Hasil untuk "Geriatrics"

David B Reuben, S. Inouye, S. Bogardus et al.

Mehmet Emin Arayici, Ali Kose, Hatice Simsek

Abstract Background It’s well established that falls are a leading cause of injury among older adults and may be influenced by sleep duration. This study aimed to investigate the association between nighttime sleep duration and fall risk in a nationally representative older population. Methods This population-based cross-sectional study used data from the Turkey Older adults Profile Survey conducted in 2023. A total of 10,321 community-dwelling adults aged 65 years and older were included. Data on demographics, health characteristics, sleep duration, environmental factors, and fall history were collected through structured interviews. Univariable and multivariable logistic regression models were undertaken to estimate the association between nighttime sleep duration (< 7 h, 7–8 h [reference], and > 8 h) and falls. Multivariable models progressively adjusted for age, gender, education, marital status, physical activity, BMI, alcohol use, regular medication, walking difficulty, visual impairment, depression, chronic disease status, self-rated health, and environmental factors. Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated. Results Among the participants (mean age: 72.8 ± 6.4 years; 54.5% female), 20.1% reported falls in the past year. Short sleep duration (< 7 h) was associated with significantly increased odds of falling in both unadjusted (OR = 1.755, 95% CI: 1.584–1.944, p < 0.001) and fully adjusted models (aOR = 1.546, 95% CI: 1.388–1.724, p < 0.001). Long sleep duration (> 8 h) initially indicated an elevated fall risk (OR = 1.224, 95% CI: 1.036–1.447, p = 0.018); however, this association lost statistical significance after fully adjusting for several health and environmental covariates (aOR = 1.091, 95% CI: 0.918–1.297, p = 0.322). Conclusions Nighttime sleep duration less than 7 h was independently associated with an increased risk of falls among older adults. Interventions promoting optimal sleep duration could be a crucial component of fall prevention strategies targeting older populations.

Chen X, Liu W, Zhang J et al.

Xiahuan Chen,1,&ast; Wenwen Liu,1,&ast; Jiaqi Zhang,1,&ast; Meilin Liu,1 Yi Li,2 Xiaozeng Wang,2 Yaling Han2 1Department of Geriatrics, Peking University First Hospital, Beijing, 100034, People’s Republic of China; 2Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning, 110016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Meilin Liu; Yaling Han, Email liumeilin@hotmail.com; hanyaling@263.netBackground: Elderly patients with coronary artery disease (CAD) are at heightened risk for ischemic and bleeding complications. This study evaluates antithrombotic therapy use and its clinical outcomes in Chinese patients aged ≥ 65 years with CAD and elevated ischemic risk.Methods: This prospective cohort study enrolled patients aged ≥ 65 years with diagnosed CAD and ≥ 1 high ischemic risk factor from two centers. We recorded major adverse cardiovascular events (MACE)—death, nonfatal myocardial infarction, nonfatal ischemic stroke—and bleeding events over a 2-year follow-up.Results: Of 1005 patients (mean age 76.3 ± 7.2 years; 25.3% female), 49.0% were aged 65– 75 and 51.0% were > 75. Antithrombotic regimens included no therapy (1.8%), single antiplatelet therapy (SAPT, 23.0%), dual antiplatelet therapy (DAPT, 64.3%), and anticoagulation (10.9%), with 60.9% of the latter combining antiplatelet therapy. Older patients (> 75 years) experienced higher MACE rates (11.5% vs 6.3%; RR: 1.825; 95% CI: 1.203– 2.769; p = 0.004) and a trend towards increased bleeding (8.4% vs 6.5%; p = 0.257). Notably, all-cause and cardiovascular mortality were significantly higher in this group. Anticoagulation therapy was linked to a higher, yet non-significant, MACE rate and significantly increased bleeding risk compared to SAPT and DAPT. Multivariate analysis identified age > 75, LVEF < 50%, and eGFR < 50 mL/min/1.73 m2 as predictors of mortality and MACE, with anticoagulation therapy increasing bleeding risk.Conclusion: In elderly CAD patients, those aged > 75 years exhibit higher mortality and MACE rates, with anticoagulation therapy associated with increased bleeding. Age, reduced LVEF, and renal function emerge as critical predictors of adverse outcomes.Keywords: coronary artery disease, antithrombotic therapy, high ischemic risk, elderly patients, clinical outcomes

Sun Hwan Choi MD, Myeong Gu Lee MD, Yoon Je Cho MD et al.

