Sigma Alimentos Congelados, which produces burritos under the Menu Del Sol brand name, is voluntarily recalling 201 cases of frozen beans and cheese burritos because they have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women. The recalled product was distributed in and sold via retail outlets in California and Nevada.
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Friday, March 31, 2017
FDA alerts consumers of nationwide voluntary recall of EpiPen and EpiPen Jr - FDA Press Releases
The U.S. Food and Drug Administration is alerting consumers to Meridian Medical Technologies’ voluntary recall of 13 lots of Mylan’s EpiPen and EpiPen Jr (epinephrine injection) Auto-Injector products used for emergency treatment of severe allergic reactions. This recall is due to the potential that these devices may contain a defective part that may result in the devices’ failure to activate. The recalled product was manufactured by Meridian Medical Technologies and distributed by Mylan Specialty.
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Reser’s Fine Foods, Inc. Issues Allergy Alert On Undeclared Milk And Soy In Limited Quantity Of One Macaroni Salad Item - FDA Safety Alerts & Drug Recalls
Reser’s Fine Foods, Inc. of Beaverton, OR is voluntarily recalling 529 cases of 16oz. Reser’s Macaroni Salad because they contain two undeclared allergens: Milk and Soy. People who have an allergy or severe sensitivity to Milk or Soy run the risk of serious or life-threatening allergic reaction if they consume this product.
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Mylan Provides Update on Meridian Medical Technologies', a Pfizer Company, Expanded Voluntary Worldwide Recall of EpiPen® Auto-Injector - FDA Safety Alerts & Drug Recalls
Mylan N.V. (NASDAQ, TASE: MYL) today announced that Meridian Medical Technologies, a Pfizer company and Mylan's manufacturing partner for EpiPen® Auto-Injector, has expanded a voluntary recall of select lots of EpiPen (epinephrine injection, USP) and EpiPen Jr® (epinephrine injection, USP) Auto-Injectors to now include additional lots distributed in the U.S. and other markets in consultation with the U.S. Food and Drug Administration (FDA).
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Thursday, March 30, 2017
Index - Geriatrics
Note Page numbers of article titles are in boldface type.
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Contributors - Geriatrics
MARY ANN E. ZAGARIA, PharmD, MS, BCGP
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Lifestyle Evolution Voluntarily Recalls One Shift of NuGo Slim Crunchy Peanut Butter - FDA Safety Alerts & Drug Recalls
The recall is only for Lot B16119A. No other products are affected. Lifestyle Evolution is voluntarily recalling one shift of NuGo Slim Crunchy Peanut Butter nutrition bars. In isolated cases, a product with milk allergen was incorrectly packaged into Slim Crunchy Peanut Butter wrappers and cartons. The NuGo Slim Crunchy Peanut Butter wrapper does not list milk as an allergen.
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Do-Not-Hospitalize Orders in Nursing Homes: “Call the Family Instead of Calling the Ambulance” - American Geriatric Society
Objectives
To determine how do-not-hospitalize (DNH) orders are interpreted and used in nursing homes (NHs) once they are in place.
Design
Qualitative study using in-depth semi-structured interviews performed from December 2013 to April 2014.
Setting
Eight skilled nursing facilities in Connecticut that ranked in the top 10% or bottom 10% in hospitalization rates from 2008 to 2010.
Participants
Nursing facility staff members (N = 31).
Measurements
A multidisciplinary team performed qualitative content analysis. The constant comparative method was used to develop a coding structure and identify themes.
Results
DNH orders were uncommon at low- and high-hospitalizing facilities. Participants reported that they did not interpret these orders literally. A DNH order was not a prohibition against hospitalization but was understood to have a variety of exceptions. These orders functioned primarily as a signal that hospitalization should be questioned and discussed with the family when an acute event occurred.
Conclusion
In-the-moment discussions about hospitalization are still necessary even when a DNH order is in place. Work to reduce potentially burdensome NH–hospital transfers needs to focus not just on eliciting preferences in advance, but also on preparing residents and their families to make the best decisions about hospitalization when the time comes.
