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1.
BMC Geriatr ; 21(1): 104, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546613

RESUMO

BACKGROUND: Total physical activity is positively associated with brain volume and cognition in older adults. While we have ample evidence that recreational physical activity influences brain health, the contributions of other daily activities are less understood. In particular, the associations between household physical activity and brain health in older adults is underexplored. The purpose of this study was to identify associations between household physical activity, brain volume, and cognition in a sample of cognitively unimpaired older adults. METHODS: We report data from 66 cognitively unimpaired older adults (71 ± 4 years) who participated in a health evaluation, cognitive assessment, and structural brain imaging. Physical activity was assessed using the Phone-FITT questionnaire and separated into household and recreational physical activity. We quantified whole brain volume, gray matter volume, and white matter volume, and assessed cognitive performance in four domains: memory, working memory/attention, processing speed, and executive function. Associations between physical activity, brain volume, and cognition were investigated in an omnibus approach using two multivariate analysis of variance (MANOVA) models. The first model assessed the associations between physical activity and brain volume adjusting for age, sex, Framingham Risk score (FRS) and intracranial volume. The second model assessed the associations between physical activity and overall cognitive performance adjusting for age, sex, FRS and education. Post hoc regression analyses were conducted to investigate significant MANOVA results. We also conducted further regression analyses to investigate associations with hippocampal and frontal lobe volume. RESULTS: Household, but not recreational, physical activity was positively associated with brain volume measurements (F = 3.07, p = .035), specifically gray matter volume (t = 2.51, p = .015). Further exploratory analyses identified that household physical activity was associated with hippocampal (p = .015) and frontal lobe (p = .010) volume. No significant relationships were observed between household or recreational physical activity and cognition. CONCLUSION: Time spent engaging in household physical activity was positively associated with brain volume, specifically gray matter volume, in older adults. Highlighting the benefits associated with household chores may motivate older adults to be more active by providing a more attainable, low risk form of physical activity.

2.
Neuropsychologia ; 151: 107735, 2021 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-33359882

RESUMO

People with amnestic mild cognitive impairment (aMCI) repeat questions, seemingly without any sense of familiarity (i.e., recognition of prior occurrence without recollection of episodic context). Accumulation of neurofibrillary tau in preclinical Alzheimer's disease begins in perirhinal cortex, a medial temporal lobe region linked to familiarity. Both observations would predict impaired familiarity assessment in aMCI; however, the extant evidence is mixed. To reveal familiarity impairments, it may be necessary to minimize the influence of recollection. In the current study, older adults with aMCI and healthy controls were administered two tasks on which a well-characterized patient (NB) with selective familiarity impairments due to surgical left temporal lobe excision sparing the hippocampus showed abnormal performance: frequency judgments for words exposed to in a recent study phase and judgments of cumulative lifetime familiarity for object concepts denoted by words. We also administered a process dissociation procedure (PDP) task that previously revealed spared familiarity in aMCI. We predicted that familiarity would be spared in aMCI on the PDP task, but impaired when assessed by frequency judgments for recent laboratory exposures and lifetime familiarity judgments. Familiarity was spared on the PDP task, but was impaired when probed with frequency judgments for recently exposed words in aMCI. Lifetime familiarity was also not impaired in aMCI. These results highlight the benefits of studying familiarity under conditions that minimize recollection and the value of frequency judgments in revealing familiarity deficits, and suggest that perirhinal cortex may not be necessary for accessing familiarity accumulated over a lifetime of experience.

3.
Alzheimers Dement (N Y) ; 6(1): e12086, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33209973

RESUMO

Introduction: Current pharmacological therapies for dementia have limited efficacy. Thus it is important to provide recommendations on individual and community-based psychosocial and non-pharmacological interventions for persons living with dementia (PLWDs) and their caregivers. Methods: Phase 1: A systematic review for developing recommendations on psychosocial and non-pharmacological interventions at the individual and community level for PLWDs and their caregivers. Phase 2: Rating of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Phase 3: Delphi process (>50 dementia experts) for approving recommendations by the 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5). Results: The CCCDTD5 approved the following recommendations: Exercise (1B) and group cognitive stimulation for PLWDs (2B), psychosocial and psychoeducational interventions for caregivers (2C), development of dementia friendly organization and communities (2C), and case management for PLWDs (2B). Discussion: The CCCDTD5 provides for the first time, evidence-based recommendations on psychosocial and non-pharmacological interventions for PLWDs and their caregivers that can inform evidence-based policies for PLWDs in Canada.

