Geriatrics
Interesting initiative for improving quality and reducing readmissions from skilled nursing facilities
25 Jun, 2017 | 14:24h | UTCNecessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities – Journal of Community Hospital Internal Medicine Perspectives (free) (RT @HMVJC see Tweet)
In this model of care, a hospitalist-led team, including the resident on the geriatrics rotation, followed patients discharged from the hospital to the skilled nursing facility, leading to significant decrease in readmission rates.
Hormone therapy position statement of The North American Menopause Society
21 Jun, 2017 | 18:44h | UTCPosition Statement: The 2017 hormone therapy position statement of The North American Menopause Society (free PDF)
Commentaries: Hormone Therapy: Updated Position Statement Released – Physician’s First Watch (free) AND NAMS 2017 position statement updates guidelines for hormone therapy use – The North American Menopause Society (NAMS), via EurekAlert (free)
Who Should Assess the Needs of and Care for a Dementia Patient’s Caregiver?
20 Jun, 2017 | 12:20h | UTCWho Should Assess the Needs of and Care for a Dementia Patient’s Caregiver? – AMA Journal of Ethics (free)
“Physicians have an obligation to check in on dementia patients’ caregivers, and provide support if necessary” (RT @JournalofEthics see Tweet)
World Elder Abuse Awareness Day (June 15, 2017)
16 Jun, 2017 | 01:01h | UTCWorld Elder Abuse Awareness Day (June 15, 2017)
WHO News release: Abuse of older people on the rise – 1 in 6 affected – World Health Organization (free)
See also: Elder abuse fact sheet (free) AND WHO’s work on elder abuse (free) AND World report on ageing and health (free)
Related: Elder abuse prevalence in community settings: a systematic review and meta-analysis – The Lancet Global Health (free) AND Protecting the global longevity dividend – The Lancet Global Health (free)
Non–Vitamin K Antagonist Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Renal Dysfunction
15 Jun, 2017 | 00:50h | UTCNon–Vitamin K Antagonist Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Renal Dysfunction – Journal of The American College of Cardiology (link to abstract – $ for full-text)
Commentary: NOAC Doses: Just Stick to the Label – MedPage Today (free registration required)
“Among the 1,473 patients with a renal indication for dose reduction, 43.0% were potentially overdosed, which was associated with a higher risk of major bleeding”
Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders
14 Jun, 2017 | 00:39h | UTCAssociation Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentary: Persistent Pain May Increase Dementia Risk – The New York Times (10 articles per month are free)
Cohort of community-dwelling older adults suggests there might be a link.
Management of polypharmacy
8 Jun, 2017 | 15:52h | UTCCurrent and future perspectives on the management of polypharmacy – BMC Family Practice (free) (RT @Azeem_Majeed see Tweet)
Can Personalized Care Planning Improve Primary Care?
8 Jun, 2017 | 15:45h | UTCViewpoint: Can Personalized Care Planning Improve Primary Care? – JAMA (free)
Related: Multimorbidity: clinical assessment and management – NICE Guideline (free)
See more on caring for people with Complex Needs in our April 24th issue (see #4),
Prevention of Catheter-Associated Urinary Tract Infection in Nursing Home Residents
4 Jun, 2017 | 19:01h | UTCInvited commentary: A Triumph for the Agency for Healthcare Research and Quality Safety Program for Long-term Care: Moving Beyond “Round Up the Usual Suspects”
Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery
25 May, 2017 | 14:50h | UTCEffect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial – JAMA Surgery (free) (RT @PreetiNMalani see Tweet)
Commentary: Anti-delirium strategy reduces after-surgery confusion in elderly – Reuters Health (free)
Multicomponent nonpharmacologic interventions, including orienting communications, oral and nutritional assistance, and early mobilization reduced postoperative delirium by 56% and length of stay by 2 days.
Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults
23 May, 2017 | 14:32h | UTCEffect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults: The ALLHAT-LLT Randomized Clinical Trial – JAMA Internal Medicine (free) (RT @EricTopol see Tweet)
Editorial: Risks of Statin Therapy in Older Adults (free)
Commentaries: Older adults may not benefit from taking statins to prevent heart disease – Medical News Today (free) AND Pravastatin Doesn’t Improve Clinical Outcomes in Seniors – Physician’s First Watch (free)
Patients > 65 years with moderate hyperlipidemia and hypertension had no benefit from pravastatin for primary prevention. “A nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older” (HR 1.34; 95% CI, 0.98-1.84; P = .07).
Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults
19 May, 2017 | 17:52h | UTCAerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Quick Take Video Summary: Exercise and Dieting in Obese Older Adults (free)
Commentary: Aerobic Plus Resistance Exercise Best for Obese Older Adults – MedPage Today (free)
Pressure ulcer prevention and treatment
19 May, 2017 | 17:53h | UTCPressure ulcer prevention and treatment. Is ‘best practice’ evidence-based? – Cochrane Blogs: Evidence for Everyday Nursing (free) (RT @CochraneUK see Tweet)
Evidence for the treatment of pressure ulcers reviewed.
