Hasil untuk "Geriatrics"

Jacob Robertson, Dillan Spector, Shanice Spence-Miller et al.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast condition that resembles infectious mastitis and malignancy, making diagnosis and treatment challenging. We report the case of a 32-year-old woman with a painful, enlarging left breast mass. Ultrasound-guided biopsy demonstrated cystic neutrophilic granulomatous mastitis. Her infectious work-up yielded negative results. The patient was treated with antibiotics that were then discontinued after biopsy and negative culture and she was discharged on steroid taper. Over the subsequent 18 months, she had steroid-dependent flares and, despite methotrexate and adalimumab, required a lumpectomy. This case highlights the need for early recognition of IGM in breast masses and the challenges in diagnosis, management, and care.

Fatemeh Rahimi, Azar Darvishpour, Roya Mansour-ghanaei et al.

Abstract Background Mental health (MH) and quality of life (QoL) are essential components of well-being in older women. Although physical activity (PA) and nutritional status (NS) are known to affect these outcomes, their mediating roles remain underexplored. This study aimed to investigate whether PA and NS mediate the relationship between MH and QoL in older women. Methods This cross-sectional study was conducted in 2024 on 180 older women visiting public parks in Rasht, Iran. We recruited participants through a convenience sampling approach, with random selection of public parks to enhance variability. Data collection used validated instruments, including the Abbreviated Mental Test Score (AMTS), physical activity, mental health, Quality of life (CASP-19), and Mini Nutritional Assessment (MNA). Data analysis employed SPSS-26 and SmartPLS-3, applying Pearson correlations, linear regression, and structural equation modelling (SEM), while controlling for demographic confounders. Results The mean age of participants was 66.6 ± 4.7 years (range: 60–78 years), with most aged 60–65 years, married, and having low educational attainment. PA levels were relatively favourable, while NS, MH, and QoL were moderate. PA and NS were significantly correlated with both MH (r = 0.28 and 0.36, respectively) and QoL (r = 0.35 and 0.46, respectively). Regression analyses confirmed their predictive roles (p < 0.01). MH was also a strong predictor of QoL (r = 0.56, p < 0.01). SEM results indicated significant indirect effects of PA (β = 0.18, p < 0.05) and NS (β = 0.21, p < 0.05) on QoL. The model explained 32% of the variance in QoL (R² = 0.319). Conclusions PA and NS significantly mediate the relationship between MH and QoL in older women. Promoting regular physical activity and balanced nutrition may improve overall quality of life. These findings highlight the need for integrated, lifestyle-based interventions in ageing health programmes.

Deirdre Kelly-Adams, Esme Fuller-Thomson

Recent research indicates that there has been a decline in the prevalence of many types of disabilities among older Americans. Less is known about temporal trends in disability-free life among older Americans. This study aims to: (1) detect temporal trends in the prevalence and odds of being free of disabilities among Americans aged 65+; 2) establish if these temporal trends differ by gender and age cohort (65–74; 75–84; 85 and older); 3) examine if these temporal trends are attenuated by generational differences in educational attainment. We conducted a secondary analysis of 10 years of annual nationally representative data from the American Community Survey with 5.4 million community-dwelling and institutionalized older adults. Individuals were defined as free from disability if they did not have serious memory problems, hearing problems, serious vision problems, limitations in activities of daily living (i.e., bathing, dressing), or functional limitations (i.e., walking, climbing stairs). The prevalence of being free of all disabilities among the US population aged 65 and older increased from 60.8 % to 64.9 % between 2008 and 2017. Had the prevalence remained at the 2008 levels, there would have been an additional 2.07 million older Americans living with one or more disabilities in 2017. The improvements in the odds of being free of disabilities across the decade was higher for women (26 %) than for men (18 %). Much of the improvement was due to higher levels of education. Improvements among baby boomers (aged 65–74) were much more modest than among older cohorts.

Hongxin Cheng, Wen Zhong, Hanbin Li et al.

Conclusion: This cohort suggests combined effects between the NLR and AIP on CVD. Our findings provide clinical implications for monitoring and managing NLR and AIP levels to mitigate the development of CVD.

