Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality - American Geriatric Society

Objectives

(1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality.

Design

Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000.

Setting

Large academic hospital.

Participants

Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only.

Measurements

(1) Incident delirium; (2) potential mediators of delirium on death including use of restraining devices (physical restraints, urinary catheters), development of hospital acquired conditions (HACs) (falls, pressure ulcers), and exposure to other noxious insults (sleep deprivation, acute malnutrition, dehydration, aspiration pneumonia); (3) death within 90 days of admission.

Results

Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs 16%, P < .001), HACs (37% vs 12%, P < .001), other noxious insults (63% vs 49%, P = .03), and 90-day mortality (24% vs 6%, P < .001). The inverse probability weighted hazard of death due to delirium was 4.2 (95% CI = 2.8–6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation.

Conclusion

Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults.

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Outcomes of Treated Hypertension at Age 80 and Older: Cohort Analysis of 79,376 Individuals - American Geriatric Society

Objectives

To estimate outcomes according to attained blood pressure (BP) in the oldest adults treated for hypertension in routine family practice.

Design

Cohort analysis of primary care inpatient and death certificate data for individuals with hypertension.

Setting

Primary care practices in England (Clinical Practice Research Datalink).

Participants

Individuals aged 80 and older taking antihypertensive medication and free of dementia, cancer, coronary heart disease, stroke, heart failure, and end-stage renal failure at baseline.

Measurements

Outcomes were mortality, cardiovascular events, and fragility fractures. Systolic BP (SBP) was grouped in 10-mmHg increments from less than 125 to 185 mmHg or more (reference 145–154 mmHg).

Results

Myocardial infarction hazards increased linearly with increasing SBP, and stroke hazards increased for SBP of 145 mmHg or greater, although lowest mortality was in individuals with SBP of 135 to 154 mmHg. Mortality of the 13.1% of patients with SBP less than 135 mmHg was higher than that of the reference group (Cox hazard ratio=1.25, 95% confidence interval=1.19–1.31; equating to one extra death per 12.6 participants). This difference in mortality was consistent over short- and long-term follow-up; adjusting for diastolic BP did not change the risk. Incident heart failure rates were higher in those with SBP less than 125 mmHg than in the reference group.

Conclusion

In routine primary care, SBP less than 135 mmHg was associated with greater mortality in the oldest adults with hypertension and free of selected potentially confounding comorbidities. Although important confounders were accounted for, observational studies cannot exclude residual confounding. More work is needed to establish whether unplanned SBPs less than 135 mmHg in older adults with hypertension may be a useful clinical sign of poor prognosis, perhaps requiring clinical review of overall care.

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Continued Use of Warfarin in Veterans with Atrial Fibrillation After Dementia Diagnosis - American Geriatric Society

Objectives

To determine the effectiveness of warfarin in older adults with dementia.

Design

Retrospective cohort study.

Setting

Department of Veterans Affairs national healthcare system.

Participants

Veterans aged 65 and older (73% aged ≥75, 99% male, 91% white) who had been receiving warfarin for nonvalvular atrial fibrillation for at least 6 months, were newly diagnosed with dementia in fiscal year 2007 or 2008, and were not enrolled in Medicare Advantage (n = 2,572).

Measurements

The onset of dementia was defined according to International Classification of Diseases, Ninth Revision, code. Participants were followed for up to 4 years for persistence of warfarin therapy, anticoagulation control, major hemorrhage, ischemic stroke, and all-cause mortality.

Results

The average CHADS2 score was 3.3 ± 1.3. After a diagnosis of dementia, 405 individuals (16%) persisted on warfarin therapy. Unadjusted Cox proportional hazards analysis demonstrated a protective effect of warfarin in prevention of ischemic stroke (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.46–0.89, P = .008), major bleeding (HR = 0.72, 95% CI = 0.55–0.94, P = .02), and all-cause mortality (HR = 0.66, 95% CI = 0.55–0.79, P < .001). Using propensity score matching, the protective effect of continuing warfarin persisted in prevention of stroke (HR = 0.74, 95% CI = 0.54–0.996, P = .047) and mortality (HR = 0.72, 95% CI = 0.60–0.87, P < .001), with no statistically significant decrease in risk of major bleeding (HR = 0.78, 95% CI = 0.61–1.01, P = .06).

Conclusion

Discontinuing warfarin after a diagnosis of dementia is associated with a significant increase in stroke and mortality.

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Use of Oral Anticoagulant Therapy in Older Adults with Atrial Fibrillation After Acute Ischemic Stroke - American Geriatric Society

Objectives

To explore barriers to anticoagulation in older adults with atrial fibrillation (AF) at high risk of stroke and to identify opportunities for interventions that might increase use of oral anticoagulants (OACs).

Design

Retrospective cohort study.

Setting

Two large community-based AF cohorts.

Participants

Individuals with ischemic stroke surviving hospitalization (N = 1,405, mean age 79).

Measurements

Using structured chart review, reasons for nonuse of OAC were identified, and 1-year poststroke survival was assessed. Logistic regression was used to identify correlates of OAC nonuse.

Results

Median CHA₂DS₂-VASc score was 5, yet 44% of participants were not prescribed an OAC at discharge. The most-frequent (nonmutually exclusive) physician reasons for not prescribing OAC included fall risk (26.7%), poor prognosis (19.3%), bleeding history (17.1%), participant or family refusal (14.9%), older age (11.0%), and dementia (9.4%). Older age (odds ratio (OR) = 8.96, 95% confidence interval (CI) = 5.01–16.04 for aged ≥85 vs <65) and disability (OR = 12.58, 95% CI = 5.82–27.21 for severe vs no deficit) were the most-important independent predictors of nonuse of OACs. By 1 year, 42.5% of those not receiving an OAC at discharge had died, versus 19.1% of those receiving an OAC (P < .001), far higher than recurrent stroke rates.

Conclusion

Despite very high stroke risk, more than 40% of participants were not discharged with an OAC. Dominant reasons included fall risk, poor prognosis, older age, and dementia. These individuals’ high 1-year mortality rate confirmed their high level of comorbidity. To improve anticoagulation decisions and outcomes in this population, future research should focus on strategies to mitigate fall risk, improve assessment of risks and benefits of anticoagulation in individuals with AF, and determine whether newer anticoagulants are safer in complex elderly and frail individuals.

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Effect of Resting Heart Rate on All-Cause Mortality and Cardiovascular Events According to Age - American Geriatric Society

Objectives

To examine whether the association between resting heart rate (RHR) and all-cause mortality and cardiovascular events differs according to age.

Design

Prospective cohort.

Setting

Community in Beijing, China.

Participants

Individuals aged 40 and older without cardiovascular disease at baseline (N = 6,209).

Measurements

Trained investigators interviewed participants using a standard questionnaire to obtain information on demographic characteristics, medical history and lifestyle risk factors in 1991. RHR was evaluated according to quartiles (<72, 72–76, 76–84, ≥84 beats/min). Cox regression models were used to assess the associations between RHR and all-cause mortality and cardiovascular events.

Results

During a mean follow-up of 8.3 years, 840 subjects died, and 676 experienced a cardiovascular event. Higher RHR was significantly associated with all-cause mortality (P trend < .001) and cardiovascular events (P trend = .002) in older (≥60) but not younger (<60) participants (both P trend > .05). There were significant modifying effects of age on the association between RHR and all-cause mortality (P interaction < .001) and cardiovascular events (P interaction =.002). Similar results were observed after exclusion of individuals who died (n = 100) or had a cardiovascular event (n = 45) during the first 2 years of follow-up.

Conclusion

High RHR appears to be an independent determinant of all-cause mortality and cardiovascular events in older but not younger individuals.