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Age of Migration Life Expectancy with Functional Limitations and Morbidity in Mexican Americans - American Geriatric Society
The U.S. Mexican American population enjoys longer life expectancies relative to other racial/ethnic groups but is disproportionately affected by chronic conditions and functional limitations. Studying the impact of heterogeneity in age, time and other characteristics of migration among older Mexican Americans can inform our understanding of health disparities and healthcare needs in later-life. This research used 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the proportion of life spent with functional limitations and one or more morbidity (according to age of migration and sex) in the U.S. Mexican-American population. The results indicate that early-life and late-life migrant women spend more years with Performance-Oriented Mobility Assessment limitations than U.S.-born women. Conversely, midlife migrant women were not statistically different from U.S.-born women in years spent disabled. In men, midlife migrants had longer life expectancies and had more disability-free years than U.S.-born men. For morbidity, late-life migrant women spent a significantly smaller proportion of their elderly years with morbidity than U.S.-born women, but late-life migrant men spent more years with morbidity than U.S.-born men. These findings illustrate that older Mexican Americans in the United States are heterogeneous in nativity and health outcomes. More years spent disabled or unhealthy may result in greater burden on family members and greater dependence on public resources. These findings have implications for the development of social and health policies to appropriately target the medical conditions and disabilities of older Mexican Americans entering late life.
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Wednesday, March 29, 2017
URGENT: Envy Me Is Recalling LaBri’s Body Health Atomic 60 Capsules Due To Undeclared Sibutramine - FDA Safety Alerts & Drug Recalls
Envy Me is recalling LaBri’s Body Health Atomic, dietary supplement marketed for weight loss, sold in 60 capsule, plastic bottles. The recall includes all lot codes, manufacturing codes and expiration dates. The United States Food and Drug Administration has analyzed samples of La Bri’s Body Health Atomic and found it to contain the undeclared ingredient sibutramine.
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Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Impaired Physical Function: The Rancho Bernardo Study - American Geriatric Society
Objectives
Investigate associations of diffuse idiopathic skeletal hyperostosis (DISH) with self-reported and measured physical function in older adults.
Design
Cross-sectional analyses of data collected in 1992–96 from a longitudinal cohort. Setting: Research clinic within a community.
Participants
Community-dwelling men (n = 630) and women (n = 961), mean age 71.5 years (SD = 10.8), from the Rancho Bernardo Study.
Measurements
DISH assessed from lateral thoracic and lumbar spine radiographs; self-reported difficulty bending over to the floor, walking 2–3 level blocks, or climbing 1 flight of stairs; performance-based measures of grip strength and chair-stand testing (ability to stand up and sit down in a chair 5 times without using chair arms).
Results
DISH was present in 25.6% of men and 5.5% of women. In age and sex-adjusted models, those with DISH had 1.72-fold increased odds (95% CI: 1.13, 2.62) of self-reported difficulty bending; this remained significant after further adjustment for Cobb angle, weight, stroke, arthritis, and exercise, OR = 1.69, (95% CI: 1.07, 2.66). In fully adjusted multivariate models, those with DISH had worse grip strength, −1.08 kg, P = .01, but did not differ from those without DISH on walking or climbing stairs. In sex-stratified, fully adjusted models, among men only, those with DISH were 2.17-times (95% CI: 1.04, 4.52) more likely to be unable to complete 5 chair stands without using their arms.
Conclusions
DISH was less prevalent in women but affected almost one-quarter of older white men. People with DISH are more likely to experience physical functional impairment, suggesting that DISH has clinical correlations and is not an incidental radiographic finding.
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FDA approves new drug to treat multiple sclerosis - FDA Press Releases
On March 28, the U.S. Food and Drug Administration approved Ocrevus (ocrelizumab) to treat adult patients with relapsing forms of multiple sclerosis (MS) and primary progressive multiple sclerosis (PPMS). This is the first drug approved by the FDA for PPMS. Ocrevus is an intravenous infusion given by a health care professional.
