Stantonmolina6893

Medicare-certified home health agencies are required to offer family caregiver training, but little is known regarding the potential impact of this training on outcomes during home health care. We estimate the proportion of family caregivers assisting Medicare home health patients who have unmet training needs and examine whether these unmet training needs are associated with older adults' risk of acute care utilization during home health care.

Observational, nationally representative cohort study.

Linked National Health and Aging Trends Study, Outcome and Assessment Information Set (OASIS), Medicare Provider of Services file, and Medicare claims data from 2011 to 2016.

Thousand two hundred seventeen (weighted n = 5,870,905) community-living Medicare beneficiaries who received home health care between 2011 and 2016.

Family caregivers' unmet training needs measured from OASIS and Medicare claims; home health patients' acute care utilization (including emergency department use and hospitalization) meaer adults' risk of acute care utilization during home health care.

Unmet training needs among family caregivers are associated with greater likelihood of acute care utilization among Medicare beneficiaries receiving home health care. Identifying and addressing family caregivers' training needs may reduce older adults' risk of acute care utilization during home health care.

Increasing the detection of fetal growth restriction (FGR), while reducing stillbirth, also leads to unnecessary early intervention, and associated morbidity, for normally grown babies who are incorrectly suspected of FGR.

We sought to design a balance measure that addresses the specificity of FGR detection.

A retrospective cohort study on all singleton births ≥32weeks gestation in 2016 and 2017 in Victoria. see more We compared two balance measures for the detection of FGR, defined as the proportion of all babies iatrogenically delivered before 39weeks gestation for suspected FGR that had a birthweight ≥10th centile (balance measure 1) or ≥25th centile (balance measure 2). Hospital level performance on each balance measure was derived and compared to an existing performance measure for severe FGR detection in Victoria.

Of the 38 hospitals analysed, 12 (32%) had a favourable performance on an existing indicator of FGR detection, seven (18%) hospitals had a favourable performance on balance measure 1, and 15 (39%) had a favourable performance on balance measure 2. There was a moderate correlation between hospital performance on the existing indicator and on balance measure 1 (r=0.447, P=0.005) but not balance measure 2 (r=-0.063, P=0.71). There was no difference in perinatal mortality between high performing hospitals and low performing hospitals.

Introducing a balance measure into routine reporting may bring greater awareness to the unintended harm associated with increased detection of FGR.

Introducing a balance measure into routine reporting may bring greater awareness to the unintended harm associated with increased detection of FGR.

The purpose was to investigate long-term prognosis of epilepsy of unknown cause with onset between ages 2 and 16 in children without any major disability, by evaluation of a previously described prognostic model and long-term follow-up of a study on the impact of duration of initial antiseizure medication (ASM) treatment.

Patients included in a randomized controlled trial (RCT) of either one or three years of ASM therapy prior to withdrawal (if seizure-free for at least 6months) were contacted after 29-35years and asked to complete a survey. Potential prognostic factors were evaluated duration of initial ASM treatment, seizure type, seizure frequency, and score in a prognostic model developed in the initial publication.

One hundred and forty-nine subjects answered the questionnaire (response rate 65%). Seizure freedom without treatment was found in 110 responders (77%, 95%CI 73-81). There was no significant difference in score in the prognostic model between responders with and without epilepsy at follon of relapse risk in the shorter term may be possible, the bearing of such models on long-term epilepsy risk is more questionable.

Gender differentiation can influence the diet, physical activity, and health of human populations. Multifaceted approaches are therefore necessary when exploring the biological consequences of gender-related social norms in the past. Here, we explore the links between diet, physiological stress, physical activity, and gender differentiation in the Medieval Islamic population of La Torrecilla (Granada, Spain, 13th-15th century AD), by analyzing stable isotope patterns, stature, and long bone diaphyseal measurements.

The sample includes 96 individuals (48 females, 48 males) classified as young and middle adults (20-34 and 35-50 years of age respectively). Diet was reconstructed through the analysis of δ

C and δ

N. Stature, humeral and femoral diaphyseal shape and product of diaphyseal diameters served as proxies of physiological stress and physical activity.

Isotopic ratios suggest a substantial dietary contribution of C

plants (e.g., sorghum, millet), a variable access to animal proteins, and no dih we cannot rule out quantitative differences. Our results shed new light on the effects of gender-related social norms on human development and lifestyle.Systemic sclerosis (SSc) is an autoimmune disease characterized by significant vascular alterations and multi-organ fibrosis. Microvascular alterations are the first event of SSc and injured endothelial cells (ECs) may transdifferentiate towards myofibroblasts, the cells responsible for fibrosis and collagen deposition. This process is identified as endothelial-to-mesenchymal transition (EndMT), and understanding of its development is pivotal to identify early pathogenetic events and new therapeutic targets for SSc. In this review, we have highlighted the molecular mechanisms of EndMT and summarize the evidence of the role played by EndMT during the development of progressive fibrosis in SSc, also exploring the possible therapeutic role of its inhibition.

