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https://www.readbyqxmd.com/read/28439842/controversies-in-the-multimodality-management-of-locally-advanced-rectal-cancer
#1
REVIEW
Robert Díaz Beveridge, Dilara Akhoundova, Gema Bruixola, Jorge Aparicio
Neoadjuvant radiotherapy previous to radical surgery, both as short-course radiotherapy and as long-course radiotherapy combined with 5-FU-based chemotherapy (LCRCT), is routinely used in the management of locally advanced rectal cancer, with consistent benefits in the reduction in the local relapse risk. Unfortunately, survival benefits have been elusive to demonstrate with this approach, especially in the setting of radical surgery in the form of total mesorectal excision (TME). Concerns about over-treating early-stage patients and about the possible long-term side effects have also cast more doubts in a blanket approach of treating all patients with neoadjuvant radiotherapy, especially with LCRCT...
June 2017: Medical Oncology
https://www.readbyqxmd.com/read/28430963/integrated-care-for-older-populations-and-its-implementation-facilitators-and-barriers-a-rapid-scoping-review
#2
Diane E Threapleton, Roger Y Chung, Samuel Y S Wong, Eliza Wong, Patsy Chau, Jean Woo, Vincent C H Chung, Eng-Kiong Yeoh
Purpose: Inform health system improvements by summarizing components of integrated care in older populations. Identify key implementation barriers and facilitators. Data sources: A scoping review was undertaken for evidence from MEDLINE, the Cochrane Library, organizational websites and internet searches. Eligible publications included reviews, reports, individual studies and policy documents published from 2005 to February 2017. Study selection: Initial eligible documents were reviews or reports concerning integrated care approaches in older/frail populations...
April 20, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28427345/variation-in-gp-decisions-on-antihypertensive-treatment-in-oldest-old-and-frail-individuals-across-29-countries
#3
Sven Streit, Marjolein Verschoor, Nicolas Rodondi, Daiana Bonfim, Robert A Burman, Claire Collins, Gerasimovska Kitanovska Biljana, Sandra Gintere, Raquel Gómez Bravo, Kathryn Hoffmann, Claudia Iftode, Kasper L Johansen, Ngaire Kerse, Tuomas H Koskela, Sanda Kreitmayer Peštić, Donata Kurpas, Christian D Mallen, Hubert Maisoneuve, Christoph Merlo, Yolanda Mueller, Christiane Muth, Marija Petek Šter, Ferdinando Petrazzuoli, Thomas Rosemann, Martin Sattler, Zuzana Švadlenková, Athina Tatsioni, Hans Thulesius, Victoria Tkachenko, Peter Torzsa, Rosy Tsopra, Tuz Canan, Rita P A Viegas, Shlomo Vinker, Margot W M de Waal, Andreas Zeller, Jacobijn Gussekloo, Rosalinde K E Poortvliet
BACKGROUND: In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision...
April 20, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28424612/an-examination-of-brain-abnormalities-and-mobility-in-individuals-with-mild-cognitive-impairment-and-alzheimer-s-disease
#4
Barbara L Fischer, Rhonda Bacher, Barbara B Bendlin, Alex C Birdsill, Martina Ly, Siobhan M Hoscheidt, Richard J Chappell, Jane E Mahoney, Carey E Gleason
Background: Mobility changes are concerning for elderly patients with cognitive decline. Given frail older individuals' vulnerability to injury, it is critical to identify contributors to limited mobility. Objective: To examine whether structural brain abnormalities, including reduced gray matter volume and white matter hyperintensities, would be associated with limited mobility among individuals with cognitive impairment, and to determine whether cognitive impairment would mediate this relationship. Methods: Thirty-four elderly individuals with mild cognitive impairment (MCI) and Alzheimer's disease underwent neuropsychological evaluation, mobility assessment, and structural brain neuroimaging...