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Warfarin in Complex Older Patients: Have we Reached a Tipping Point? - American Geriatric Society

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Mikesell’s Recalls 2.25 Oz. Nacho Cheese Tortilla Chips Because Of Possible Health Risk - FDA Safety Alerts & Drug Recalls

Mikesell’s Potato Chip Company. is recalling its 2.25 oz. Nacho Cheese Tortilla Chips because they have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

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Changes in Descriptive Terms for Older People in the Medical Literature Over the Last 65 Years - American Geriatric Society

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Extension for Community Healthcare Outcomes—Care Transitions: Enhancing Geriatric Care Transitions Through a Multidisciplinary Videoconference - American Geriatric Society

Objectives

To examine whether a novel videoconference that connects an interdisciplinary hospital-based team with clinicians at postacute care sites improves interprofessional communication and reduces medication errors.

Design

Prospective cohort.

Setting

One tertiary care medical center and eight postacute care sites.

Participants

Hospital-based providers (hospitalists, geriatricians, pharmacists, social workers, medical trainees, and subspecialists) and postacute care clinicians.

Intervention

All patients discharged to eight postacute care sites were discussed in a weekly videoconference.

Measurement

Preliminary data including demographic characteristics of the patients discussed, postacute care provider satisfaction survey results, and data on medication errors are reported.

Results

Over 2 years, 907 patients were discussed; 84.6% were discussed with staff at subacute skilled nursing facilities and the remainder with clinicians at one long-term acute care facility. They had an average hospital length of stay of 6.8 days. Postacute care providers felt that the videoconference enhanced communication and provided much-needed access to information and hospital staff. Of the 106 pharmacy discrepancies identified, 16% involved an omission of a medication.

Conclusion

As increasing numbers of older adults are discharged to postacute care facilities, they face high-risk care transitions. Extension for Community Healthcare Outcomes—Care Transitions (ECHO-CT) facilitates interdisciplinary communication between hospital and postacute care providers, who normally have minimal interaction. Preliminary data suggests that ECHO-CT may improve the transitions of care processes between these sites.

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Huvepharma, Inc. Issues Voluntary Nationwide Recall of Duramycin-10 Due to Stability Failure - FDA Safety Alerts & Drug Recalls

Longmont, Colorado, Huvepharma, Inc., which recently acquired the Longmont Colorado manufacturing facility including the respective FDA registration associated with this recall, is voluntarily recalling 1 lot of Duramycin-10 Soluble Powder, distributed by Durvet, to the consumer level. The product had a stability failure at the 48 month time point. Risk Statement: The product does not have the potential to result in a health risk to any animals that are indicated for use.

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TreeHouse Foods Amends Best By Dates in Voluntary Product Recall of Macaroni & Cheese Cup Products - FDA Safety Alerts & Drug Recalls

TreeHouse Foods, Inc. (NYSE: THS) today announced an amendment to the Best By Dates in its December 11, 2016, press release related to its voluntary recall of certain macaroni and cheese cup products. The products contain cheddar cheese seasoning which may be contaminated with Salmonella.

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American Roland Food Corp. Initiates A Recall Of Roland® Manzanilla Olives Stuffed With Anchovies Due To Product Quality Issue - FDA Safety Alerts & Drug Recalls

American Roland Food Corp., in cooperation with the manufacturer in Spain, is initiating a recall of one lot of Roland® Manzanilla Olives Stuffed with Anchovies, due to a product quality issue that may pose a potential health hazard to those who consume the product.

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Combining Gait Speed and Recall Memory to Predict Survival in Late Life: Population-Based Study - American Geriatric Society

Objectives

To evaluate the relationship between gait speed, recall memory, and mortality.

Design

A cohort study (last follow-up December 2009).

Setting

Tuscany, Italy.

Participants

Individual data from 1,014 community-dwelling older adults aged 60 years or older with baseline gait speed and recall memory measurements and follow-up for a median time of 9.10 (IQR 7.1;9.3) years. Participants were a mean (SD) age of 73.9 (7.3) years, and 55.8% women. Participants walking faster than 0.8 m/s were defined as fast walkers; good recall memory was defined as a score of 2 or 3 in the 3-word delayed recall section of the Mini-Mental State Examination.

Measurements

All-cause mortality.

Results

There were 302 deaths and the overall 100 person-year death rate was 3.77 (95% CI: 3.37–4.22). Both low gait speed and poor recall memory were associated with mortality when analysed separately (HR = 2.47; 95% CI: 1.87–3.27 and HR = 1.47; 95% CI: 1.16–1.87, respectively). When we grouped participants according to both recall and gait speed, death rates (100 person-years) progressively increased from those with both good gait speed and memory (2.0; 95% CI: 1.6–2.5), to those with fast walk but poor memory (3.4; 95% CI: 2.8–4.2), to those with slow walk and good memory (8.8; 95% CI: 6.4–12.1), to those with both slow walk and poor memory (13.0; 95% CI: 10.6–16.1). In multivariate analysis, poor memory significantly increases mortality risk among persons with fast gait speed (HR = 1.40; 95% CI: 1.04–1.89).

Conclusion

In older persons, gait speed and recall memory are independent predictors of expected survival. Information on memory function might better stratify mortality risk among persons with fast gait speed.

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Cognitive Reserve: Predictor of Onset of Postoperative Delirium in Older Adults? - American Geriatric Society

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Reply to Cognitive Reserve: Predictor of Onset of Postoperative Delirium in Older Adults? - American Geriatric Society

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Increasing Role of Nurse Practitioners in House Call Programs - American Geriatric Society

Objectives

Residence-based primary care provides homebound frail patients with a care plan that is individually tailored to manage multiple chronic conditions and functional limitations using a variety of resources. We (1) examine the visit volume and Medicare payments for residence-based health care provided by nurse practitioners (NPs) in the Medicare fee-for-service environment; (2) compare NP's residential visits to those of internists and family physicians; and (3) compare the geographical service area of full-time house call NPs versus NPs who make nursing facility visits a major portion of their work.

Design

An observational study using secondary data.

Setting

Medicare Provider Utilization and Payment Data.

Participants

Medicare beneficiaries.

Measurements

Medicare payments for home and domiciliary care visits, the number of residence-based medical visits, provider volume, geographical distribution of full-time house call providers.

Results

About 3,300 NPs performed over 1.1 million home and domiciliary care visits in 2013, accounting for 22% of all residential visits to Medicare fee-for-service beneficiaries. A total of 310 NPs individually made more than 1,000 residential visits (defined as a full-time house call provider); among full-time house call providers, including physicians, NPs are now the most common provider type. There are substantial variations in the geographic distribution of full-time house call NPs, internists, and family physicians. Full time NP's service area is about 30% larger than family physicians and internists. Nursing home residents are far more likely to receive NP visits than are homebound persons receiving home visits.

Conclusion

NPs are now the largest type of provider delivering residence-based care and NPs provide care over the largest geographical service area. However, the vast majority of frail Americans are more likely to receive NP's care in a nursing facility versus at home.

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Sense of Control in End-of-Life Decision-Making - American Geriatric Society

Objectives

To explore how older adults in the community with a limited life expectancy make healthcare decisions and the processes used when they are not in an acute crisis.

Design

Grounded theory.

Setting

Medical programs and geriatrics clinics at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center.

Participants

Community-dwelling adults aged 67 to 98 with a life expectancy of less than 1 year (N = 20).

Measurements

In-depth semistructured interviews in participants’ homes. Constant comparative analysis was used to develop codes and identify themes.

Results

Participants generally delegated decisions to others, expressing their wishes by describing desired end-of-life outcomes and highlighting meaningful aspects of their lives. They did this in the belief that the delegate would make appropriate decisions on their behalf. In this way, participants were able to achieve a sense of control without being in control of decisions. Four themes emerged from the analysis that reflect the various approaches participants used to articulate their goals and maintain a sense of control: direct communication, third-party analogies, adaptive denial, and engaged avoidance.

Conclusion

These findings challenge the prevailing view of personal autonomy. These older adults suggest a path to decision-making that focuses on priorities and goals, allowing them to take a more-passive approach to decision-making while still maintaining a sense of control.