4.
Pediatr Transplant ; : e13897, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33131128

RESUMO

BACKGROUND: Pediatric patients undergoing heart transplant have a number of factors predisposing them to become fluid-overloaded, including capillary leak syndrome. Capillary leak and FO are associated with organ injury and may influence both short- and long-term outcomes. This study aimed to 1) determine the extent, timing, and predictors of post-operative FO and 2) investigate the association of FO with clinically important outcomes. METHODS: Between 2000 and 2012, 70 children less than 6 years old had a heart transplant at our institution. This was a secondary analysis of data from an ongoing prospective cohort study. RESULTS: FO, defined as cumulative fluid balance greater than 10% of body weight in the first 5 post-operative days, occurred in 16/70 patients (23%); 7 of these had more than 20% FO. Shorter donor ischemic time and longer cardiopulmonary bypass time were independently associated with increased risk of FO. FO >20% was a statistically significant independent predictor of mortality (P = .005), ventilation time, and PICU length of stay. There was no statistically significant association between identified neurodevelopment domains and FO. CONCLUSIONS: Our single-center experience demonstrates that FO was common after pediatric heart transplant and was associated with worse clinical outcomes. FO is a potentially modifiable factor, and research is needed to better determine risk factors and whether intervention to reduce FO can improve outcomes in pediatric heart transplant patients.

5.
Front Aging Neurosci ; 12: 571074, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33192462

RESUMO

Background: Gait deficits are associated with brain atrophy and white matter hyperintensities (WMH) - both markers of underlying cerebral small vessel disease (SVD). Given reduced subcortical cerebral blood flow (CBF) is prevalent in SVD, we tested the hypothesis that regional CBF is positively associated with gait performance among older adults. Methods: Thirty-two older adults (55-80 years) with at least one vascular risk factor were recruited. We assessed gait during 2 consecutive walking sequences using a GAITRite system: (1) at a self-selected pace, and (2) while performing a serial subtraction dual-task challenge. We quantified CBF using pseudo-continuous arterial spin labeling MRI within 4 regions of interest: putamen, pallidum, thalamus, and hippocampus. We investigated associations between gait characteristics and overall CBF adjusting for age, sex, and height in an omnibus approach using multivariate analysis of variance, followed by regression analysis with each individual region. We also conducted further regression analyses to investigate associations between gait characteristics and frontal lobe CBF. Sensitivity analyses examined how the observed associations were modified by WMH, executive function, and depressive symptoms. A change of 10% in the model's adjusted r2 and effect size was considered as a threshold for confounding. Results: Overall subcortical CBF was not associated with self-paced gait. When examining individual ROI, gait velocity was directly related to thalamic CBF (p = 0.026), and across all gait variables the largest effect sizes were observed in relation to thalamic CBF. In the dual-task condition, gait variables were not related to CBF in either the omnibus approach or individual multiple regressions. Furthermore, no significant associations were observed between frontal CBF and gait variables in either the self-paced or dual-task condition. Sensitivity analyses which were restricted to examine the association of velocity and thalamic CBF identified a cofounding effect of depressive symptoms which increased the effect size of the CBF-gait association by 12%. Conclusion: Subcortical hypoperfusion, particularly in regions that comprise central input/output tracts to the cortical tissue, may underlie the association between gait deficits and brain aging.