2017: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/28420723/mitochondrial-bax-determines-the-predisposition-to-apoptosis-in-human-aml
#5
Frank Reichenbach, Cornelius Wiedenmann, Enrico Schalk, Diana Becker, Kathrin Funk, Peter Scholz-Kreisel, Franziska Todt, Denise Wolleschak, Konstanze Dohner, Jens U Marquardt, Florian Heidel, Frank Edlich
Purpose: Cell-to-cell variability in apoptosis signaling contributes to heterogenic responses to cytotoxic stress in clinically heterogeneous neoplasia, such as acute myeloid leukemia (AML). The BCL-2 proteins BAX and BAK can commit mammalian cells to apoptosis and are inhibited by retrotranslocation from the mitochondria into the cytosol. The subcellular localization of BAX and BAK could determine the cellular predisposition to apoptotic death. Experimental design: The relative localization of BAX and BAK was determined by fractionation of AML cell lines and patient samples of a test cohort and a validation cohort...
April 18, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28420687/home-visits-to-frail-elderly-can-save-money-and-angst
#6
Brit Cooper-Jones, Katelyn Verstraten
No abstract text is available yet for this article.
April 18, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/28420324/evaluation-of-a-technology-enhanced-integrated-care-model-for-frail-older-persons-protocol-of-the-spec-study-a-stepped-wedge-cluster-randomized-trial-in-nursing-homes
#7
Hongsoo Kim, Yeon-Hwan Park, Young-Il Jung, Hyoungshim Choi, Seyune Lee, Gi-Soo Kim, Dong-Wook Yang, Myunghee Cho Paik, Tae-Jin Lee
BACKGROUND: Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes. METHODS/DESIGN: SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting the inclusion/exclusion criteria in all the homes are eligible to participate...
April 18, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28419042/geriatric-fracture-care-future-trajectories-a-2015-aoa-critical-issues-symposium
#8
Julie A Switzer, Kevin J Bozic, Stephen L Kates
The population of the United States and the world is aging rapidly. Musculoskeletal care for older adults will be impacted by the manner in which health care is financed and the ability of the orthopaedic community to provide evidence-based integrated care for this population. We review the financial aspects of health-care reform and the implications for musculoskeletal care in the elderly. We discuss the establishment of quality measures for hip fracture care in the elderly, team building to accomplish this, and an innovative program designed to provide orthopaedic care to the frail elderly outside of the usual office setting...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28417310/telemedicine-and-palliative-care-an-increasing-role-in-supportive-oncology
#9
REVIEW
Brooke Worster, Kristine Swartz
With the emergence of telemedicine as a routine form of care in various venues, the opportunities to use technology to care for the most vulnerable, most ill cancer patients are extremely appealing. Increasingly, evidence supports early integration of palliative care with standard oncologic care, supported by recent NCCN guidelines to increase and improve access to palliative care. This review looks at the use of telemedicine to expand access to palliative care as well as provide better care for patients and families where travel is difficult, if not impossible...
June 2017: Current Oncology Reports
https://www.readbyqxmd.com/read/28416751/proteasome-inhibition-enhances-the-efficacy-of-volasertib-induced-mitotic-arrest-in-aml-in-vitro-and-prolongs-survival-in-vivo
#10
Dominik Schnerch, Julia Schüler, Marie Follo, Julia Felthaus, Dagmar Wider, Kathrin Klingner, Christine Greil, Justus Duyster, Monika Engelhardt, Ralph Wäsch
Elderly and frail patients, diagnosed with acute myeloid leukemia (AML) and ineligible to undergo intensive treatment, have a dismal prognosis. The small molecule inhibitor volasertib induces a mitotic block via inhibition of polo-like kinase 1 and has shown remarkable anti-leukemic activity when combined with low-dose cytarabine. We have demonstrated that AML cells are highly vulnerable to cell death in mitosis yet manage to escape a mitotic block through mitotic slippage by sustained proteasome-dependent slow degradation of cyclin B...