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Operating a Monitoring Unit in the Geriatric Department: Effects on Outcomes - American Geriatric Society

Objectives

To compare the effect of a five-bed geriatric monitoring unit (MU) on in-hospital mortality and length of stay with the effect of usual care in a geriatric hospital department and a medical MU.

Design

Prospective, case–control, noninterventional study.

Participants

All individuals hospitalized for 24 hours or longer in the geriatric MU (n = 89, aged 53–101, mean age 82.2 ± 9.6) over a period of 5 months (January–May 2015); individuals admitted to the geriatric department (n = 178, aged 55–100, mean age 83.2 ± 9.8), matched at a ratio of 1:2 according to sex, age ±5 years, and need for mechanical ventilation; and individuals admitted to a similar five-bed medical MU (n = 95, aged 35–90, mean age 68.2 ± 14.4) during the same period.

Measurements

Primary outcome was in-hospital mortality.

Results

The predicted death rate was 49 ± 26 for participants in the geriatric MU, 39.6 ± 27 for those in the medical MU (P = .02), and 36.7 ± 27 for those in the geriatric department (P < .001). Observed in-hospital mortality was higher for geriatric MU participants (n = 40, 44.9%) than for the department control group (n = 48, 27%) (P = .002), although the mortality ratios (actual divided by predicted death rates) of these two groups were similar, indicating that the more severely ill participants in the geriatric MU did better than control participants in the departments, in particular those requiring hemodynamic pressure support and those with acute renal failure.

Conclusion

For elderly, severely ill adults, care in a geriatric MU was associated with lower in-hospital mortality than care in the hospital geriatric ward and a longer stay and may be an alternative to medical MU admission.

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Route 11 Issues Voluntary Recall For Sour Cream & Chive Flavored Potato Chips - FDA Safety Alerts & Drug Recalls

On December 19th, Route 11 Potato Chips was advised by its seasoning supplier that an ingredient in its Sour Cream & Chive seasoning was subject to a recall. The ingredient, nonfat dry milk powder, was produced in a facility where the FDA identified Salmonella in the environment. 

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Texas Best Protein DBA Farm to Market Foods Issues Allergy Alert on Undeclared Peanut in Green Bean Casserole - FDA Safety Alerts & Drug Recalls

Farm To Market Foods of Santo, Texas is recalling 26,506 pounds of Green Bean Casserole, because it may contain undeclared Peanut Allergens. People who have an allergy or severe sensitivity to Peanut Allergens run the risk of serious or life-threatening allergic reaction if they consume these products.

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Whitestone Feeds, Inc. Announces Voluntary Recall of all JES Premium 40 Tubs due to Potential Health Risk - FDA Safety Alerts & Drug Recalls

Whitestone Feeds, Inc. has initiated a voluntary recall of a single product from its beef cattle feed line. Effective immediately, all JES Premium 40 Tubs are being recalled. A farm located in Alabama reported that five of its beef cows died after having access to the subject batch of cattle tubs. Samples from the subject batch were assayed following a customer complaint.

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Response to Letter to the Editor: Aging and Statins - American Geriatric Society

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Age of Statin Therapy; Statin Therapy With Aging - American Geriatric Society

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Agreement and Predictive Validity Using Less-Conservative Foundation for the National Institutes of Health Sarcopenia Project Weakness Cutpoints - American Geriatric Society

Objectives

To derive lean mass cutpoints based on a less-conservative Foundation for the National Institutes of Health (FNIH) Sarcopenia Project Weakness cutpoint for grip strength (Weak_I) and to assess their agreement with European Working Group on Sarcopenia in Older People (EWGSOP) and prediction of incident slow walking and mortality.

Design

Longitudinal analysis.

Setting

Baltimore Longitudinal Study of Aging.

Participants

Individuals aged 65 and older (287 men, 258 women) with 2 to 10 years of follow-up.

Measurements

Weakness was determined according to handgrip strength using a hand dynamometer, appendicular lean mass (ALM) using dual-energy X-ray absorptiometry, and walking speed according to 6-m usual pace walk speed. Analyses were performed using classification and regression tree analysis, Cohen's kappa, and Cox models.

Results

Cutpoints derived from Weak_I for ALM (ALM_I) were less than 21.4 kg in men and less than 14.1 kg in women and for ALM adjusted for body mass index (ALM/BMI_I) were less than 0.725 in men and less than 0.591 in women. Kappas with EWGSOP were 0.65 for men and 0.75 for women for ALM_I and 0.34 for men and 0.47 for women for ALM/BMI_I. Men with Weak_I + ALM_I were twice as likely to develop slow walking as those not weak with normal ALM_I (Hazard ratio (HR) = 2.44, 95% confidence interval (CI) = 1.02-5.82). Under EWGSOP, men with weakness and low RALM were almost 3 times as likely to develop slow walking as those not weak with normal RALM (HR = 2.91, 95% CI = 1.11-7.62). Neither approach predicted incident slow walking in women.

Conclusion

The ALM_I cutpoints agree with EWGSOP and predict slow walking in men. Future studies should explore sex differences in the relationship between body composition and physical function and the effect of change in muscle mass on muscle strength and physical function.

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Oral Hygiene in the Elderly with Different Degrees of Cognitive Impairment and Dementia - American Geriatric Society

The control of bacterial dental plaque through daily oral hygiene is essential to prevent oral diseases such as caries or periodontal disease, especially in at-risk populations, including the elderly with mild cognitive impairment and dementia. The aim of this study was to determine the association between different levels of cognitive impairment and dementia in an elderly population and their capacity to maintain adequate oral hygiene. A case–control study (elderly with versus without mild cognitive impairment or dementia) was performed in Granada, Spain. Outcome variables were tooth/prosthesis-brushing frequency/day, bacterial plaque index, and gingival bleeding index. Statistical models were adjusted by age, sex, educational level, and tobacco and alcohol habits. The study included 240 cases and 324 controls. The final model, adjusted by age, sex, educational level, and tobacco and alcohol consumption, showed a significant association between degree of cognitive impairment and daily oral hygiene, accumulation of bacterial plaque, and gingival bleeding. In summary, deficient daily oral hygiene, evidenced by greater bacterial dental plaque accumulation and gingival inflammation, is independently associated with cognitive impairment, even at its earliest stage.

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Is Polypharmacy Associated with Frailty in Older People? Results From the ESTHER Cohort Study - American Geriatric Society

Objectives

To investigate the relationship between polypharmacy and frailty.

Design

Longitudinal, observational cohort study.

Setting

Saarland, Germany.

Participants

3,058 community-dwelling adults aged between 57 and 84 years.

Measurements

Frailty was assessed according to the frailty phenotype, described by Fried et al. Polypharmacy and hyperpolypharmacy were defined as the concomitant use of five or more and 10 or more drugs, respectively. We assessed associations between polypharmacy and prevalent and incident frailty within 3 years of follow-up by logistic regression models controlled for multiple potential confounders including comorbidity. Additionally, cubic splines were used to assess dose–response associations.

Results

Polypharmacy was reported in 39.1% (n = 1,194), and hyperpolypharmacy in 8.9% (n = 273) of participants. Prevalent frailty was present in 271 (8.9%) participants; 186 (9.3%) of 1,998 non-frail participants with follow-up data became frail within 3 years. After adjustment, polypharmacy and hyperpolypharmacy were associated with prevalent frailty with adjusted odds ratios (95% confidence interval) of 2.30 (1.60–3.31) and 4.97 (2.97–8.32), respectively. Polypharmacy (odds ratio (OR) 1.51 (1.05–2.16)) and hyperpolypharmacy (OR 1.90 (1.10–3.28)) were also independent predictors of incident frailty. Furthermore, there was a moderate exposure–response relationship between the number of medicines and prevalent as well as incident frailty.

Conclusion

Our study showed that polypharmacy is associated with frailty. Further research should address the potential benefit of reducing of inappropriate polypharmacy and better pharmacotherapeutic management for preventing medication-associated frailty.