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Discovery and genetic analysis of novel coronaviruses in least horseshoe bats in southwestern China
Discovery and genetic analysis of novel coronaviruses in least horseshoe bats in southwestern China
Emerging Microbes & Infections 6, e14 (March 2017). doi:10.1038/emi.2016.140
Authors: Lihua Wang, Shihong Fu, Yuxi Cao, Hailin Zhang, Yun Feng, Weihong Yang, Kai Nie, Xuejun Ma & Guodong Liang
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AXL is not essential for Zika virus infection in the mouse brain
AXL is not essential for Zika virus infection in the mouse brain
Emerging Microbes & Infections 6, e16 (March 2017). doi:10.1038/emi.2017.10
Authors: Feng Li, Pei-Rong Wang, Lin-Bing Qu, Chang-Hua Yi, Fu-Chun Zhang, Xiao-Ping Tang, Li-Guo Zhang & Ling Chen
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Tuesday, March 28, 2017
Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia - American Geriatric Society
Objectives
To determine the prevalence of and resident characteristics associated with the prescription of medications of questionable benefit (MQBs) near the end of life in older adults with advanced dementia in nursing homes.
Design
Population-based, cross-sectional study using Resident Assessment Instrument Minimum Data Set 2.0 linked to health administrative data.
Setting
Ontario, Canada.
Participants
All 9,298 nursing home residents with advanced dementia who died between June 1, 2010, and March 31, 2013; were aged 66 and older at time of death; and received at least one MQB in their last year of life.
Measurements
Prevalence of eight classes of MQBs (e.g., lipid-lowering agents, antidementia drugs) used in the last 120 days and last week of life.
Results
Of older nursing home residents with advanced dementia who received at least one MQB in the last year of life, 8,027 (86.3%) received them in the last 120 days and 4,180 (45.0%) in the last week of life. The most commonly prescribed MQB were antidementia (63.6%) and lipid-lowering agents (47.8%). Severe cognitive impairment (adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.07–1.33, P = .002) and fewer signs and symptoms of health instability (aOR = 1.58, 95% CI = 1.44–1.74, P < .001) were associated with MQB use into the last week of life. Seeing a neurologist or psychiatrist was associated with less likelihood of MQB use in the last week of life.
Conclusion
Many nursing home residents with advanced dementia are dispensed MQBs in the last week of life. Given that MQBs may cause more harm than benefit in this vulnerable population, it is important for physicians to actively reassess the role of all medications toward the end of life.
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Sunshine Bakery Announces Voluntary Recall of Cassava Cake And Mixed Nut Mooncake - FDA Safety Alerts & Drug Recalls
Sunshine Bakery of Alhambra, CA is voluntarily recalling CASSAVA CAKE AND MIXED NUT MOONCAKE with best by dates of 3/24/2017. The products were sold to retail stores in 2/24/2017.
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FDA approves new eczema drug Dupixent - FDA Press Releases
The U.S. Food and Drug Administration today approved Dupixent (dupilumab) injection to treat adults with moderate-to-severe eczema (atopic dermatitis). Dupixent is intended for patients whose eczema is not controlled adequately by topical therapies, or those for whom topical therapies are not advisable. Dupixent can be used with or without topical corticosteroids.
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Association of Physician Specialty with Hospice Referral for Hospitalized Nursing Home Patients with Advanced Dementia - American Geriatric Society
Objectives
Hospitalists hospice referral patterns have been unstudied. This study aims to examine hospice referral rates by attending type for hospitalized nursing home (NH) residents with advanced cognitive impairment (ACI) at the time of discharge between 2000 and 2010.
Design
Retrospective cohort study.
Participants
Hospitalized NH residents age ≥66 drawn from the 20% sample of Medicare beneficiaries with ACI, 4 or more activities of daily living (ADL) impairments on last minimum data set (MDS) assessment completed within 120 days of admission (n = 128,989).
Measurements
Hospice referral was defined as referral to hospice within 1 day after hospital discharge. Attending physician type was determined by Part B physician billing for 100% of the billings during that admission. Continuity of care was defined as the hospital physician also billing for an outpatient visit within 120 days of that hospital admission. Number of ADL impairments, cognitive measures, pre-admission illnesses and illness severity were derived from the MDS.
