The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, ...healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3‐year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674–694, 2019.
See related editorial by Steinman et al. in this issue.
CONTEXT Women have a higher incidence of torsades de pointes than men, but it
is not known if the risk of drug-induced torsades de pointes varies during
the menstrual cycle. OBJECTIVES To determine ...if the degree of QT prolongation in response to ibutilide
varies with the menstrual cycle phase and to compare QT prolongation between
women and men. DESIGN AND SETTING Cohort study of men and women who received the same intervention conducted
between November 1998 and November 2000 at a general clinical research center
of a university hospital. PARTICIPANTS A volunteer sample of 58 healthy adults (38 men and 20 women) aged 21
to 40 years. INTERVENTION A low dose of ibutilide (0.003 mg/kg), infused intravenously for 10
minutes. Subjects were monitored for 120 minutes. Women received the intervention
on 3 separate occasions to correspond with menstrual cycle phases, which were
verified by using hormonal assays. MAIN OUTCOME MEASURE QT interval, recorded from electrocardiogram at timed intervals during
and after ibutilide infusion and standardized for variations in heart rate
(QTc). RESULTS Maximum (mean SD) millisecond increase in QTc after ibutilide infusion
was greater for women during menses (63 13) and the ovulatory phase (59
17) compared with women during the luteal phase (53 14) and compared with
men (46 16; P = .002 vs menses and P = .007 vs ovulation). Progesterone (r = −0.40)
and progesterone-to-estradiol ratio (r = −0.41),
but not estradiol (r = 0.14) or testosterone (r = 0.09), were inversely correlated with ibutilide-induced
QT prolongation. CONCLUSIONS Menstrual cycle and sex differences exist in QTc responses to ibutilide,
with the greatest increase in QTc corresponding to the first half of the menstrual
cycle.
Complication rates associated with thyroid surgery can be evaluated only through analysis of case studies and follow‐up data. This study covers postoperative data from 14,934 patients subjected to a ...follow‐up of 5 years. Among them, 3130 (20.9%) underwent total lobectomy (TL), 9599 (64.3%) total thyroidectomy (TT), 1448 (9.7%) subtotal thyroidectomy with a monolateral remnant (MRST), and 757 (5.1%) subtotal thyroidectomy with bilateral remnants (BRST). A total of 6% of the patients had already been operated on. Persistent hypoparathyroidism occurred after 1.7% of all the operations, and temporary hypoparathyroidism was noted in 8.3%. Permanent palsy of the laryngeal recurrent nerve (LRN) occurred in 1.0% of patients, transient palsy in 2.0%, and diplegia in 0.4%. The superior laryngeal nerve was damaged in 3.7%; dysphagia occurred in 1.4% of cases, hemorrhage in 1.2%, and wound infection in 0.3%. No deaths were reported. A significant rate of LRN damage was noted, which has an important impact on the patient’s social life. Hypoparathyroidism after total thyroidectomy is an important complication that can be successfully treated by therapy, although it is not always easily managed in special circumstances such as in young persons or pregnant women. The complications associated with thyroid surgery must be kept in mind so the surgeon can carefully evaluate the surgical and medical therapeutic options, have more precise surgical indications, and be able to give the patient adequate information.
This essay offers a narrative of rhetorical field methods and intertwined climate justice exigencies. We argue the emergence of and resistance toward rhetorical field methods responds to a growing ...ecological consciousness, reflecting a changing understanding of the relationship between human agency and the planet. Drawing upon fieldwork from our own research and other scholars in the field, we organize our argument in three related themes: culture, interconnection, and voice. Given the expansive objects, people, and practices rhetorical field methods engage, this approach offers one compelling way to listen to and amplify marginalized voices. Overall, this essay explores how rhetorical field methods have provided and might further offer a compelling set of principles and practices for resisting structures of ecological and social precarity for life on Earth.
While atrial fibrillation (AF) is suggested to induce a prothrombotic state, increasing thrombotic risk, it is also hypothesized that coagulation underlies AF onset. However, conclusive evidence is ...lacking. With this systematic review and meta-analysis, we aimed to summarize and combine the evidence on the associations between coagulation factors with AF in both longitudinal and cross-sectional studies.
We systematically searched for longitudinal cohort and cross-sectional studies investigating AF and thrombosis. For longitudinal studies, pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. For cross-sectional studies, we determined pooled standardized mean differences (SMDs) and 95% CIs. A total of 17 longitudinal and 44 cross-sectional studies were included. In longitudinal studies, we found significant associations between fibrinogen (HR 1.05, 95% CI 1.00-1.10), plasminogen activator inhibitor 1 (PAI-1) (HR 1.06, 95% CI 1.00-1.12), and D-dimer (HR 1.10, 95% CI 1.02-1.19) and AF incidence. In cross-sectional studies, we found significantly increased levels of fibrinogen (SMD 0.47, 95% CI 0.20-0,74), von Willebrand factor (SMD 0.96, 95% CI 0.28-1.66), P-selectin (SMD 0.31, 95% CI 0.08-0.54), ß-thromboglobulin (SMD 0.82, 95% CI 0.61-1.04), Platelet Factor 4 (SMD 0.42, 95% CI 0.12-0.7), PAI-1 (1.73, 95% CI 0.26-3.19), and D-dimer (SMD 1.74, 95% CI 0.36-3.11) in AF patients, as opposed to controls.
These findings suggest that higher levels of coagulation factors are associated with prevalent and incident AF. These associations are most pronounced with prevalent AF in cross-sectional studies. Limited evidence from longitudinal studies suggests a prothrombotic state underlying AF development.
