Search

Breast cancer is the most common type of cancer affecting women worldwide and its risk increases with age. Compared with other breast cancer subtypes, triple negative breast cancer (TNBC) behaves more aggressively, with earlier relapses and poorer survival outcomes. Although the incidence of TNBC decreases with age, it still affects about 10% of older women with breast cancer. The management of TNBC in older patients is particularly challenging as chemotherapy is the main treatment choice in both early and advanced diseases and older patients are often prone to increased treatment-related toxicities. This review highlights the specific considerations in this vulnerable group of patients and summarizes the current evidence for TNBC management in older adults from early to late stage of disease. [ABSTRACT FROM AUTHOR]

Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper 'Pharmaceutical development of medicines for use in the older population', which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Topics include patient acceptability, (dis)advantages of an administration route, formulation, dosage form, packaging, dosing device and user instruction. While the paper is directed at older people and the pharmaceutical industry, the reflections are also relevant to younger patients with similar disease‐related needs and of value to other stakeholders parties, e.g., healthcare professionals, academics, patients and caregivers, as the paper makes clear what can be expected from industry and where collaborative work is needed. This commentary provides an overview of the different steps in the development of the reflection paper, discusses points considered most controversial and/or subject to (multidisciplinary) expert discussions and indicates their value for real world clinical practice. [ABSTRACT FROM AUTHOR]

EVALUATION OF ABILITY TO TOLERATE THERAPY (COMORBIDITY ASSESSMENT AND MORTALITY PREDICTION) Evaluation of fitness for treatment in older AML patients All patients should be assessed for their suitability to receive intensive induction therapy at presentation. CLINICAL TRIALS This patient population has historically contributed low recruitment to clinical trials due to ineffective therapies, adverse disease biology and physical limitations of the older AML patient. High risk, fit, older patients with high-risk APL (white cell count >10 × 10 SP 9 sp /L) can be treated with a similar treatment approach to that used in younger patients, although dose reduction should be considered with chemotherapy (especially anthracyclines)-based regimens.97-100 Patients with a high white cell count >10 × 10 SP 9 sp /L should receive prophylactic corticosteroids which can potentially reduce the risk of APL differentiation syndrome.97,99 Dexamethasone 10 mg intravenously twice a day should be started immediately at the earliest clinical suspicion of APL differentiation syndrome. An evaluation of 17 years of low dose cytarabine as therapy for AML patients not fit for intensive treatment, including patients with adverse cytogenetics, shows improving survival, potential underutilisation and highlights the need for new therapy. An analysis of 2,767 AML patients in the Swedish Acute Leukaemia Registry evaluated the effect of the decision to treat on outcomes.31 In this study, 30-day mortality rates were dependent on both age and PS; however, older patients with good PS had low early death rates and patients with poor PS had increased early mortality across all ages. [Extracted from the article]

Pancreatic cancer is the fourth leading cause of cancer-related death in the US with an increasing incidence in older adults (OA) over age 70. There are currently no treatment guidelines for OA with metastatic pancreatic cancer (mPCA) and selecting a chemotherapy regimen for these patients is subjective, based largely on chronologic age and performance status (PS). Geriatric screening tools provide a more objective and accurate evaluation of a patient's overall health but have not yet been validated in patient selection for mPCA treatment. This study aims to elucidate the optimal chemotherapy treatment of vulnerable OA with mPCA and understand the geriatric factors that affect outcomes in this population. The GIANT (ECOG-ACRIN EA2186) study is multicenter, randomized phase II trial enrolling patients over age 70 with newly diagnosed mPCA. This study utilizes a screening geriatric assessment (GA) which characterizes patients as fit, vulnerable, or frail. Patients with mild abnormalities in functional status and/or cognition, moderate comorbidities, or over age 80 are considered vulnerable. Enrolled patients are randomized to one of two dose-reduced treatment regimens (gemcitabine/nab-paclitaxel every other week, or dose-reduced 5-fluoruracil (5FU)/ liposomal irinotecan (nal-IRI) every other week). GA and quality of life (QoL) evaluations are completed prior to treatment initiation and at each disease evaluation. Overall survival (OS) is the primary endpoint, with secondary endpoints including progression free survival (PFS) and objective response rate (ORR). Enrolled patients will be stratified by age (70–74 vs ≥75) and ECOG PS (0–1 vs 2). Additional endpoints of interest for OA include evaluation of risk factors identified through GA, QoL evaluation, and toxicities of interest for older adults. Correlative studies include assessment of pro-inflammatory biomarkers of aging in the blood (IL-6, CRP) and imaging evaluation of sarcopenia as predictors of treatment tolerance. The GIANT study is the first randomized, prospective national trial evaluating vulnerable OA with mPCA aimed at developing a tailored treatment approach for this patient population. This trial has the potential to establish a new way of objectively selecting vulnerable OA with mPCA for modified treatment and to establish a new standard of care in this growing patient population. Trial Registration: This trial is registered with ClinicalTrial.gov Identifier NCT04233866. [ABSTRACT FROM AUTHOR]

Introduction: While the putative benefits of "fitness trackers" continue to fuel a booming consumer market, results of device-based clinical interventions remain remarkably mixed. This study will explore factors influencing wearable physical activity (PA) sensor use in the context of stroke prevention and rehabilitation for older adults. The findings of this thematic synthesis will provide insights into factors influencing the use of PA sensors in stroke which may inform more effective device-based interventions. Methods and analysis: Thematic synthesis as a formal method described by Thomas and Arden can be used within a systematic review to synthesize primary qualitative research. Accordingly, the proposed study will systematically search bibliographic databases for relevant peer-reviewed papers and synthesize coded thematic data within included papers. The quality of papers will be assessed using the JBI Critical Appraisal Checklist for Qualitative Research. Patterns in the text will be coded, preliminary data visualised, and higher-level analytical themes discerned to explain factors influencing the use of PA sensors in older stroke patients. Discussion: This study does not require ethics approval. Results are expected to be available by June 2024. Data from the thematic synthesis will provide insights into barriers and facilitators influencing the use of wearable PA sensors in stroke and older adults at risk, and implications these factors have for the design of effective device-based interventions. Trial registration: Systematic review registration: PROSPERO registration number: CRD42020211472. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020211472. [ABSTRACT FROM AUTHOR]

Background: Prompt recognition of delirium is the first key step in its proper management. A previous study has demonstrated that nurses' delirium screening using the usual paper version assessment tool has no effect on clinical outcomes. Clinical decision assessment systems have been demonstrated to improve patients' adherence and clinical outcomes. Therefore, We developed a clinical decision assessment system (3D-DST) based on the usual paper version (3-min diagnostic interview for CAM-defined delirium), which was developed for assessing delirium in older adults with high usability and accuracy. However, no high quality evidence exists on the effectiveness of a 3D-DST in improving outcomes of older adults compared to the usual paper version. Methods: A pair-matched, open-label, parallel, cluster randomized controlled superiority trial following the SPIRIT checklist. Older patients aged 65 years or older admitted to four medical wards of a geriatric hospital will be invited to participate in the study. Prior to the study, delirium prevention and treatment interventions will be delivered to nurses in both the intervention and control groups. The nurses in the intervention group will perform routine delirium assessments on the included older patients with 3D-DST, while the nurses in the control group will perform daily delirium assessments with the usual paper version. Enrolled patients will be assessed twice daily for delirium by a nurse researcher using 3D-DST. The primary outcome is delirium duration. The secondary outcomes are delirium severity, incidence of delirium, length of stay, in-hospital mortality, adherence to delirium assessment, prevention, and treatment of medical staff. Discussion: This study will incorporate the 3D-DST into clinical practice for delirium assessment. If our study will demonstrate that 3D-DST will improve adherence with delirium assessment and clinical outcomes in older patients, it will provide important evidence for the management of delirium in the future. Trial registration: Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402. https://www.chictr.org.cn/showproj.aspx?proj=47127. Protocol version: 1, 29/7/22. [ABSTRACT FROM AUTHOR]

