No other significant relationships between the GBI and CI speech perception ability were observed.
CONCLUSION: CI global outcomes significantly related to speech perception ability in noise (AzBio), suggesting that this novel metric may be useful for capturing bimodal CI patient-reported outcomes
A Multisite Demonstration of Shared Access to Older Adults\u27 Patient Portals.
No full textIMPORTANCE: The patient portal has a growing role in health care. Many health systems have implemented shared access functionality in which patients may register a care partner with unique identity credentials to access their portal. Uptake of shared access has been limited.
OBJECTIVE: To examine the outcomes of a multisite demonstration involving organizational strategies associated with registration and use of patient portal shared access.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted in diverse sites within 3 health systems in the US: (1) geriatric oncology, (2) geriatric medicine, and (3) primary care. Patients aged 65 years or older with 1 or more visits during the 12-month demonstration period (July 1, 2022, through July 1, 2023, for sites 1 and 2; site 3 was delayed 3 months) and care partners who used the portal accounts of patients meeting these criteria were included. The 6-month postdemonstration period (August 1, 2023, through January 1, 2024) was compared with the 6-month predemonstration period (January 1 through June 1, 2022).
EXPOSURES: Organizational strategies (brochures, webpages, tip sheets, and implementation toolkits created using a human-centered design) to encourage shared access registration and use.
MAIN OUTCOMES AND MEASURES: Portal registration and use (logins, laboratory results viewed, clinical notes viewed, visits scheduled) by type of access (patient and care partner) from electronic health record data were examined. Patient- and care partner-reported awareness and use of shared access were measured using a postdemonstration survey.
RESULTS: A total of 16 005 patients from the 3 sites met the inclusion criteria (84.8% younger than 85 years and 61.5% women). Most patients had an activated portal account (91.0%) and logged in at least once (84.8%) during the 24 months spanning the demonstration and pre- and postdemonstration periods. New portal registrations were stable, but nonsignificant for shared access (110 of 14 758 [0.7%] vs 91 of 14 016 [0.6%]) and significantly decreased for patient access (677 of 3158 [21.5%] vs 225 of 1520 [13.2%]). Use of shared access before vs after the demonstration increased for number of logins (mean [SD], 5.9 [11.4] vs 6.8 [14.1]), laboratory results viewed (mean [SD], 0.7 [2.7] vs 1.1 [3.7]), clinical notes viewed (mean [SD], 0.2 [1.1] vs 0.6 [3.2]), and visits scheduled (mean [SD], 0.8 [10.8] vs 1.0 [5.4]). Of the 91 care partners reporting portal use in the postdemonstration survey, 48 (52.7%) indicated primarily using patient credentials and 31 (34.1%) indicated primarily using their own credentials. Less than one-half of patients (721 of 1664 [43.3%]) stated being aware of shared access.
CONCLUSIONS AND RELEVANCE: These findings show no association of the multisite demonstration with increased new registrations for shared access and only modest increases in portal use among care partners of older adults. As portal use expands to encompass legal documentation, medical decision-making, and patient education, policies to support proper use of identity credentials are needed
State of Practice: ASNR Statement on Gadolinium-Based Contrast Agent Use in Patients with Chronic Kidney Disease.
No full textBACKGROUND: Beginning in 2006, neuroradiologists became increasingly aware of the risk of nephrogenic system fibrosis (NSF) when patients with chronic kidney disease (CKD) received gadolinium-based contrast agents (GBCAs) in conjunction with MRI scans. Radiology practices began withholding GBCAs from MRI patients with substantial CKD and instated a variety of safety measures to ensure that these individuals did not inadvertently receive GBCAs. As a result, the worldwide incidence of NSF was dramatically reduced. Since that time, a wealth of research on NSF and its etiology has found few unconfounded cases associated with those GBCAs categorized as group II agents by the American College of Radiology.
METHODS: In 2023 and 2024, members of the American Society of Neuroradiology (ASNR) Standards and Guidelines Committee reviewed new research evidence on GBCA safety and its relevance to current MRI contrast administration guidelines for patients with CKD. This focused on systematic reviews and meta-analyses conducted during the past 5 years. Upon consideration of this literature, recommendations for the administration of GBCAs to patients with CKD were formulated.
KEY MESSAGE: For neuroimaging applications, the ASNR recommends that group II GBCAs no longer be withheld in patients with CKD when these agents are medically indicated for diagnosis. Moreover, if group II GBCAs are exclusively used in an MRI practice, other safety measures, such as checking renal function or querying patients about CKD, can be discontinued
The Role of Lactate Metabolism in Heart Failure and Cardiogenic Shock: Clinical Insights and Therapeutic Implications.
No full textHeart failure (HF) is associated with poor prognosis, especially when it progresses to cardiogenic shock (CS), where survival rates substantially decline. A key area of interest is the role of blood lactate as a biomarker in these conditions. Lactate is produced under normal physiological conditions but increases with impaired tissue perfusion, a hallmark of HF and CS. Elevated lactate levels result from increased production, reduced clearance or both and are often associated with worse outcomes. Traditionally considered a byproduct of anaerobic metabolism, lactate is now recognized as an important energy substrate, particularly in myocardial tissue during periods of metabolic stress. Recent studies suggest that dynamic lactate monitoring, including lactate clearance (LC), may provide critical insights into patients\u27 prognoses and responses to therapy. Serial measurements of lactate have been shown to predict survival in critically ill patients, including those with HF and CS. In CS, elevated lactate levels correlate with increased mortality risk, and LC is emerging as an important parameter in treatment protocols. Despite growing evidence of lactate\u27s clinical relevance, research is needed to establish standardized thresholds and optimal monitoring timelines. Understanding the complexities of lactate metabolism and its role in HF and CS could lead to improved risk stratification and more personalized treatment approaches
Construct Validity of the IDEOM Musculoskeletal Questionnaire: An Instrument to Measure Musculoskeletal Symptoms in Patients with Psoriatic Disease.
