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Increasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis.

Cross-sectional study of patient characteristics at the point of dementia diagnosis.

In total, 12,154 patients aged 65years or older diagnosed with dementia in Southeast London between 2007 and2015.

Data were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtypantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. #link# They need to be taken into consideration to optimize pathways into care and personalize assessment and management.

Transtendinous rotator cuff tear is likely to occur due to trauma in sports activities, with a frequency of <2% of total rotator cuff tears. These tears are difficult to treat because of limited tendon tissue in the proximal stump, and standard repair techniques are sometimes ineffective. Few studies have reported on the repair technique and clinical outcomes for transtendinous rotator cuff tear, and an appropriate repair technique has, therefore, not been established. The purpose of this study was to use our modified load sharing rip-stop technique to repair transtendinous rotator cuff tear and to clarify the clinical effectiveness of this technique.

This was a retrospective case series review of eight patients who underwent the modified load sharing rip-stop technique for repairing traumatic transtendinous rotator cuff tear between January 2013 and June 2017. The eight patients were followed up for at least 2 years (range 24-41 months). link2 Cuff integrity was evaluated using magnetic resonance imaging atff tear, patients obtained good clinical outcomes and could return to sports activities.

To perform self-care in patients with heart failure (HF), we developed and implemented a new HF point self-care system, which was characterized by 1) the way weight and HF symptoms were scored ("Heart Failure Points") and 2) the timing of consultations defined for both patients and health care providers. We examined the association between the induction of the new system and 1-year outcomes in patients hospitalized for HF.

We retrospectively enrolled 569 consecutive patients into our study who were admitted for HF treatment at our hospital 275 patients between November 2011 and October 2013 (before the induction of the self-management system) and 294 patients between November 2015 and October 2017 (after the induction). We sought to compare the clinical outcomes between patients using the self-management system and those not using the system after propensity-score (PS) matching. The primary outcome measure was a composite of all-cause death or HF rehospitalization.

The cumulative 1-year incidence of the primary outcome measure in the use group (n = 153) was significantly lower than that in the non-use group (n = 153) (24.5% vs. 34.9%, respectively; p = 0.031; hazard ratio 0.62; 95% confidence interval 0.40-0.96), mainly due to a reduction in HF hospitalization.

The induction of the new self-care system was associated with better 1-year outcomes in patients hospitalized for HF. This system may help patients with HF to achieve more efficient self-care.

The induction of the new self-care system was associated with better 1-year outcomes in patients hospitalized for HF. This system may help patients with HF to achieve more efficient self-care.The aim of this study was to clinically evaluate the effectiveness of various palatoplasty techniques for the repair of cleft palates greater than 8mm in width. This prospective cohort study included 142 patients with complete cleft palate between September 2017 and January 2019. Among the patients, 60 underwent a modified palatoplasty with Furlow Z-plasty (MPFZP), 51 underwent a von Langenbeck (VL) repair, and 31 underwent a two-flap palatoplasty (2FP). The MPFZP technique was modified with bilateral relaxing incisions and a radical intravelar veloplasty. Descriptive statistics and the χ2 test were used to explore and compare the rates of complications among the three surgical techniques. No statistically significant difference in sex, age at repair, cleft width, or cleft Veau type was found among the three groups. Rates of wound dehiscence at 1 week and fistula formation at 3 months after the surgery also did not differ significantly among the three techniques. However, velopharyngeal function for speech was better in patients who underwent MPFZP compared to the other two techniques (P less then 0.05). The repair of a wide cleft palate can be difficult due to the tension at closure. Although the study findings did not demonstrate a difference in complication rates among the three techniques, MPFZP appears to have the best functional outcomes in patients with a cleft palate wider than 8mm.

Early use of parenteral nutrition (early-PN), as compared with withholding it for one week (late-PN), in the PICU, has shown to slow down recovery from critical illness and impair long-term development of 6 neurocognitive/behavioural/emotional functions assessed 2 years later. Given that key steps in brain maturation occur at different times during childhood, we hypothesised that age at time of exposure determines long-term developmental impact of early-PN.

Withaferin A nmr who were neurocognitively tested 2 years after participation in the PEPaNIC-RCT were included in this study. First, for each studied long-term outcome, interaction between randomisation to early-PN versus late-PN and age was assessed with multivariable linear regression analysis. Subsequently, for outcomes with an interaction p≤0.15, the impact of early-PN versus late-PN was analysed, after adjustment for risk factors, for 4 subgroups defined based on developmentally-relevant age at time of exposure [≤28 days (n=121), 29 days to 11 monof exposure were identified as most vulnerable to developmental harm evoked by early-PN. CLINICAL TRIALS.GOV NCT01536275.