6.
Neoreviews ; 21(11): e749-e760, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33139512

RESUMO

Neonatal indirect hyperbilirubinemia (IHB) is caused by an imbalance in bilirubin production and elimination. Approximately 60% of term and 80% of preterm infants develop jaundice in the first week of age. This review seeks to provide the reader with a thorough understanding of the physiology of bilirubin, etiology of IHB, and management of severe IHB. Phototherapy and exchange transfusion remain the mainstays of treatment for severe IHB. Noninvasive screening tools, innovative treatments, and a better understanding of how prematurity and genetics contribute to severe IHB have improved our understanding of IHB and may help eliminate the hazards associated with severe IHB, including kernicterus spectrum disorder.

7.
Plant Dis ; 104(12): 3192-3196, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33079640

RESUMO

Screening methodology of wheat genotypes for resistance to sharp eyespot (caused by Rhizoctonia cerealis) was developed. Disease severity differed among cultivars and between field and greenhouse trials. However, the cultivars Bobtail and Rosalyn had consistently lower severity in field experiments with high sharp eyespot disease pressure. Artificial inoculation was crucial to achieving adequate disease levels for effective screening but planting date had very little effect. Greenhouse inoculation of adult wheat plants was much less successful in categorizing resistance to sharp eyespot. Seedling inoculations in the greenhouse were highly inadequate as a screening method. Selection for resistance to sharp eyespot by artificial inoculation in field trials is feasible in wheat breeding programs.

8.
Artigo em Inglês | MEDLINE | ID: mdl-33067996

RESUMO

OBJECTIVE: To examine known-groups validity of a telephone administration of the total learning scores of the Rey Auditory Verbal Learning Test (RAVLT) in discriminating between people with subjective cognitive decline (SCD) and amnestic mild cognitive impairment (aMCI) and convergent validity of the telephone-RAVLT. METHOD: In total, 83 older adults (age = 71.4 ± 7.0) with SCD or aMCI completed the RAVLT learning trials over the telephone and the Hopkins Verbal Learning Test (HVLT) in-person. RESULTS: Telephone-RAVLT total recall significantly correlated with HVLT total recall (r = .49, p < .001). Significant between group differences were found (effect size = 0.94). CONCLUSIONS: This study provides support for known-groups and convergent validity of the telephone-RAVLT.

9.
J Am Heart Assoc ; 9(20): e018814, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33059494
10.
Artigo em Inglês | MEDLINE | ID: mdl-33063101

RESUMO

OBJECTIVE: This study examined the effect of dietary patterns and engagement in cognitive stimulating lifestyle behaviours on trajectory of global cognition, executive function (EF), and verbal episodic memory (VEM). METHOD: Western and prudent dietary patterns were empirically derived using food frequency questionnaire responses from 350 community-dwelling older adults (mean age: 73.7 years) participating in the Québec Longitudinal Study on Nutrition and Successful Aging. Cognitive stimulating lifestyle (CSL) was represented by a binary composite indicator based on education, occupational complexity, and social engagement. Global cognition, EF, and VEM were assessed prospectively. RESULTS: Primary effect models revealed an association between higher Western dietary pattern score and greater rate of decline in global cognition and EF. Higher Western dietary pattern adherence also associated with poorer baseline VEM.. Primary effect models also revealed that CSL independently associated with baseline global cognition and EF. Effect modification models suggested an interactive effect between Western dietary pattern and CLS on global cognition only. No associations were found for prudent dietary pattern score. DISCUSSION: Contributing to existing research supporting the negative impact of consuming an unhealthy diet on cognitive function, the current study suggests increased vulnerability among older adults who do not engage in a cognitive stimulating lifestyle. These findings can inform the development of lifestyle intervention programs that target brain health in later adulthood.

11.
Curr Biol ; 30(16): R921-R925, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32810447

RESUMO

A tumor is not simply a group of cancer cells, but rather a heterogeneous collection of infiltrating and resident host cells, secreted factors and extracellular matrix. Tumor cells stimulate significant molecular, cellular and physical changes within their host tissues to support tumor growth and progression. An emerging tumor microenvironment is a complex and continuously evolving entity. The composition of the tumor microenvironment varies between tumor types, but hallmark features include immune cells, stromal cells, blood vessels, and extracellular matrix. It is believed that the "tumor microenvironment is not just a silent bystander, but rather an active promoter of cancer progression" (Truffi et al., 2020). Early in tumor growth, a dynamic and reciprocal relationship develops between cancer cells and components of the tumor microenvironment that supports cancer cell survival, local invasion and metastatic dissemination. To overcome a hypoxic and acidic microenvironment, the tumor microenvironment coordinates a program that promotes angiogenesis to restore oxygen and nutrient supply and remove metabolic waste. Tumors become infiltrated with diverse adaptive and innate immune cells that can perform both pro- and anti- tumorigenic functions (Figure 1). An expanding literature on the tumor microenvironment has identified new targets within it for therapeutic intervention.