No full textThe Autonomic Nervous System and Inflammation in Chronic Kidney Disease.
No full textThe autonomic nervous system plays a crucial role in regulating physiological processes and maintaining homeostasis through its two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system. Dysregulation of the autonomic system, characterized by increased sympathetic activity and reduced parasympathetic tone, is a common feature in chronic kidney disease (CKD) and cardiovascular disease. This imbalance contributes to a pro-inflammatory state, exacerbating disease progression and increasing the risk for cardiovascular events. The sympathetic system promotes inflammation by releasing catecholamines, which activate adrenergic receptors on immune cells. The parasympathetic system exerts anti-inflammatory effects via the cholinergic anti-inflammatory pathway mediated by the vagus nerve. Targeting the autonomic system to restore the balance between the sympathetic and the parasympathetic components offers promising approaches to reduce inflammation and improve outcomes in CKD and cardiovascular disease. Beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), and angiotensin II receptor blockers (ARBs) are pharmacological agents that modulate sympathetic activity and have shown anti-inflammatory effects. Lifestyle interventions, such as a healthy diet, physical exercise, mindfulness, and meditation, enhance parasympathetic activity and improve autonomic function. Vagus nerve stimulation has emerged as a promising therapy, demonstrating significant potential in reducing inflammation and improving clinical outcomes in various conditions, including CKD, myocardial infarction and stroke. Despite mixed results in heart failure trials, vagal nerve stimulation has consistently improved quality-of-life measures. Understanding the mechanisms underlying autonomic system regulation of inflammation can inform the development of novel therapeutic strategies to restore autonomic balance and improve patient outcomes in CKD and cardiovascular disease
Ethical Controversies in Normothermic Regional Perfusion: Issues for Intensive Care Unit Nurses
No full textTrinh, a nurse, was caring for Devon, a 20-year-old college student who experienced cardiac arrest in the hot tub while home visiting his family for the holidays. His mother, Catalina, found him partially submerged and not breathing. She pulled him out, called emergency services, and started cardiopulmonary resuscitation. When the paramedics arrived, Devon was in cardiac arrest with ventricular fibrillation. Spontaneous circulation returned after 4 cycles of cardiopulmonary resuscitation, 4 defibrillations, and 2 doses of epinephrine. He did not regain consciousness after the resuscitation. He was transported to the local community hospital for continued care. He was intubated and received targeted temperature management and vasopressor support. He responded to noxious stimuli with decerebrate posturing but had no cough, gag, or corneal reflexes. His toxicology screen result was negative for drugs. Imaging studies on admission and 7 days later confirmed he had experienced severe anoxic brain injury. His neurologic assessment remained..
Quality Improvement Methodologies: An Application in Cardiac Anesthesiology.
No full textQuality improvement (QI) in medicine serves as the cornerstone of best practices. It enhances medical care by maximizing safety and efficiency while minimizing errors and waste. For a QI initiative to succeed it requires careful strategizing and effective change management plans, including the application of established QI methodologies to ensure sustainable success. Today, QI processes are integral to foundational learning for students and trainees, as well as for maintaining board certification for anesthesiologists. However, many anesthesiologists, including those actively pursuing QI efforts, are often unaware of these methodologies and their associated tools. A successful QI program that leads to sustainable improvement in outcomes relies on methodologies that assess the true current state, define value-added measures, evaluate defects and opportunities for enhancement, implement solutions through a robust change management plan, and ensure the sustainability of the process. This document provides a concise summary of methodologies that can be effectively led and executed by process improvement teams. We examine these methods within the context of cardiac anesthesiology, highlighting one institution\u27s experience in reducing surgical site infections following coronary artery bypass graft surgery. However, these principles are applicable to various healthcare situations and beyond
Laparoscopic revisional antireflux and hiatal hernia surgery results in a higher rate of complications and severity at 90 days than primary surgery.
No full textOBJECTIVE: Data on graded complications and their frequency after laparoscopic revisional antireflux and hiatal hernia surgery compared with primary surgery are lacking. We describe 30- and 90-day morbidity using the Clavien-Dindo classification.
METHODS: A total of 298 patients underwent revision surgery between 2003 and 2020 and were propensity matched to primary surgeries (1:2 ratio) based on age, sex, body mass index, American Society of Anesthesiology classification, Los Angeles grade esophagitis, presence of Barrett\u27s, and indication for surgery. Complications were graded using the Clavien-Dindo classification, with the highest grade of complication reported per patient.
RESULTS: After matching, both groups had a majority of female patients, with a median age of 60 years and a median body mass index of 29.5 kg/m
CONCLUSIONS: Revisional surgery results in similar total complications at 30 days, but additional complications can occur out to 90 days