Results
Of the 105,329 hospitalized patients with ACI that survived to discharge (72.3% white, 30.6% male), the hospice referral rate at the time of hospital discharge increased from 2.8% in 2000 to 11.2% in 2010. Using a multivariate, hospital fixed effects model examining changes in the distribution of inpatient attending physicians, hospitalists compared to generalist physicians were more likely to refer these patients to hospice at discharge (AOR 1.17, 95% CI 1.09–1.26). Continuity of physician care from the outpatient setting to the hospital was associated with lower hospice referral (AOR 0.78, 95% CI 0.73–0.85).
Conclusion
Hospice referrals for NH-dwelling persons with ACI admitted to the hospital increased between 2000 and 2011 and disproportionately so when the attending physician was a hospitalist.
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The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents - American Geriatric Society
Objectives
Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (UTIs) in nursing home (NH) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship.
Methods
Chart review of 260 randomly-selected cases from 247 NH residents treated with an antibiotic for a presumed UTI in 31 NHs in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work-up and subsequent clinical events including emergency department use, hospitalization, and death. Analyses described the decision-making processes and outcomes and compared decisions made with Loeb criteria for initiation of antibiotics.
Results
Of 260 cases, 60% had documented signs/symptoms of the presenting illness and 15% met the Loeb criteria. Acute mental status change was the most commonly documented sign/symptom (24%). NH providers (81%) were the most common prescribers and ciprofloxacin (32%) was the most commonly prescribed antibiotic. Fourteen percent of presumed UTI cases included a white blood cell count, 71% included a urinalysis, and 72% had a urine culture. Seventy-five percent of cultures grew at least one organism with ≥100,000 colony-forming units/milliliter and 12% grew multi-drug resistant organisms; 28% of antibiotics were prescribed for more than 7 days, and 7% of cases had a subsequent death, emergency department visit, or hospitalization within 7 days.
Discussion
Non-specific signs/symptoms appeared to influence prescribing more often than urinary tract-specific signs/symptoms. Prescribers rarely stopped antibiotics, and a minority prescribed for overly long periods. Providers may need additional support to guide the decision-making process to reduce antibiotic overuse and antibiotic resistance.
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Restraint Use in Older Adults Receiving Home Care - American Geriatric Society
Objectives
To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application.
Design
Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses.
Setting
Homes of older adults receiving care from a home nursing organization in Belgium.
Participants
Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female).
Measurements
For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions.
Results
Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated.
Conclusion
Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings.
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Recent Literature Update on Medication Risk in Older Adults, 2015–2016 - American Geriatric Society
Medications can pose considerable risk in older adults. This article annotates four articles addressing this concern from 2016. The first provides national data on the use of specific prescription, over-the-counter and dietary supplements in older adults and their change over time. The second discusses the opportunity of deprescribing ineffective/unnecessary stool softeners (i.e., docusate) routinely given to older hospital patients. The third national study examines common adverse drug events in older emergency room patients. Finally, a study published demonstrating a potential association between melatonin and fractures is discussed. This manuscript is intended to provide a narrative review of key publications in medication safety for clinicians and researchers committed to improving medication safety in older adults.
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Effect of Metabolic Syndrome on the Mobility Benefit of a Structured Physical Activity Intervention—The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial - American Geriatric Society
Objectives
To test whether structured physical activity (PA) is associated with a greater reduction in major mobility disability (MMD) in older persons with metabolic syndrome (MetS) than in those without.
Design
Data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter randomized trial of 1,635 persons with assessments every 6 months (average 2.7 years).
Setting
Eight U.S. centers.
Participants
Sedentary men and women aged 70 to 89 with functional limitations (N = 1,535); 100 participants were excluded because of missing MetS data.
Intervention
Participants were randomized to a moderate-intensity PA program (n = 766) or a health education program (n = 769).
Measurements
MetS was defined according to the 2009 multiagency harmonized criteria. Outcomes included incident MMD (loss of ability to walk 400 m) and persistent MMD (two consecutive MMD diagnoses or one MMD diagnosis followed by death).
