Effects of audit and feedback on professional practice in Geriatric Acute Care Units

PurposeTo evaluate the effects of audit and feedback on service delivery and patient functioning in Austrian Geriatric Acute Care Units.MethodsQuality initiative based on a standardised documentation form (core and optional data set) and a web-based performance feedback with peer comparison in 18 Geriatric Acute Care Units, representing 40% of all Austrian units. Main outcome measures were compliance with desired practice of geriatric care (comprehensive geriatric assessment [CGA], therapeutic consequences), discharge characteristics and mortality.ResultsOverall 22,279 patient records were documented between 2008 and 2010. Active involvement in the web-based feedback system was indicated by a high frequency of data queries per year, 1401, 3148 and 2883 for 2008, 2009 and 2010, respectively. The mean completion rate for CGA tests increased from 73% in 2008 to 78% in 2010 (P < 0.05). For centres with completion of core and optional data (n = 8), the average number of documented therapeutic interventions increased from 4.4 to 5.0 (P < 0.05). Those aspects of CGA focusing on activities of daily living, mobility and cognition prompted the greatest degree of corresponding therapeutic interventions (> 90%). A lower intervention rate was induced by the nutritional assessment (< 20%). Mortality and discharge characteristics such as level of care and percentage of patients living at home after discharge did not change over the time.ConclusionFollowing implementation of a web-based performance feedback with peer comparison in Austrian Geriatric Acute Care Units, an improvement in health care professionals’ compliance with desired practice of geriatric care, but not in patients’ discharge characteristics, was observed.     

肠内营养混悬液对急性脑出血并吞咽障碍患者营养状况及感染的影响研究

目的探讨肠内营养混悬液对急性脑出血并吞咽障碍患者营养状况及感染的影响。方法选择深圳市宝安区第二人民医院2013年2月—2014年2月收治的急性脑出血并吞咽障碍患者78例,按照随机、平行、对照原则分为对照组和观察组,每组39例。对照组患者在常规治疗基础上给予家属自制的普通流质饮食,观察组患者在常规治疗基础上给予肠内营养混悬液。观察两组患者治疗6周后营养状况、治疗前和治疗6周后营养相关指标〔血清血红蛋白(Hb)、清蛋白(ALB)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)水平〕及住院期间感染情况。结果观察组患者治疗后营养状况优于对照组,且营养低下者严重程度轻于对照组(P0.05)。两组患者治疗前血清Hb、ALB、IgG、IgA、IgM水平比较,差异均无统计学意义(P0.05);观察组患者治疗后血清Hb、ALB、IgG、IgA、Ig M水平均高于对照组(P0.05)。观察组患者住院期间感染率为38.5%,低于对照组的66.7%(P0.05)。结论肠内营养混悬液可较好地改善急性脑出血并吞咽障碍患者营养状况,减轻营养低下严重程度,提高免疫力,减少住院期间感染的发生。     

Impact of the Diet on the Formation of Oxidative Stress and Inflammation Induced by Bacterial Biofilm in the Oral Cavity

The diet is related to the diversity of bacteria in the oral cavity, and the less diverse microbiota of the oral cavity may favor the growth of pathogenic bacteria of all bacterial complexes. Literature data indicate that disturbances in the balance of the bacterial flora of the oral cavity seem to contribute to both oral diseases, including periodontitis, and systemic diseases. If left untreated, periodontitis can damage the gums and alveolar bones. Improper modern eating habits have an impact on the oral microbiome and the gut microbiome, which increase the risk of several chronic diseases, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease and cancer. The subject of our consideration is the influence of the traditional diet on the formation of oxidative stress and inflammation caused by bacterial biofilm in the oral cavity. Through dental, biomedical and laboratory studies, we wanted to investigate the effect of individual nutrients contained in specific diets on the induction of oxidative stress inducing inflammation of the soft tissues in the oral cavity in the presence of residual supra- and subgingival biofilm. In our research we used different types of diets marked as W, T, B, F and noninvasively collected biological material in the form of bacterial inoculum from volunteers. The analyzed material was grown on complete and selective media against specific strains of all bacterial complexes. Additionally, the zones of growth inhibition were analyzed based on the disc diffusion method. The research was supplemented with dental and periodontological indicators. The research was supplemented by the application of molecular biology methods related to bacterial DNA isolation, PCR reactions and sequencing. Such selected methods constitute an ideal screening test for the analysis of oral bacterial microbiota. The obtained results suggest that certain types of diet can be an effective prophylaxis in the treatment of civilization diseases such as inflammation of the oral cavity along with periodontal tissues and gingival pockets.     