Background and objective There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature. Methods We undertook a systematic scoping review guided by the Arksey and O'Malley framework and reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between 2001 and 2021. Study selection criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles. A data-charting form was then developed to facilitate thematic analysis. Narrative synthesis then involved identifying major themes and subthemes from the data. Results We identified and reviewed 65 studies, and included 25. We identified five categories: 'field triage', 'ageing impacts', 'decision-making', 'paramedic' awareness' and 'paramedic's behaviour'. Undertriage and overtriage (sensitivity and specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes. Conclusion This is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. Field-triage tools, paramedics' knowledge about injuries in the older population, and understanding of paramedics' negative behaviours towards older patients were identified as key research priorities. [ABSTRACT FROM AUTHOR]

In the context of global aging, promoting the health of the elderly has become a critical issue. However, whether the development of smart cities can impact the health of older adults remains to be further validated. In this paper, based on panel data from the China Health and Retirement Longitudinal Study (CHARLS), a difference in difference model is used to empirically investigate whether smart city construction improves the health of older people in the region. The results show that smart city construction enhances the health of the elderly. Specifically, the construction achieved a significant improvement in the physical health of the elderly who did not live with their children. The health promotion effect of the smart city was more significant for the urban elderly than for the rural elderly. The elucidated mechanisms of influence suggest that smart cities bring about their effects through the promotion of urban leisure infrastructure, enhancement of medical service provision, advancement in urban environmental protection and stimulation of urban information and communication technology infrastructure development. [ABSTRACT FROM AUTHOR]

There is a growing population of adults aged 50 years or older living with HIV, facing unique challenges in care due to age, minority status, and stigma. Co-design methodologies, aligning with patient-centered care, have potential for informing interventions addressing the complex needs of older adults with HIV. Despite challenges, co-design has shown promise in empowering older individuals to actively participate in shaping their care experiences. The scoping review outlined here aims to identify gaps in existing co-design work with this population, emphasizing the importance of inclusivity based on PROGRESS-Plus characteristics for future patient-oriented research. This scoping review protocol is informed by the Joanna Briggs Institute Manual to explore co-design methods in geriatric HIV care literature. The methodology encompasses six stages: 1) developing research questions, 2) creating a search strategy, 3) screening and selecting evidence, 4) data extraction, 5) data analysis using content analysis, and 6) consultation with key stakeholders, including community partners and individuals with lived experience. The review will involve a comprehensive literature search, including peer-reviewed databases and gray literature, to identify relevant studies conducted in the past 20 years. The inclusive criteria focus on empirical data related to co-design methods in HIV care for individuals aged 50 or older, aiming to inform future research and co-design studies in geriatric HIV care. The study will be limited by the exclusion of papers not published or translated to English. Additionally, the varied terminology used to describe co-design across different research may result in the exclusion of articles using alternative terms. The consultation with key stakeholders will be crucial for translating insights into meaningful co-design solutions for virtual HIV care, aiming to provide a comprehensive synthesis that informs evidence-based strategies and addresses disparities in geriatric HIV care. [ABSTRACT FROM AUTHOR]

As one of the most prevalent chronic inflammatory skin diseases, atopic dermatitis (AD) increasingly affects the aging population. Amid the ongoing global aging trend, it's essential to recognize the intricate relationship between AD and aging. This paper reviews existing knowledge, summarizing clinical observations of associations between AD and aging-related diseases in various systems, including endocrine, cardiovascular, and neurological. Additionally, it discusses major theories explaining the correlation, encompassing skin-mucosal barriers, systemic inflammation and stress, genes, signal transduction, and environmental and behavioral factors. The association between AD and aging holds significant importance, both in population and basic perspectives. While further research is warranted, this paper aims to inspire deeper exploration of inflammation/allergy-aging dynamics and the timely management of elderly patients with AD. [ABSTRACT FROM AUTHOR]

Background: The importance of involving members of the public in the development, implementation and dissemination of research is increasingly recognised. There have been calls to share examples of how this can be done, and this paper responds by reporting how professional and lay researchers collaborated on a research study about falls prevention among older patients in English acute hospitals. It focuses on how they worked together in ways that valued all contributions, as envisaged in the UK standards for public involvement for better health and social care research. Methods: The paper is itself an example of working together, having been written by a team of lay and professional researchers. It draws on empirical evidence from evaluations they carried out about the extent to which the study took patient and public perspectives into account, as well as reflective statements they produced as co-authors, which, in turn, contributed to the end-of-project evaluation. Results: Lay contributors' deep involvement in the research had a positive effect on the project and the individuals involved, but there were also difficulties. Positive impacts included lay contributors focusing the project on areas that matter most to patients and their families, improving the quality and relevance of outcomes by contributing to data analysis, and feeling they were 'honouring' their personal experience of the subject of study. Negative impacts included the potential for lay people to feel overwhelmed by the challenges involved in achieving the societal or organisational changes necessary to address research issues, which can cause them to question their rationale for public involvement. Conclusions: The paper concludes with practical recommendations for working together effectively in research. These cover the need to discuss the potential emotional impacts of such work with lay candidates during recruitment and induction and to support lay people with these impacts throughout projects; finding ways to address power imbalances and practical challenges; and tips on facilitating processes within lay groups, especially relational processes like the development of mutual trust. Plain English summary: Involving members of the public in all stages of research as equal partners is a powerful way to make research more relevant. This paper shares an example of such involvement, from a study about falls prevention in English hospitals. Developed by a team of lay people and professional researchers, the paper looks at how we worked together, drawing on evaluations we carried out about how the study took patient and public perspectives into account, and on personal reflections we wrote. Public involvement had a positive effect on the project and the individuals involved, but there were also difficulties. Positive impacts included lay people ensuring the study focused on what mattered most to patients and their families and feeling they had done right by their personal experience of the study's subject. Negative impacts included the potential for people to feel overwhelmed by the changes in organisations or in wider society needed to address the issues being explored by a research study, which could cause them to question why they became involved in the first place. The paper ends with practical recommendations about working together, covering things such as helping lay people with the emotional impact of involvement from the beginning to the end of projects; finding ways to ensure everybody is treated in the same way and solving practical problems; and tips on leading and supporting groups of this kind, especially with personal issues like trusting each other. [ABSTRACT FROM AUTHOR]