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Leisure-Time Physical Activity Reduces Total and Cardiovascular Mortality and Cardiovascular Disease Incidence in Older Adults - American Geriatric Society

Objectives

To determine whether leisure-time physical activity (LTPA) is independently associated with all-cause and cardiovascular mortality and with incidence of cardiovascular disease (CVD) and stroke in older adults.

Design

Population-based cohort study (median follow-up 11.8 years).

Setting

Community, five Finnish provinces.

Participants

Men and women aged 65 to 74 who participated in a baseline risk factor survey between 1997 and 2007 in Finland (N = 2,456).

Measurements

The study protocol included a self-administered questionnaire, health examination at the study site, and blood sample for laboratory analysis. LTPA was classified into three levels: low, moderate, high. Mortality data were obtained from the National Causes of Death Register and data on incident CVD (coronary heart disease, stroke) events from the National Hospital Discharge Register.

Results

Multifactorial-adjusted (age, area, study year, sex, smoking, body mass index, systolic blood pressure, serum cholesterol, education, marital status) risks of total mortality (moderate: hazard ratio (HR) = 0.61, 95% confidence interval (CI) = 0.50–0.74; high: HR = 0.47, 95% CI = 0.34–0.63, P for trend <.001), CVD mortality (moderate: HR = 0.46, 95% CI = 0.33–0.64; high: HR = 0.34, 95% CI = 0.20–0.59, P for trend <.001), and an incident CVD event (moderate HR = 0.69, 95% CI = 0.54–0.88; high: HR = 0.55, 95% CI = 0.38–0.79, P for trend <.001) were lower for those with moderate or high LTPA levels than for those with low LTPA levels. Further adjustment for self-reported inability to perform LTPA did not change the associations remarkably.

Conclusions

Baseline LTPA reduces the risk of total and CVD mortality and incident CVD events in older adults independently of the major known CVD risk factors. The protective effect of LTPA is dose dependent.

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Cost-Effectiveness of the 4 Pillars Practice Transformation Program to Improve Vaccination of Adults Aged 65 and Older - American Geriatric Society

Objectives

To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices.

Design

Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention.

Setting

Diverse primary care practices in two U.S. cities.

Participants

Clinical trial participants aged 65 and older.

Measurements

Quality-adjusted life years (QALYs), public health outcomes, and costs. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial. Other parameters were derived from the medical literature and Centers for Disease Control and Prevention data. All parameters were individually and simultaneously varied over their distributions.

Results

With the intervention program and extrapolating over 10 years, there would be approximately 60,920 fewer influenza cases, 2,031 fewer pertussis cases, and 13,842 fewer pneumococcal illnesses in adults aged 65 and older. Total per-person vaccination and illness costs with the intervention were $23.93 higher than without the intervention, with a concurrent increase in effectiveness of 0.0031 QALYs, or $7,635 per QALY gained. In sensitivity analyses, no individual parameter variation caused the intervention to cost more than $50,000 per QALY gained.

Conclusions

Implementing an intervention based on the 4 Pillars Practice Transformation Program is a cost-effective undertaking in primary care practices for individuals aged 65 and older, with predicted public health benefits.

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Osteoporotic Fractures in Postmenopausal Women - American Geriatric Society

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Southeastern Mills, Inc. Announces Recall of Certain Food Ingredients and Food Mixes Due to Possible Health Risk - FDA Safety Alerts & Drug Recalls

Southeastern Mills, Inc. is initiating a voluntary recall of certain quantities of food ingredients and branded food mixes (Southeastern Mills Biscuit Gravy Mix, Southeastern Mills Country Biscuit Mix, Southeastern Mills Buttermilk Drop Biscuit Mix, Southeastern Mills Easy Drop Cheddar Garlic Drop Biscuit Mix, Shore Lunch Original Breading and Shore Lunch Cajun Style Breading) because these ingredients and food mixes contain milk or buttermilk powder purchased from Valley Milk Products, Inc. that is potentially contaminated with Salmonella.

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FDA approves first drug for spinal muscular atrophy - FDA Press Releases

The U.S. Food and Drug Administration today approved Spinraza (nusinersen), the first drug approved to treat children and adults with spinal muscular atrophy (SMA), a rare and often fatal genetic disease affecting muscle strength and movement. Spinraza is an injection administered into the fluid surrounding the spinal cord.

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A Pilot Randomized Controlled Trial of the Effects of Chair Yoga on Pain and Physical Function Among Community-Dwelling Older Adults With Lower Extremity Osteoarthritis - American Geriatric Society

Objectives

To determine effects of Sit ‘N’ Fit Chair Yoga, compared to a Health Education program (HEP), on pain and physical function in older adults with lower extremity osteoarthritis (OA) who could not participate in standing exercise.

Design

Two-arm randomized controlled trial.

Setting

One HUD senior housing facility and one day senior center in south Florida.

Participants

Community-dwelling older adults (N = 131) were randomly assigned to chair yoga (n = 66) or HEP (n = 65). Thirteen dropped after assignment but prior to the intervention; six dropped during the intervention; 106 of 112 completed at least 12 of 16 sessions (95% retention rate).

Interventions

Participants attended either chair yoga or HEP. Both interventions consisted of twice-weekly 45-minute sessions for 8 weeks.

Measurements

Primary: pain, pain interference; secondary: balance, gait speed, fatigue, functional ability measured at baseline, after 4 weeks of intervention, at the end of the 8-week intervention, and post-intervention (1 and 3 months).

Results

The chair yoga group showed greater reduction in pain interference during the intervention (P = .01), sustained through 3 months (P = .022). WOMAC pain (P = .048), gait speed (P = .024), and fatigue (P = .037) were improved in the yoga group during the intervention (P = .048) but improvements were not sustained post intervention. Chair yoga had no effect on balance.

Conclusion

An 8-week chair yoga program was associated with reduction in pain, pain interference, and fatigue, and improvement in gait speed, but only the effects on pain interference were sustained 3 months post intervention. Chair yoga should be further explored as a nonpharmacologic intervention for older people with OA in the lower extremities.

Trial Registration: ClinicalTrials.gov: NCT02113410.

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Physician Participation in Meaningful Use and Quality of Care for Medicare Fee-for-Service Enrollees - American Geriatric Society

Objectives

The Meaningful Use initiative has made nearly $30 billion available through incentive programs to encourage provider adoption and use of electronic health records. The objective of this study was to evaluate the impact of outpatient physicians' participation in Meaningful Use on the quality of care provided to Medicare fee-for-service (FFS) enrollees.

Design

Retrospective cohort study.

Setting

One hundred percent inpatient and outpatient Medicare FFS claims covering the period January 2010 through December 2012.

Participants

303,110 Medicare FFS enrollees from New York State.

Measurements

Hospitalizations and emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs), diabetic retinopathy screening, diabetic nephropathy screening, colorectal cancer screening, and influenza vaccinations.

Results

Physician participation in the Meaningful Use initiative was not associated with reductions in ACSC-related hospitalizations (0.0 percentage points, 95% confidence interval (CI): 0.0–0.1) or ED visits (0.0 percentage points, 95% CI: 0.0–0.1) relative to the comparison group. Meaningful Use participation was associated with higher odds of colorectal cancer screening (odds ratio (OR): 1.2, 95% CI: 1.1–1.4) relative to the comparison group, but not for diabetic retinopathy screening (OR: 1.1, 95% CI: 1.0–1.2), diabetic nephropathy screening (OR: 1.0, 95% CI: 0.8–1.2), or influenza vaccinations (OR: 1.1, 95% CI: 1.0–1.2). Similar results were found in secondary analyses of dually-eligible beneficiaries participating in both Medicare and Medicaid.

Conclusion

Physician participation in Meaningful Use was not associated with substantial improvements on six quality measures.