Aims: To quantify the total economic costs of vision loss in Australia. Methods: Prevalence data of visual impairment, unpublished data on indirect costs, and national healthcare cost databases were ...used. Results: Vision disorders cost Australia an estimated A$9.85 billion in 2004. A$4.8 billion is the loss of wellbeing (years of life lost as a result of disability and premature mortality). Vision disorders rank seventh and account for 2.7% of the national loss of wellbeing. Direct health system costs total A$1.8 billion. They have increased by A$1 billion over the last 10 years and will increase a further A$1–2 billion in the next 10 years. Cataract, the largest direct cost, takes 18% of expenditure. The health system costs place vision disorders seventh, ahead of coronary heart disease, diabetes, depression, and stroke. Indirect costs, A$3.2 billion, include carers’ costs, low vision aids, lost earnings, and other welfare payments and taxes. Conclusions: Even a developed economy such as Australia’s cannot afford avoidable vision loss. Priority needs to be given to prevent preventable vision loss; to treat treatable eye diseases; and to increase research into vision loss that can be neither prevented nor treated.
Vision loss in Australia Taylor, Hugh R; Keeffe, Jill E; Vu, Hien T V ...
Medical journal of Australia,
06/2005, Letnik:
182, Številka:
11
Journal Article
Recenzirano
Objective: To assess the prevalence and causes of vision loss in Australia and to project these data into the future.
Design: Synthesis of data from two cross‐sectional population‐based cohort ...studies — the Melbourne Visual Impairment Project and the Blue Mountains Eye Study — and extrapolation to the entire Australian population.
Setting and participants: 8376 community and 533 nursing home residents recruited between 1992 and 1996 in urban and rural Victoria and New South Wales.
Main outcome measures: Age‐standardised prevalence of low vision (visual acuity < 6/12) and blindness (visual acuity < 6/60) (both measured in the best eye, with spectacles if usually worn for distance vision), and their causes for the Australian population for 2000 to 2024, projected from Australian Bureau of Statistics population data.
Results: In 2004, 480 300 Australians were estimated to have low vision, including 50 600 with blindness. The most common causes of low vision were undercorrected refractive error (62%), cataract (14%) and age‐related macular degeneration (10%). The latter was responsible for almost half of all cases of blindness. The numbers of people with low vision and blindness are projected to almost double by 2024.
Conclusions: Vision loss in Australia is a much bigger problem than is usually recognised; 76% of low vision is caused by uncorrected refractive error or cataract, both readily treatable. However, the prevention and treatment of macular degeneration poses a major challenge.
Extrarenal rhabdoid tumours (ERT) are highly aggressive tumours that are poorly responsive to standard cytotoxic chemotherapy and are associated with a grim prognosis. Primary ERT of the liver are ...most commonly observed in early childhood and exceptionally rare later in life.
We report the case of a 16-year-old male patient, presenting with flu-like symptoms after his second COVIDvaccination. During the work-up, a large solid liver lesion was incidentally discovered upon abdominal ultrasound examination. Pathological examination rendered the diagnosis of primary ERT of the liver, characterized by the loss of expression of INI-1 protein, encoded by the SMARCB1 gene. We summarized and discuss the existing literature by reviewing 53 pediatric and 6 adult cases, including the histological features treatment and outcomes of primary hepatic ERT.
Primary ERT of the liver are usually not associated with specific signs or symptoms, making the diagnosis very challenging. As ERT are associated with a high metastatic rate, delayed diagnoses lead to increased mortality, as complete resection is not possible in advanced-stage cases. Therefore, early diagnoses, enabling complete resection of the tumour are crucial to improve patient outcomes. Of interest, primary ERT of the liver, is associated with biallelic loss of the SMARCB1 (SWI/ SNF Related, Matrix Associated, Actin Dependent Regulator Of Chromatin, Subfamily B, Member 1) gene, a potential target for cancer therapeutics. This is, to our knowledge, the first case of a hepatic rhabdoid tumour treated with liver transplantation.
The purpose of this study was to describe the treatment techniques and results of 38 consecutive imaging-guided percutaneous radiofrequency ablations of solid renal masses performed in 32 patients.
...Solid renal masses in 32 patients underwent 38 treatment sessions using imaging-guided percutaneous radiofrequency ablation. During 36 sessions, radiofrequency ablation was performed using CT guidance, and two, using sonographic guidance. The average patient age was 76 years (range, 52-87 years), and the average renal mass size was 2.6 cm (range, 1-5 cm). The average number of radiofrequency treatments per solid mass at each session was 2.4 (range, 1-6 treatments), and the average time per treatment was 9.2 min (range, 3-14 min). A single electrode was used in 12 sessions, and a cluster electrode was used in 26 sessions. The average follow-up time was 9 months (range, 1-36 months).
Twenty-six of 32 patients had successful treatment of the solid renal mass using percutaneous imaging-guided radiofrequency ablation after one treatment session. Successful treatment was defined as lack of enhancement of the treated region on follow-up CT. Six of 32 patients had residual enhancing tissue after the first treatment session and returned for a second session. Five of these six retreatments were successful. Masses requiring a second treatment session were significantly larger than masses treated in a single session (3.5 vs 2.4 cm, respectively; p = 0.0013). Two patients had perinephric hematomas (which did not require transfusion), and one patient developed a 5-mm skin metastasis at the electrode insertion site, which was resected without recurrence.
Percutaneous imaging-guided radiofrequency ablation shows promise in the treatment of solid renal malignancies.
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