Introduction Prophylactic surgery for symptomatic incomplete atypical femoral fractures (SIAFFs) has demonstrated favorable outcomes. However, concerns remain regarding surgical intervention for a fracture that has not yet completed. This retrospective study aimed to evaluate the efficacy of conservative treatment using teriparatide (TPTD) as a conservative treatment for SIAFF. Methods This retrospective study reviewed 30 cases with SIAFF who underwent conservative treatment between November 2012 and September 2019. The diagnosis of SIAFF was based on the criteria established by the Task Force of the American Society for Bone and Mineral Research(ASBMR). The treatment protocol included (1) discontinuation of bisphosphonates, (2) use of 2 crutches or a four-point walker, (3) daily subcutaneous TPTD injection until pain subsided, and (4) monthly radiographic follow-up. Radiographs and bone scans were used to assess bone union, and follow-up continued for up to 2 years from protocol initiation. Comparisons between the successful and failed treatment groups were performed using the Student’s t-test for continuous variables and Fisher’s exact test for categorical variables. Results The mean age was 72.6 years (range, 55-87) and all patients were female. 13 cases involved the diaphyseal region and 17 involved the subtrochanteric region. The average duration of TPTD treatment was 6.5 months (range, 3-12), and the average follow-up was 45.5 months (range, 19-84) after the final injection. The mean SIAFF severity score was 9.5 (range, 7-11). Symptom-free bone union was achieved in 23 of 30 cases (76.7%). Five cases (4 with worsening pain, 1 with radiographic progression) underwent prophylactic intramedullary nailing, and 2 cases progressed to complete fracture and were treated with intramedullary nailing. Conclusion The result of this study suggests that the conservative treatment with teriparatide injection may be a potentially effective option for patients with SIAFF.

Emilia Ambrosini, Chiara Giangregorio, Eugenio Lomurno et al.

BackgroundThe rise in life expectancy is associated with an increase in long-term and gradual cognitive decline. Treatment effectiveness is enhanced at the early stage of the disease. Therefore, there is a need to find low-cost and ecological solutions for mass screening of community-dwelling older adults. ObjectiveThis work aims to exploit automatic analysis of free speech to identify signs of cognitive function decline. MethodsA sample of 266 participants older than 65 years were recruited in Italy and Spain and were divided into 3 groups according to their Mini-Mental Status Examination (MMSE) scores. People were asked to tell a story and describe a picture, and voice recordings were used to extract high-level features on different time scales automatically. Based on these features, machine learning algorithms were trained to solve binary and multiclass classification problems by using both mono- and cross-lingual approaches. The algorithms were enriched using Shapley Additive Explanations for model explainability. ResultsIn the Italian data set, healthy participants (MMSE score≥27) were automatically discriminated from participants with mildly impaired cognitive function (20≤MMSE score≤26) and from those with moderate to severe impairment of cognitive function (11≤MMSE score≤19) with accuracy of 80% and 86%, respectively. Slightly lower performance was achieved in the Spanish and multilanguage data sets. ConclusionsThis work proposes a transparent and unobtrusive assessment method, which might be included in a mobile app for large-scale monitoring of cognitive functionality in older adults. Voice is confirmed to be an important biomarker of cognitive decline due to its noninvasive and easily accessible nature.

Valerio Nardone, Federica Marmorino, Marco Maria Germani et al.

The integration of multidisciplinary tumor boards (MTBs) is fundamental in delivering state-of-the-art cancer treatment, facilitating collaborative diagnosis and management by a diverse team of specialists. Despite the clear benefits in personalized patient care and improved outcomes, the increasing burden on MTBs due to rising cancer incidence and financial constraints necessitates innovative solutions. The advent of artificial intelligence (AI) in the medical field offers a promising avenue to support clinical decision-making. This review explores the perspectives of clinicians dedicated to the care of cancer patients—surgeons, medical oncologists, and radiation oncologists—on the application of AI within MTBs. Additionally, it examines the role of AI across various clinical specialties involved in cancer diagnosis and treatment. By analyzing both the potential and the challenges, this study underscores how AI can enhance multidisciplinary discussions and optimize treatment plans. The findings highlight the transformative role that AI may play in refining oncology care and sustaining the efficacy of MTBs amidst growing clinical demands.