Hyunjin Kang, Tingting Yang, Nazira Banu et al.

Abstract BackgroundSmart health wearables offer significant benefits for older adults, enabling seamless health monitoring and personalized suggestions based on real-time data. Promoting adoption and sustained use among older adults is essential to empower autonomous health management, leading to better health outcomes, improved quality of life, and reduced strain on health care systems. ObjectiveThis study investigates how autonomy-related contextual factors, including artificial intelligence (AI) anxiety, perceived privacy risks, and health consciousness, are related to older adults’ psychological needs of competence, autonomy, and relatedness (RQ1). We then examined whether the fulfillment of these needs positively predicts older adults’ intentions to adopt these devices (H1), and how they mediate the relationship between these factors and older adults’ intentions to use smart health wearables (RQ2). Additionally, it compares experienced and nonexperienced older adult users regarding the influence of these psychological needs on use intentions (RQ3). MethodsA web-based survey was conducted with individuals aged 60 years and above in Singapore, using a Qualtrics survey panel. A total of 306 participants (177 male; mean age of 65.47 years, age range 60‐85 years) completed the survey. A structural equation model was used to analyze associations among AI anxiety, perceived privacy risks, and health consciousness, and the mediating factors of competence, autonomy, and relatedness, as well as their relationship to smart health wearable use intention. ResultsHealth consciousness positively influenced all intrinsic motivation factors—competence, autonomy, and relatedness—while perceived privacy risks negatively affected all three. AI anxiety was negatively associated with competence only. Both privacy risk perceptions and health consciousness were indirectly linked to older adults’ intentions to use smart health wearables through competence and relatedness. No significant differences were found in motivational structures between older adults with prior experience and those without. ConclusionsThis study contributes to the application of self-determination theory in promoting the use of smart technology for health management among older adults. The results highlight the critical role of intrinsic motivation—particularly competence—in older adults’ adoption of smart health wearables. While privacy concerns diminish motivation, health consciousness fosters it. The study results offer valuable implications for designing technologies that align with older adults’ motivations, potentially benefiting aging populations in other technologically advanced societies. Developers should focus on intuitive design, transparent privacy practices, and social features to encourage adoption, empowering older adults to use smart wearables for proactive health management.

Jia-qi Zhang, Jia-qi Zhang, Zeng-jin Wen et al.

Cardiocerebral vascular disease has long been the leading cause of morbidity and mortality worldwide. Although there are many effective avenues for preventing and treating cardiocerebral vascular disease, further research is still needed to identify more novel molecular targets for therapeutic intervention. Anoctamin-1 (ANO1), also known as transmembrane protein 16A (TMEM16A), is the molecular identity of calcium-activated chloride channels (CaCCs) and is widely distributed in myocardial cells and the vasculature, including but not limited to the thoracic aorta, mesenteric artery, cerebral artery, and portal vein. ANO1 has many functions in the cardiocerebral vascular system, including cardiac excitability, vascular smooth muscle contraction, and epithelial cell secretion. Aberrant expression or dysfunction of ANO1 is associated with several cardiocerebral vascular diseases, including myocardial ischaemia/reperfusion injury (MIRI), arrhythmias, cardiac fibrosis, hypertension, and stroke. Therefore, this review provides an overview of ANO1, including its structure, distribution, and activation mechanism, and highlights the current knowledge of ANO1 in the pathophysiological process of heart diseases, hypertension, and stroke. We also summarise the pharmacological regulatory target of ANO1, providing promising insights for applying ANO1 inhibitors as cardiac and cerebrovascular therapeutic agents.

Zahra Shams-Ghahfarokhi

Mathieu Dallaire, Alexandra Houde-Thibeault, Jérôme Bouchard-Tremblay et al.

