Factors related to the mobility of hospitalized older adults: A prospective cohort study.

A low ambulation rate is common even among acutely ill hospitalized older adults. This prospective observational study conducted among 769 older adults (≥70) hospitalized in acute-care units tested the relationship of satisfaction with hospital environment, sleep-medication consumption, and in-hospital caloric intake to mobility levels during hospitalization on 3 consecutive hospitalization days. Approximately 20% of the patients did not walk, 30% walked only in their room, and 50% mobilized outside their room. A multinomial-logistic regression, controlling for potential intervening factors, showed that sleep-medication avoidance (AOR = 1.99; p < 0.01) and higher caloric intake (AOR = 9.69; p < 0.001) differentiated patients walking outside the room from non-walking patients. Satisfaction with the physical environment was lower in the non-mobile group than in the other two. Results suggest that hospital environment, sleep-medication consumption, and caloric intake during hospitalization need to be addressed in attempts to improve in-hospital mobility in older adults.

Effects of treatment of ectopic pregnancy with methotrexate or salpingectomy in the subsequent IVF cycle.

Ectopic pregnancy is a known risk for patients treated with IVF. The objective of this study was to evaluate the effect of methotrexate (MTX) and laparoscopic salpingectomy as treatments of ectopic pregnancy on ovarian response during IVF cycles. Data of all women treated for ectopic pregnancy as a result of IVF treatment were evaluated; the study included women who had an unruptured ectopic pregnancy after IVF treatment that was treated with either MTX or laparoscopic salpingectomy and underwent a subsequent IVF cycle. The main outcome measures were baseline serum FSH concentrations and ovarian response in the subsequent IVF cycle after treatment of ectopic pregnancy. Of a total of 58 patients, 36 were previously treated with MTX and 22 others by salpingectomy. No significant differences were observed between the MTX and the salpingectomy groups in the parameters of ovarian response in the subsequent IVF cycle.

Oocyte Donation From Donor Older Than 35 Years. Is It Worth Trying?

INTRODUCTION: Due to several reasons, in some countries commercial oocyte donation is not possible. Accordingly, patients should find their own donors who may be over 35 years. The aim of this study was to compare the results of oocyte donation from donors <35 years (young donors) and donors ≥35 years old (older donors). MATERIAL AND METHODS: A retrospective cohort study was conducted at a single academic reproductive center. We compared the results of oocyte donation from donors <35 years (345 cycles) and from donor ≥35 years old (83 cycles). We also performed subgroup analysis for single embryo transfer (SET) and fresh and frozen embryo transfers. RESULTS: Recipient demographic characteristics of the 2 groups were comparable. The age of the donors was 29.8 ± 3.9 years in the young donor group and 37.6 ± 2.1 years in the older donor group ( P < .0001). Pregnancy and implantation rates in the recipients from young donor group were statistically significantly higher than those from the older donor group (50.7% and 40.9% vs 38.3% and 23%; P = .04, P < .001). Cumulative pregnancy and live birth rates were significantly higher in the young donor group compared to the older donor group (86.1% vs 57.4% P < .0001 and 52.2% vs 33.3%, P = .02, respectively). Subgroup analysis showed comparable pregnancy and live birth rates for SET cycles (45.5% vs 40.4% and 25.0% vs 21.2%, respectively) and fresh cycles (54.7% vs 42.6% and 35.8% vs 29.6%, respectively). CONCLUSION: In nonanonymous oocyte donation programs, donation from older donors with good ovarian reserve is an acceptable approach when young donor is not available.

Adverse outcome of pregnancies with extremely high levels of maternal serum human chorionic gonadotropin.

BACKGROUND: The associated risk of elevated levels of maternal serum human chorionic gonadotropin (MShCG) with pregnancy complications was reported in many studies. However, the outcome of pregnancies with extremely high levels of MShCG was never independently studied. METHODS: We report on 6 out of 45,990 studied patients with extremely high levels of MShCG (>15 multiples of the medians) analyzed during the second trimester. RESULTS: Although our patient population was composed of more Jewish than Arab pregnant women, all those patients were Arabs. Overall, the prognosis of those pregnancies was poor. In 1 case, an antepartum fetal death occurred, 2 had premature deliveries (one of the newborns had severe failure to thrive), and 2 delivered small for gestational age babies. In 5 of these 6 cases, no specific diagnosis was established. One case was complete hydatidiform mole with a coexisting normal fetus. CONCLUSIONS: We recommend that these patients undergo counseling in which the predicted outcome will be described. In addition, a follow-up of high-risk pregnancy should be implemented: sonographic evaluation should be performed, initially to rule out a molar gestation. The patients should then be followed for growth restriction and they should be monitored to rule out other pregnancy complications such as premature labor and antepartum fetal death. Finally, the overrepresentation of Arabs among our affected patients raises the question of a possible genetic tendency for increased MShCG levels especially in the extreme level group.