Background: Dizziness and vertigo are among the most prevalent complaints in the elderly and have a major negative influence on (i) the perception of the quality of life; and (ii) the risk of falling. Due to population aging, particularly in wealthy nations, vertigo represents a growing issue and a serious public health concern. In order to approach the patient correctly and to offer the best treatment options, it is mandatory to identify vertigo's underlying causes. The aim of this paper was to identify the different etiologies of vertigo and possibly their frequency in the elderly population, by reviewing the scientific literature of the last decade (2012–2022). Methods: A systematic review was performed according to PRISMA guidelines, searching the Medline database from January 2012 through to December 2022. The search identified 1025 candidate papers, but after the application of specific selection criteria, only five were considered for further analysis. Results: A total of 2148 elderly patients (60–90 y old) presenting with vertigo were reported in the selected papers. A total of 3404 conditions were identified as the cause of vertiginous symptoms, (some patients presented multiple etiologies). All major diagnoses were categorized into different subgroups: the most common origin of vertigo was represented by audio-vestibular disorders (28.4%), followed by cardiovascular (20.4%) and neurological diseases (15.1%). Furthermore, 9.1% of patients were diagnosed with psychiatric conditions, whilst ophthalmologic and musculoskeletal disorders accounted for 7.5% and 6.3% of the cases respectively. Medication adverse effects and metabolic-related diseases were also considered among the causes. For 3.4% of cases the etiology remains unclear. Conclusions: Audio-vestibular disorders represent the most frequent cause of vertigo in the elderly. The etiologies affecting the vertigo patient must be defined in order to identify potential life-threatening conditions, such as cardiovascular and neurological disorders, which according to the data of this review constitute the second and third common causes of vertigo. A multidisciplinary strategy, involving different specialists (such as ENTs, Neurologists, Cardiologists, Geriatricians) is recommended for the correct assessment of these disorders. [ABSTRACT FROM AUTHOR]

The article titled "[Retracted] Dexmedetomidine improves early postoperative neurocognitive disorder in elderly male patients undergoing thoracoscopic lobectomy" has been retracted by the Editor of Experimental and Therapeutic Medicine due to concerns raised by a reader. The article was found to have unexpected similarities with a pre-print article that has not been formally submitted for publication. The pre-print article has since been retracted by Research Square. The Editor decided to retract the article from the Journal due to a lack of confidence in the presented data. The authors accepted the decision to retract the paper. [Extracted from the article]

Background: After pancreatic surgery, the development of postoperative pancreatic fistula (POPF) is a serious concern. POPF involves the leakage of pancreatic fluids from the surgical site, which can lead to complications and even death. Preventing POPF is essential for enhancing patient recovery and lessening the impact on healthcare resources. This systematic review and meta-analysis evaluated medical methods and surgical techniques to prevent POPF. Methods: This study was registered under the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024500938. An electronic search was conducted through the PubMed, Google Scholar, Web of Science, and ScienceDirect databases for all relevant articles published in English from 2018 to 2023. The following search terms were used: ((Whipple procedure OR Pancreaticojejunal OR Pancreaticogastrostomy) AND (Prevention of postoperative pancreatic fistula) AND (Prevention OR Octreotide OR Sealant agent OR Stent OR Postoperative drain)). Results: Of 260 papers, 28 articles extracted through the database search were considered suitable for the systematic review. The included studies investigated a variety of surgical approaches for pancreatic resection. Pancreaticoduodenectomy (PD) was the most prevalent intervention. The incidence rates for POPF varied widely across the studies, ranging from as low as 11.6% to as high as 100%. The incidence rate of clinically relevant POPF (CR-POPF) ranged from 11.7% to 33.3%. The length of postoperative hospital stays also varied significantly. Discussion: Postoperative pancreatic fistula (POPF) affects 13–41% of patients post-pancreatic surgery. Despite its high incidence, mortality rates are low. Postoperative hospital stay varies, with higher rates in older patients and overweight individuals. Advancements in surgical techniques and perioperative management have reduced mortality rates to <5%. Conclusions: This study provides insights into the outcomes of pancreatectomy, including the incidence of POPF, postoperative hospital stays, and mortality rate. The findings suggest that the incidence of POPF is similar to that suggested in the literature and is influenced by various factors. [ABSTRACT FROM AUTHOR]

Background: Low comprehension and adherence to medical treatment among the elderly directly and negatively affect their health. Many elderly patients forget medical instructions immediately after their appointments, misunderstand them, or fail to recall them altogether. Some identified causes include the short time slots allocated for appointments in the public health system in Chile, the complex terminology used by healthcare professionals, and the stress experienced by patients during appointments. One approach to improving patients' adherence to medical treatment is to combine written and oral instructions with graphical elements such as pictograms. However, several challenges arise due to the ambiguity of natural language and the need for pictograms to accurately represent various medication combinations, doses, and frequencies. Objective: This study introduces SIMAP (System for Integrating Medical Instructions with Pictograms), a technological framework aimed at enhancing adherence among asthma patients through the delivery of pictograms via a computational system. SIMAP utilizes a collaborative and user-centered methodology, involving health professionals and patients in the construction and validation of its components. Methods: The technological framework presented in this study is composed of three parts. The first two are medical indications and pictograms related to the treatment of the disease. Both components were developed through a comprehensive and iterative methodology that incorporates both qualitative and quantitative approaches. This methodology includes the utilization of focus groups, interviews, paper and online surveys, as well as expert validation, ensuring a robust and thorough development. The core of SIMAP is the technological component that leveraged artificial intelligence methods for natural language processing to analyze, tokenize, and associate words and their context to a set of one or more pictograms, addressing issues such as the ambiguity in the text, the cultural factor that involves many ways of expressing the same indication, and typographical errors in the indications. Results: Firstly, we successfully validated 18 clinical indications along with their respective pictograms. Some of the pictograms were redesigned based on the validation results. However, in the final validation, the comprehension percentages of the pictograms exceeded 70%. Furthermore, we developed a software called SIMAP, which translates medical indications into previously validated pictograms. Our proposed software, SIMAP, achieves a correct mapping rate of 96.69%. Conclusions: SIMAP demonstrates great potential as a technological component for supplementing medical instructions with pictograms when tested in a laboratory setting. The use of artificial intelligence for natural language processing can successfully map medical instructions, both structured and unstructured, into pictograms. This integration of textual instructions and pictograms holds promise for enhancing the comprehension and adherence of elderly patients to their medical indications, thereby improving their long-term health. [ABSTRACT FROM AUTHOR]

Background: To evaluate the feasibility and benefits of digitized informed patient consent (D-IPC) for contrast-enhanced CT and compare digitized documentation with paper-based, conventional patient records (C-PR). Methods: We offered D-IPC to 2016 patients scheduled for a CT. We assessed patient history (e.g., CT examinations, malignant or cardiovascular diseases) and contraindications (red flags) for a CT (e.g., thyroid hyperfunction, allergies) using a tablet device. We evaluated the success rate of D-IPC and compared patient age between the subgroups of patients who were able or unable to complete D-IPC. We analyzed the prevalence of marked questions and red flags (RF). RF were compared with the documentation from C-PR. We estimated greenhouse gas (GHG) emissions for paperless workflow and provide a cost–benefit analysis. Results: Overall, 84.4% of patients completed D-IPC. They were younger (median 61 years) than unsuccessful patients (65 years; p < 0.001). Patients who marked questions (21.7%) were older than patients without inquiries (median 63.9 vs 59.5 years; p < 0.001). The most prevalent RF was thyroid disease (23.8%). RF were considered critical for contrast-agent injection in 13.7%, requiring personalized preparation. The detection rate for RF documented with D-IPC was higher than for C-PR (n = 385 vs. 43). GHG emissions for tablet production are 80–90 times higher than for paper production. The estimated costs were slightly higher for D-IPC (+ 8.7%). Conclusion: D-IPC is feasible, but patient age is a relevant factor. Marked questions and RF help personalize IPC. The availability of patient history by D-IPC was superior compared to C-PR. [ABSTRACT FROM AUTHOR]

