The relationship between social media use and psychosocial outcomes in older adults: A systematic review.

OBJECTIVES: Social isolation and loneliness are prevalent in older adults and are detrimental to physical and mental health. Social media use has been shown to be effective in maintaining social connections and improving older adults' psychosocial outcomes. This study aimed to systematically review and synthesize current research on this topic. DESIGN: Searches were conducted in November 2021 (and updated in October 2023) in PsycINFO, PubMed, and CINAHL. Inclusion criteria: (1) participants ≥ 65 years (mean, median, or minimum age) and (2) reported impact of social media use on psychosocial outcomes (including loneliness, depression, anxiety, social connectedness, wellbeing, life satisfaction, and quality of life). Quality appraisal tools were utilized, and results were synthesized using narrative synthesis. RESULTS: Sixty-four papers met inclusion criteria, including cross-sectional (n = 38), observational longitudinal (n = 6), interventional (n = 9), mixed-methods (n = 4), and qualitative (n = 7) studies. Participant numbers ranged from 6 to 16,925. While associations between social media use and positive psychosocial outcomes were generally reported in cross-sectional studies, the impact of social media use over time from longitudinal studies was mixed and inconclusive. CONCLUSIONS: While social media use is associated with positive psychosocial outcomes, casual conclusions cannot be drawn. Few longitudinal and randomized controlled trial studies existed, and these reported mixed findings. Large variations in study methodology including participants, measurement of social media use, and outcome measures contributed to the inconsistencies of findings. Addressing this heterogeneity through standardized approaches and more rigorous research may enhance understanding.

COVID-19 Infection and Vaccination and Its Relation to Amyloidosis: What Do We Know Currently?

Amyloidosis is a complex disorder characterized by deposited insoluble fibrillar proteins which misfold into ß-pleated sheets. The pathogenesis of amyloidosis can vary but can be the result of immune dysregulation that occurs from sustained high inflammatory states, often known as AA amyloidosis. Multi-organ involvement including hepatic, gastrointestinal, renal, cardiac and immunological pathological manifestations has been observed amongst individuals presenting with amyloidosis. The recent global pandemic of severe acute respiratory syndrome coronavirus 2, also referred to as coronavirus 2019 (COVID-19), has been shown to be associated with multiple health complications, many of which are similar to those seen in amyloidosis. Though COVID-19 is recognized primarily as a respiratory disease, it has since been found to have a range of extra-pulmonary manifestations, many of which are observed in patients with amyloidosis. These include features of oxidative stress, chronic inflammation and thrombotic risks. It is well known that viral illnesses have been associated with the triggering of autoimmune conditions of which amyloidosis is no different. Over the recent months, reports of new-onset and relapsed disease following COVID-19 infection and vaccination have been published. Despite this, the exact pathophysiological associations of COVID-19 and amyloidosis remain unclear. We present a scoping review based on our systematic search of available evidence relating to amyloidosis, COVID-19 infection and COVID-19 vaccination, evaluating current perspectives and providing insight into knowledge gaps that still needs to be addressed going forward.

A Scoping Review of the Measurement of Depression in Older Adults with Cognitive Impairment.

OBJECTIVES: Depression and cognitive impairment are disabling conditions that commonly occur together in older adults. The interaction is challenging when choosing appropriate measurement scales. This review aimed to summarize the scales to measure depression symptoms in older people with cognitive impairment, investigating how cognitive impairment is related to the choice of measurement, and how the setting may affect the choice of measurement. METHODS: A scoping review of literature published between 2015 and 2021. RESULTS: After screening 1580 articles, 26 were included in the review with 11 different measures of depression symptoms identified. The measures mostly commonly used were the Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory (NPI-Q). Most studies did not report on the usability of depression scales used with people with cognitive impairment and only two scales (CSDD and NPI-Q, not GDS) have been validated for use with this population. CONCLUSIONS: Severe cognitive impairment was under-represented in the identified studies, and no association was detected between study setting, cognitive impairment and type of measure used. CLINICAL IMPLICATIONS: Clinicians and researchers should consider both the cognitive status of participants and the setting they live in when choosing a measure of depression symptoms.

English language proficiency and hospital admissions via the emergency department by aged care residents in Australia: A mixed-methods investigation.

Residents of Residential Age Care Facilities (RACFs) have particularly high rates of Emergency Department (ED) visits, with up to 55% being potentially avoidable (e.g. not resulting in a hospital admission). This is concerning as ED visits by RACF residents are associated with negative outcomes including longer hospital stays, iatrogenic illness, complications and mortality. Limited English proficiency (LEP) has significant negative impacts on the healthcare quality and outcomes for older people but has not been studied as a factor in ED visits from RACFs. This study aimed to examine if RACF residents with LEP have a lower rate of hospital admission via the ED compared to non-LEP controls and identify any associated factors. We hypothesised that LEP-related communication difficulties would reduce the ability to manage minor health issues in the RACF, leading to a lower proportion of LEP ED transfers being admitted. We used a parallel mixed-methods design, comprising a quantitative matched cohort study of ED visit data from two Local Hospital Networks (LHNs) in South-East Melbourne, Australia and secondary thematic analysis of 25 interviews with LEP residents, family carers and staff from two RACFs in the same region. We found no differences in the proportion of hospital ED transfers that led to admission (LHN1, 87.1% LEP, 85.6% non-LEP controls, p = 0.57; LHN2, 76.0% LEP, 76.9% non-LEP controls, p = 0.41) and no direct qualitative evidence suggesting that resident LEP affected decisions to transfer residents to ED, despite communication difficulties being reported during the transfer process. These results may be due to the high level of family carer involvement in residents' care identified in the qualitative study. However, additional research using different measures of LEP is recommended to further explore a broader range of cultural and linguistic factors in both rates of ED presentations and the decision-making processes underpinning resident transfers to ED.