12.
J Gerontol B Psychol Sci Soc Sci ; 75(7): 1359-1360, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32789478
13.
Nutr J ; 19(1): 58, 2020 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-32563260

RESUMO

BACKGROUND: Consumption of a prudent dietary pattern rich in healthy nutrients is associated with enhanced cognitive performance in older adulthood, while a Western dietary pattern low in healthy nutrients is associated with poor age-related cognitive function. Sex differences exist in dietary intake among older adults; however, there is a paucity of research examining the relationship between sex-specific dietary patterns and cognitive function in later life. METHODS: The current study aimed to investigate sex differences in the relationship between sex-specific dietary pattern adherence and global cognitive function at baseline and over a 3-year follow-up in 1268 community-dwelling older adults (Mage = 74 years, n = 664 women, n = 612 men) from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge). A 78-item Food Frequency Questionnaire was used to estimate dietary intake over the previous year. Sex-specific dietary pattern scores were derived using principal component analysis. Global cognition was assessed using the Modified Mini-Mental State Examination (3MS). RESULTS: Adjusted linear mixed effects models indicated that a healthy, prudent dietary pattern was not associated with baseline cognitive performance in men or women. No relationship was found between Western dietary pattern adherence and baseline cognitive function in women. Among men, adherence to an unhealthy, Western dietary pattern was associated with poorer baseline cognitive function (ß = - 0.652, p = 0.02, 95% CI [- 1.22, - 0.65]). No association was found between prudent or Western dietary patterns and cognitive change over time in men or women. CONCLUSIONS: These findings highlight the importance of conducting sex-based analyses in aging research and suggest that the relationship between dietary pattern adherence and cognitive function in late life may be sex-dependent.

14.
Artigo em Inglês | MEDLINE | ID: mdl-32433815

RESUMO

OBJECTIVE: To compare the performance of Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and SLEDAI-2K glucocorticoids (SLEDAI-2KG) indices in identifying responders to standard of care (SoC) therapy. METHODS: Data from adult patients seen between 1995-2018 at the University of Toronto Lupus Clinic was analyzed. Patients with active disease (SLEDAI-2K ≥6) and on prednisone ≥ 5 mg/day, and with a follow up visit at 9 months were studied. Response to SoC therapy, at first follow up visit, was assessed by SLEDAI-2K and SLEDAI-2KG. The performances of SLEDAI-2K and SLEDAI-2KG were compared using a cut-off point of 4. RESULTS: In a cohort of 188, the majority were female (86.0%) and Caucasian (47.9%). Of 188 patients, 145 (77.1%) were responders and had a decrease in SLEDAI-2K score of ≥4. SLEDAI-2KG identified 142 (97.9%) responders of SLEDAI-2K responders. More importantly, SLEDAI-2KG identified 11 (25.6%) additional responders among SLEDAI-2K non-responders (n=43). This resulted from the ability of SLEDAI-2KG to account for the decrease in glucocorticoids dose. CONCLUSIONS: SLEDAI-2KG provides a novel concept for the assessment of lupus disease activity while accounting for glucocorticoids dose to reflect on disease activity overall at a particular visit. SLEDAI-2KG accounts for the disease activity for each descriptor while also accounting for the current glucocorticoids dose. SLEDAI-2KG adds one additional variable (corticosteroid dose) to SLEDAI-2K which could alter response rates in drug trials and observational studies.