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In Memoriam: Samay Jain - American Geriatric Society

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Screening Tool of Older Person's Prescriptions/Screening Tools to Alert Doctors to Right Treatment Medication Criteria Modified for U.S. Nursing Home Setting - American Geriatric Society

Objectives

To develop a set of prescribing indicators measurable with available data from electronic nursing home (NH) databases by adapting the European-based 2014 Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tools to Alert Doctors to Right Treatment (START) criteria of potentially inappropriate and underused medications for the U.S. setting.

Design

A two-stage expert panel process. In the first stage, the investigator team reviewed 114 criteria for compatibility and measurability. In the second stage, an online modified e-Delphi (OMD) panel was convened to rate the validity of criteria, and two webinars were held to identify criteria with highest relevance to U.S. NHs.

Participants

Seventeen experts with recognized reputations in NH care participated in the e-Delphi panel and 12 in the webinar.

Measurements

Compatibility and measurability were assessed by comparing criteria with U.S. terminology and setting standards and data elements in NH databases. Validity was rated using a 9-point Likert-type scale (1 = not valid at all, 9 = highly valid). Mean, median, interpercentile ranges, and agreement were determined for each criterion score. Relevance was determined by ranking the mean panel ratings on criteria that reached agreement; the webinar participants reviewed and approved half of the criteria with the highest mean values.

Results

Fifty-three STOPP/START criteria were deemed to be compatible with the U.S. NH setting and measurable using data from electronic NH databases. E-Delphi panelists rated 48 criteria as valid for U.S. NHs. Twenty-four criteria were deemed to be most relevant, consisting of 22 measures of potentially inappropriate medications and two measures of underused medications.

Conclusion

This study created the first explicit criteria for assessing the quality of prescribing in U.S. NHs.

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Randomized Trial of the Family Intervention: Telephone Tracking—Caregiver for Dementia Caregivers: Use of Community and Healthcare Resources - American Geriatric Society

Objectives

To examine the effects of a telephone-delivered intervention, Family Intervention: Telephone Tracking—Caregiver (FITT-C), on community support and healthcare use by dementia caregivers.

Design

Randomized, controlled trial.

Setting

Academic medical center.

Participants

Dyads (n = 250) of distressed informal dementia caregivers and care recipients.

Intervention

Caregivers were randomly assigned to receive the FITT-C (n = 133) or telephone support (TS; n = 117). Both groups received 16 telephone contacts from a master's-level therapist over 6 months. The FITT-C intervention provided psychoeducation, problem solving, and other directive approaches based on assessment of critical areas (e.g., mood, behavior, family functioning, social support). TS provided supportive therapeutic strategies.

Measurements

Outcome variables were caregiver report of community support service use, number of visits to the emergency department (ED) for caregivers and care recipients, and hospital stays for caregivers during the interventions.

Results

Intervention groups did not differ in demographic characteristics, use of support services, or use of healthcare resources at baseline. Caregivers who received the FITT-C used community support services at end of treatment significantly more than those receiving TS (P = .02). FITT-C caregivers had a significantly lower rate of ED visits (rate difference 9.5%, P = .048) and hospital stays (rate difference 11.4%, P = .01) over the 6-month course of the intervention than TS caregivers. Care recipient use of community or medical resources did not differ according to group.

Conclusion

An entirely telephone-delivered intervention was effective in increasing caregiver engagement in community resources and reducing caregiver use of hospital-based healthcare resources. Results highlight the potential effect of FITT-C on healthcare use.

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The Association of Vitamin D Deficiency and Incident Frailty in Older Women: The Role of Cardiometabolic Diseases - American Geriatric Society

Objectives

Evidence suggests vitamin D deficiency is associated with developing frailty. However, cardiometabolic factors are related to both conditions and may confound and/or mediate the vitamin D–frailty association. We aimed to determine the association of vitamin D concentration with incidence of frailty, and the role of cardiometabolic diseases (cardiovascular disease, diabetes, hyperlipidemia, hypertension) in this relationship.

Design

Prospective longitudinal cohort study (7 visits from 1994–2008).

Setting

Baltimore, Maryland.

Participants

Three hundred sixty-nine women from the Women's Health and Aging Study II aged 70–79 years, free of frailty at baseline.

Measurements

Serum circulating 25-hydroxyvitamin D (25[OH]D) concentration was assessed at baseline and categorized as: <10; 10–19.9; 20-29.9; and ≥30 ng/mL. Frailty incidence was determined based on presence of three or more criteria: weight loss, low physical activity, exhaustion, weakness, and slowness. Cardiometabolic diseases were ascertained at baseline. Analyses included Cox regression models adjusted for key covariates.

Results

Incidence rate of frailty was 32.2 per 1,000 person-years in participants with 25(OH)D < 10 ng/mL, compared to 12.9 per 1,000 person-years in those with 25(OH)D ≥ 30 ng/mL (mean follow-up = 8.5 ± 3.7 years). In cumulative incidence analyses, those with lower 25(OH)D exhibited higher frailty incidence, though differences were non-significant (P = .057). In regression models adjusted for demographics, smoking, and season, 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) was associated with nearly three-times greater frailty incidence (hazard ratio (HR) = 2.77, 95% CI = 1.14, 6.71, P = .02). After adjusting for BMI, the relationship of 25(OH)D < 10 ng/mL (vs ≥30 ng/mL) with incident frailty persisted, but was attenuated after further accounting for cardiometabolic diseases (HR = 2.29, 95% CI = 0.92, 5.69, P = .07).

Conclusion

Low serum vitamin D concentration is associated with incident frailty in older women; interestingly, the relationship is no longer significant after accounting for the presence of cardiometabolic diseases. Future studies should explore mechanisms to explain this relationship.

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Bickel's Snack Foods Notice of Voluntary Recall - FDA Safety Alerts & Drug Recalls

Bickel's Snack Foods, Inc., of York, PA is voluntarily recalling all snack products that were made with milk ingredients supplied by one of its' secondary seasoning component suppliers, Valley Milk Products LLC, due to Salmonella contamination. On 12/16/16, Bickel's Snack Foods, Inc. was notified Valley Milk Products, LLC initiated a recall of products made with milk powders or sour cream. The Food and Drug Administration (FDA) has been made aware of this recall.

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Herrs Announces Voluntary Recall of Chipotle-Flavored Chips - FDA Safety Alerts & Drug Recalls

Herrs Foods Inc. has announced a voluntary recall of some chipotle-flavored potato chips due to possible salmonella contamination. The recall covers Herr's smoked chipotle-flavored kettle cooked potato chips and Peddler's Pantry smoke-dried chipotle-flavored kettle cooked potato chips.

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Dawn Food Products Recalls Limited Quantities of Bulk Bakery Mix Products Due to Possible Health Risk - FDA Safety Alerts & Drug Recalls

Jackson, MI - Dawn Food Products is voluntarily recalling limited quantities of bakery mix products manufactured for Dawn by a third party and affected by a recall from Valley Milk Products of milk powder due to the possible presence of Salmonella.

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Fresh Express Announces Precautionary Recall of a Limited Quantity of 9 oz. Hearts of Romaine Salad Due to Possible Allergen Exposure - FDA Safety Alerts & Drug Recalls

Orlando, FL - Fresh Express Incorporated is voluntarily conducting a precautionary recall of 100 cases of 9 oz. Fresh Express Hearts of Romaine Salad, distributed in Maryland with Product Codes of H34711A or H34711B and Use-By Date of December 27, due to possible exposure to undeclared allergens (egg, milk, wheat, and anchovy).

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House-Autry Mills Announces Voluntary Recall of Limited Products Due to Potential Health Risk - FDA Safety Alerts & Drug Recalls

Four Oaks, NC - House-Autry Mills, Inc. is voluntarily recalling limited quantities of House- Autry Buttermilk Cornbread Mix, House-Autry Buttermilk Biscuit Mix, and House-Autry Cheese Biscuit Mix as a precaution because one of the company’s third-party ingredient suppliers, Franklin Farms, had purchased milk powder from Valley Milk Products, Inc. This milk powder is potentially contaminated with Salmonella.

