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Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty.
Methods: A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019.
Results: Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty.
Conclusion: So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.
Keywords: Frailty; Inappropriate drug treatment; Medication optimization; Older people; Polypharmacy; Prefrailty
Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadObjective: To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity.
Design: Population-based cross-sectional study.
Setting: Iceland.
Participants: A total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19.
Main outcome measures: Symptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities.
Results: Compared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44).
Conclusions: Severe disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.
Keywords: COVID-19; epidemiology; mental health; public health.Icelandic government
NordFors
STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) and a deprescribing tool were developed by a European expert group.
Methods: STOPPFall was created by two facilitators based on evidence from recent meta-analyses and national fall prevention guidelines in Europe. Twenty-four panellists chose their level of agreement on a Likert scale with the items in the STOPPFall in three Delphi panel rounds. A threshold of 70% was selected for consensus a priori. The panellists were asked whether some agents are more fall-risk-increasing than others within the same pharmacological class. In an additional questionnaire, panellists were asked in which cases deprescribing of FRIDs should be considered and how it should be performed.
Results: The panellists agreed on 14 medication classes to be included in the STOPPFall. They were mostly psychotropic medications. The panellists indicated 18 differences between pharmacological subclasses with regard to fall-risk-increasing properties. Practical deprescribing guidance was developed for STOPPFall medication classes.
Conclusion: STOPPFall was created using an expert Delphi consensus process and combined with a practical deprescribing tool designed to optimise medication review. The effectiveness of these tools in falls prevention should be further evaluated in intervention studies.
Keywords: accidental falls; adverse effects; aged; deprescribing; fall-risk-increasing drugs; older people.Amsterdam Public Health Aging and Later Life Innovation Price and Clementine Brigitta Maria Dalderup fund
Amsterdam University fun
Cell-phone traces reveal infection-associated behavioral change.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadEpidemic preparedness depends on our ability to predict the trajectory of an epidemic and the human behavior that drives spread in the event of an outbreak. Changes to behavior during an outbreak limit the reliability of syndromic surveillance using large-scale data sources, such as online social media or search behavior, which could otherwise supplement healthcare-based outbreak-prediction methods. Here, we measure behavior change reflected in mobile-phone call-detail records (CDRs), a source of passively collected real-time behavioral information, using an anonymously linked dataset of cell-phone users and their date of influenza-like illness diagnosis during the 2009 H1N1v pandemic. We demonstrate that mobile-phone use during illness differs measurably from routine behavior: Diagnosed individuals exhibit less movement than normal (1.1 to 1.4 fewer unique tower locations; [Formula: see text]), on average, in the 2 to 4 d around diagnosis and place fewer calls (2.3 to 3.3 fewer calls; [Formula: see text]) while spending longer on the phone (41- to 66-s average increase; [Formula: see text]) than usual on the day following diagnosis. The results suggest that anonymously linked CDRs and health data may be sufficiently granular to augment epidemic surveillance efforts and that infectious disease-modeling efforts lacking explicit behavior-change mechanisms need to be revisited.
Keywords: call detail records; disease; influenza; outbreak; surveillance.Alan Turing Institute Engineering and Physical Sciences Research Council EP/N510129/1
UK Research & Innovation (UKRI)
Medical Research Council UK (MRC)
European Commission
National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions at the University of Brist
Janus endurhæfing, hlutverk sjúkraþjálfara í einstaklingsmiðaðri starfsendurhæfingu
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadJanus endurhæfing er læknisfræðileg starfs- og atvinnuendurhæfing
þar sem þverfaglegt teymi sérfræðinga aðstoða þátttakendur aftur
út á vinnumarkaðinn. Flestir þátttakendur glíma við flókin og
fjölþætt vandamál bæði andleg og/eða líkamleg. Þeir þarfnast
starfsendurhæfingar sem er aðlöguð að mismunandi þörfum
þeirra. Starfsemin tekur tillit til þessara þarfa meðal annars með
því að bjóða upp á mismundandi brautir. Þróun hefur átt sér stað
innan starfseminnar meðal annars er fyrirtækið brautryðjandi í
notkun gervigreindar innan starfsendurhæfingar. Hlutverk
sjúkraþjálfara í endurhæfingunni hefur þróast í takt við breytta
tíma, en snýr í dag að mestum hluta að fræðslu og þjálfun í hóp,
auk einstaklingsmeðferða.Janus rehabilitation is a medical vocational rehabilitation centre
where an interdisciplinary team of specialists assist participants
back to the labour market. Most participants are dealing with a
multitude of complex psychological and physical difficulties.
Therefore, it is necessary that each participant receive a bespoke
treatment. Different paths are available in the rehabilitation with
the aim to fit each participant’s needs. Janus rehabilitation has
been rapidly developing and is for ans example a pioneer in the
use of Artificial Intelligence in vocational rehabilitation. The part
of physical therapist has developed with changing times, but the
primarily focus is on group lessons and training, as well as
individualised treatments.