15.
Neuropsychol Rev ; 30(1): 97-125, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32166707

RESUMO

Amnestic mild cognitive impairment (aMCI) is a prodromal stage of Alzheimer's disease that is characterized by impairments in episodic memory. Recent evidence has shown that inhibitory control is also impaired in aMCI. The aim of the present meta-analysis was to quantify inhibitory control ability in individuals with aMCI by examining performance across a range of well-defined inhibition paradigms that tapped into one of three inhibitory control subtypes (i) interference control (e.g., Stroop task), (ii) response inhibition (e.g., Go/Nogo task), or (iii) inhibition of cognitive sets (Wisconsin Card Sort Task). Reference databases (PsychINFO, PubMed, and Web of Science) were searched for studies comparing individuals with aMCI to healthy controls on behavioural measures of inhibition. Across 70 effect sizes involving 2184 adults with aMCI and 3049 controls, overall inhibition deficits of moderate magnitude (g = -0.73) were found among individuals with aMCI. Inhibition deficits were moderate in size regardless of inhibitory control subtype: interference control (g = -0.74), response inhibition (g = -0.71), inhibition of cognitive sets (g = -0.76). Subgroup analyses revealed that Stroop outcome measure (reaction time vs. accuracy) and recruitment source (clinical vs. community) moderated interference control deficits. Together these findings support a generalized inhibition deficit in aMCI, and suggest that inhibition tasks should be included routinely in neuropsychological test batteries to provide a more comprehensive overview of executive dysfunction in aMCI.

16.
Complement Ther Med ; 49: 102333, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147065

RESUMO

OBJECTIVE: Sickle Cell Disease (SCD) is an inherited blood disorder that includes acute pain episodes and chronic pain that can dramatically impact quality of life and goal-achievement. Our staff had limited success in connecting families with the Pain, Palliative Care and Integrative Medicine Clinic (PPCIM) to receive specialized skills for pain management. We created a partnership between Hematology and PPCIM to provide SCD patients/families with needed resources. DESIGN/SETTING: In 2016, key stakeholders collaborated to create a Sickle Cell Wellness Clinic (SCWC) clinic to provide families access to integrative medicine and wellness strategies. Design/structure, based on family focus group data and staff expertise, included a half-day, 7-discipline clinic housed in the PPCIM space. Patients with SCD, ages 8-20, learned strategies in an effort to improve health care utilization and increase overall quality of life. MAIN OUTCOME MEASURES/RESULTS: Feedback from two successful pilot clinics in 2017 was incorporated into the formal roll-out of SCWC in 2018. SCWCs continued monthly for one year, serving a total of 20 families post-pilot. SCD patients increased follow-up appointment engagement in the PPCIM clinic following SCWC and reported high levels of satisfaction with their healthcare experience. CONCLUSIONS: It is feasible to run a multidisciplinary clinic focused on pain management, coping skills, and healthy living with SCD. Providers benefited from the opportunity to collaborate with other disciplines. Patient and family feedback was positive, highlighted benefits of being introduced to new modalities, and reported advantages of meeting other patients/families in a new setting.


Assuntos
Anemia Falciforme/terapia , Medicina Integrativa/métodos , Manejo da Dor/métodos , Equipe de Assistência ao Paciente , Preferência do Paciente , Adolescente , Criança , Feminino , Humanos , Masculino , Clínicas de Dor , Projetos Piloto , Qualidade de Vida , Inquéritos e Questionários
17.
Arthroscopy ; 36(6): 1523-1532, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32057982