Medication deprescribing in palliative care settings has been insufficiently studied.

To determine the feasibility of a deprescribing program in hospice patients with limited life expectancy.

Pharmacist-led, single arm, single-centered, retrospective analysis of a pilot deprescribing program in an integrated healthcare delivery organization between 9/1/2018 to 1/31/2019.

The primary outcome was the proportion of patients who achieved ≥50% reduction of the recommended medications to deprescribe.

A total of 97 patients were included in the analysis. The average age was 77.5 ± 23.7 years, with 53.6% being women and 54.6% white. The most common primary diagnosis was cancer (58.8%), with cardiovascular disease the next most common (15.5%). The mean number of baseline comorbidities was 2.0 ± 1.6. Of 698 prescriptions at the start of hospice enrollment, 79.4% of patients achieved a ≥50% reduction in medications recommended for deprescribing. This success was seen mostly in cardiovascular and other nonspecie impact on quality of life.

In genetic admixture processes, source groups for an admixed population possess distinct patterns of genotype and phenotype at the onset of admixture. Particularly in the context of recent and ongoing admixture, such differences are sometimes taken to serve as markers of ancestry for individuals-that is, phenotypes initially associated with the ancestral background in one source population are assumed to continue to reflect ancestry in that population. Such phenotypes might possess ongoing significance in social categorizations of individuals, owing in part to perceived continuing correlations with ancestry. However, genotypes or phenotypes initially associated with ancestry in one specific source population have been seen to decouple from overall admixture levels, so that they no longer serve as proxies for genetic ancestry. Here, we aim to develop an understanding of the joint dynamics of admixture levels and phenotype distributions in an admixed population.

We devise a mechanistic model, consisting of a trait that initially differed between source populations might serve as a reliable proxy for ancestry for only a short time, especially if the trait is determined by few loci. It follows that a social categorization based on such a trait is increasingly uninformative about genetic ancestry and about other traits that differed between source populations at the onset of admixture.

To test the impact of a multicomponent behavioral intervention to reduce the use of high-risk anticholinergic medications in primary care older adults.

Cluster-randomized controlled trial.

Ten primary care clinics within Eskenazi Health in Indianapolis.

The multicomponent intervention included provider- and patient-focused components. The provider-focused component was computerized decision support alerting of the presence of a high-risk anticholinergic and offering dose- and indication-specific alternatives. The patient-focused component was a story-based video providing education and modeling an interaction with a healthcare provider resulting in a medication change. Alerts within the medical record triggered staff to play the video for a patient. Our design intended for parallel, independent priming of both providers and patients immediately before an outpatient face-to-face interaction.

Medication orders were extracted from the electronic medical record system to evaluate the prescribing behavios receiving primary care. Improving nudges or a policy-focused component may be necessary to reduce use of high-risk medications.

This multicomponent intervention did not reduce the use of high-risk anticholinergics in older adults receiving primary care. Improving nudges or a policy-focused component may be necessary to reduce use of high-risk medications.Torsade de Pointes (TdP), a rare but lethal ventricular arrhythmia, is a toxic side effect of many drugs. To assess TdP risk, safety regulatory guidelines require quantification of hERG channel block in vitro and QT interval prolongation in vivo for all new therapeutic compounds. Unfortunately, these have proven to be poor predictors of torsadogenic risk, and are likely to have prevented safe compounds from reaching clinical phases. Although this has stimulated numerous efforts to define new paradigms for cardiac safety, none of the recently developed strategies accounts for patient conditions. In particular, despite being a well-established independent risk factor for TdP, female sex is vastly under-represented in both basic research and clinical studies, and thus current TdP metrics are likely biased toward the male sex. Here, we apply statistical learning to synthetic data, generated by simulating drug effects on cardiac myocyte models capturing male and female electrophysiology, to develop new sex-specific classification frameworks for TdP risk. We show that (i) TdP classifiers require different features in females vs. males; (ii) male-based classifiers perform more poorly when applied to female data; and (iii) female-based classifier performance is largely unaffected by acute effects of hormones (i.e., during various phases of the menstrual cycle). Notably, when predicting TdP risk of intermediate drugs on female simulated data, male-biased predictive models consistently underestimate TdP risk in women. Therefore, we conclude that pipelines for preclinical cardiotoxicity risk assessment should consider sex as a key variable to avoid potentially life-threatening consequences for the female population.