March 28, 2017: Oncotarget
https://www.readbyqxmd.com/read/28413364/delivering-integrated-care-to-the-frail-elderly-the-impact-on-professionals-objective-burden-and-job-satisfaction
#11
Benjamin Janse, Robbert Huijsman, Ruben Dennis Maurice de Kuyper, Isabelle Natalina Fabbricotti
BACKGROUND: The impact of integrated working on professionals' objective burden and job satisfaction was examined. An evidence-based intervention targeting frail elderly patients was implemented in the Walcheren region of the Netherlands in 2010. The intervention involved the primary care practice as a single entry point, and included proactive frailty screening, a comprehensive assessment of patient needs, case management, multidisciplinary teams, care plans and protocols, task delegation and task specialisation, a shared information system, a geriatric care network and integrated funding...
August 17, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28412165/effects-of-a-community-based-program-for-oral-health-and-nutrition-on-cost-effectiveness-by-preventing-disability-in-japanese-frail-elderly-a-quasi-experimental-study-using-propensity-score-matching
#12
Yasutake Tomata, Takashi Watanabe, Kemmyo Sugiyama, Shu Zhang, Yumi Sugawara, Ichiro Tsuji
OBJECTIVE: In the Japanese Long-Term Care Insurance (LTCI) system, a community-based program for oral health and nutrition (OHN program) has been implemented with the aim of reducing incident disability and care costs. However, the effectiveness of this program has not been confirmed epidemiologically. The purpose of the present study was to test the hypothesis that the OHN program does reduce incident disability and care costs. DESIGN: A prospective study with a 28-month follow-up period was conducted using data from administrative databases at Tagajo City, Japan...
April 12, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28409441/isolated-rectal-cancer-surgery-a-2007-2014-population-study-based-on-a-large-administrative-database
#13
Mario Saia, Alessandra Buja, Domenico Mantoan, Gino Sartor, Ferdinando Agresta, Vincenzo Baldo
Rectal resection is technically one of the most demanding laparoscopic procedures, requiring additional training and expertise of both surgeons and institutions. The literature has shown that laparoscopic procedures can be appropriate for the treatment of rectal cancer (RC), in terms of safety, outcome and efficiency, but results may not always be directly transferable to the general population. This study aimed to investigate the use of laparoscopic rectal cancer resections in a north-eastern Italian region (the Veneto) and to see how the characteristics of patients and hospitals are associated with the use of laparoscopy...
April 13, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28408809/assessment-of-effects-of-differences-in-trunk-posture-during-fowler-s-position-on-hemodynamics-and-cardiovascular-regulation-in-older-and-younger-subjects
#14
Satoshi Kubota, Yutaka Endo, Mitsue Kubota, Tomohiko Shigemasa
BACKGROUND: Downward shifts in blood volume with changing position generally cause tachycardic responses. Age-related decreases in vagal nerve activity could contribute to orthostatic hypotension in older individuals. Fowler's position is a reclined position with the back between 30° and 60°, used to facilitate breathing, eating, and other routine daily activities in frail and elderly patients. OBJECTIVE: This study examined whether stroke volume (SV) was higher and heart rate (HR) lower in Fowler's position with an upright upper trunk than in Fowler's position with the whole trunk upright in both older and younger subjects, based on the assumption that lower HR would result from reduced sympathetic activation in older individuals...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/28407778/coping-strategies-and-quality-of-life-in-caregivers-of-dependent-elderly-relatives
#15
Margarita Rodríguez-Pérez, Ana Abreu-Sánchez, María Jesús Rojas-Ocaña, Rafael Del-Pino-Casado
BACKGROUND: Despite the importance of coping in caregiving, there are few studies on the relationship between coping and quality of life in caregivers of the frail dependent elderly. Thus, this study aims to analyze the relationship between coping strategies and quality of life dimensions in primary caregivers of dependent elderly relatives. METHODS: A cross-sectional study was conducted from 86 caregivers. Predictive variables were coping strategies (problem-focused, emotion-focused, socially-supported, and dysfunctional); dependent variables were quality of life dimensions (psychological, physical, relational, and environmental); and potential confounding variables were age, gender, perceived health and burden of caregiver, and functional capacity of care receiver...