An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care‐dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture‐related conditions, hyposalivation, and oral pre‐ and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person‐related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non‐dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.     

Precision Medicine in Cardiovascular Disease: Genetics and Impact on Phenotypes: JACC Focus Seminar 1/5

Our understanding of the genetic basis of cardiovascular diseases (CVDs) has evolved rapidly. This has resulted from a combination of dedicated research in well phenotyped CVD patients, the sequencing of the human genome, and the ready accessibility and decreasing cost of next-generation sequencing technologies. This increased knowledge of the genetic basis of CVDs has heralded the era of precision medicine. This encompasses many elements including improved diagnosis, family screening, assistance with reproductive decisions, targeted therapeutics guided by both phenotype and genotype, and providing important insights into risk stratification and prognosis. Furthermore, novel insights into genetic mechanisms, clinical rollout of polygenic risk scores for common CVDs, and the promise of genome editing approaches to effectively cure disease represent some of the exciting future endeavors that will change established clinical approaches. This Part 1 of a 5-part series focuses on the underpinnings and fundamental aspects of precision medicine.     

开滦集团职工中老年人群心血管健康行为和因素对颈动脉内膜中膜厚度的影响

目的探讨中老年人群心血管健康行为和因素对颈动脉内膜中膜厚度的影响。方法采用横断面研究方法,随机分层抽取唐山开滦(集团)有限责任公司在职及离退休职工中年龄≥40岁,排除既往心肌梗死、缺血性脑卒中(不包括腔隙性脑梗死)及相关研究资料缺失者,最终纳入统计分析的共5353例,进行统一问卷调查、血液生物化学指标检测及颈动脉超声检测,采用多元线性回归分析心血管健康评分对颈动脉内膜中膜厚度的影响,采用多因素Logistic回归分析心血管健康行为和因素对颈动脉硬化的影响。结果本研究人群共5353例,年龄40~94(55.1±11.8)岁,其中男性3209例,占59.9%。1具备≤1项、2项、3项、4项、5项以及≥6项理想心血管健康行为和因素的研究人群颈动脉内膜中膜厚度分别为0.89±0.19 mm、0.88±0.19 mm、0.85±0.19 mm、0.82±0.18 mm、0.80±0.18 mm、0.76±0.15 mm,各组颈动脉硬化检出率分别为32.6%、31.4%、24.7%、20.3%、15.9%、9.5%。2影响颈动脉内膜中膜厚度的多元线性回归模型校正年龄、性别、甘油三酯、高密度脂蛋白、低密度脂蛋白等因素后,心血管健康评分与颈动脉内膜中膜厚度呈线性负相关(B=-0.012,95%CI:-0.014~-0.011,P0.001);影响颈动脉硬化的多因素Logistic回归模型校正年龄、性别、甘油三酯、高密度脂蛋白、低密度脂蛋白等因素后,与具有≤1项理想心血管健康行为和因素的研究人群比较,具有3项、4项、5项以及≥6项理想心血管健康行为和因素的研究人群发生颈动脉硬化的风险值(OR)分别为0.62、0.40、0.31、0.18。结论中老年人群理想心血管健康行为和因素是颈动脉内膜中膜厚度的保护性因素,随着理想心血管健康行为和因素项数及其评分的增加,颈动脉内膜中膜厚度和颈动脉硬化检出率均降低。     

Impact of HIV Counseling and Testing on HIV-Infected Men Who Have Sex with Men: The South Beach Health Survey

The impact of HIV counseling and testing on sexual risk-taking and related behaviors reported by HIV-infected men who have sex with men (MSM) was examined in a cross-sectional study conducted among a representative sample of residents living in a resort area. Participants provided specimens of oral mucosal transudate for HIV-antibody testing, were interviewed in their homes, and completed a self-administered questionnaire. Specimens were tested by modified ELISA and, if repeatedly positive, confirmed by Western blot. Of 205 men enrolled, 51 (24.9%) tested positive for antibody to HIV. All 51 had been counseled and tested for antibody to HIV-1 (median = 4 tests); 37 (74%) of 50 reported that their most recent test was positive. Twenty (39.2%) said they had engaged in unprotected insertive anal intercourse in the past year; 15 (29.4%) engaged in unprotected insertive anal intercourse with partners who may have been susceptible to HIV infection. Men who reported that their last HIV-antibody test was positive were three times more likely to have engaged in unprotected insertive anal intercourse in the past year (45.9%) as those who did not know they were infected with HIV (15.4%). Counseling and testing is ineffective as a measure for promoting behavior change among HIV-positive MSM in South Beach. More effective social and behavioral interventions must be developed, implemented, and evaluated.     