RESUMO

PURPOSE: To evaluate the biomechanical performance of Bankart repair using 1.8-mm knotless all-suture anchors in comparison to 1.8-mm knotted all-suture anchors with both simple and horizontal mattress stitch configurations. METHODS: Thirty fresh-frozen human cadaveric shoulders were dissected to the capsule, leaving the glenoid and humeral capsular insertions intact. A standardized anteroinferior labral tear was created and repaired using 3 anchors. A 2 × 2 factorial design was implemented, with 6 matched pairs randomized between knotless and knotted anchor repairs and 6 matched pairs randomized into simple and horizontal mattress stitch configurations. In addition, 6 unpaired shoulders were used to evaluate the native capsulolabral state. First failure load, ultimate load, and stiffness were assessed. Linear mixed-effects modeling was used to compare endpoints. Digital image correlation was used to evaluate capsular strain throughout testing. Failure modes were reported qualitatively. RESULTS: The knotless all-suture anchor repair showed similar biomechanical strength to the knotted all-suture anchors for first failure load (coefficient, 142 N; 95% confidence interval [CI], -30 to 314 N; P = .12), ultimate load (coefficient, 11.1 N; 95% CI, -104.9 to 127.2 N; P = .847), and stiffness (coefficient, 3.4 N/mm2; 95% CI, -14.1 to 20.9 N/mm2; P = .697) when stitch configuration was held constant. No statistically significant differences were found on comparison of simple and mattress stitch configurations for first failure load (coefficient, -31 N; 95% CI, -205 to 143 N; P = .720), ultimate load (coefficient, 112 N; 95% CI, -321 to 97 N; P = .291), and stiffness (coefficient, -9.6 N/mm2; 95% CI, -27.3 to 8.1 N/mm2; P = .284) when anchor type was held constant. Specimens with knotless anchors and simple stitch techniques resulted in lower stiffness compared with the native state (P = .030). The knotless-mattress configuration resulted in significantly lower strain than the knotted-mattress (P = .037) and knotless-simple (P = .019) configurations and was the only configuration that did not result in a significant increase in strain compared with the intact specimens (P = .216). Fewer instances of suture slippage (loss of loop security) were observed with knotless anchors versus knotted anchors (11% vs 30%), and less soft-tissue failure was observed with the mattress stitch configuration versus the simple stitch configuration (36% vs 47%). CONCLUSIONS: Knotless and knotted all-suture anchor repairs with simple and mattress stitch configurations showed similar values of ultimate load, first failure load, and stiffness. However, the horizontal mattress stitch configuration proved to decrease capsular strain more similarly to the native state compared with the simple stitch configuration. Ultimate load and first failure load for all repairs were similar to those of the native state. CLINICAL RELEVANCE: Knotless all-suture anchors have a smaller diameter than solid anchors, can be inserted through curved guides, and preserve glenoid bone stock. This study presents knotless, tensionable all-suture anchor repair for labral tears that displays high biomechanical fixation strength, similar to the native capsulolabral state.


Assuntos
Lesões do Manguito Rotador/cirurgia , Âncoras de Sutura , Adulto , Fenômenos Biomecânicos , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura
18.
J Pain Symptom Manage ; 59(1): 95-104.e11, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419540

RESUMO

CONTEXT: Evidence-based resource allocation is receiving increasing attention as we strive for equity, transparency, and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritized for urgent palliative care? OBJECTIVES: To develop the scoring system for the novel Responding to Urgency of Need in Palliative Care triage tool. METHODS: Online international discrete choice experiment involving palliative care clinicians to establish the relative importance of seven key attributes of palliative care triage identified during an earlier qualitative study. RESULTS: Participants (n = 772) were mainly female (79.9%) with a decade of clinical experience. All attributes contributed significantly (all P-values < 0.001) and independently to clinician assessment of urgency. This study found physical suffering (coefficient 3.45; 95% confidence interval: 3.24 to 3.66) was the most important determinant of urgency, followed by imminent dying (coefficient 1.56; 1.43 to 1.69), psychological suffering (coefficient 1.49; 1.37 to 1.60), caregiver distress (coefficient 1.47; 1.35 to 1.59), discrepancy between care needs and care arrangements (coefficient 1.14; 1.02 to 1.26), mismatch between current and desired site of care (coefficient 0.94; 0.85 to 1.03), and unmet communication needs (coefficient 0.84; 0.76 to 0.92). CONCLUSION: Palliative care triage, which is complex and contextual, has been made more transparent through this discrete choice experiment. The Responding to Urgency of Need in Palliative Care triage tool provides an important step toward evidence-based assessment of priority for palliative care. Further research is underway to determine the validity of the tool in clinical practice and its impact on patient and caregiver outcomes.