Background: Parkinson's Disease (PD), a neurodegenerative condition, affects normal aging and leads to reduced motor abilities. In addition, frailty syndrome can increase vulnerability and risks of undesirable effects such as disease progression, falls, disability, and premature death among individuals with PD. Aims: To assess the impact of frailty on balance and gait parameters in older with PD and to determine if sex mediates these measures. Methods: Twenty-seven (27) participants (n = 18 men; n = 10 frail) performed 4 balance tasks on a force platform (eyes opened/closed in bipodal/semi-tandem position) while linear center of pressure (COP) parameters were calculated. Participants also performed two different speed walks on a gait analysis system to assess gait parameters. Results: Significant differences between the frail and non-frail group were observed on postural control (mainly for area of COP p = 0.013/d = 0.47/70 %; sway velocity p = 0.048/d = 0.41/23 %) where frail reported poor balance. No significant sex differences were reported for postural control. Gait analysis was comparable between frail and non-frail, while significant differences between men and women were observed for step length (p = 0.002, d = 0.71), step width (p = 0.001, d = 0.75) and base of support (p = 0.012, d = 0.64) variables. Conclusion: Frail Parkinson's individuals present poorer postural control than non-frail individuals, but comparable gait parameters. Men and women are comparable on postural control but show different gait parameters. These results may have implications in clinical decision-making in rehabilitation for frailty in older adults, men and women with Parkinson's disease when balance and gait are of concern.

Robert Power, Colm Mac Eochagain, Christine Sam et al.

Immune checkpoint inhibitors (ICI) have transformed the management of cancer, particularly for older adults, who constitute a majority of the global cancer patient population. This study aimed to assess the inclusion, characteristics, and reporting of older adults enrolled in Food and Drug Administration (FDA) registration clinical trials of ICI between 2018 and 2022. Clinical trials of ICI leading to an FDA approval in solid tumor oncology between 2018 and 2022 were included. Primary study reports and all available secondary publications were assessed. The availability and completeness of older subgroup data for protocol-defined clinical efficacy endpoints, health-related quality of life (HRQOL) and toxicity outcomes, and baseline characteristics were assessed according to predefined criteria which categorized reporting completeness hierarchically in relation to the availability of published data, including effect size, sample size, and measures of precision. 53 registration trials were included, involving a total of 37,094 participants. Most trials (64.2%) were of ICI combination therapy. 42.3% of patients were aged≥65 years; 11.1% were aged≥75. No trials specified an upper age limit for eligibility. 98.1% of trials excluded patients with European Cooperative Oncology Group performance status&gt;1. 87.2% of primary efficacy endpoints and 17.9% of secondary efficacy endpoints were reported completely for older adults. Five studies (9.4%) reported baseline characteristics, three (6.1%) reported HRQOL assessments, and four (7.5%) reported toxicity outcomes completely among older subgroups. No trials conducted baseline geriatric assessments or reported geriatric-specific symptoms or quality of life scales. This analysis highlights significant deficits in the enrollment and reporting of older subgroups in pivotal trials of ICI therapy. The findings highlight an urgent need for improved reporting and inclusion standards in clinical trials of ICI to better inform treatment decisions for older adults.

Frank Knoefel, Shehreen Hossain, Amy T. Hsu

Background: Decisions around driving retirement are difficult for older persons living with cognitive decline and their caregivers. In many jurisdictions, physicians are responsible for notifying authorities of driving risks. However, there are no standardized guidelines for this assessment. Having access to a driving risk assessment tool could help older adults and their caregivers prepare for discussions around driving retirement. This study compares the clinical profiles of older adult drivers assessed in an academic memory clinic who were referred to the driving authority to older drivers who were not with a focus on instrumental activities of daily living (iADLs). Methods: Data on referred (R) and not-referred (NR) drivers were extracted from medical records. Elements from the medical history, cognitive history, functional abilities, Modified Mini-Mental State (3MS) examination, Trails A/B, and clock drawing were included in the analysis. Four risk factors of interest were examined in separate logistic regression analyses, adjusted for demographic variables. Results: 50 participants were identified in each group. The R group was older on average than the NR. As expected, R were more likely to have Trails B scores over 3 min and have significantly abnormal clock drawing tests. R also showed lower 3MS scores and a higher average number of functional impairments (including managing appointments, medications, bills, or the television). Conclusion: Beyond standard cognitive tests, impairment in iADLs may help general practitioners identify at-risk drivers in the absence of standardized guidelines and tools. This finding can also inform the design of a risk assessment tool for driving and could help with approaches for drivers with otherwise borderline test results.