Results
Seven hundred sixty-three (49.7%) participants met criteria for MetS. PA reduced incident MMD more than health education did in participants with MetS (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.57–0.91, P = .007) but not in those without MetS (HR = 0.96, 95% CI = 0.73–1.25, P = .75); the test for statistical interaction was not significant (P = .13). PA reduced the risk of persistent MMD in participants with MetS (HR = 0.57, 95% CI = 0.41–0.79, P < .001) but not in those without MetS (HR = 0.97, 95% CI = 0.67–1.41, P = .87). The test for statistical interaction was significant (P = .04).
Conclusion
Moderate-intensity PA substantially reduces the risk of persistent MMD in older persons with functional limitations with MetS but not in those without MetS. Comparable results were observed for incident MMD. The LIFE PA program may be an effective strategy for reducing mobility disability in vulnerable older persons with MetS.
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The Hispanic Paradox: Race/Ethnicity and Nativity, Immigrant Enclave Residence and Cognitive Impairment Among Older US Adults - American Geriatric Society
Hispanics, and particularly foreign-born Mexican Americans, have been shown to fare better across a range of health outcomes than might be expected given the generally higher levels of socioeconomic disadvantage in this population, a phenomena termed the “Hispanic Paradox”. Previous research on social disparities in cognitive aging, however, has been unable to address both race/ethnicity and nativity (REN) in a nationally-representative sample of US adults leaving unanswered questions about potentially “paradoxical” advantages of Mexican ethnic-origins and the role of nativity, socioeconomic status (SES), and enclave residence. We employ biennial assessments of cognitive functioning to study prevalent and incident cognitive impairment (CI) within the three largest US REN groups: US-born non-Hispanic whites (US-NHW), US-born non-Hispanic blacks (US-NHB), US-born Mexican Americans (US-MA), and foreign-born Mexican Americans (FB-MA). Data come from a nationally-representative sample of community-dwelling older adults in the Health and Retirement Study linked with the 2000 Census and followed over 10 years (N = 8,433). Large disadvantages in prevalent and incident CI were observed for all REN minorities respective to US-born non-Hispanic whites. Individual and neighborhood SES accounted substantially for these disadvantages and revealed an immigrant advantage: FB-MA odds of prevalent CI were about half those of US-NHW and hazards of incident CI were about half those of US-MA. Residence in an immigrant enclave was protective of prevalent CI among FB-MA. The findings illuminate important directions for research into the sources of cognitive risk and resilience and provide guidance about CI screening within the increasingly diverse aging US population.
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Monday, March 27, 2017
Allergy Alert Issued by Whole Foods Market in Hadley, Massachusetts For Undeclared Walnuts in Banana Chocolate Chip Muffins - FDA Safety Alerts & Drug Recalls
Whole Foods Market® in Hadley, Massachusetts is issuing an allergy alert to recall six-packs of Banana Chocolate Chip Muffins due to an in-store labeling error.
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FDA approves maintenance treatment for recurrent epithelial ovarian, fallopian tube or primary peritoneal cancers - FDA Press Releases
The U.S. Food and Drug Administration today approved Zejula (niraparib) for the maintenance treatment (intended to delay cancer growth) of adult patients with recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer, whose tumors have completely or partially shrunk (complete or partial response, respectively) in response to platinum-based chemotherapy.
