Categorizing fear of falling using the survey of activities and fear of falling in the elderly questionnaire in a cohort of hospitalized older adults: A cross-sectional design.

BACKGROUND: Fear of falling is commonly assessed using the Activities-specific Balance Confidence Scale which is an instrument to measure balance confidence, based on the assumption that fear of falling is due to the absence of balance confidence. The "Survey of Activities and Fear of Falling in the Elderly" measures the concept of fear of falling more directly on a scale of 0.0 and 3.0 points. However, there are no valid cut-off points that might help practitioners to interpret "Survey of Activities and Fear of Falling in the Elderly" scores. The aim of this study was to identify such cut-off points and distinguish between low, moderate and high fear of falling, in relation to balance confidence. METHOD: In this cross-sectional study different cut-off point schemes for classifying fear of falling scores as low, moderate or high were compared with F-values in ANOVA using the cut-off point scheme as an independent variable and the balance confidence scores as a dependent variable. The analysis was performed using data from a cohort of 98 hospitalized older adults. RESULTS: Using the Activities-specific Balance Confidence Scale as a reference tool, values of 0.6 and 1.4 were identified as optimal cut-off points for low, moderate and high fear of falling. CONCLUSIONS: This study was the first to systematically classify fear of falling using the "Survey of Activities and Fear of Falling in the Elderly". This classification can assist health practitioners to interpret fear of falling score and guide clinical decision making. Registration: The study is registered with the German Clinical Trials Register (DRKS00010773, date of registration 2016/05/07, date of recruitment 2016/11/07).

Influence of Music Therapy and Music-Based Interventions on Dementia: A Pilot Study.

According to national dementia plan in many countries, the music implementation into the daily routine as an adjunctive therapy to medication treatment is common. However, the ability of long-term care facilities to implement individualized music therapy (MT) and music-based interventions is not sufficiently taken into account. This pilot study examined the frequency of use and acceptance of MT and technology-based music interventions (TBMI) as well as the influence of high and low usage of both interventions of dementia on behavioral and psychological symptoms (BPSD) at two timepoints. Furthermore, the influence on the combination of MT and TBMI of dementia within the nursing home setting on BPSD with a focus on agitation, apathy, depression, and quality of life at all timepoints was considered. In the present study, data from 30 people with dementia (PwD) aged on average 81 years were analyzed within an eight-week noncontrolled intervention study, including four-week follow-up. Initial outcome data indicated significant decreases at times T2 and T3 in agitation and apathy among PwD with a high usage of MT and TBMI than among those with a low usage. In general, reductions were obtained from all observed BPSD at all timepoints. Significant results were found only for agitation over time. Considering the demonstrated results, a long-term implementation of music within daily routines in nursing homes for PwD should be strived for.

COVID-19 #StayAtHome Restrictions and Deep Vein Thrombosis: Case Report.

BACKGROUND: The COVID-19 pandemic triggered countermeasures like #StayAtHome initiatives, which have changed the whole world. Despite the success of such initiatives in limiting the spread of COVID-19 to #FlattenTheCurve, physicians are now confronted with the adverse effects of the current restrictive pandemic management strategies and social distancing measures. OBJECTIVE: We aim to draw attention to the particular importance and magnitude of what may be the adverse effects of COVID-19-related policies. METHODS: We herein report a case of an otherwise healthy 84-year-old woman with deep vein thrombosis (DVT) due to COVID-19-related directives. #StayAtHome policies and consequential social isolation have diminished our patient's social life and reduced her healthy movement behaviors. The patient spent long hours in a seated position while focusing on the intensive flow of media information regarding the pandemic. RESULTS: Reduced mobility due to preventive social isolation during the COVID-19 pandemic was the only identified cause of the DVT. CONCLUSIONS: While evaluating the effect of the COVID-19 pandemic and governmentally implemented containment measures, including social isolation and mobility reduction, adverse events should be considered. Digital approaches might play a crucial role in supporting public health.

Severity of cardiac impairment in the early stage of community-acquired sepsis determines worse prognosis.

INTRODUCTION: In sepsis, the reduced systemic vascular resistance (SVR) can lead to a compensatory increase in cardiac output (CO). This may mimic a normal cardiac function although there is already a sepsis-induced myocardial depression. On a cohort of patients with septic multi-organ dysfunction syndrome, we have recently developed a method to correlate the actual CO to the afterload (estimated by SVR) and introduced the parameter "afterload-related cardiac performance" (ACP), which indicates if the rise of CO is adequate for the particular SVR. In this present study it was to be investigated, if ACP can reveal septic cardiomyopathy in patients with community-acquired sepsis in the early state soon after admission to the emergency department (ED), and if there is a prognostic relevance of septic cardiomyopathy defined by ACP. Results were compared to cardiac index (CI) and cardiac power index (CPI). METHODS: Adults presenting at the ED with sepsis were included. ACP, CI and CPI were calculated at the time of admission, after 24, and 72 h. They were correlated to severity of disease and the prognostic values were analyzed. RESULTS: A total of 141 patients were included. Only ACP was significantly influenced by severity of sepsis, whereas CI and CPI were not. ACP was the only hemodynamic parameter predicting mortality: nonsurvivors had lower ACP values at the time of admission to the ED (66.9 vs. 88.9 %, p < 0.05) and ACP predicted non-survival with an AUC value of 0.72, p = 0.003. Cardiac impairment defined by an ACP value of 80 % or below determined worse prognosis. CONCLUSIONS: Septic cardiomyopathy occurs already at the early stage of disease and is of prognostic relevance. It might be recognized best, if cardiac function is correlated to afterload.