Andreia N. Cadar, Dominique E. Martin, Jenna M. Bartley

Abstract Age-related declines in immune response pose a challenge in combating diseases later in life. Influenza (flu) infection remains a significant burden on older populations and often results in catastrophic disability in those who survive infection. Despite having vaccines designed specifically for older adults, the burden of flu remains high and overall flu vaccine efficacy remains inadequate in this population. Recent geroscience research has highlighted the utility in targeting biological aging to improve multiple age-related declines. Indeed, the response to vaccination is highly coordinated, and diminished responses in older adults are likely not due to a singular deficit, but rather a multitude of age-related declines. In this review we highlight deficits in the aged vaccine responses and potential geroscience guided approaches to overcome these deficits. More specifically, we propose that alternative vaccine platforms and interventions that target the hallmarks of aging, including inflammation, cellular senescence, microbiome disturbances, and mitochondrial dysfunction, may improve vaccine responses and overall immunological resilience in older adults. Elucidating novel interventions and approaches that enhance immunological protection from vaccination is crucial to minimize the disproportionate effect of flu and other infectious diseases on older adults.

Neil J. Meigh, Alexandra R. Davidson, Justin W. L. Keogh et al.

Abstract Objectives This study examined older adults’ experiences of participating in the Ballistic Exercise of the Lower Limb (BELL) trial, involving 12-weeks of group-based hardstyle kettlebell training. Methods In the BELL trial, 28 insufficiently active older adults (15 women, 13 men, 59–79 years) completed six weeks of face-to-face group training, and six weeks of home-based training. In-depth semi-structured interviews were audio recorded, transcribed, and inductively coded, with themes constructed from patterns of shared meaning. Results Four higher-order themes were developed that reflect older adults’ experiences participating in a group-exercise program of hardstyle kettlebell training. These included: (1) “It’s one of the best things we’ve done”—enjoying the physical and psychosocial benefits, (2) “It’s improved it tremendously!”—change in a long-term health condition, (3) “It put me on a better course”—overcoming challenges, and (4) “I wasn’t just a number”—feeling part of a group/community. Discussion Findings highlight the perceived physical and psychological benefits of older adults participating in hardstyle group kettlebell training, and the value attributed to being part of an age-matched community of like-minded people engaged in group exercise. Implications for program design and delivery, and future research, are discussed.

Si‐Yuan Chen, Meng‐Meng Ji, Peng‐Peng Xu et al.

Abstract Diffuse large B‐cell lymphoma (DLBCL) is the most common subtype of non‐Hodgkin's lymphoma and represents a heterogeneous entity. One‐third of DLBCL arises from extranodal organs and its prognosis often varies with regard to the sites involved. Molecular features are important to elucidate the differences in clinical features, predict the disease prognosis, and improve effective targeted therapeutic strategies. Extranodal DLBCLs originated from the breast, skin, uterus, immune‐privileged sites such as the central nervous system and testes, often show a high proportion of non‐germinal center B‐cell‐like (non‐GCB) phenotypes, with a high frequency of MYD88/CD79B mutations. In contrast, extranodal DLBCLs originated from the thyroid gland and stomach show a relatively low proportion of non‐GCB phenotype, with a considerably excellent prognosis. Immunochemotherapy with rituximab is the standard of care in both nodal and extranodal DLBCLs. However, approximately 40% of the patients experience treatment failure. It is critical to optimize the treatment strategy, including radiotherapy, autologous stem cell transplantation and targeted therapy according to the clinical characteristics and molecular heterogeneity. In this review, we present an overview of the key molecular pathways, prognosis assessment and innovative therapies in primary extranodal DLBCLs.

Pascal Martin, Alexander Martin Keppler, Paolo Alberton et al.