Elisa dePaula França Resende, Vivian P. Lara, Ana Luisa C. Santiago et al.

Abstract INTRODUCTION The influence of hippocampal connectivity on memory performance is well established in individuals with high educational attainment. However, the role of hippocampal connectivity in illiterate populations remains poorly understood. METHODS Thirty‐five illiterate adults were administered a literacy assessment (Test of Functional Health Literacy in Adults [TOFHLA]), structural and resting state functional magnetic resonance imaging, and an episodic memory test (Free and Cued Selective Reminding Test). Illiteracy was defined as a TOFHLA score < 53. We evaluated the correlation between hippocampal connectivity at rest and both free recall and literacy scores. RESULTS Participants were mostly female (57.1%) and self‐declared as being Black individuals (84.8%), with a median age of 50 years. The median TOFHLA literacy score was 28.0 [21.0; 42.5] out of 100 points and the median free recall score was 30.0 [26.2; 35] out of 48 points. The median gray matter volume of both the left and right hippocampi was 2.3 [2.1; 2.4] cm3. We observed a significant connectivity between both hippocampi and the precuneus and the ventral medial prefrontal cortex. The right hippocampal connectivity positively correlated with the literacy scores (β = 0.58, P = 0.008). There was no significant association between episodic memory and hippocampal connectivity. Neither memory nor literacy scores correlated with hippocampal gray matter volume. DISCUSSION Low literacy levels correlated with hippocampal connectivity in illiterate adults. The lack of association with memory scores might be associated with low brain reserve in this sample. Highlights A significant link was found between health literacy and hippocampal connectivity. Enhanced hippocampus– ventromedial prefrontal cortex connectivity suggests potential cognitive reserve improvement. Higher cognitive reserve may protect against hippocampal atrophy and neurodegeneration. Health literacy improvements could help prevent cognitive impairment in illiterate populations. Study highlights importance of considering structural racism in brain connectivity research.

Junliang Chen, Mingjie Wu, Yulan Yang et al.

Abstract Replication fork reversal, a critical protective mechanism against replication stress in higher eukaryotic cells, is orchestrated via a series of coordinated enzymatic reactions. The Bloom syndrome gene product, BLM, a member of the highly conserved RecQ helicase family, is implicated in this process, yet its precise regulation and role remain poorly understood. In this study, we demonstrate that the GCFC domain-containing protein TFIP11 forms a complex with the BLM helicase. TFIP11 exhibits a preference for binding to DNA substrates that mimic the structure generated at stalled replication forks. Loss of either TFIP11 or BLM leads to the accumulation of the other protein at stalled forks. This abnormal accumulation, in turn, impairs RAD51-mediated fork reversal and slowing, sensitizes cells to replication stress-inducing agents, and enhances chromosomal instability. These findings reveal a previously unidentified regulatory mechanism that modulates the activities of BLM and RAD51 at stalled forks, thereby impacting genome integrity.

Qingqing Yin, Qingqing Yin, Yan Gao et al.

Marwa M. Elsayed, Ghada A. Abdallah, Safaa S. Hassan et al.

Abstract The prevalence of obesity has increased the incidence of obesity-related coagulation disorders. The current study assessed the effectiveness of combined aerobic exercise and laser phototherapy on the coagulation profile and body measurements in older adults with obesity compared to aerobic exercise alone, which has not been adequately explored. We included 76 obese people (50% women and 50% men) with a mean age of 67.83 ± 4.84 years and a body mass index of 34.55 ± 2.67 kg/m2. The participants were randomly assigned to the experimental group (which received aerobic training with laser phototherapy) and the control group (which received aerobic training alone) for three months. From the baseline to the final analysis, the absolute changes in specific coagulation biomarker levels (fibrinogen, fibrin fragment D, prothrombin time, Kaolin-Cephalin Coagulation Time), and contributing parameters (C-reactive protein and total cholesterol), were assessed. In comparison to the control group, the experimental group showed significant improvements in all evaluated measures (p < 0.001). So, in comparison to aerobic exercise alone, combined aerobic exercise and laser phototherapy had superior positive effects on coagulation biomarkers and decreased the risk of thromboembolism throughout a three-month intervention period in senior obese persons. Therefore, we suggest adopting laser phototherapy for individuals with a greater risk of hypercoagulability. The research was entered into the database of clinical trials under the identification NCT04503317.

Hao Han, Yawei Zhao, Junda Du et al.