This article explores the impact of COVID-19 policies on the mobility of elderly individuals in Australia and China. It highlights the digital exclusion faced by older people as smartphone use became mandatory for accessing public spaces and services. The article discusses how this digital exclusion deepened social isolation and exacerbated feelings of loneliness among older individuals. It also examines the gender inequalities and the increased burden on women as unpaid caregivers during the pandemic. The paper emphasizes the need for age-inclusive policies that address intersecting factors and promote equitable access to technology and public spaces. [Extracted from the article]

Background: Cerebral amyloid angiopathy (CAA), a cerebral small vessel disease affecting leptomeningeal and cortical small blood vessels, is a common cause of spontaneous lobar intracerebral hemorrhage and cognitive impairment, particularly in elderly patients. This study aims to investigate the field of CAA research from a scientometric perspective. Methods: Publications related to CAA from January 1st, 1999 to September 29th, 2023 were retrieved from the Web of Science Core Collection database. The scientometric software VOSviewer and CiteSpace were used to analyze and visualize the publication trends, countries/regions, institutions, authors, journals, cited references, and keywords of CAA. Results: A total of 2,798 publications related to CAA from 73 countries/regions, led by the United States, were included. The number of publications showed an increasing trend over time. Massachusetts General Hospital was the most productive institution, and authors Greenberg and Charidimou published the most papers and were most frequently co-cited. Journal of Alzheimer's Disease was the most prolific journal in this field, and Neurology was the most co-cited journal. Apart from "cerebral amyloid angiopathy", the most frequently used keywords were "Alzheimer's disease", "amyloid beta", "intracerebral hemorrhage", and "dementia". The burst keywords in recent years included "cortical superficial siderosis" and "dysfunction". Conclusions: This scientometric analysis provides a comprehensive overview of CAA research over the past 25 years, and offers important insights for future research directions and scientific decision-making in this field. [ABSTRACT FROM AUTHOR]

Elderly patients receiving palliative care are terminally ill, thereby requiring an increasing amount of caregivers' time and attention. Caregivers often face diverse issues and challenges while performing caregiving tasks. The purpose of this paper is to systematically investigate the challenges that trigger family caregivers' dilemmas while providing palliative care to their elderly patients. The sample size was 10 respondents (family caregivers) who were purposively selected by the researchers from hospital-based palliative care settings and home-based palliative care settings. The finding of this study presents the existing and emerging dilemmas confronted by the caregivers of the elderly receiving palliative care. The caregivers in both settings reported elderly patients' reluctance to perform daily exercises and medication. The caregivers in the hospital-based palliative care setting mentioned the patient's desire to go home, while the caregivers in the home setting needed extra assistance to manage the care needs of the elderly patients. The paper also highlights the implications for social workers functioning in palliative care settings. In conclusion, caregiving for an elderly patient is a very arduous and demanding task. Family caregivers grapple with many day-to-day challenges which creates dilemma in providing quality palliative care to their elderly patients. They try to fix their dilemmas by looking at the issue through a medical lens and discussing it with professional palliative care providers. [ABSTRACT FROM AUTHOR]

Background: Many researchers have examined the impact of social insurance on health in elderly. However, in most cases, they have only demonstrated correlational results and have not been able to determine causal effects, possibly because confounding biases have not been fully addressed. In this study, we investigated the health effects of the New Rural Pension Scheme (NRPS) on the elderly (age≥60 years old) with chronic diseases in rural areas, and to explore the causal relationship and effects of NRPS and health status. Methods: This paper used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and applied Bayesian networks and fuzzy regression discontinuity design to conduct causal analysis. Bayesian networks were used to explore the causal directed acyclic graphs of factors related to NRPS and health status. Based on the results of Bayesian network, a fuzzy regression discontinuity design was employed to estimate the causal effect of NRPS on health status. Results: Among rural elderly with chronic diseases, Bayesian network mapping of causal relationships among NRPS, health status and covariates showed that age was a common cause of NRPS receipt and satisfaction with health. The results of the fuzzy regression discontinuity analysis showed that the effect of receiving NRPS on the health status was positive, but there was no statistically significant difference concerning the interval estimates. The results of the subgroup analysis with chronic obstructive pulmonary disease (COPD) and asthma indicated that the effect of NRPS receipt on the health status of elderly people with COPD was positive. There was a statistically significant effect of receiving NRPS on self-rated health description ( β 1 = 3.653 , P = 0.032 ) and health satisfaction ( β 1 = 4.204 , P = 0.033 ) in COPD population and a statistically significant effect of receiving NRPS on health satisfaction in asthma population ( β 1 = 9.844 , P = 0.008 ). Conclusion: This paper has confirmed the contribution and positive causal effect of NRPS on health status in a subgroup of older adults with COPD and asthma, using the CHARLS database as evidence. Thus, Chinese government should increase the take-up rate of the NRPS to enhance their positive impact on health status of elderly people with chronic diseases in rural areas. [ABSTRACT FROM AUTHOR]

Increasing informalisation, nuclearisation of family, inadequate social security for the aged, rising health care cost in many countries imposes some challenges before the elderly people like those in India. In today's world 60+populations are participating in the labour market. In this paper, I have examined the financial conditions of the elderly people in India. In particular, I have focused on the daily real earnings of the elderly people in India in recent years across six different geographical zones. Presence of discrimination that the elderly people are facing in the labour market has also been analysed here. For the purpose of analysis, NSS 68th round (2011-2012) data have been used. Bivariate analysis confirms that North-East Indian 60+populations earn more than their counter parts in all others regions. A negative relation between the daily average real earning and age of the elderly has been noticed in all the geographical zones except the above 75 years for the North-East Indian elderly. Across education level, the elderly who have secondary level of education and above, earn more than primary educated elderly in almost all the zones. Socio-religious identity of the aged depicts that in most of the zones the Muslim elderly earn more that the Hindu upper caste elderly in 2011-2012. Although the North-East Indian elderly are getting highest earnings compared to others but in the labour market they are facing highest discrimination in recent years. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to analyse the labour force participation among the elderly population (aged 60 and above) in India from data available for the most recent time periods. The paper reviews the types of employment, industries and occupations that the elderly in India are employed in presently and also examines the impact of different factors on the decision of the elderly to be a part of the labour force. Design/methodology/approach: Unit-level data has been extracted from the most recent data available on employment and labour force in India provided by the Periodic Labour Force Survey (PLFS), from 2017 to 2018 to 2019–2020. Binary logistic regression model has been used to identify some of the socio-economic and demographic factors that influence the odds of the elderly being a part of the labour force along with the extent of their influence, and Wald statistic has been used to examine the dynamics. Findings: The study finds that among the elderly population, males, individuals living in rural areas, those living alone, those who are currently married and those with low educational attainment are more likely to be a part of the labour force. Again, elderly females are found to be employed mostly in the informal or unorganised sector which provide minimal or nil social security benefits. Between 2017–2018 and 2019–2020, the coefficients for sector, gender, marital status, education and income are found to be significantly different. Originality/value: This paper attempts to shed some light on the scanty literature with regards to studies on the elderly in India, and also to reveal the possible factors which induce the elderly in India to participate in the labour force with the help of the most recent data available. Peer review: The peer-review history for this article is available at: https://publons.com/publon/10.1108/IJSE-06-2021-0350. [ABSTRACT FROM AUTHOR]