Critically ill children aged 29 days to 11 months at time of exposure were identified as most vulnerable to developmental harm evoked by early-PN. CLINICAL TRIALS.GOV NCT01536275.

Patients who have chronic intestinal failure require home parenteral nutrition (HPN) support. Intravenous lipid emulsions (IVLEs) are a vital part of HPN. The conventional IVLE is based on pure soybean oil, which contains a high concentration of omega-6 fatty acids. Alternative IVLEs are commercially available. These contain various oil blends and have different fatty acid compositions from soybean oil that could provide benefit to patients on HPN. The aim of this systematic review is to assess the effects of different IVLEs in adult patients requiring HPN.

A systematic literature search was conducted up to October 2019 using relevant search terms in the Medline, EMBASE and CINAHL databases. Only randomised controlled trials (RCTs) in adults on HPN that compared two or more IVLEs were included. Data were extracted and the Cochrane Collaboration's tool for assessing risk of bias was used.

Six articles were identified for inclusion in this systematic review. Studies differed according to sample size, duraHPN, although there is currently insufficient evidence to determine superiority of one formulation over another. More and larger RCTs are required in this area.

Controversy persists about the effects of laparoscopic distal gastrectomy (LDG) versus open distal gastrectomy (ODG) on short-term surgical outcomes and long-term survival within the field of advanced gastric cancer (AGC).

Studies published from January 1994 to February 2020 that compare LDG and ODG for AGC were identified. All randomized controlled trials (RCTs) were included. The selection of high-quality nonrandomized comparative studies (NRCTs) was based on a validated tool (Methodological Index for Nonrandomized Studies, MINORS). The short- and long-term outcomes of both procedures were compared.

Overall, 30 studies were included in this meta-analysis, which comprised of 8 RCTs and 22 NRCTs involving 16,029 patients (7864 LDGs, 8165 ODGs). The recurrence, 3-year disease-free survival (DFS), 3-year overall survival (OS), and 5-year OS rates for LDG and ODG were comparable. LDG was associated with a lower postoperative complication rate (OR 0.79; P<0.00001), lower estimated volume of blood loss (WMD -102.21mL; P<0.00001), shorter postoperative hospital stay (WMD -1.96 days; P<0.0001), shorter time to first flatus (WMD -0.54 day; P=0.0007) and shorter time to first liquid diet (WMD -0.66 day; P=0.001). The number of lymph nodes retrieved, mortality, intraoperative complications, intraoperative blood transfusion, and time to ambulation were similar. However, LDG was associated with a longer surgical time (WMD 33.57min; P<0.00001).

LDG with D2 lymphadenectomy is a safe and effective technique for patients with AGC when performed by experienced surgeons at high-volume specialized centers.

LDG with D2 lymphadenectomy is a safe and effective technique for patients with AGC when performed by experienced surgeons at high-volume specialized centers.

While many clinicians encounter parents or adolescents who refuse HPV vaccine, little is known about the prevalence of hesitancy for HPV vaccine nationally or its association with vaccination.

In April 2019, we surveyed families with adolescents 11-17 years using a national online panel (Knowledge Panel®) as the sampling frame. We assessed the prevalence of HPV vaccine hesitancy with the validated 9-item Vaccine Hesitancy Scale (VHS). We used multivariate analyses to assess demographic factors associated with HPV vaccine hesitancy. We also assessed practical barriers to receipt of HPV vaccine and the relationship between barriers and hesitancy. Finally, we evaluated the association between both HPV vaccine hesitancy and practical barriers on HPV vaccine receipt or refusal.

2,177 parents out of 4,185 sampled (52%) completed the survey, 2,020 qualified (lived with adolescent). link3 Using a VHS cut-off score > 3 out of 5 points, 23% of US parents were hesitant about HPV vaccine. Hesitancy was lower among tho and vaccine refusal.

Outcomes of knee arthroscopy (KA) after total knee arthroplasty (TKA) have been limited to small case series with short-term follow-up. The purpose of this study is to report the outcomes of patients who undergo a KA after a TKA using a large longitudinal database.

The PearlDiver Medicare database was queried for patients who underwent a KA procedure after a TKA on the ipsilateral extremity. A randomly selected control group was created by matching controls to cases in a 31 ratio based on age, gender, year of procedure, and Elixhauser Comorbidity Index. Revision for infection and all-cause revision were used as end points.

A total of192 TKA patients who underwent a subsequent KA (TKA+ KA group) were compared to 571 TKA patients who did not have a subsequent KA (TKA- KA group). The incidence of revision for infection was 6.3% in the TKA+ KA group compared to 2.2% in the TKA- KA group (odds ratio, 2.87; P= .009). The incidence of all-cause revision was 18.8% in the TKA+ KA group compared to 5.1% in the TKA- KA group (odds ratio, 4.