Abstract Background Exercise is postulated to be a promising non-pharmacological intervention for the improvement of neurodegenerative disease pathology. However, the mechanism of beneficial effects of exercise on the brain remains to be further explored. In this study, we investigated the effect of an exercise-induced metabolite, lactate, on the microglia phenotype and its association with learning and memory. Results Microglia were hyperactivated in the brains of AlCl3/D-gal-treated mice, which was associated with cognitive decline. Running exercise ameliorated the hyperactivation and increased the anti-inflammatory/reparative phenotype of microglia and improved cognition. Mice were injected intraperitoneally with sodium lactate (NaLA) had similar beneficial effects as that of exercise training. Exogenous NaLA addition to cultured BV2 cells promoted their transition from a pro-inflammatory to a reparative phenotype. Conclusion The elevated lactate acted as an “accelerator” of the endogenous “lactate timer” in microglia promoting this transition of microglia polarization balance through lactylation. These findings demonstrate that exercise-induced lactate accelerates the phenotypic transition of microglia, which plays a key role in reducing neuroinflammation and improving cognitive function.

Zhaoyang Yin, Ge Gong, Xiang Wang et al.

Periprosthetic osteolysis (PPO) induced by wear particles is an important cause of aseptic loosening after artificial joint replacement, among which the imbalance of osteogenesis and osteoclastic processes occupies a central position. The cells involved in PPO mainly include osteoclasts (macrophages), osteoblasts, osteocytes, and fibroblasts. RANKL/RANK/OGP axis is a typical way for osteolysis. Autophagy, a mode of regulatory cell death and maintenance of cellular homeostasis, has a dual role in PPO. Although autophagy is activated in various periprosthetic cells and regulates the release of inflammatory cytokines, osteoclast activation, and osteoblast differentiation, its beneficial or detrimental role remains controversy. In particular, differences in the temporal control and intensity of autophagy may have different effects. This article focuses on the role of autophagy in PPO, and expects the regulation of autophagy to become a powerful target for clinical treatment of PPO.

Kondwani Joseph Banda, Hsin Chu, Xiao Linda Kang et al.

Abstract Background Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke. Methods Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD. Results The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13–7.79) and mortality 4.07 (95% CI, 2.17–7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13–2.07), previous stroke 1.40 (95% CI, 1.18–1.67), severe stroke 1.38 (95% CI, 1.17–1.61), females 1.25 (95% CI, 1.09–1.43), and diabetes mellitus 1.24 (95% CI, 1.02–1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70–0.95) and ischaemic stroke 0.54 (95% CI, 0.46–0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis. Conclusions Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate. Trial registration https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb .

Runqiu Chen, Huaijun Tu, Tingtao Chen

Heavy metal (HM) exposure remains a global occupational and environmental problem that creates a hazard to general health. Even low-level exposure to toxic metals contributes to the pathogenesis of various metabolic and immunological diseases, whereas, in this process, the gut microbiota serves as a major target and mediator of HM bioavailability and toxicity. Specifically, a picture is emerging from recent investigations identifying specific probiotic species to counteract the noxious effect of HM within the intestinal tract via a series of HM-resistant mechanisms. More encouragingly, aided by genetic engineering techniques, novel HM-bioremediation strategies using recombinant microorganisms have been fruitful and may provide access to promising biological medicines for HM poisoning. In this review, we summarized the pivotal mutualistic relationship between HM exposure and the gut microbiota, the probiotic-based protective strategies against HM-induced gut dysbiosis, with reference to recent advancements in developing engineered microorganisms for medically alleviating HM toxicity.

Jie Yang, Hu Tan, Mengjia Sun et al.