The Impact of Sociodemographic,Nutritional, and Health Factors on the Incidence and Complications of COVID-19 in Egypt: A Cross-Sectional Study

This study was intended to explore sociodemographic, nutritional, and health-related factors on the incidence of COVID-19 infection within the Egyptian population by assessing the frequency and determinants of post-COVID-19 symptoms and complications. A cross-sectional study using a structured survey on 15,166 participants was adopted. The results revealed common symptoms including fever (79.1%), cough (74.5%), anosmia& ageusia (68.4%), and dyspnea (66.9%). The patients were nonsmokers (83.9%), while 9.7% were mild smokers. The percentage of infected patients with comorbidities versus those without comorbidities were 29%, 71%, respectively. The highest incidence of infection was in those patients with hypertension (14.8%) and diabetes (10.9%), especially females with age >50 years and obesity (BMI; 30–39.9). The highest risks were observed for anticoagulants in the age above 50 years, morbid obesity, presence of comorbidities, and being a healthcare worker. The predictors of clot risk were in the age above 50 years, non-educated, and eating meat and eggs. Nonetheless, the highest risk of using antidepressants was in patients >50 years and those who traveled abroad. These findings and similarities within the surrounding region, the Middle East, North Africa, and South Europe, indicate the possibility of sharing the same viral strain and characteristics that may predict a similar vaccine efficacy and response.     

Public Health Impact of the Centers for Medicare and Medicaid Services Decision on Pass-Through Add-On Payments for Drug-Coated Balloons: A Call to Action

On Wednesday, November 1, 2017, the Centers for Medicare and Medicaid Services (CMS) made a public decision to end the transitional pass-through add-on payment for drug-coated balloons beginning January 1, 2018, without creating a new ambulatory payment classification rate for these devices. In this Viewpoint, the authors highlight the disconnect between the CMS’s decision not to create a new ambulatory payment classification category for drug-coated balloons despite demonstrated clinical superiority. The authors believe this decision is more in line with a rigid fee-for-service payment system than a value-based system that encourages quality over quantity, and disadvantages both the elderly and the poor. They call on all who advocate for patients with peripheral artery disease to action, encouraging their engagement on CMS decisions regarding payment.     

Impact of the vitamin D deficiency on COVID-19 infection and mortality in Asian countries

Background and aimsCOVID-19 is a pandemic that has affected beyond 100 million and caused nearly 3 million deaths globally. Vitamin D is a known risk factor for COVID-19. Therefore, we aimed to investigate the association of prevalence of vitamin D deficiency and mean vitamin D level with COVID-19 infection and mortality in Asia, predicting with other confounding factors such as median age, obesity, and diabetes.MethodsCOVID-19 infections and mortalities among the Asian countries were retrieved from the Worldometer website. Information on prevalence of vitamin D deficiency and mean vitamin D values in each Asian country was retrieved through literature searching on PubMed® and Google scholar. The associations between COVID-19 infections and mortalities with prevalence of vitamin D deficiency and mean vitamin D level were explored with correlation coefficients. As a predictive analysis, multiple linear regression was carried out with all confounders.ResultsPositive correlations were observed for prevalence of vitamin D deficiency with COVID-19 infections (r = 0.55; p = 0.01; R² = 0.31) and mortalities (r = 0.50; p = 0.01; R² = 0.25). Moreover, the associations for the COVID-19 infections and mortalities improved to r = 0.76 (p = 0.002; R² = 0.58) and r = 0.65 (p = 0.03; R² = 0.42), respectively, after predicting with confounding factors. Similarly, mean vitamin D level had a significant negative correlation with COVID-19 infections (r = ?0.77; p = 0.04; R² = 0.59) and mortalities (r = ?0.80; p = 0.03; R² = 0.63) when combining with confounders.ConclusionPrevalence of vitamin D deficiency is significantly positively associated whereas the mean vitamin D level is significantly negatively associated with both infection and mortality rate of COVID-19 among Asian countries upon predicting with all confounders.     

Prognostic Impact of Extent,Severity, and Heterogeneity of Abnormalities on 18F-FDG PET Scans for Suspected Cardiac Sarcoidosis

Objectives

This study sought to evaluate the incremental value of quantifying the extent and severity of myocardial perfusion and ¹⁸F-labeled fluorodeoxyglucose (FDG) abnormalities in predicting adverse outcomes among patients with suspicion for cardiac sarcoidosis (CS).