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H-E-B Expands Recall On Raw Shelled Pistachios - FDA Safety Alerts & Drug Recalls

H-E-B announced today that it has expanded the recall on raw shelled pistachios to include “Fireside Roasted Nut Butter” produced in a limited number of H-E-B stores. The product is being removed because there is potential it could be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

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Dieffenbach's Potato Chips Inc. Issues Voluntary Recall for Sour Cream & Onion Kettle Chips Due to Possible Salmonella Contamination - FDA Safety Alerts & Drug Recalls

Womelsdorf, PA - Dieffenbach's Potato Chips, Inc. is issuing a voluntary recall for our Sour Cream & Onion Kettle Chips. This decision was made after being informed by a seasoning supplier, that an ingredient in the seasoning may contain traces of salmonella. Although tests have shown no existence of salmonella in the seasoning that was supplied to Dieffenbach's, out of abundance of caution we are voluntarily issuing the recall of these products in conjunction with FDA guidance.

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Rich Products Corporation Issues Nationwide Allergy Alert on Undeclared Walnuts in Certain Ice Cream Cake Products - FDA Safety Alerts & Drug Recalls

Rich Products Corporation in Buffalo, NY, is voluntarily recalling approximately 6,600 cases of ice cream cake products because they may contain undeclared walnuts. People who have an allergy to walnuts run the risk of a serious life threatening allergic reaction if they consume these products.

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FDA permits marketing of new tissue expander for women undergoing breast reconstruction following mastectomy - FDA Press Releases

The U.S. Food and Drug Administration today allowed marketing of a new tissue expander system for soft tissue expansion in two-stage breast reconstruction following mastectomy and in the treatment of underdeveloped breasts and soft tissue deformities. A patient uses a dose controller to independently inflate the expander.

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Predictors for Unplanned Hospitalization of New Home Care Clients - American Geriatric Society

Objectives

To identify factors predicting unplanned hospitalization of new home care clients using the Resident Assessment Instrument for Home Care (RAI-HC).

Design

A register-based study based on RAI-HC assessments and nationwide hospital discharge records.

Setting

Municipal home care services in Finland.

Participants

New Finnish home care clients aged 63 and older (N = 15,700).

Measurements

Information from home care clients’ first RAI-HC assessment was connected to information regarding their first hospitalization over 1 year of follow-up. Multivariate regression analyses were used to evaluate the independent risk factors for hospitalization.

Results

Forty-three percent (n = 6,812) of participants were hospitalized at least once. The strongest independent risk factors were hospitalization during the year preceding the RAI-HC assessment (odds ratio (OR) = 2.01, 95% confidence interval (CI) = 1.87–2.16), aged 90 and older (OR = 1.69, 95% CI = 1.48–1.92), renal insufficiency (OR = 1.44, 95% CI = 1.22–1.69) and using 10 or more drugs (OR = 1.41, 95% CI = 1.26–1.58). Other independent risk factors were male sex, previous emergency department visits or other acute outpatient care use, daily urinary incontinence, fecal incontinence, history of falls, cognitive impairment, chronic skin ulcer, pain, unstable health status, housing-related problems, and poor self-rated health. Parkinson's disease, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and cancer were independent prognostic indicators. A body mass index of 24 kg/m² or greater and the client's own belief that functional capacity could improve had a protective role.

Conclusion

Assessing new home care clients using the RAI-HC reveals modifiable risk factors for unplanned hospitalization. Systematic assessment by a multidisciplinary team at the beginning of the service and targeting modifiable risk factors could reduce the risk of unplanned hospitalization.

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Polyphyletic origin of MERS coronaviruses and isolation of a novel clade A strain from dromedary camels in the United Arab Emirates

Polyphyletic origin of MERS coronaviruses and isolation of a novel clade A strain from dromedary camels in the United Arab Emirates

Emerging Microbes & Infections 5, e128 (December 2016). doi:10.1038/emi.2016.129

Authors: Susanna K P Lau, Renate Wernery, Emily Y M Wong, Sunitha Joseph, Alan K L Tsang, Nissy Annie Georgy Patteril, Shyna K Elizabeth, Kwok-Hung Chan, Rubeena Muhammed, Jöerg Kinne, Kwok-Yung Yuen, Ulrich Wernery & Patrick C Y Woo

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Characterization of community-associated Staphylococcus aureus from skin and soft-tissue infections: a multicenter study in China

Characterization of community-associated Staphylococcus aureus from skin and soft-tissue infections: a multicenter study in China

Emerging Microbes & Infections 5, e127 (December 2016). doi:10.1038/emi.2016.128

Authors: Ying Liu, Zhe Xu, Zhou Yang, Juan Sun & Lin Ma

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A camel-derived MERS-CoV with a variant spike protein cleavage site and distinct fusion activation properties

A camel-derived MERS-CoV with a variant spike protein cleavage site and distinct fusion activation properties

Emerging Microbes & Infections 5, e126 (December 2016). doi:10.1038/emi.2016.125

Authors: Jean Kaoru Millet, Monty E Goldstein, Rachael N Labitt, Hung-Lun Hsu, Susan Daniel & Gary R Whittaker

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First documented case of avian influenza (H5N1) virus infection in a lion

First documented case of avian influenza (H5N1) virus infection in a lion

Emerging Microbes & Infections 5, e125 (December 2016). doi:10.1038/emi.2016.127

Authors: Quanjiao Chen, Hanzhong Wang, Lihua Zhao, Liping Ma, Runkun Wang, Yongsong Lei, Yong Li, Guoxiang Yang, Jing Chen, Guang Chen, Liqiang Li, Tao Jin, Jiandong Li, Xin Liu, Xun Xu, Gary Wong, Lei Liu, Yingxia Liu, Weifeng Shi, Yuhai Bi & George F Gao

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FDA expands indication for continuous glucose monitoring system, first to replace fingerstick testing for diabetes treatment decisions - FDA Press Releases

The U.S. Food and Drug Administration today expanded the approved use of Dexcom’s G5 Mobile Continuous Glucose Monitoring System to allow for replacement of fingerstick blood glucose (sugar) testing for diabetes treatment decisions in people 2 years of age and older with diabetes.

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Altijira Murray Products, LLC Recalls Selected Ice Cream Products Because Of Possible Health Risk - FDA Safety Alerts & Drug Recalls

Out of an abundance of caution, Altijira Murray Products LLC is undertaking a voluntary recall of selected, 16 oz. (pint size) packages of Foxy’s Thoughtful Ice Cream produced by a contract manufacturer because they have the potential to be contaminated with Listeria monocytogenes.

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DNA sequence-selective C8-linked pyrrolobenzodiazepine–heterocyclic polyamide conjugates show anti-tubercular-specific activities - Journal of Antibiotics

DNA sequence-selective C8-linked pyrrolobenzodiazepine–heterocyclic polyamide conjugates show anti-tubercular-specific activities

The Journal of Antibiotics 69, 843 (December 2016). doi:10.1038/ja.2016.43

Authors: Federico Brucoli, Juan D Guzman, Mohammad A Basher, Dimitrios Evangelopoulos, Eleanor McMahon, Tulika Munshi, Timothy D McHugh, Keith R Fox & Sanjib Bhakta

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Antibacterial activity of the novel semisynthetic lantibiotic NVB333 in vitro and in experimental infection models - Journal of Antibiotics

Antibacterial activity of the novel semisynthetic lantibiotic NVB333 in vitro and in experimental infection models

The Journal of Antibiotics 69, 850 (December 2016). doi:10.1038/ja.2016.47

Authors: Steven Boakes, William J Weiss, Mary Vinson, Sjoerd Wadman & Michael J Dawson

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Kinetic characterization of GES-22 β-lactamase harboring the M169L clinical mutation - Journal of Antibiotics

Kinetic characterization of GES-22 β-lactamase harboring the M169L clinical mutation