19.
Arthritis Care Res (Hoboken) ; 72(12): 1809-1819, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31628718

RESUMO

OBJECTIVE: Screening for cognitive impairment in systemic lupus erythematosus (SLE) conventionally relies on the American College of Rheumatology (ACR) neuropsychologic battery (NB), which is not universally available. To develop a more accessible screening approach, we assessed validity of the Automated Neuropsychological Assessment Metrics (ANAM). Using the ACR NB as the gold standard for cognitive impairment classification, the objectives were 1) to measure overall discriminative validity of the ANAM for cognitive impairment versus no cognitive impairment, 2) to identify ANAM subtests and scores that best differentiate patients with cognitive impairment from those with no cognitive impairment, and 3) to derive ANAM composite indices and cutoffs. METHODS: A total of 211 consecutive adult patients, female and male, with SLE were administered the ANAM and ACR NB. 1) For overall discriminative validity of the ANAM, we compared patients with cognitive impairment versus those with no cognitive impairment on 4 scores. 2) Six ANAM models using different scores were developed, and the most discriminatory subtests were selected using logistic regression analyses. The area under the receiver operating characteristic curve (AUC) was calculated to establish ANAM validity against the ACR NB. 3) ANAM composite indices and cutoffs were derived for the best models, and sensitivities and specificities were calculated. RESULTS: Patients with no cognitive impairment performed better on most ANAM subtests, supporting ANAM's discriminative validity. Cognitive impairment could be accurately identified by selected ANAM subtests with top models, demonstrating excellent AUCs of 81% and 84%. Derived composite indices and cutoffs demonstrated sensitivity of 78-80% and specificity of 70%. CONCLUSION: This study provides support for ANAM's discriminative validity for cognitive impairment and utility for cognitive screening in adult SLE. Derived composite indices and cutoffs enhance clinical applicability.

20.
Am J Sports Med ; 48(1): 252-261, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30855979

RESUMO

BACKGROUND: Return to sport (RTS) remains an important challenge and measure of success for athletes undergoing arthroscopic rotator cuff repair (RCR). PURPOSE: To determine the rate of RTS after RCR and to analyze predictive factors associated with a lower rate of return. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. Study quality was evaluated according to the Coleman Methodology Score. Studies in English evaluating RTS after arthroscopic repair of partial- or full-thickness rotator cuff tears among athletes of all levels, ages, and sports were included. Random effects meta-analysis and metaregression were performed to investigate RTS activity rate after arthroscopic RCR and to explore study heterogeneity, respectively. RESULTS: Fifteen studies were reviewed, including 486 patients (499 shoulders) who were treated with arthroscopic RCR and who had a mean follow-up of 40.1 months (range, 18-74.4 months). Eighteen patients were lost to follow-up, leaving 468 patients with outcome data; 347 identified themselves as athletes (81 competitive, 266 recreational). The most commonly included sports were baseball (n = 45), golf (n = 38), football (n = 23), and tennis (n = 18). RTS specific to the type of athlete was reported for 299 of 347 athletes. According to the meta-analysis, the overall rate of RTS at a similar level of play or higher was 70.2%, with 73.3% of recreational athletes and 61.5% of competitive athletes able to return. A subset of 43 baseball and softball players across 4 studies yielded a 79% rate of RTS; however, only 38% returned to the same level of play or higher. Subgroup meta-analysis revealed no significant difference in the rate of RTS between competitive and recreational athletes. Metaregression analysis revealed that the mean follow-up time and mean age at surgery were not significantly associated with RTS rate. CONCLUSION: Most athletes (70.2%) were able to return to a preinjury level of play after arthroscopic RCR. While recreational sports participation (73.3%) was associated with higher return, competitive sports (61.5%) and overhead sports (38%) were associated with lower return. Exactly why all athletes do not return remains uncertain and likely multifactorial.


Assuntos
Artroscopia/métodos , Volta ao Esporte , Lesões do Manguito Rotador/cirurgia , Atletas , Humanos , Articulação do Ombro/cirurgia , Resultado do Tratamento
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