Background and Objectives: Nowadays, various clinical scoring systems are used in the medical care of the elderly to assess the quality of mobility. However, people often tend to under- or overestimate themselves in many aspects. Since this can have serious consequences in their treatment and care, the aim of this study was to identify differences in the self and external assessment of mobility of persons over 65 years of age. Materials and Methods: 222 participants over 65 years of age and one external, closely-related relative or professional caregiver were interviewed by a unique study assistant using a standardized questionnaire. Participants were divided into people living in nursing homes and independent people living at home, where either the caregivers or the relatives provided the external assessment of mobility, respectively. The questionnaire included demographics, cognitive abilities (Mini Mental Status Test); fall risk (Hendrich 2 Fall Risk Model); as well as the Parker Mobility Score, Barthel Index, and EQ-5D-5L to measure mobility, activities of daily life and quality of life. In each case, the participant and the external person were asked for their assessment to the participants’ mobility situation. Statistical significance of the difference between self and external assessment was calculated with a Wilcoxon rank-sum test and assumed with a <i>p</i>-value of ≤ 0.05. Results: Self-assessment indicated a significantly higher value, when compared to an external assessment for the Parker Mobility Score for females in nursing homes (<i>p</i> ≤ 0.01), as well as for the Barthel Index for females (<i>p</i> ≤ 0.01) and males (<i>p</i> ≤ 0.01) in nursing homes. The <i>EQ-5D-5L</i> received a significantly higher self-assessment value for females (<i>p</i> ≤ 0.01) and males (<i>p</i> ≤ 0.01) living at home and females (<i>p</i> ≤ 0.01) and males (<i>p</i> ≤ 0.05) in nursing homes. Conclusions: Persons over 65 years of age tend to overestimate their level of mobility, quality of life and activities of daily life. Especially for people living in nursing homes, these scoring systems should be treated with caution due to the differences between the verbal statements. It is important to properly assess the mobility situation of elderly patients to ensure correct medical treatment and prevention of falls.

Gunnhild J. Hjetland, Eirin Kolberg, Ståle Pallesen et al.

Abstract Background Up to 70% of nursing home patients with dementia suffer from sleep problems. Light is the main zeitgeber to the circadian system and thus has a fundamental impact on sleep-wake behaviour. Low indoor light levels in nursing homes have been reported, and in combination with age-related reductions in light sensitivity, insufficient light exposure is likely to contribute to sleep problems in this population. Increasing daytime light exposure using bright light treatment (BLT) may represent a feasible non-pharmacological treatment for sleep problems in nursing home patients with dementia. Methods The present study reports on sleep outcomes, which are the primary outcomes of the DEM.LIGHT trial (Therapy Light Rooms for Nursing Home Patients with Dementia– Designing Diurnal Conditions for Improved Sleep, Mood and Behavioural Problems), a 24-week cluster-randomised placebo-controlled trial including 8 nursing home units and 69 resident patients. The intervention comprised ambient light of 1000 lx and 6000 K from 10:00 to 15:00, with gradually increasing and decreasing light levels prior to and following this interval, using ceiling mounted light-fixtures and light emitting diode technology. The placebo condition had continuous standard light levels (150–300 lx, ~ 3000 K). Sleep was assessed at baseline and follow-up at week 8, 16, and 24, using the proxy-rated Sleep Disorder Inventory (SDI) and actigraphy (Actiwatch II, Philips Respironics). Mixed linear models were used to evaluate intervention effects, adjusting for relevant covariates such as age, gender, number of drugs, severity of dementia, eye disease, and estimated light exposure. Results Sleep as measured by the SDI was significantly improved in the intervention group compared to the control group from baseline to week 16 (B = − 0.06, 95% CI -0.11 - -0.01, p < .05) and from baseline to week 24 (B = − 0.05, 95% CI -0.10 - -0.01, p < .05). There was no effect according to the SDI at week 8 and no significant effects in terms of actigraphically measured sleep. Conclusions Proxy-rated sleep improved among nursing home patients with dementia following 16 and 24 weeks of BLT. These improvements were not corroborated by actigraphy recordings. Trial registration ClinicalTrials.gov Identifier: NCT03357328 . Registered 29 November 2017 – Retrospectively registered.