Insufficient cardiorespiratory compensation is closely associated with acute hypoxic symptoms and high-altitude (HA) cardiovascular events. To avoid such adverse events, predicting HA cardiorespiratory fitness impairment (HA-CRFi) is clinically important. However, to date, there is insufficient information regarding the prediction of HA-CRFi. In this study, we aimed to formulate a protocol to predict individuals at risk of HA-CRFi. We recruited 246 volunteers who were transported to Lhasa (HA, 3,700 m) from Chengdu (the sea level [SL], &lt;500 m) through an airplane. Physiological parameters at rest and during post-submaximal exercise, as well as cardiorespiratory fitness at HA and SL, were measured. Logistic regression and receiver operating characteristic (ROC) curve analyses were employed to predict HA-CRFi. We analyzed 66 pulmonary vascular function and hypoxia-inducible factor- (HIF-) related polymorphisms associated with HA-CRFi. To increase the prediction accuracy, we used a combination model including physiological parameters and genetic information to predict HA-CRFi. The oxygen saturation (SpO2) of post-submaximal exercise at SL and EPAS1 rs13419896-A and EGLN1 rs508618-G variants were associated with HA-CRFi (SpO2, area under the curve (AUC) = 0.736, cutoff = 95.5%, p &lt; 0.001; EPAS1 A and EGLN1 G, odds ratio [OR] = 12.02, 95% CI = 4.84–29.85, p &lt; 0.001). A combination model including the two risk factors—post-submaximal exercise SpO2 at SL of &lt;95.5% and the presence of EPAS1 rs13419896-A and EGLN1 rs508618-G variants—was significantly more effective and accurate in predicting HA-CRFi (OR = 19.62, 95% CI = 6.42–59.94, p &lt; 0.001). Our study employed a combination of genetic information and the physiological parameters of post-submaximal exercise at SL to predict HA-CRFi. Based on the optimized prediction model, our findings could identify individuals at a high risk of HA-CRFi in an early stage and reduce cardiovascular events.

Peng Li, JiaLe Liu, Junjun Liu

ObjectiveWe aimed to evaluate the effect of procalcitonin (PCT) guided therapy on antibiotic exposure in pediatric patients with infectious disease.MethodsWe performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) identified in systematic searches of MEDLINE, Embase, the Cochrane Database, Google Scholar, and SinoMed (through July 2021). The primary outcome was the length of the antibiotic therapy. Required information size (RIS) was calculated using trial sequential analysis (TSA).ResultsFour RCTs with 1,313 patients with infectious disease were included. Overall, after a mean 22-day follow-up, PCT-guided antibiotic therapy was associated with a significantly shorter length of antibiotic therapy compared with the control group (WMD, −2.22 days; 95% CI, −3.41 to −1.03; P &lt;0.001) and a decreased rate of antibiotic adverse events (RR, 0.25; 95% CI, 0.11–0.58; P &lt;0.001). However, the length of hospital stay (WMD, −0.39 days; 95% CI, −0.84 to 0.07; P = 0.094), rates of antibiotic prescription (RR, 1.10; 95% CI, 0.97–1.25; P = 0.122), hospital readmission (RR, 1.03; 95% CI, 0.92–1.16; P = 0.613) and mortality (RR, 0.73; 95% CI, 0.17–3.19; P = 0.674) were comparable between the PCT-guided antibiotic and control groups. TSA showed that the RIS was 2,340, indicating a statistically significantly shorter length of antibiotic therapy between PCT-guided antibiotic and control groups (P &lt;0.05).ConclusionsPCT-guided management seems to be able to decrease antibiotic exposure in patients with infectious disease. However, much larger prospective clinical studies are warranted to confirm these findings.

Wang M, Sun X, Ni L et al.