Microbiota restoration therapy has become a standard treatment for recurrent Clostridioides difficile infection (rCDI). In this article, we review the studies supporting the licensure of two live biotherapeutic products (LBPs) designed to prevent rCDI and to provide clinicians with a perspective on their differences. PubMed was reviewed on 1 October 2023, for all papers published concerning the current Food and Drug Administration allowance of the use of fecal microbiota transplantation (FMT) and the studies that led to the licensure of RBX2660 (REBYOTA™), generic name, fecal microbiota, live-jslm, and SER-109 (VOWST™), generic name, fecal microbiota spores, live-brpk. OpenBiome continues to produce fecal products for patients with rCDI at their treatment sites, and the American Gastroenterology Association has a National Registry focused on long-term safety of administering fecal microbiota products. The science behind the licensing of fecal microbiota, live-jslm, a consortium of fecal anaerobes found in stool augmented with strains of Bacteroidetes and fecal microbiota spores, live-brpk, a mixture of 50 species of purified Firmicutes spores is reviewed. Both products appear to be safe in clinical trials and effective in reducing rCDI episodes by mechanisms established for FMT, including normalization of α- and β-diversity of the microbiome and by increasing fecal secondary bile acids. The different makeup of the two LBPs suggests that rCDI responds to a variety of engrafting microbiota which explains why nearly all donors in FMT of rCDI are generally effective. Fecal microbiota, live-jslm has also been shown to successfully treat rCDI in elderly patients with advanced comorbidities. With the licensure of two novel LBPs, we are entering a new phase of microbiota replacement therapy. Having standardized manufacturing and proper monitoring of products, harnessing the microbiome to control and prevent disease has a new beginning. Plain language summary: Licensure of two new live biotherapeutic products to treat recurrent C difficile infection is changing the landscape for treatment of this common and often serious infection Microbiota replacement therapy is the most effective way to prevent multiple recurrences of C difficile infection. The article discusses where fecal microbiota transplantation is available in North America. The major focus is on two recently licensed live biotherapeutic products, RBX2660 (REBYOTA), generic name fecal microbiota, live-jslm and SER-109 (VOWST), generic fecal microbiota spores, live-brpk, manufactured under standardized methods which should be safer and more standardized in response. The article compares the new LBPs for safety, effectiveness, cost to help clinicians make decisions. The licensure and availability of two safe and effective standardized and regulated biotherapies, fecal microbiota, live-jslm and fecal microbiota spores, live-brpk, for preventing rCDI is a critical advance in medical management. Both treatments were shown to cure rCDI, to normalize the microbiome of the treated patients by reducing proportions of proinflammatory Enterobacteriaceae and increasing the α- and β-diversity of the microbiome, and to convert primary bile acids to C. difficile -inhibiting secondary bile acids in fecal samples. Both products included follow-up studies show durable cure without important short-term adverse events. The two recently licensed LBP differ in a number of ways. Fecal microbiota, live-jslm is a broad consortium of microbiota expected in a healthy donor fecal samples, including all the major phyla including Firmicutes. It is augmented with strains of Bacteroidetes, while fecal microbiota spores, live-brpk is ethanol washed spores exclusively within the phylum of Firmicutes. The fact that both products are effective in preventing rCDI support the idea that bacterial restoration in rCDI can be achieved by transplantation of a variety of different microbiota. This is seen in FMT for rCDI where it is generally accepted that all healthy adults are suitable donors and large number of donors can be included unscreened for microbiome diversity in a stool bank such as OpenBiome. When treating conditions other than CDI, the specific makeup of an LBP may need to be adjusted. One way around the unique microbiome requirements of non-CDI illnesses with dysbiosis is to administer FMT product derived from multiple donors. Evidence developed and presented here indicate that the two new LBPs are effective in treating rCDI, although head-to-head comparisons have not been carried out. fecal microbiota, live-jslm is a more traditional microbiome restoration product employing a full range of microbiota. fecal microbiota spores, live-brpk is novel in design and is based on the selection of Firmicutes spores with a narrower range of bioactivity. The future of microbiota-therapy has gotten brighter with the licensure of fecal microbiota, live-jslm and fecal microbiota spores, live-brpk. [ABSTRACT FROM AUTHOR]

COVID‐19 has been ravaging the world for a long time, and although its effects are currently the same as those of a cold or a fever, timely diagnosis of COVID‐19 in the elderly and in patients with related illnesses is still a matter of great urgency. To address this challenge, we propose a model that combines the strengths of the Swin Transformer and ResNet34 architectures to efficiently diagnose COVID‐19 in elderly and vulnerable patients. In this paper, we design a model that integrates Swin transformer and resnet34, which not only integrates the advantages of transformer and CNN but also achieves excellent performance in this image classification problem. Moreover, a pre‐processing method is also proposed to increase the accuracy of the model to 99.08%. In this paper, experiments were conducted on Kaggle's publicly available three‐classification and four‐classification datasets, respectively, and on the three main evaluation metrics of Accuracy, Precision, and Recall, the first dataset obtained 98.81%, 99.49%, and 97.99%, while the second dataset obtained 88.82%, 88.92%, and 86.38%. These findings highlight the validity and potential of our proposed model for diagnosing the presence or absence of COVID‐19 in elderly and vulnerable patients. [ABSTRACT FROM AUTHOR]

In the healthcare sector, the growth in technology has had a huge effect. Besides, when introduced to the world of healthcare, the Internet of Things (IoT) will simplify the transition by helping physicians closely track their patients, allowing rapid recovery. Aged patients/people should be intensively checked, and their loved ones must be aware of their wellbeing periodically. Therefore, using IoT in healthcare will simplify the lives of physicians and patients alike. Hence, this study explored a comprehensive review of intelligent IoT-based embedded healthcare systems. The papers around intelligent IoT-based healthcare systems printed until Dec-2022 are studied, and some research lines are suggested for the upcoming researchers. Thus, this study's innovation will apply healthcare systems based on IoT to include certain strategies for the future deployment of new generations of IoT-based health technology. The findings revealed that IoT is beneficial for governments to strengthen society's health and economic relations. Besides, owing to novel functional principles, IoT needs modern safety infrastructure. This study is helpful for prevalent and useful electronic healthcare services, health experts, and clinicians. [ABSTRACT FROM AUTHOR]

The harsh climate and the aging of urban populations have negatively impacted the quality of life of the elderly in severely cold regions. As a result, there is an urgent need to improve environment quality and accurately evaluate outdoor thermal comfort. However, existing studies have paid little attention to older adults living in severely cold climates. This paper aims to fill this gap by studying the elderly population in severely cold cities with high aging rates in China. By combining on-site testing, questionnaire surveys, CFD modeling, parametric computing, and statistical analysis, the study presents an adapted UTCI for elderly people, as well as multi-seasonal prediction models. The results (1) show that the neutral ranges of the UTCI are significantly affected by both climate zones and age groups. Older people are more tolerant to heat but more sensitive to cold. (2) The results also reveal the importance of factors such as air temperature, wind speed, solar radiation temperature, wind direction, relative humidity, and cloud cover in evaluating outdoor thermal comfort. (3) Multi-seasonal thermal comfort models based on neural networks were developed, and empirical studies verified that the model had the highest accuracy in the transitional season and the lowest accuracy in the winter season. [ABSTRACT FROM AUTHOR]