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Preface for the Special Issue dedicated to Professor Julian E. Davies - Journal of Antibiotics
Preface for the Special Issue dedicated to Professor Julian E. Davies
The Journal of Antibiotics 70, 335 (April 2017). doi:10.1038/ja.2017.14
Authors: Kunimoto Hotta & Morimasa Yagisawa
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Julian Davies and the discovery of kanamycin resistance transposon Tn5 - Journal of Antibiotics
Julian Davies and the discovery of kanamycin resistance transposon Tn5
The Journal of Antibiotics 70, 339 (April 2017). doi:10.1038/ja.2016.120
Author: Douglas E Berg
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Production of valuable compounds by molds and yeasts - Journal of Antibiotics
Production of valuable compounds by molds and yeasts
The Journal of Antibiotics 70, 347 (April 2017). doi:10.1038/ja.2016.121
Authors: Arnold L Demain & Evan Martens
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Antibiotics in microbial coculture - Journal of Antibiotics
Antibiotics in microbial coculture
The Journal of Antibiotics 70, 361 (April 2017). doi:10.1038/ja.2016.127
Authors: Kenji Ueda & Teruhiko Beppu
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Bacterial proteases, untapped antimicrobial drug targets - Journal of Antibiotics
Bacterial proteases, untapped antimicrobial drug targets
The Journal of Antibiotics 70, 366 (April 2017). doi:10.1038/ja.2016.138
Authors: Elizabeth Culp & Gerard D Wright
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Bio-based production of fuels and industrial chemicals by repurposing antibiotic-producing type I modular polyketide synthases: opportunities and challenges - Journal of Antibiotics
Bio-based production of fuels and industrial chemicals by repurposing antibiotic-producing type I modular polyketide synthases: opportunities and challenges
The Journal of Antibiotics 70, 378 (April 2017). doi:10.1038/ja.2016.136
Authors: Satoshi Yuzawa, Jay D Keasling & Leonard Katz
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Development of new polymyxin derivatives for multi-drug resistant Gram-negative infections - Journal of Antibiotics
Development of new polymyxin derivatives for multi-drug resistant Gram-negative infections
The Journal of Antibiotics 70, 386 (April 2017). doi:10.1038/ja.2016.146
Authors: Pamela Brown & Michael J Dawson
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Decatamariic acid, a new mitochondrial respiration inhibitor discovered by pesticidal screening using drug-sensitive Saccharomyces cerevisiae - Journal of Antibiotics
Decatamariic acid, a new mitochondrial respiration inhibitor discovered by pesticidal screening using drug-sensitive Saccharomyces cerevisiae
The Journal of Antibiotics 70, 395 (April 2017). doi:10.1038/ja.2016.164
Authors: Yoshihiro Watanabe, Takuya Suga, Satomi Narusawa, Masato Iwatsuki, Kenichi Nonaka, Takuji Nakashima, Yasuo Shinohara, Takahiro Shiotsuki, Naoya Ichimaru, Hideto Miyoshi, Yukihiro Asami, Satoshi Ōmura & Kazuro Shiomi
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New aminoglycoside-modifying enzymes APH(3′)-VIII and APH(3′)-IX in Acinetobacter rudis and Acinetobacter gerneri - Journal of Antibiotics
New aminoglycoside-modifying enzymes APH(3′)-VIII and APH(3′)-IX in Acinetobacter rudis and Acinetobacter gerneri
The Journal of Antibiotics 70, 400 (April 2017). doi:10.1038/ja.2016.144
Authors: Eun-Jeong Yoon, Catherine Grillot-Courvalin & Patrice Courvalin
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Characterization of the biosynthetic gene cluster (ata) for the A201A aminonucleoside antibiotic from Saccharothrix mutabilis subsp. capreolus - Journal of Antibiotics
Characterization of the biosynthetic gene cluster (ata) for the A201A aminonucleoside antibiotic from Saccharothrix mutabilis subsp. capreolus
The Journal of Antibiotics 70, 404 (April 2017). doi:10.1038/ja.2016.123
Authors: Irene Saugar, Brian Molloy, Eloisa Sanz, María Blanca Sánchez, María Fernández-Lobato & Antonio Jiménez
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New isofuranonaphthoquinones and isoindolequinones from Streptomyces sp. CB01883 - Journal of Antibiotics