The Journal of Antibiotics 69, 858 (December 2016). doi:10.1038/ja.2016.48

Authors: Aysegul Saral, David A Leonard, Azer Ozad Duzgun, Aysegul Copur Cicek, Cynthia M June & Cemal Sandalli

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Quantitative measurement of the outer membrane permeability in Escherichia coli lpp and tol–pal mutants defines the significance of Tol–Pal function for maintaining drug resistance - Journal of Antibiotics

Quantitative measurement of the outer membrane permeability in Escherichia coli lpp and tol–pal mutants defines the significance of Tol–Pal function for maintaining drug resistance

The Journal of Antibiotics 69, 863 (December 2016). doi:10.1038/ja.2016.50

Authors: Hikaru Kowata, Saeko Tochigi, Tomonobu Kusano & Seiji Kojima

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Efficacy of ampicillin against methicillin-resistant Staphylococcus aureus restored through synergy with branched poly(ethylenimine) - Journal of Antibiotics

Efficacy of ampicillin against methicillin-resistant Staphylococcus aureus restored through synergy with branched poly(ethylenimine)

The Journal of Antibiotics 69, 871 (December 2016). doi:10.1038/ja.2016.44

Authors: Melissa A Foxley, Anthony W Friedline, Jessica M Jensen, Susan L Nimmo, Erin M Scull, Jarrod B King, Stoffel Strange, Min T Xiao, Benjamin E Smith, Kieth J Thomas III, Daniel T Glatzhofer, Robert H Cichewicz & Charles V Rice

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Preclinical development of Ramizol, an antibiotic belonging to a new class, for the treatment of Clostridium difficile colitis - Journal of Antibiotics

Preclinical development of Ramizol, an antibiotic belonging to a new class, for the treatment of Clostridium difficile colitis

The Journal of Antibiotics 69, 879 (December 2016). doi:10.1038/ja.2016.45

Authors: Shasha Rao, Clive A Prestidge, Lynn Miesel, Deb Sweeney, Dean L Shinabarger & Ramiz A Boulos

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Eighth Korea–Japan Chemical Biology symposium: chemical biology notes from a small island - Journal of Antibiotics

Eighth Korea–Japan Chemical Biology symposium: chemical biology notes from a small island

The Journal of Antibiotics 69, 885 (December 2016). doi:10.1038/ja.2016.58

Authors: Tilman Schneider-Poetsch, Shunji Takahashi, Jae-Hyuk Jang, Jong Seog Ahn & Hiroyuki Osada

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Corrigendum: Tripropeptins, novel antimicrobial agents produced by Lysobacter sp. II. structure elucidation - Journal of Antibiotics

Corrigendum: Tripropeptins, novel antimicrobial agents produced by Lysobacter sp. II. structure elucidation

The Journal of Antibiotics 69, 889 (December 2016). doi:10.1038/ja.2016.104

Authors: Hideki Hashizume, Sehei Hirosawa, Ryuichi Sawa, Yasuhiko Muraoka, Daishiro Ikeda, Hiroshi Naganawa & Masayuki Igarashi

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Corrigendum: A new type of tripropeptin with anteiso-branched chain fatty acid from Lysobacter sp. BMK333-48F3 - Journal of Antibiotics

Corrigendum: A new type of tripropeptin with anteiso-branched chain fatty acid from Lysobacter sp. BMK333-48F3

The Journal of Antibiotics 69, 892 (December 2016). doi:10.1038/ja.2016.105

Authors: Hideki Hashizume, Masayuki Igarashi, Ryuichi Sawa, Hayamitsu Adachi, Yoshio Nishimura & Yuzuru Akamatsu

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Author Index for Volume 69 - Journal of Antibiotics

Author Index for Volume 69

The Journal of Antibiotics 69, 894 (December 2016). doi:10.1038/ja.2016.118

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Substance Index for Volume 69 - Journal of Antibiotics

Substance Index for Volume 69

The Journal of Antibiotics 69, 898 (December 2016). doi:10.1038/ja.2016.119

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Afternoon Napping and Cognition in Chinese Older Adults: Findings from the China Health and Retirement Longitudinal Study Baseline Assessment - American Geriatric Society

Objectives

To examine the cross-sectional associations between self-reported postlunch napping and structured cognitive assessments in Chinese older adults.

Design

Cross-sectional cohort study.

Setting

China.

Participants

Individuals aged 65 and older from the baseline national wave of the China Health and Retirement Longitudinal Study (CHARLS) (N = 2,974).

Measurements

Interview-based cognitive assessments of orientation and attention, episodic memory, visuospatial abilities, and a combined global cognition score incorporating these assessments. Other self-reported or interview-based assessments included postlunch napping duration, nighttime sleep duration, demographic characteristics, health habits, comorbidities, functional status and social activities. According to reported napping duration, older adults were categorized as non-nappers (0 minutes), short nappers (<30 minutes), moderate nappers (30–90 minutes), and extended nappers (>90 minutes).

Results

Postlunch napping was reporting in 57.7% of participants for a mean of 63 minutes. Cognitive function was significantly associated with napping (P < .001). Between-group comparisons showed that moderate nappers had better overall cognition than nonnappers (P < .001) or extended nappers (P = .01). Nonnappers also had significantly poorer cognition than short nappers (P = .03). In multiple regression analysis, moderate napping was significantly associated with better cognition than non- (P = .004), short (P = .04), and extended napping (P = .002), after controlling for demographic characteristics, body mass index, depression, instrumental activities of daily living, social activities, and nighttime sleep duration.

Conclusion

A cross-sectional association was found between moderate postlunch napping and better cognition in Chinese older adults. The cross-sectional design and self-reported measures of sleep limited the findings. Longitudinal studies with objective napping measures are needed to further test this hypothesis.

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Food Recall Warning - Snyder of Berlin Buffalo Blue Kettle Cooked Potato Chips Recalled Due To Possible Salmonella Contamination - FDA Safety Alerts & Drug Recalls

Snyder of Berlin is warning consumers not to consume Snyder of Berlin Buffalo Blue Kettle Cooked Potato Chips after being informed by a supplier that a milk powder used within a spice blend ingredient may contain Salmonella.

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H-E-B Issues Voluntary Recall On Bakery Products - FDA Safety Alerts & Drug Recalls

In cooperation with Dawn Food Products, Inc., H-E-B announced today that it has issued a voluntary recall for certain bakery products made with Valley Milk Products LLC’s High Heat Nonfat Dry Milk Powder. As part of a larger recall affecting several retailers, Valley Milk Products has recalled the affected product, which was supplied to H-E-B for use in bakery products.

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FDA grants accelerated approval to new treatment for advanced ovarian cancer - FDA Press Releases

The U.S. Food and Drug Administration today granted accelerated approval to Rubraca (rucaparib) to treat women with a certain type of ovarian cancer.

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Weight Trajectory over 20 Years and Likelihood of Mild Cognitive Impairment or Dementia Among Older Women - American Geriatric Society

Objectives

The association between weight change and cognition is controversial. We examined the association between 20-year weight change and cognitive function in late life.

Design

Cohort study.

Setting

Study of Osteoporotic Fractures (SOF).

Participants

One thousand two hundred eighty-nine older, community-dwelling women (mean baseline age 68 (65–81) and 88 (82–102) at cognitive testing).

Measurements

Study of Osteoporotic Fractures participants had body weight measured repeatedly over 20 years (mean 8 weights). Adjudicated cognitive status was classified as normal (n = 775) or mild cognitive impairment (MCI)/dementia (n = 514) at Year 20. Logistic models were used to evaluate whether absolute weight change, rate of weight loss per year, presence of abrupt, unrecovered weight loss, and weight variability were associated with MCI or dementia.