This paper addresses the growing demand for healthcare systems, particularly among the elderly population. The need for these systems arises from the desire to enable patients and seniors to live independently in their homes without relying heavily on their families or caretakers. To achieve substantial improvements in healthcare, it is essential to ensure the continuous development and availability of information technologies tailored explicitly for patients and elderly individuals. The primary objective of this study is to comprehensively review the latest remote health monitoring systems, with a specific focus on those designed for older adults. To facilitate a comprehensive understanding, we categorize these remote monitoring systems and provide an overview of their general architectures. Additionally, we emphasize the standards utilized in their development and highlight the challenges encountered throughout the developmental processes. Moreover, this paper identifies several potential areas for future research, which promise further advancements in remote health monitoring systems. Addressing these research gaps can drive progress and innovation, ultimately enhancing the quality of healthcare services available to elderly individuals. This, in turn, empowers them to lead more independent and fulfilling lives while enjoying the comforts and familiarity of their own homes. By acknowledging the importance of healthcare systems for the elderly and recognizing the role of information technologies, we can address the evolving needs of this population. Through ongoing research and development, we can continue to enhance remote health monitoring systems, ensuring they remain effective, efficient, and responsive to the unique requirements of elderly individuals. [ABSTRACT FROM AUTHOR]

Introduction: We conducted a bibliometric analysis to determine the most impactful articles in the oncologic management of elderly cancer patients. Material and methods: We searched Web of Science papers with six keywords: "geriat*" OR "older patient*" OR "older adult*" OR "elderly" and "*cancer" OR "oncolog*". We identified and analyzed the top 100 most-cited articles and abstracted information on topic, journal, first author, year, institution, level of evidence, and the adjusted citation index. Results: Of the 100 most-cited papers, 62 had at least one author from the United States of America. Of the 62 United States papers, 18 had at least one author from Harvard University and 14 had authors from the National Institutes of Health. Among the 50 authors who contributed to the most-cited papers, Hurria is the most prolific author, with nine papers. Lung, breast, and colorectal cancers are the most studied cancer types, and the Geriatric 8 scale is the most studied scale. Conclusions: Our study is the first to analyze the top 100 most-cited studies in geriatric oncology. By comprehensively identifying the authors, institutes, journals, and the levels of evidence of these studies, we have created an easily accessible resource for practicing physicians to reference within this important area of oncology. [ABSTRACT FROM AUTHOR]

Despite significant progress in targeted therapy for acute myeloid leukemia (AML), clinical outcomes are disappointing for elderly patients, patients with less fit disease characteristics, and patients with adverse disease risk characteristics. Over the past 10 years, adaptive T-cell immunotherapy has been recognized as a strategy for treating various malignant tumors. However, it has faced significant challenges in AML, primarily because myeloid blasts do not contain unique surface antigens. The preferentially expressed antigen in melanoma (PRAME), a cancer-testis antigen, is abnormally expressed in AML and does not exist in normal hematopoietic cells. Accumulating evidence has demonstrated that PRAME is a useful target for treating AML. This paper reviews the structure and function of PRAME, its effects on normal cells and AML blasts, its implications in prognosis and follow-up, and its use in antigen-specific immunotherapy for AML. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is increasingly recognized as being implicated in acute illness in older adults, with a significant weight in hospitalizations for respiratory illness and death. By means of a best-evidence review, this paper aims to investigate whether RSV can be considered a forgotten pathogen in older patients, looking at trends in the literature volume and exploring possible epidemiological and clinical features underlying the focus given to it. We then present an assessment of its disease burden and present and future strategies for its reduction, particularly in light of the recent availability of new vaccines. [ABSTRACT FROM AUTHOR]

Background: The use of local perforator flaps recently arose as an alternative to free flaps for lower extremity reconstruction. In this paper, a single surgeon's experience is discussed in the reconstruction of lower extremity defects with the use of local perforator flaps. Aim: This study speculates the impact of risk factors on local perforator flap outcome and reoperation rates. Study Design: This study is a retrospective study. Materials and Methods: Between December 2013 and December 2020, a total of 51 lower extremity defects were reconstructed using local perforator flaps. Patients were categorized based on risk factors including diabetes mellitus, hypertension, venous insufficiency of the lower extremity, cigarette smoking, and being older than 60 years in addition to the number of risk factors each patient bear. Partial flap necrosis rates, total flap necrosis rates, reoperation rates and their relationship with risk factors were assessed. Results: Out of 51 local perforator-based flaps, no total flap loss and four partial flap loss were encountered. Patients older than 60 years old, hypertensive patients, patients who are smokers, and patients with multiple risk factors had higher partial flap loss rates. In addition, diabetic patients, patients older than 60 years old, and patients bearing multiple risk factors are shown to have higher reoperation rates. Conclusion: Meticulous operative planning and considering the risk factors each patient bear are important in the reconstruction of lower extremity defects. Therefore, risk factors identified in this study must be evaluated during patient selection in the reconstruction of lower extremity defects using local perforator flaps. [ABSTRACT FROM AUTHOR]

Robust wireless communication using relaying system and Non-Orthogonal Multiple Access (NOMA) will be extensively used for future IoT applications. In this paper, we consider a fall detection IoT application in which elderly patients are equipped with wearable motion sensors. Patient motion data is sent to fog data servers via a NOMA-based relaying system, thereby improving the communication reliability. We analyze the average signal-to-interference-plus-noise (SINR) performance of the NOMA-based relaying system, where the source node transmits two different symbols to the relay and destination node by employing superposition coding over Rayleigh fading channels. In the amplify-and-forward (AF) based relaying, the relay re-transmits the received signal after amplification, whereas, in the decode-and-forward (DF) based relaying, the relay only re-transmits the symbol having lower NOMA power coefficient. We derive closed-form average SINR expressions for AF and DF relaying systems using NOMA. The average SINR expressions for AF and DF relaying systems are derived in terms of computationally efficient functions, namely Tricomi confluent hypergeometric and Meijer's G functions. Through simulations, it is shown that the average SINR values computed using the derived analytical expressions are in excellent agreement with the simulation-based average SINR results. [ABSTRACT FROM AUTHOR]

Background: This study explored the specific relationship between different lipid indicators and cognitive impairment and aimed to provide a reference for implementing targeted lipid regulation measures to prevent and alleviate cognitive impairment. Methods: We searched three databases (PubMed, Embase, and Web of Science) for literature related to hyperlipidaemia, lipid levels, and cognitive impairment, and used the Newcastle-Ottawa Scale to evaluate the quality of the identified literature. A meta-analysis was performed using RevMan 5.4, and the combined effect size ratio using a random-effects model (odds ratio [OR] and 95% confidence interval [CI]) was used to evaluate the association between dyslipidaemia and cognitive impairment. Results: Among initially identified 2247 papers, we ultimately included 18 studies involving a total of 758,074 patients. The results of the meta-analysis revealed that patients with hyperlipidaemia had a 1.23-fold higher risk of cognitive impairment than those with normal lipid levels (OR = 1.23, 95% CI: 1.04-1.47, p = 0.02). Further subgroup analysis showed that elevated total cholesterol (TC) levels increased the risk of cognitive impairment by 1.59-fold (OR = 1.59, 95% CI: 1.27-2.01, p < 0.0001) and were more significant in older or male patients. Moreover, elevated triglyceride levels were inversely correlated with cognitive disorders, whereas elevated low-density lipoprotein cholesterol levels were unrelated to cognitive impairment risk. Conclusions: Dyslipidaemia was strongly associated with cognitive impairment, and elevated TC levels were a risk factor for cognitive impairment. Furthermore, the damaging effects of elevated TC levels on cognition were more pronounced in older and male populations. [ABSTRACT FROM AUTHOR]

Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder. Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies-of Exposure (ROBINS-E). Meta-analyses were conducted. Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients. Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Engineering Sciences is the property of Faculty of Engineering - Assiut University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this paper was to show the challenges of the social worker in the Clinical Hospital Centre Rijeka in the process of planned discharge and at the same time promoting the right to self-determination of an elderly patient with impaired functioning who has no close family members. The paper presents the tasks of a social worker in the process of planned discharge, which range from targeted and short analyzes of specific needs, to comprehensive psychosocial assessments and risk assessments of a whole range of social and psychological needs, strengths and stressors. The challenges that were imposed and ultimately overcome were the patient's lack of social support, different perceptions of the problem and insufficiently transparent communication between stakeholders, the patient's weakened social capital and physical disability. Therefore, the presentation of the case shows the importance of direct mutual communication of all the mentioned stakeholders, timely exchange and transparency of information. Although, the primary and most important thing is to respect the voice of the patient and enable him to shape the vision of his future life, in accordance with the resources available to him. [ABSTRACT FROM AUTHOR]

Purpose: The aging society poses new challenges to managers of medical facilities to ensure that older adults have adequate conditions and access to professional health care and provide them with opportunities to increase their level of satisfaction and improve the quality of their functioning in society. The aim of the survey was to examine the opinions of older adults aged 65 years and older on the quality of medical services and to identify the most important characteristics of the quality of medical services included in their assessment. Design/methodology/approach: The study used a diagnostic survey method based on a questionnaire technique that was addressed to older adults living in the Silesian Voivodeship. The survey was conducted in late 2022 and early 2023 and covered 128 older adults. Findings: The survey showed that older adults living in the Silesian Voivodeship rated the medical services offered relatively well. Older adults gave the highest ratings to the location of health facilities, the approach to patients, the efficiency of service, and the availability of services provided by primary care physicians. Research limitations/implications: Analysis of the survey of older adults’ opinions on the quality of medical services identified key areas in need of corrective actions, such as the availability of night and holiday care, the use of modern solutions, the need for additional fees for medical services, and the number of medical staff members in medical facilities. Practical implications: By measuring patient satisfaction, healthcare facilities gain information on how well their healthcare delivery meets patients' expectations and needs, and what in their services is a source of patient dissatisfaction. The results of the survey provide the basis for corrective measures to improve the services provided whereas the managers in healthcare facilities gain knowledge about the needs of older adult patients and areas requiring solutions to improve the quality of the services offered. Social implications: The use of information from the survey makes it possible, through changes, to adapt the care system to the needs of older adults and suggests a direction for further quality assurance measures in healthcare. Originality/value: The paper provides an introduction to the complex topic of improving the quality of medical services and achieving a sufficient level of satisfaction among older adults. [ABSTRACT FROM AUTHOR]

Background There is an increasing incidence of early-onset colorectal cancer; however, the psychosocial impacts of this disease on younger adults have been seldom explored. Methods A systematic review was conducted according to the PRISMA guidelines. The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PubMed, and Scopus were searched, and papers were included if published in English within the last 10 years and if they reported results separately by age (including early-onset colorectal cancer, defined as colorectal cancer diagnosed before the age of 50 years). Critical appraisal of all studies was done using the Joanna Briggs Institute tools. The primary outcome of interest was the global quality of life in patients with early-onset colorectal cancer. Secondary outcomes included the effect on sexual function, body image, finances, career, emotional distress, and social and family functioning. Results The search yielded 168 manuscripts and 15 papers were included in the review after screening. All studies were observational, and included a total of 18 146 patients, of which 5015 were patients with early-onset colorectal cancer. The studies included scored highly using Joanna Briggs Institute critical appraisal tools, indicating good quality and a low risk of bias, but data synthesis was not performed due to the wide range of scoring systems that were used across the studies. Six papers reported significant negative impacts on quality of life in patients with early-onset colorectal cancer. Three of the four studies that compared the quality of life in patients with early-onset colorectal cancer with older patients found that the younger group had worse mean quality-of-life scores (P ≤ 0.05). Secondary outcomes measured in five studies in relation to sexual dysfunction, body image, financial and career impacts, and social and family impacts and in eight studies in relation to emotional distress were found to be more severely impacted in those with early-onset colorectal cancer compared with those with late-onset colorectal cancer. Conclusion Whilst data are limited, the impact of colorectal cancer is different in patients with early-onset colorectal cancer compared with older patients in relation to several aspects of the quality of life. This is particularly prominent in areas of global quality of life, sexual functioning, family concerns, and financial impacts. [ABSTRACT FROM AUTHOR]

Pharmacokinetic and pharmacodynamic changes associated with old age, along with multimorbidity and polypharmacy might lead to inappropriate prescribing and adverse reactions. Explicit criteria such as the Screening tool of older people's prescribing (STOPP) are useful to identify potential inappropriate prescribing's (PIPs). Our retrospective study included discharge papers from patients aged ≥65 years, from an internal medicine department in Romania (January–June 2018). A subset of the STOPP-2 criteria was used to assess the prevalence and characteristics of PIPs. Regression analysis was performed to evaluate the impact of associated risk factors (i.e., age, gender, polypharmacy and specific disease). Out of the 516 discharge papers analyzed, 417 were further assessed for PIPs. Patients' mean age was 75 years, 61.63% were female and 55.16% had at least one PIP, with 81.30% having one or two PIPs. Antithrombotic agents in patients with significant bleeding risk was the most prevalent PIP (23.98%), followed by the use of benzodiazepines (9.11%). Polypharmacy, extreme (>10 drugs) polypharmacy, hypertension and congestive heart failure were found as independent risk factors. PIP was prevalent and increased with (extreme) polypharmacy and specific cardiac disease. Comprehensive criteria like STOPP should be regularly used in clinical practice to identify PIPs to prevent potential harm. [ABSTRACT FROM AUTHOR]

Aim: To study long‐term clinical and cognitive outcomes of patients with anti‐N‐methyl‐d‐aspartate receptor encephalitis (NMDAR‐E), an acute autoimmune neurological disease with severe acute presentations. Method: In this French multicentre retrospective observational cohort study, patients no older than 18 years with a follow‐up of at least 2 years were included. Data from clinical and cognitive assessments were collected. Results: Eighty‐one patients were included (57 females, 24 males; median age 10 years 7 months [range 1–18 years], median follow‐up 40 months [range 25–53 months]). At last follow‐up, 35 patients (45%) had cognitive impairment, 48 (70%) had academic difficulties, and 65 (92%) needed rehabilitation. Seventy‐one patients (88%) had a modified Rankin Scale score of no more than 2. A higher number of symptoms at diagnosis was associated with cognitive impairment (p = 0.01), while an abnormal electroencephalogram at diagnosis increased the risk of academic difficulties (p = 0.03). Interpretation: Although most children with NMDAR‐E seemed to recover from motor disabilities, more than 45% had cognitive and academic difficulties. The initial severity of symptoms seems to have an impact on cognition and academic performances. What this paper adds: Forty‐five per cent of patients had cognitive impairment at ≥2 years diagnosis of anti‐N‐methyl‐d‐aspartate receptor encephalitis (NMDAR‐E).Seventy per cent of patients had academic difficulties at ≥2 years diagnosis of NMDAR‐E.Ninety‐two per cent of patients needed rehabilitative care at ≥2 years diagnosis of NMDAR‐E.A high number of symptoms at diagnosis were associated with cognitive impairment. What this paper adds: Forty‐five per cent of patients had cognitive impairment at ≥2 years diagnosis of anti‐N‐methyl‐d‐aspartate receptor encephalitis (NMDAR‐E).Seventy per cent of patients had academic difficulties at ≥2 years diagnosis of NMDAR‐E.Ninety‐two per cent of patients needed rehabilitative care at ≥2 years diagnosis of NMDAR‐E.A high number of symptoms at diagnosis were associated with cognitive impairment. [ABSTRACT FROM AUTHOR]