April 14, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28400984/is-technology-present-in-frailty-technology-a-back-up-tool-for-dealing-with-frailty-in-the-elderly-a-systematic-review
#16
REVIEW
Iranzu Mugueta-Aguinaga, Begonya Garcia-Zapirain
This study analyzes the technologies used in dealing with frailty within the following areas: prevention, care, diagnosis and treatment. The aim of this paper is, on the one hand, to analyze the extent to which technology is present in terms of its relationship with frailty and what technological resources are used to treat it. Its other purpose is to define new challenges and contributions made by physiotherapy using technology. Eighty documents related to research, validation and/or the ascertaining of different types of hardware, software or both were reviewed in prominent areas...
April 2017: Aging and Disease
https://www.readbyqxmd.com/read/28400963/psychiatry-and-the-geriatric-syndromes-creating-constructive-interfaces
#17
EDITORIAL
Simon Thacker, Mike Skelton, Rowan Harwood
Integrating mental and physical healthcare is difficult to achieve because of professional and organisational barriers. Psychiatrists recognise the problems resulting from fragmentation of services and want continuity of care for patients, but commissioning and service structures perpetuate these problems. One way forward may be to follow the syndromic model employed by geriatricians as a means of avoiding over-emphasis on diagnosis above the pragmatics of implementing multi-component, coordinated care. Commissioners need to be made aware of the overlap and complementarity of skills possessed by old age psychiatry and geriatric medicine to create joint services for people vulnerable to dementia and delirium...
April 2017: BJPsych Bulletin
https://www.readbyqxmd.com/read/28399218/timed-up-and-go-predicts-functional-decline-in-older-patients-presenting-to-the-emergency-department-following-minor-trauma%C3%A2
#18
Debra Eagles, Jeffrey J Perry, Marie-Josée Sirois, Eddy Lang, Raoul Daoust, Jacques Lee, Lauren Griffith, Laura Wilding, Xavier Neveu, Marcel Emond
Background: there is no standardised test for assessing mobility in the Emergency Department (ED). Objective: we wished to evaluate the relationship between the Timed Up and Go (TUG) and frailty, functional decline and falls in community dwelling elders that present to the ED following minor trauma. Methods: this was a secondary analysis of a prospective cohort study conducted at eight Canadian hospitals. Evaluations included: TUG; Study of Osteoporotic Fractures Frailty Index; Older American Resources and Service Functional Scale; and self-reported falls...
March 1, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28398377/-new-oral-anticoagulants-in-patients-with-atrial-fibrillation-efficacy-and-safety-data-from-the-real-world
#19
Letizia Riva, Giuseppe Di Pasquale
New oral anticoagulants (NOACs: dabigatran, rivaroxaban, apixaban and edoxaban) proved to be at least non-inferior to warfarin in reducing thromboembolic risk in patients with atrial fibrillation. In addition, NOACs have been demonstrated to be safe and associated with a significant reduction in major and intracranial bleeding events. With the exception of apixaban, an increase in gastrointestinal bleedings has been observed, but as a whole NOACs have been shown to reduce mortality with rates similar to those of warfarin...
March 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28398376/-efficacy-and-safety-of-oral-anticoagulants-in-frail-elderly-patients-with-atrial-fibrillation-an-unsolved-problem
#20
Paolo Alboni, Nicola Stucci, Elena Cojocaru, Andrea Ungar
At present, the efficacy and safety of anticoagulants, warfarin, or new oral anticoagulants in frail patients remain unknown, as these patients have largely been excluded from both randomized trials and "real-world" studies; as a result, the guidelines do not provide guidance for the management of this population. Frail patients with atrial fibrillation (AF) are significantly less likely to receive oral anticoagulants compared to their nonfrail counterparts; is that an expression of reasonable prudence or malpractice? In this regard, some aspects of physical frailty should be considered: (i) increased vulnerability to stressors, including pharmacological agents with potential severe adverse effects; (ii) frail elderly patients are at high risk of falls and, therefore, of severe traumatic hemorrhages on oral anticoagulation; (iii) frail patients are more likely to have complications during intercurrent affections, potentially responsible for hemorrhages...
March 2017: Giornale Italiano di Cardiologia
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