Septic cardiomyopathy: hemodynamic quantification, occurrence, and prognostic implications.

INTRODUCTION: In sepsis, severe reduction of afterload may often mask cardiac impairment. By establishing the parameter "afterload-related cardiac performance (ACP)" we wanted to determine the extent, frequency, and prognostic relevance of septic cardiomyopathy. METHODS: Over a 12 months period, all patients of our medical intensive care ward were included into the study when they were classified as having "septic MODS" (sepsis score ≥12 as long as APACHE II score was ≥20). Hemodynamic assessments were performed using a pulmonary artery catheter. RESULTS: A total of 524 patients were screened, and from these 39 had septic MODS. In survivors, APACHE II score values declined from day 0 (day of diagnosis, 27.6 ± 8.0) to day 4 (17.8 ± 8.0), while in non-survivors, score values remained high (day 0: 31.8 ± 5.7; day 4: 33.2 ± 6.7; p < 0.001). Hemodynamic measurements showed an inverse correlation of cardiac output (CO(measured)) and SVR which can be described as CO = ß (0) × SVR( ß1). The upper limit of 80% tolerance range of CO was defined as the "normal" CO values (CO(normal)). The parameter "afterload-related cardiac performance (ACP)" was calculated as ACP (%) = CO(measured)/CO(normal) × 100. It turned out that ACP shows a stronger correlation with APACHE II- and sepsis-score than CO, cardiac index (CI), cardiac power (CPO), or cardiac power index (CPI). Furthermore, ACP correlated with sepsis-induced myocardial damage as indicated by elevations of troponin I and significantly differed between surviving (86.9 ± 1.6%) and non-surviving patients (69.2 ± 1.4%; p < 0.0001). While 75% of the surviving patients showed an ACP >60%, 38% of the non-survivors had a moderate (ACP 40-60%) and 25% a severe impairment of cardiac function (ACP < 40%). CONCLUSION: By using the parameter "afterload-related cardiac performance, ACP", the impairment of cardiac function can be reliably quantified showing that septic cardiomyopathy occurs frequently and is of prognostic relevance in patients with septic MODS.

Apoptosis contributes to septic cardiomyopathy and is improved by simvastatin therapy.

Bacterial toxins cause cardiac dysfunction and death through an inflammatory process, but the mechanism remains unclear. Simvastatin is recognized as having anti-inflammatory properties beyond its lipid-lowering effects. We examined Staphylococcus aureus alpha-toxin in isolated heart and in vivo models and tested simvastatin's effects in sepsis. Isolated Langendorff-perfused rat hearts were exposed to a recirculating perfusate containing alpha-toxin (0.5 microg mL(-1)). Compared with controls, there was a significant increase in coronary perfusion pressure and fall in myocardial performance. Significant increases in p53 expression and apoptosis (1.3 +/- 0.5 to 7.1 +/- 1.4 terminal deoxynucleaotidyl transferase nick end labeling-positive cells; P < 0.05) compared with controls were observed, but markers of necrosis were similar. In parallel experiments, anaesthetized rats receiving alpha-toxin (40 microg kg(-1), i.v.) had in vivo hemodynamic parameters and serum markers of necrosis monitored for 4 h before the hearts were analyzed for histological change, p53 expression, and apoptosis. Over 4 h, alpha-toxin exposure produced substantial hemodynamic effects. In addition, p53 expression (0.2 +/- 0.2 to 7.1 +/- 0.5 p53-positive myocytes; P < 0.05), TNF-alpha levels, the degree of apoptosis, and markers of necrosis were all significantly increased compared with control animals. Pretreatment with simvastatin protected against alpha-toxin-induced sepsis associated with reduced p53, TNF-alpha, apoptosis, and necrosis. We found significant changes in systemic hemodynamics, coronary perfusion pressure, myocardial function, and increased p53 expression with apoptosis due to bacterial exotoxin. In vivo changes were significantly inhibited by pretreatment with simvastatin. We provide novel evidence for the mechanisms by which septicemia causes myocardial depression and hint at a potential role for simvastatin as an inhibitor of apoptosis in sepsis.

Intramural delivery of Sirolimus prevents vascular remodeling following balloon injury.

OBJECTIVE: Several studies have demonstrated that Sirolimus-eluting stents reduce restenosis in patients with coronary artery disease. Here, we tested whether direct delivery of Sirolimus into the vessel wall during balloon angioplasty can modify vascular remodeling over several weeks. METHODS AND RESULTS: During angioplasty of the rabbit iliac artery we administered an intramural infusion of Sirolimus or its vehicle directly through a balloon catheter into the vessel wall. After 3 weeks neointimal formation was decreased (0.71+/-0.1 vs. 1.4+/-0.12 intima/media ratio), and this process was attributed to the inhibitory properties of Sirolimus on ECM deposition and smooth muscle cell proliferation. Sirolimus also significantly reduced the deposition of elastin, collagen III and fibronectin within the vascular wall. In parallel, proteomic profiles of arterial wall segments were obtained and 485 protein spots were consistently matched between non-dilated and dilated vessels. Differential expression of 12 proteins were observed between the groups and direct sequencing of digested peptides was performed. Local delivery of sirolimus during angioplasty attenuated the expression of structural proteins that included lamin A, vimentin, alpha-1-antitrypsin, and alpha-actin. CONCLUSIONS: Local administration of Sirolimus during angioplasty prevents smooth muscle cell proliferation associated with vascular remodeling as well as the expression of extracellular matrix and structural proteins. Therefore, local injection of Sirolimus during balloon inflation may be an alternative therapeutic approach for preventing restenosis in small stenotic vessels (i.e., <2.5 mm).