Xiaolin Ni, Zhaoping Wang, Danni Gao et al.

Abstract Human longevity is a complex phenotype influenced by both genetic and environmental factors. It is also known to be associated with various types of age-related diseases, such as Alzheimer’s disease (AD) and cardiovascular disease (CVD). The central dogma of molecular biology demonstrates the conversion of DNA to RNA to the encoded protein. These proteins interact to form complex cell signaling pathways, which perform various biological functions. With prolonged exposure to the environment, the in vivo homeostasis adapts to the changes, and finally, humans adopt the phenotype of longevity or aging-related diseases. In this review, we focus on two different states: longevity and aging-related diseases, including CVD and AD, to discuss the relationship between genetic characteristics, including gene variation, the level of gene expression, regulation of gene expression, the level of protein expression, both genetic and environmental influences and homeostasis based on these phenotypes shown in organisms.

Ning Wang, Bo Sun, Haonan Guo et al.

ObjectiveTo study the discrepancy of the insulin sensitivity alteration pattern, circulating fibroblast growth factor (FGF21) levels and FGF21 signaling in visceral white adipose tissue (vWAT) of gestational diabetes mellitus (GDM) subtypes.Methods26 GDM women with either a predominant of insulin-secretion defect (GDM-dysfunction, n = 9) or insulin-sensitivity defect (GDM-resistance, n = 17) and 13 normal glucose tolerance (NGT) women scheduled for caesarean-section at term were studied. Blood and vWAT samples were collected at delivery.ResultsThe insulin sensitivity was improved from the 2nd trimester to delivery in the GDM-resistance group. Elevated circulating FGF21 concentration at delivery, increased FGF receptor 1c and decreased klotho beta gene expression, enhanced ERK1/2 phosphorylation, and increased GLUT1, IR-B, PPAR-γ gene expression in vWAT were found in the GDM-resistance group as compared with the NGT group. The circulating FGF21 concentration was negatively correlated with fasting blood glucose (r = -0.574, P &lt; 0.001), and associated with the GDM-resistance group (r = 0.574, P &lt; 0.001) in pregnant women at delivery. However, we observed no insulin sensitivity alteration in GDM-dysfunction and NGT groups during pregnancy. No differences of plasma FGF21 level and FGF21 signaling in vWAT at delivery were found between women in the GDM-dysfunction and the NGT group.ConclusionsWomen with GDM heterogeneity exhibited different insulin sensitivity alteration patterns. The improvement of insulin sensitivity may relate to the elevated circulating FGF21 concentration and activated FGF21 signaling in vWAT at delivery in the GDM-resistance group.

Feng YR, Meuleners L, Stevenson M et al.

Ying Ru Feng,1 Lynn Meuleners,1 Mark Stevenson,2,3 Jane Heyworth,4 Kevin Murray,4 Michelle Fraser,1 Sean Maher5 1Western Australian Centre for Road Safety Research, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; 2Transport, Health and Urban Design Research Lab, Melbourne School of Design, University of Melbourne, Melbourne, VIC, Australia; 3Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; 4School of Population and Global Health, The University of Western Australia, Crawley, WA, 6009, Australia; 5Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, WA, AustraliaCorrespondence: Lynn MeulenersWestern Australian Centre for Road Safety Research, School of Population and Global Health, The University of Western Australia (M431), 35 Stirling Highway, Crawley, WA, 6009, AustraliaTel +61 8 6488 7375Email lynn.meuleners@uwa.edu.auPurpose: Mild cognitive impairment and gender can impact different aspects of driving performance and behaviour in older drivers. However, there is little evidence on how these may affect naturalistic speeding behaviour. Therefore, the aim of this study was to examine the relationship between speeding events and cognitive status for older male and female drivers.Participants and Methods: A naturalistic driving study collected objective driving information over a two-week period using an in-vehicle monitoring device from 36 older drivers with suspected mild cognitive impairment and 35 older drivers without cognitive impairment. The outcome of interest examined was the number of speeding events, defined as travelling 5+ km/h over the posted speed limit for at least a minute.Results: The majority of participants (n=58, 81.69%) did not have a speeding event during the two-week monitoring period. Twenty-three speeding events were recorded among seven drivers with suspected mild cognitive impairment and six drivers without cognitive impairment. The majority of speeding events (82.61%) were by older male drivers and occurred in 60km/h and 70km/h speed zones. The results of the two negative binomial regression models found that in older male drivers, suspected mild cognitive impairment (IRR=7.45, 95% CI=1.53– 36.15, p=0.01) was associated with a significantly higher rate of speeding events, while increasing age was associated with a lower rate of speeding events (IRR=0.80, 95% CI=0.64– 1.00, p=0.04). For older female drivers, there were no factors significantly associated with the rate of speeding events.Conclusion: While the overall number of speeding events were infrequent, suspected mild cognitive impairment was associated with a significant increase in the rate of speeding events for older male drivers, but not for older female drivers. Speeding interventions and injury prevention policy strategies may need to be targeted differently for male and female drivers with mild cognitive impairment.Keywords: naturalistic, driver monitoring, cognitive decline, gender differences, driving behaviour