New isofuranonaphthoquinones and isoindolequinones from Streptomyces sp. CB01883
The Journal of Antibiotics 70, 414 (April 2017). doi:10.1038/ja.2016.122
Authors: Zhikai Guo, Guohui Pan, Zhengren Xu, Dong Yang, Hindra , Xiangcheng Zhu, Yong Huang, Li-Xing Zhao, Yi Jiang, Yanwen Duan & Ben Shen
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Substrate specificity of radical S-adenosyl-l-methionine dehydratase AprD4 and its partner reductase AprD3 in the C3′-deoxygenation of aminoglycoside antibiotics - Journal of Antibiotics
Substrate specificity of radical S-adenosyl-l-methionine dehydratase AprD4 and its partner reductase AprD3 in the C3′-deoxygenation of aminoglycoside antibiotics
The Journal of Antibiotics 70, 423 (April 2017). doi:10.1038/ja.2016.110
Authors: Fumitaka Kudo, Takahiro Tokumitsu & Tadashi Eguchi
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Allantopyrone A activates Keap1–Nrf2 pathway and protects PC12 cells from oxidative stress-induced cell death - Journal of Antibiotics
Allantopyrone A activates Keap1–Nrf2 pathway and protects PC12 cells from oxidative stress-induced cell death
The Journal of Antibiotics 70, 429 (April 2017). doi:10.1038/ja.2016.99
Authors: Shota Uesugi, Makoto Muroi, Yasumitsu Kondoh, Yoshihito Shiono, Hiroyuki Osada & Ken-ichi Kimura
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Amide compound synthesis by adenylation domain of bacillibactin synthetase - Journal of Antibiotics
Amide compound synthesis by adenylation domain of bacillibactin synthetase
The Journal of Antibiotics 70, 435 (April 2017). doi:10.1038/ja.2016.117
Authors: Tomoko Abe, Yoshiteru Hashimoto, Sayaka Sugimoto, Kenta Kobayashi, Takuto Kumano & Michihiko Kobayashi
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Antiviral effect of theaflavins against caliciviruses - Journal of Antibiotics
Antiviral effect of theaflavins against caliciviruses
The Journal of Antibiotics 70, 443 (April 2017). doi:10.1038/ja.2016.128
Authors: Mai Ohba, Tomoichiro Oka, Takayuki Ando, Saori Arahata, Asaka Ikegaya, Hirotaka Takagi, Naohisa Ogo, Chelsea Zhu, Kazuhiro Owada, Fumihiko Kawamori, Qiuhong Wang, Linda J Saif & Akira Asai
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Isolation and anti-HIV-1 integrase activity of lentzeosides A–F from extremotolerant lentzea sp. H45, a strain isolated from a high-altitude Atacama Desert soil - Journal of Antibiotics
Isolation and anti-HIV-1 integrase activity of lentzeosides A–F from extremotolerant lentzea sp. H45, a strain isolated from a high-altitude Atacama Desert soil
The Journal of Antibiotics 70, 448 (April 2017). doi:10.1038/ja.2016.78
Authors: Dominik Wichner, Hamidah Idris, Wael E Houssen, Andrew R McEwan, Alan T Bull, Juan A Asenjo, Michael Goodfellow, Marcel Jaspars, Rainer Ebel & Mostafa E Rateb
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Saturday, March 25, 2017
Friday, March 24, 2017
Nutiva Expanded Voluntary Recall for Undeclared Peanuts In All Lots of Organic Plant Based Protein Superfood 30 Shake - FDA Safety Alerts & Drug Recalls
Nutiva, an Organic Superfoods company, has decided to expand its initial voluntary product recall of the Organic Plant Based Protein Superfood 30 Shake – Vanilla to include all lots of both Vanilla and Chocolate flavored products after identifying that this product may contain trace amounts peanuts. People who have an allergy or severe sensitivity to peanuts run the risk of serious or life-threatening allergic reaction if they consume this product.
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Pro Sports Club Recalls Yogurt Peanut Crunch Bar Because of Possible Health Risk - FDA Safety Alerts & Drug Recalls
Pro Sports Club of Bellevue, WA is recalling 36.957 Yogurt Peanut Crunch bars because it may be contaminated with Escherichia coli H7 bacteria (E.Coli O157:H7) E Coli O157:H7 causes a diarrheal illness often with bloody stools. Although most healthy adults can recover completely within a week, some people can develop a form of kidney failure called Hemolytic Uremic Syndrome (HUS). HUS is most likely to occur in young children and the elderly. The condition can lead to serious kidney damage and even death.