Mengjing Wang,1,2,* Xuehui Sun,3,* Li Ni,1 Minmin Zhang,1 Jiaying Zhang,4 Guoxin Ye,1 Li Jin,2,3 Xiaofeng Wang,2,3 Jing Chen1,2 1Nephrology, Huashan Hospital, Fudan University, Shanghai, People&rsquo;s Republic of China; 2National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People&rsquo;s Republic of China; 3State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, People&rsquo;s Republic of China; 4Nutrition, Huashan Hospital, Fudan University, Shanghai, People&rsquo;s Republic of China*These authors contributed equally to this workCorrespondence: Jing Chen; Xiaofeng Wang Email chenjing1998@fudan.edu.cn; xiaofengwang71@163.comPurpose: Reduced kidney function has been associated with an increased risk for adverse outcomes. Accurate assessment of glomerular filtration rate (GFR) is key to diagnosis and management of kidney disfunction. Debate exists on the best GFR estimation equation for elderly people. This study aimed to compare the predictive validity and discriminative ability of four GFR equations in relation to 2-year and 6-year mortality in exceptional longevity (EL) (those over 95 years old with intact health) individuals and is an ideal model to address factors relating to life span and age-related diseases.Patients and Methods: This study used 6 years&rsquo; data of 278 EL from the Rugao longevity cohort. Baseline GFR was estimated using four equations: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, Modification of Diet in Renal Disease Study (MDRD) equation, Berlin Initiative Study-1 (BIS) equation, and modified MDRD equation. Predictive validity was tested using Cox proportional hazards analysis. Overall improvement in reclassification based on estimated GFR (eGFR) was assessed applying net reclassification improvement (NRI).Results: Mean age of participants was 97&plusmn; 2 years with median follow-up of 2.6 years. Median (IQR) eGFR by CKD-EPI, MDRD, BIS, and modified MDRD equations were 73.9 (62.2&ndash; 77.6), 82.3 (67.4&ndash; 98.6), 56.4 (47.9&ndash; 63.9), and 101.5 (83.1&ndash; 121.6) mL/min per 1.73 m2, respectively. Higher eGFREPI was associated with lower mortality after multivariate adjustment (for continuous eGFREPI, HRtwo-year 1.018, 95% CI 1.002&ndash; 1.033, P=0.023; HRsix-year 1.013, 95% CI 1.002&ndash; 1.025, P=0.022), while eGFR from other equations did not show any associations with mortality. NRI for two-year mortality was 0.14 and approximately significant, which may favor the CKD-EPI when compared to BIS equation (P=0.052).Conclusion: The CKD-EPI equation showed more accurate estimation of kidney function in the elderly with respect to GFR distribution and predictability of mortality risk.Keywords: glomerular filtration rate, kidney function, equation, exceptional longevity, mortality

C. Baum MD, M. Leimbacher MD, P. Kriechling MD et al.

Introduction: The Vancouver algorithm recommends revision arthroplasty (RA) for Vancouver type B2 (VTB2) fractures. However, open reduction and internal fixation (ORIF) using locking compression plates (LCP) may be a valid and less invasive alternative treatment. Materials and Methods: Between January 2007 and March 2017, we retrospectively recruited all patients treated with either ORIF with LCP or RA for VTB2 fractures in our clinic. All of the following were reviewed: the length of hospital stay, the operating time, the need for blood transfusions during and/or after surgery, implant-related and patient-related complications, need for revision surgery, and the radiological outcome. Additionally, the functional outcome was investigated. Results: Fifty-nine patients were recruited. Thirty-five (59.3%) patients underwent RA, while 24 (40.7%) patients received ORIF with LCP. The median surgical time was 137.50 minutes in the LCP group compared to 160.00 minutes in the RA group ( P = .051). Three (12.5%) patients in the LCP group and 10 (28.6%) patients in the RA group experienced an implant-associated complication ( P = .131). Patient-related complications occurred in 3 (12.5%) patients in the LCP group versus 6 (17.1%) patients in the RA group ( P = .628). The mean preoperative Parker mobility score was 9 points in both groups and decreased in both groups to a mean of 5 points in the LCP and 7 points in the RA group. Discussion: Open reduction and internal fixation with LCP seems to be a less invasive procedure for VTB2 fractures in comparison to RA. It is a bone-sparing procedure that can be advantageous for further revision operations. Moreover, some fractures can only be anatomically reduced by ORIF with LCP, whereas for proximal fractures with a radiologically unambiguously loosened stem RA might be advantageous. Conclusion: In line with previously published studies, our data suggest that ORIF using LCP is a valid treatment option for VTB2 fractures.

Janelle S. Taylor, Shaune M. DeMers, E. Vig et al.

Dieneke Smit, Jacomine de Lange, Bernadette Willemse et al.

Abstract Background Despite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement. Methods Data were derived from the second measurement (2011) of the Living Arrangements for people with Dementia study. One thousand two hundred eighteen people residing in 139 dementia care homes were involved. Forty predictors of higher involvement were studied. Multilevel backward regression analyses were performed. Results The most important predictors of higher involvement were: absence of agitation, less ADL dependency, and a higher cognitive status of the residents, higher staff educational level, lower experienced job demands by care staff and a smaller number of residents living in the dementia care wards of a facility. More social supervisor support as perceived by staff was found to predict less activity involvement. Conclusions To increase the activity involvement of care home residents with dementia it seems vital to: 1) reduce staff’s experienced job demands; 2) elevate their overall educational level; 3) train staff to provide suitable activities, taking account of the behavior and preserved capabilities of residents; and 4) foster transition towards small-scale care. In order to achieve these aims, care organizations might need to evaluate the use of their financial means.