Copyright of Hypertonia és Nephrologia is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

With the medical and social importance of resistant arterial hypertension (HTN) in mind, we had three goals in this paper: to study the definitions of resistant HTN in the guidelines on the topic, to analyze them, and to suggest some improvements. We found (at least) eleven insufficiencies in the definition of resistant HTN: (1) different blood pressure (BP) values are used for diagnoses; (2) the number of BP measurements is not specified; (3) the time-frame for the definition is not obtained; (4) it fails to provide normal or target or controlled BP values; (5) secondary HTN is not currently defined as true resistant HTN, but as apparently treatment-resistant HTN; (6) the definition usually directly incorporates BP cut-offs for systolic BP (sBP) and diastolic BP (dBP) making the diagnosis temporary; (7) stress is not included in the exclusion strategy for resistant HTN; (8) there is potentially a need to introduce a category of recovered resistant HTN; (9) to what degree do healthy lifestyle measures have to be fulfilled to consider it as sufficient to change the diagnosis from "apparent treatment-resistant HTN" to the "resistant HTN"; (10) sBP values normal-for-the-age for 61 and 81 year old patients in some guidelines fulfill the criterion for resistant HTN; (11) it probably ought to read "In the absence of contraindications and compelling indications..." in the others. We believe that it is better to use the phrase "above the target BP" for the definition of (treatment) resistant HTN, because the whole story of resistant HTN is related to non-responders to antihypertensive treatment. Therefore, as we treat to target and not to normal values, it is appropriate to define resistant HTN as an insufficiency to reach the target BP values. Moreover, the definition of (treatment) resistant HTN should not be universal for every patient with HTN, but it should be age-related: (treatment) resistant HTN is elevated BP over the target/normal BP values. Using this modification, there will be no need to automatically change the definition of resistant HTN when we change the BP targets in the future. [ABSTRACT FROM AUTHOR]

Introduction: With the upsurge of COVID-19 cases, Lebanese hospitals were overburdened and hospital care was prioritized for COVID-19 patients with the highest probability of poor outcomes. This paper aimed to assess the suitability of residential settings for home isolation and to explore the patient's ability to adhere to the required precautions measures. Methods: All COVID-19 cases reported between February, 21 and the end of June 2020 and who had mild or moderate symptoms, were contacted via phone calls by a healthcare professional to fill out a standardized questionnaire developed to assess the suitability of the residential setting for home care. Inpatient cases were required, before their discharge from the hospitals, to sign consent related to their adherence to the mandatory precautionary measures. They were also asked to complete, on daily basis, the symptoms monitoring log form. A referral system to health facilities was established to manage cases with worsening health status. A collaborative framework to address violations of home isolation rules was also put in place. Results: Of the 600 cases assessed, 44.7% of them were isolated in a living building apartment (67.2%) with one entrance (85.5%) including four to eight rooms (71%). Around one-quarter of patients have children (< 5 years) and 75% of them were living with elderly people. Most of the patients confirmed the availability of a well-ventilated single room (96.2%) and a separate bathroom (80.17%). As for infrastructure, more than 90% of patients confirmed the availability of drinking and tank water, heating facilities, electricity, and safe trash elimination. Similarly, more than 90% of them had access to personal hygiene items, disinfectants, and personal protective equipment. The bulk of homes care were rated as easily reachable. As for awareness and ability to self-serving, 94.5% of patients were knowledgeable about the required preventive measures, able to serve themselves and to adhere to the isolation requirements as well. Only 51.8% of them had access to psychological support. Conclusion: Proper assessment of the residential setting for home care of COVID-19 cases combined with close monitoring of the adherence of patients to the required precaution measures are highly needed for limiting the spread of infection within the household and the community. [ABSTRACT FROM AUTHOR]

Background: Back pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes' first point-of-contact. Methods: The study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care. Results: Four latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the "positive" class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the "fearful" class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the "distressed" class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the "hopeful" class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists. Conclusions: The identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity. Trial registration: Clinicaltrials.gov NCT04261309. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We have developed Convacell®—a COVID-19 vaccine based on the recombinant nucleocapsid (N) protein of SARS-CoV-2. This paper details Convacell's® combined phase I/II and IIb randomized, double-blind, interventional clinical trials. The primary endpoints were the frequency of adverse effects (AEs) and the titers of specific anti-N IgGs induced by the vaccination; secondary endpoints included the nature of the immune response. Convacell® demonstrated high safety in phase I with no severe AEs detected, 100% seroconversion by day 42 and high and sustained for 350 days anti-N IgG levels in phase II. Convacell® also demonstrated a fused cellular and humoral immune response. Phase IIb results showed significant post-vaccination increases in circulating anti-N IgG and N protein-specific IFNγ+-producing PBMC quantities among 438 volunteers. Convacell® showed same level of immunological efficacy for single and double dose vaccination regimens, including for elderly patients. The clinical studies indicate that Convacell® is safe and highly immunogenic. [ABSTRACT FROM AUTHOR]

Background: An increasing number of elderly patients now require neurosurgical intervention, and it is sometimes unclear if the benefits of surgery outweigh the risks, especially considering the confounding factor of numerous comorbidities and often poor functional states. Historically, many patients were denied surgery on the basis of age alone. This paper examines the current selection criteria being used to determine which patients get offered neurosurgical management and attempts to show if these patients have a good outcome. Particular focus is given to the increasing insight into the need to develop a neurosurgical frailty index. Methods: Using a prospective cohort study, this study observed 324 consecutive patients (n) over a 3-month period who were =65 years of age at the time of referral or admission to the neurosurgical department of the Royal Hallamshire Hospital. It highlights the selection model used to determine if surgical intervention was in the patient's best interest and explores the reasons why some patients did not need to have surgery or were considered unsuitable for surgery. Strengths and weaknesses of different frailty indices and indicators of functional status currently in use are discussed, and how they differ between the patients who had surgery and those who did not. Results: Sixty-one (18.83%) of n were operated on in the timeframe studied. Compared to patients not operated, they were younger, less frail, and more functionally independent. The 30-day mortality of patients who had surgery was 3.28%, and despite the stringent definition of poor outcomes, 65.57% of patients had good postoperative results overall, suggesting that the present selection model for surgery produces good outcomes. The independent variables that showed the greatest correlation with outcome were emergency surgery, the American Society of Anesthesiology grade, the Glasgow Coma Scale, and modified frailty index-5. Conclusion: It would be ideal to carry out future studies of similar designs with a much larger sample size with the goal of improving existing selection criteria and possibly developing a neurosurgical frailty index. [ABSTRACT FROM AUTHOR]