Results

Women with greater rate of weight loss over 20 years had increased chance of developing MCI or dementia. In age/education/clinic-adjusted “base” models, each 0.5 kg/yr decrease resulted in 30% increased odds of MCI/dementia (OR = 1.30 [95% CI: 1.14, 1.49]). After adjustment for age, education, clinic, depression, and walking speed, there was 17% (OR = 1.17 [95% CI: 1.02, 1.35]) increased odds of MCI/dementia for each 0.5 kg/yr decrease in weight. In base models, variability in weight was significant. Each 1% average deviation from each woman's predicted weight curve was associated with 11% increased odds of MCI/dementia (OR = 1.11 [95% CI: 1.04, 1.18]). The estimate was attenuated after full adjustment (OR = 1.06 [95% CI: 0.99, 1.14]). The presence of an abrupt weight decline was not associated with MCI/dementia.

Conclusions

Rate of weight loss over 20 years was associated with development of MCI or dementia in women surviving past 80 years, suggesting that nutritional status, social-environmental factors, and/or adipose tissue function and structure may affect cognitive function with aging.

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Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review - American Geriatric Society

Objectives

To systematically review clinical outcomes associated with medication regimen complexity in older people.

Design

Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library.

Setting

Hospitals, home, and long-term care.

Participants

English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants’ overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity.

Measurements

Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool.

Results

Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff.

Conclusion

Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization.

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Trends in Prevalence of Dementia in French Farmers from Two Epidemiological Cohorts - American Geriatric Society

Objectives

To determine the prevalence of dementia and cognitive impairment in older people across generations.

Design

Two prospective cohort studies (Personnes Agées QUID (PAQUID), Aging Multidisciplinary Investigation (AMI)).

Setting

Baseline data from two subsamples of older farmers in southwestern France.

Participants

PAQUID (n = 595) and AMI (n = 906) participants aged 65 and older living at home at baseline (1988 PAQUID, 2008 AMI).

Measurements

Two methods were used to diagnose dementia: a clinical consensus diagnosis and a computer-assisted taxonomy approach (cognitive impairment with disability (CIWD)) using Mini-Mental State Examination and instrumental activity of daily living scores. Crude and standardized prevalences (using PAQUID age-sex structure) and 95% confidence intervals were calculated, and logistic regression was used to explore confounding.

Results

The prevalence of consensus diagnosis of dementia was higher in AMI in 2008 than in PAQUID in 1988 (12.0% vs 5.7%, P < .001), whereas the reverse was observed for CIWD (14.8% vs 23.8%, P < .001), confirmed by logistic regressions (odds ratio (OR)_AMIvsPAQUID = 2.50, 95% confidence interval (CI) = 1.52–4.12; OR_AMIvs.PAQUID = 0.60, 95% CI = 0.42–0.87, respectively). Educational level increased and management of vascular risk factors improved over the study period, and health and living conditions improved globally.

Conclusion

These findings suggest global cognitive and functional improvement in old farmers (the prevalence of CIWD decreased by 40% over 20 years) and simultaneously a marked change in the subjective boundary between dementia and nondementia according to clinicians.

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Quality of Life, Perceptions, and Health Satisfaction of Older Adults with End-Stage Renal Disease: A Systematic Review - American Geriatric Society

Objectives

To explore the quality of life (QOL), perceptions, and health satisfaction of older adults with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT).

Design

Systematic review of literature.

Participants

Individuals with ESRD undergoing RRT aged 65 and older.

Measurements

Articles identified from PubMed database search from January 1994 to December 2014. The methodological quality of each of the selected articles was assessed using eight standards adapted from well-established research quality review criteria.

Results

Of the initial 1,401 articles identified, 23 met the inclusion criteria. The age range of study participants examined was 65 to 90. Seventy-eight percent of the studies met six or more of the methodological standards; 47% found overall health-related and mental component summary QOL scores in elderly adults with ESRD to be similar to or higher than those of age-matched controls or younger individuals, although the physical component summary QOL scores tended to be lower in older adults. Only six studies addressed health satisfaction and perceptions of elderly adults with ESRD, with widely variable findings.

Conclusion

Few studies specifically examine QOL in elderly adults with ESRD undergoing RRT and even fewer address issues of perceptions and health satisfaction. However, the limited data from the QOL studies looks promising with a significant proportion showing similar or higher overall health-related and mental component summary QOL scores in elderly adults with ESRD. The very limited data on perceptions and health satisfaction of elderly adults with ESRD undergoing RRT makes it difficult to make any generalizable conclusions. Overall, more research is needed to examine these factors in elderly adults with ESRD.

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Self-Reported Hearing Impairment and Incident Frailty in English Community-Dwelling Older Adults: A 4-Year Follow-Up Study - American Geriatric Society

Objectives

To examine the association between hearing impairment and incident frailty in older adults.

Design

Cross-sectional and longitudinal analyses with 4-year follow-up using data from the English Longitudinal Study of Ageing.

Setting

Community.

Participants

Community-dwelling individuals aged 60 and older with data on hearing and frailty status (N = 2,836).

Measurements

Hearing impairment was defined as poor self-reported hearing. Having none of the five Fried frailty phenotype components (slow walking, weak grip, self-reported exhaustion, weight loss and low physical activity) was defined as not frail, having one or two as prefrail, and having three or more as frail. Participants who were not frail at baseline were followed for incident prefrailty and frailty. Participants who were prefrail at baseline were followed for incident frailty.

Results

One thousand three hundred ninety six (49%) participants were not frail, 1,178 (42%) were prefrail, and 262 (9%) were frail according to the Fried phenotype. At follow-up, there were 367 new cases of prefrailty and frailty among those who were not frail at baseline (n = 1,396) and 133 new cases of frailty among those who were prefrail at baseline (n = 1,178). Cross-sectional analysis showed an association between hearing impairment and frailty (age- and sex-adjusted odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.37–2.01), which remained after further adjustments for wealth, education, cardiovascular disease, cognition, and depression. In longitudinal analyses, nonfrail participants with hearing impairment were at greater risk of becoming prefrail and frail at follow-up (OR = 1.43, 95% CI = 1.05–1.95), but the association was attenuated after further adjustment. Prefrail participants with hearing impairment had a greater risk of becoming frail at follow-up (OR = 1.64, 95% CI = 1.07–2.51) even after further adjustment.

Conclusion

Hearing impairment in prefrail older adults was associated with greater risk of becoming frail, independent of covariates, suggesting that hearing impairment may hasten the progression of frailty.

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I'm So Glad You're Here: Positive Aspects of Informal Caregiving - American Geriatric Society

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Balance and Mobility in Community-Dwelling Older Adults: Effect of Daytime Sleepiness - American Geriatric Society

Objectives

To examine the effect of self-reported daytime sleepiness on performance-based balance measures and self-reported balance confidence in community-dwelling older adults.

Design

Cross-sectional secondary analysis of an observational cohort study designed to develop and refine measures of balance and mobility in community-dwelling older adults.

Setting

Community.

Participants

Older adults (aged 78.2 ± 5.9) (n = 120).

Measurements

The performance-based gait and balance measures included gait speed, double support time, and step width. Narrow walk, obstacle walk, and timed standing balance were also assessed. The Activities-Specific Balance Confidence Scale was included as a self-reported measure. Daytime sleepiness was defined as an Epworth Sleepiness Scale score of 9 or greater. Body mass index, fall-related comorbidities, and use of central nervous system (CNS) medications were considered as covariates.

Results

Forty-five percent of participants reported daytime sleepiness. Participants reporting daytime sleepiness differed significantly from those without in gait speed (adjusted difference (standard error (SE)) −0.09 (0.04) m/s, P = .03), step width (adjusted difference (SE) 0.02 (0.01), P = .03), and self-reported balance confidence (adjusted difference (SE) −1.02 (0.38), P = .01) even after adjusting for covariates. Two-way analysis of variance of CNS medication use and daytime sleepiness showed no significant interaction effects.

Conclusion

Self-reported daytime sleepiness is associated with slower gait speed and poor balance confidence in community-dwelling older adults. Subjective sleep assessment should be considered when assessing balance and implementing interventions for improving balance in older adults. Further study is needed to examine the role of CNS medication use.

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