Key words: Physical Therapist, Vocational Rehabilitation,
Innovation, Quality of Lif
Outcomes of freestanding midwifery units and alongside midwifery units. A systematic review.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBakgrunnur: Ljósmæðrastýrðar einingar innan og
utan sjúkrahúsa eru að ryðja sér til rúms, sérstaklega
síðustu ár, sem valkostur fyrir heilbrigðar konur í eðlilegri meðgöngu. Ljósmæður eru í lykilhlutverki við að
fræða konur um val á fæðingarstað en í mæðravernd
er unnið eftir klínískum leiðbeiningum sem segja til
um að konur eigi að fá faglegar upplýsingar þannig
að þær geti tekið upplýsta ákvörðun um fæðingarstað. Til að geta sinnt fræðsluhlutverki sínu þurfa
ljósmæður að hafa aðgang að áreiðanlegum upplýsingum um ávinning og áhættur ólíkra fæðingarstaða.
Markmið: Að bera saman útkomu kvenna og
barna og inngrip í fæðingar hjá heilbrigðum
konum í eðlilegri meðgöngu sem ætla að fæða
á ljósmæðrastýrðum einingum innan eða utan
sjúkrahúsa, við útkomu kvenna sem ætla að fæða
á þverfræðilegum fæðingardeildum sjúkrahúsa.
Aðferð: Framkvæmd var kerfisbundin, fræðileg
samantekt. Gerð var heimildaleit á leitarsíðunum
Scopus, Cinahl, PubMed og Proquest. Notuð voru
leitarorðin; ljósmæðrastýrð eining (e. midwifery
unit), fæðingarheimili (e. birth center), fæðingarstaður (e. birthplace), útkoma (e. outcome) og
Útkoma ljósmæðrastýrðra
eininga innan og utan
sjúkrahúsa
Kerfisbundin fræðileg samantekt
Outcomes of freestanding midwifery units and
alongside midwifery units
A systematic review
Guðlaug Erla Vilhjálmsdóttir, ljósmóðir, fæðingarvakt Landspítala,
Berglind Hálfdánsdóttir, ljósmóðir og dósent við Háskóla Íslands,
Ólöf Ásta Ólafsdóttir, ljósmóðir og prófessor við Háskóla Íslands
Ritrýnd fræðigrein, tengiliður: [email protected]
23
ljósmóðurfræði (e. midwifery). Eftir mat á 459
rannsóknum stóðu eftir tíu rannsóknir sem uppfylltu inntökuskilyrði og stóðust gæðamat. Rannsóknirnar skoðuðu útkomu hjá yfir 102.000 konum
sem ætluðu að fæða á ljósmæðrastýrðum einingum, innan og utan sjúkrahúsa og báru saman við
útkomu um 820.000 kvenna sem ætluðu að fæða á
þverfræðilegum fæðingardeildum sjúkrahúsa.
Niðurstöður: Rannsóknir benda til þess að betri
útkoma sé hjá heilbrigðum konum í eðlilegri meðgöngu sem ætla að fæða á ljósmæðrastýrðum
einingum en þeim sem ætla að fæða á þverfræðilegum fæðingardeildum sjúkrahúsa. Meiri líkur
voru á sjálfkrafa, eðlilegri fæðingu og minni líkur á
inngripum á borð við mænurótardeyfingu, hríðarörvun, áhaldafæðingu og keisaraskurði. Einnig
voru almennt minni líkur á spangarklippingu og
blæðingu eftir fæðingu á ljósmæðrastýrðum einingum. Flutningstíðnin var 14,8% – 33,9%, þar sem
frumbyrjur voru frekar fluttar en fjölbyrjur. Ekki var
marktækur munur á útkomu nýbura.
Ályktun: Við val á fæðingarstað á meðgöngu
ætti að upplýsa konur um ólíka útkomu fæðinga á
ólíkum fæðingarstöðum, þar á meðal um lága inngripatíðni og jákvæða útkomu mæðra sem ætla
að fæða á ljósmæðrastýrðum einingum.
Lykilorð: ljósmæðrastýrð eining, útkoma
fæðinga, eðlileg fæðing, ljósmóðurfræði.Background: Midwifery units, both freestanding
and alongside, are increasingly popular locations
for birth amongst healthy women in low-risk
pregnancies. Midwives have a leading role in
antenatal education on choice in place of birth.
Clinical guidelines for maternity care guide midwives to inform women in a professional manner
such that women can make informed decisions
on place of birth. In order to fulfil their informative
roles, midwives must be able to access evidence
based information about the benefits and risks
associated with different birth places.
Objective: To compare maternal and perinatal
outcomes and obstetric interventions in low-risk
women by planned place of birth in freestanding
or alongside midwifery units to obstetric units in
hospitals.
Design: Scopus, Cinahl, PubMed and Proquest
databases were used to identify studies in this systematic review. Search terms where: midwifery
unit, birth center, birthplace, outcome and midwifery. After reviewing 459 articles, ten articles
met inclusion criteria and evaluation of study quality. Participants were over 102,000 women who
planned to give birth in midwifery units, compared
to around 820,000 women who planned to give
birth at obstetric units.