Alia T. Tuqan, Ming Lee, Nancy T. Weintraub et al.

Background/Objectives Although the Accreditation Council for Graduate Medical Education requires that geriatrics fellowship programs be evaluated, evaluation is challenging because of lack of appropriate instruments. The purpose of this study was to develop and validate a geriatrics knowledge test appropriate for evaluation of geriatrics fellowship programs. Design Initial and replication cross‐sectional validation studies. Setting Academic medical center. Participants Initial study: 11 postgraduate year ( PGY )‐2 and five PGY ‐3 internal medicine residents, eight incoming and eight graduating geriatrics fellows, and 11 geriatrics faculty (N = 43). Replication study: nine graduating fellows and three mid‐year fellow cohorts (n = 11, 8, and 9) (N = 37). Measurements A geriatrics knowledge test was developed consisting of 31 multiple‐choice questions ( MCQ s) selected from a 54‐item pool of MCQ s that the authors created. Selection criteria included content appropriateness, item correlation with total score, item discriminatory power, and item difficulty. Results The instrument demonstrated high reliability (Cronbach alpha = 0.83) and known group validity. The mean percentage correct scores on the knowledge test were progressively higher with more geriatrics training ( P < .001). The replication study continued to show patterns of progressive increases in score with additional training. There were no floor or ceiling effects. Conclusion A 31‐item geriatrics knowledge test demonstrates sound reliability and validity. The findings support that it is appropriate as a tool for evaluation of geriatrics fellowship programs.

Jeremiah R. Brown, Richard J. Solomon, R. Brooks Robey et al.

BackgroundStudies of kidney disease associated with cardiac catheterization typically rely on billing records rather than laboratory data. We examined the associations between percutaneous coronary interventions, acute kidney injury, and chronic kidney disease progression using comprehensive Veterans Affairs clinical and laboratory databases. Methods and ResultsPatients undergoing percutaneous coronary interventions between 2005 and 2010 (N=24 405) were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking registry and examined for associated acute kidney injury and chronic kidney disease development or progression relative to 24 405 matched population controls. Secondary outcomes analyzed included dialysis, acute myocardial infarction, and mortality. The incidence of chronic kidney disease progression following percutaneous coronary interventions complicated by acute kidney injury, following uncomplicated coronary interventions, and in matched controls were 28.66, 11.15, and 6.81 per 100 person‐years, respectively. Percutaneous coronary intervention also increased the likelihood of chronic kidney disease progression in both the presence and absence of acute injury relative to controls in adjusted analyses (hazard ratio [HR], 5.02 [95% CI, 4.68–5.39]; and HR, 1.76 [95% CI, 1.70–1.86]). Among patients with estimated glomerular filtration rate <60 mL/min per 1.73 m2, acute kidney injury increased the likelihood of disease progression by 8‐fold. Similar results were observed for all secondary outcomes. ConclusionsAcute kidney injury following percutaneous coronary intervention was associated with increased chronic kidney disease development and progression and mortality.