Menopausal Hormone Therapy for Prevention of Chronic Conditions
17 May, 2017 | 20:18h | UTCDraft Recommendation Statement: Menopausal Hormone Therapy: Primary Prevention of Chronic Conditions – U.S. Preventive Services Task Force (free)
Source: USPSTF Recommendation Against HRT for Chronic Conditions Stands – Medscape (free registration required)
“The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women”.
Intra-articular triamcinolone not effective for knee osteoarthritis
17 May, 2017 | 20:16h | UTCAuthor interview video: Comparison of Intra-articular Triamcinolone vs Saline for Knee Osteoarthritis (free)
JAMA report video: Comparison of Intra-articular Triamcinolone vs Saline for Knee Osteoarthritis (free)
Source: Study: Intra-articular triamcinolone not effective for symptomatic knee osteoarthritis – Healio Rheumatology (free)
Measuring the Burden of Medications in Older Adults near the End of Life
16 May, 2017 | 20:00h | UTCSee related study on the use of Medications of Questionable Benefit at the End of Life in our April 10th issue, see #8 and Deprescribing guidelines for elderly in our May 8th issue, see #4.
Source: Patient often prescribed potentially futile drugs in their final months of life – Science Daily (free)
“Nearly half of older adults in Sweden take 10 or more medications in their last months of life” (from Science Daily)
Risk of acute myocardial infarction with NSAIDs
11 May, 2017 | 18:38h | UTCCommentaries: Meta-Analysis: Just a Week of NSAID Use Tied to Increased Heart Attack Risk – Journal Watch (free) AND Common painkillers linked to increased risk of heart attack, study says – CNN (free) All NSAIDs Linked to Increased MI Risk – Medscape (free registration required)
Another study suggesting NSAIDs may be associated with increased cardiovascular risk.
Reducing inappropriate prescribing easier said than done
6 May, 2017 | 20:37h | UTCReducing inappropriate prescribing easier said than done – CMAJ News (free)
Related: Canadian Deprescribing Network (CaDeN) (free)
AND CaDeN Deprescribing Guidelines and Algorithms (free) AND Deprescribing guidelines for the elderly – Ontario Pharmacy Evidence Network(free)
Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents
2 May, 2017 | 17:14h | UTCSources: Study: Resistant gram-negative bacteria common in nursing homes – CIDRAP (free) (RT @IDSAInfo see Tweet) AND A quarter of nursing home residents are colonized with drug-resistant bacteria – EurekAlert (free)
UK guideline for the prevention and treatment of osteoporosis
1 May, 2017 | 16:50h | UTCUK clinical guideline for the prevention and treatment of osteoporosis – Archives of Osteoporosis (free)
A better way to care for the dying
28 Apr, 2017 | 16:39h | UTCA better way to care for the dying – The Economist (a few articles per month are free) (RT @EricTopol see Tweet)
“How the medical profession is starting to move beyond fighting death to easing it”.
Exercise interventions for cognitive function in adults older than 50
26 Apr, 2017 | 16:07h | UTCMeta-analysis: Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis – British Journal of Sports Medicine (free)
Source: Exercise Could Benefit Cognition in Older Adults – Physician’s First Watch (free)
“Physical exercise interventions significantly improved cognitive function in adults older than 50 years, regardless of baseline cognitive status”.
After Knee or Hip Replacement, No Place Like Home
27 Apr, 2017 | 16:28h | UTCAfter Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are free)
See also: Time to Rethink Inpatient Rehab After Knee Replacement? – The Rheumatologist (free)
Original article abstract ($ for full-text): Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial – JAMA (free)
The NYT commentary talks about the futility of some interventions currently used to postpone surgery and about the benefits of outpatient rehabilitation.
Caring for High-Need, High-Cost Patients
24 Apr, 2017 | 15:30h | UTCPerspective: Focusing on High-Cost Patients — The Key to Addressing High Costs? – NEJM Catalyst (free) (RT @brhospitalist)
Related commentaries: Caring for High-Need, High-Cost Patients — An Urgent Priority – New England Journal of Medicine (free) AND Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs (free)
Playbook: Better Care for People with Complex Needs – Institute for Healthcare Improvement (free)
Use of Medications of Questionable Benefit at the End of Life
20 Apr, 2017 | 14:34h | UTCUse of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia – Journal of the American Geriatrics Society (link to abstract – $ for full-text)
See also: Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia – CBCNews (free) AND Many With Advanced Dementia Receiving Drugs of Uncertain Benefit – Medscape (free registration required)
“Too much use of meds of questionable benefit at the end of life: Just Stop.” (RT @DeeMangin see Tweet)