Results: Studies point to a better outcome for
healthy women in low-risk pregnancies who plan
to give birth at midwifery units than for those who
plan to give birth in obstetric units. They had an
increased likelihood of spontaneous vaginal birth
and were less likely to need interventions including; epidural analgesia, augmentation of labour, instrumental delivery, and caesarean section.
Rates of maternal outcome including episiotomy
and postpartum haemorrhage were generally
lower in midwifery units. Transfer rates ranged
from 14.8% to 33.9%, were nulliparous women had
higher rates of transfer than multiparous women.
There was not a significant difference in perinatal
outcomes.
Conclusions: When choosing their place of
birth in pregnancy women should be informed on
different birth outcomes in different birth places,
including low intervention rates and positive maternal outcomes in planned midwifery unit births.
Keywords: midwifery unit, birth outcome, low-
-risk birth, midwifer
Hematopoietic Stem Cell Transplantation Resolves the Immune Deficit Associated with STAT3-Dominant-Negative Hyper-IgE Syndrome.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAutosomal dominant hyper-IgE syndrome caused by dominant-negative loss-of-function mutations in signal transducer and activator of transcription factor 3 (STAT3) (STAT3-HIES) is a rare primary immunodeficiency with multisystem pathology. The quality of life in patients with STAT3-HIES is determined by not only the progressive, life-limiting pulmonary disease, but also significant skin disease including recurrent infections and abscesses requiring surgery. Our early report indicated that hematopoietic stem cell transplantation might not be effective in patients with STAT3-HIES, although a few subsequent reports have reported successful outcomes. We update on progress of our patient now with over 18 years of follow-up and report on an additional seven cases, all of whom have survived despite demonstrating significant disease-related pathology prior to transplant. We conclude that effective cure of the immunological aspects of the disease and stabilization of even severe lung involvement may be achieved by allogeneic hematopoietic stem cell transplantation. Recurrent skin infections and abscesses may be abolished. Donor TH17 cells may produce comparable levels of IL17A to healthy controls. The future challenge will be to determine which patients should best be offered this treatment and at what point in their disease history.Job Research Foundation
Welsh Clinical Academic Training (WCAT) programme
German Research Foundation (DFG)
German Research Foundation (DFG)
Federal Ministry of Education & Research (BMBF)
Center for Chronic Immunodeficiency (CCI), Freiburg Center for Rare Diseases (FZSE
Automatic fundus image quality assessment on a continuous scale.
No full textTo access publisher's full text version of this article click on the hyperlink belowFundus photography is commonly used for screening, diagnosis, and monitoring of various diseases affecting the eye. In addition, it has shown promise in the diagnosis of brain diseases and evaluation of cardiovascular risk factors. Good image quality is important if diagnosis is to be accurate and timely. Here, we propose a method that automatically grades image quality on a continuous scale which is more flexible than binary quality classification. The method utilizes random forest regression models trained on image features discovered automatically by combining basic image filters using simulated annealing as well as features extracted with the discrete Fourier transform. The method was developed and tested on images from two different fundus camera models. The quality of those images was rated on a continuous scale from 0.0 to 1.0 by five experts. In addition, the method was tested on DRIMDB, a publicly available dataset with binary quality ratings. On the DRIMDB dataset the method achieves an accuracy of 0.981, sensitivity of 0.993 and specificity of 0.958 which is consistent with the state of the art. When evaluating image quality on a continuous scale the method outperforms human raters.
Keywords: Fundus image quality assessment; Fundus imaging; Machine learning; Simulated annealing
Þunglyndi meðal aldraðra: Einkenni, orsök, mat og meðferð
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadÞunglyndi er einn af algengustu sjúkdómum í heiminum, en um 15% aldraðra eru metnir með
þunglyndi og talið er að á árabilinu 2015 til 2050 muni hlutfall þeirra sem eru með þunglyndi
hækka í 22% (World Health Organization, 2017). Á Íslandi er um 20.000 manns greindir með
þunglyndi og af þeim eru aldraðir um 12% og er það um 50% meira en í öðrum aldurshópum
hér á landi. Eldri konur eru líklegri til að greinast með þunglyndi en eldri karlar, og voru 11%
kvenna en 4,5% karla með þunglyndi af þeim sem voru 67 ára og eldri árið 2015 (Hagstofa Íslands, 2015)
Af hverju er mikilvægt að fylgjast með kvíða, þunglyndi og hvataröskun hjá parkinsonsjúklingum í kjölfar djúpkjarna-rafskautsörvunar?
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadDjúpkjarna-rafskautsörvun er meðferð sem notuð er fyrir einstaklinga með parkinsonveiki
(PV)sem eru með svæsin hreyfieinkenni. Þó meðferðin beinist aðallega að því að bæta hreyfigetu getur hún leitt til breytinga á ekki-hreyfieinkennum svo sem kvíða, þunglyndi og hvataröskun. Þessi einkenni falla oft í skuggann af hreyfieinkennum en geta haft afdrifarík áhrif á
sálfélagslega líðan. Hjúkrunarfræðingar gegna mikilvægu hlutverki í skimun og eftirliti með
kvíða, þunglyndi og hvataröskun þannig að hægtsé að grípa til viðeigandi meðferðarúrræða
ef vandamál koma í ljós