Giving intravenous iron to patients with symptomatic heart failure is safe and cost effective.

AIMS/BACKGROUND: Heart failure affects approximately 1 million people in the UK, adversely affecting quality of life, functional capacity and cognitive health. Iron deficiency complicates heart failure in approximately 50% of patients. Giving intravenous ferric carboxymaltose has been shown to improve quality of life in patients with heart failure (New York Heart Association class and Kansas City Cardiomyopathy Questionnaire). METHODS: A quality improvement project was designed to assess the feasibility, safety and cost implications of establishing an intravenous iron service in the authors' centre. RESULTS: Between July and December 2019 61 patients who were screened met the inclusion criteria and were administered intravenous ferric carboxymaltose. There were statistically significant improvements in ferritin levels (83.3 ug/litre to 433 ug/litre; P<0.0001), transferrin saturation (18% to 30% P<0.0001) and haemoglobin levels (126 g/litre to 135 g/litre; P<0.01). No demonstrable changes in New York Heart Association class or quality of life scores were noted. The overall financial impact for the trust was income generation of £14 665, a net income of £240 per patient. CONCLUSIONS: Intravenous iron replacement with ferric carboxymaltose is safe and cost effective, and should be considered in eligible iron-deficient patients with symptomatic heart failure. Integration with another day case intravenous service represented the most logistically simple and economically viable method of service delivery.

Discrepancies Between Community-Dwelling Individuals with Dementia and Their Proxies in Completing the Cornell Scale for Depression in Dementia: A Secondary Data Analysis.

BACKGROUND: Depressive symptoms are common in people with dementia. PURPOSE: This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia. PARTICIPANTS AND METHODS: This study is a cross-sectional secondary analysis. Twenty-five people living with dementia ("participants") and their family caregivers ("proxies") participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t-test was used to investigate differences in CSDD scores between participants and proxies. Kendall's tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann-Whitney U-test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group. RESULTS: The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The "high functional impairment" group had larger discrepancy scores and a lower level of agreement than the "low functional impairment" group. CONCLUSION: The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced.

The effects of transcranial direct current stimulation (tDCS) on clinical symptoms in schizophrenia: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aims to examine the effects of transcranial direct current stimulation (tDCS) on clinical symptoms in schizophrenia. METHODS: A literature search was performed for articles published in English using the following databases: MEDLINE, EMBASE, PsycINFO, INSPEC, the Cumulative Index to Nursing & Allied Health Literature Plus (CINAHL Plus), AMED, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, EU Clinical Trials Register, and WHO International Clinical Trials Registry Platform, from their inception to October 2019. The primary outcome variables were the clinical symptoms of schizophrenia including positive symptoms, negative symptoms, and auditory hallucinations. RESULTS: 16 randomized controlled trials (RCTs) were included in the meta-analysis, with a sample of 326 patients with active and with 310 sham tDCS. Active tDCS was found to be more effective in improving positive symptoms [standardized mean difference (SMD) = 0.17; 95 % confidence interval (CI) 0.001 to 0.33], negative symptoms [SMD = 0.43, 95 % CI 0.11, 0.75] and auditory hallucinations [SMD = 0.36 95 % CI 0.02, 0.70]. Subgroup analyses showed better results in cases of pure diagnosis of schizophrenia, higher frequency and more sessions of stimulation. CONCLUSION: tDCS was effective in improving positive symptoms, negative symptoms and auditory hallucination in schizophrenia. It therefore has potential as a safe and well-tolerated adjunctive intervention for schizophrenia.

Combining lapatinib and pertuzumab to overcome lapatinib resistance due to NRG1-mediated signalling in HER2-amplified breast cancer.

Acquired resistance to lapatinib, an inhibitor of EGFR and HER2 kinases, is common. We found that reactivation of EGFR, HER2 and HER3 occurred within 24 hours of lapatinib treatment after their initial dephosphorylation. This was associated with increased expression of NRG1 in cells treated with lapatinib. Exogenous NRG1 partially rescued breast cancer cells from growth inhibition by lapatinib. In addition, both parental and lapatinib-resistant breast cancer cells were sensitive to SGP1, which inhibits binding of NRG1 and other HER3 ligands. Addition of pertuzumab to lapatinib further inhibited NRG1-induced signalling, which was not fully inhibited by either drug alone. In animal model, a combination of pertuzumab to lapatinib induced a greater tumor regression than either lapatinib or pertuzumab monotherapy. This novel combination treatment may provide a promising strategy in clinical HER2-targeted therapy and may inhibit a subset of lapatinib-resistant breast cancer, although the group of patients that will respond to this therapy requires further stratification.