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Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes - American Geriatric Society
Objectives
To identify the rate of delirium present during admission to postacute care (PAC) in the nursing home setting and to determine whether patients with delirium had higher risk for adverse outcomes.
Design
Retrospective cohort study.
Setting
US Medicare- and Medicaid-certified nursing homes, 2011 to 2014.
Participants
Individuals admitted to all US nursing homes for PAC, aged ≥65 years, and without prior history of nursing home residence (n = 5,588,702).
Measurements
Minimum Data Set (MDS) 3.0 admission assessments identified delirium based upon Confusion Assessment Method (CAM) items. Robust Poisson regression was used to calculate adjusted relative risks (aRRs) with 95% confidence intervals (CIs) for death following PAC admission, and for 30-day discharge outcomes including re-hospitalization from PAC, discharge home, and functional improvement.
Results
Delirium was identified in 4.3% of new postacute nursing home admissions. Mortality within 30 days of PAC admission was observed in 16.3% of patients with delirium and 5.8% of patients without delirium (aRR = 2.27, CI = 2.24–2.30). The rate of 30-day readmission from PAC was 21.3% for patients with delirium compared with 15.1% among patients without delirium (aRR = 1.42, 95% CI = 1.40, 1.43). 26.9% of patients with delirium were discharged home within 30 days of admission compared to 52.5% of patients without delirium (aRR = 0.57, 95% CI = 0.57, 0.58). 48.9% of patients with delirium showed functional improvement at discharge compared to 59.9% of patients without delirium (aRR = 0.83, 95% CI = 0.82, 0.83).
Conclusions
Patients with delirium present upon PAC admission were at high risk for mortality and 30-day re-hospitalization and were less likely to have timely discharge to home or to improve in physical function at discharge. Early identification and care planning for individuals with delirium at PAC admission may be essential to improve outcomes.
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Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction - American Geriatric Society
Objectives
To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF).
Design
Secondary analysis of a randomized controlled trial.
Setting
Outpatient cardiac rehabilitation program.
Participants
Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training.
Measurements
The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models.
Results
Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs −0.3 ± 15.4%, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peak with exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak.
Conclusion
The change in VO2peak in response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peak improvement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.
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Long-Term Self-Reported Cognitive Problems After Delirium in the Intensive Care Unit and the Effect of Systemic Inflammation - American Geriatric Society
Objectives
To describe the association between intensive care unit (ICU) delirium and self-reported cognitive problems in 1-year ICU survivors, and investigate whether this association was altered by exposure to systemic inflammation during ICU stay.
Design
Prospective cohort study.
Setting
Dutch medical-surgical ICU.
Participants
One-year ICU survivors, admitted to the ICU ≥48 hours.
Measurements
Self-reported cognitive problems were measured with the Cognitive Failures Questionnaire (CFQ). Cumulative exposure to systemic inflammation was based on all daily C-reactive protein (CRP) measurements during ICU stay, expressed as the area under the curve (AUC). Multivariable linear regression was conducted to evaluate the association between delirium and the CFQ. The effect of inflammation on the association between delirium and CFQ was assessed, comparing the effect estimate (B) of delirium and CFQ between models with and without inclusion of the AUC of CRP.
Results
Among 567 1-year ICU survivors, the CFQ was completed by 363 subjects. Subjects with multiple days of delirium during ICU stay reported more self-reported cognitive problems (Badj = 5.10, 95% CI 1.01–9.20), whereas a single day delirium was not associated with higher CFQ scores (Badj = −0.72, 95% CI −5.75 to 4.31). Including the AUC of CRP did not change the association between delirium and the CFQ (ratio for a single and multiple days were respectively: 1.00, 95%CI 0.59–1.44 and 0.86, 95% CI 0.47–1.16).
Conclusion
Multiple days of delirium was associated with long-term self-reported cognitive problems. The cumulative exposure to systemic inflammation did not alter this association, suggesting that delirium in the context of little inflammation is also detrimental.
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Thursday, March 23, 2017
FDA approves first treatment for rare form of skin cancer - FDA Press Releases
The U.S. Food and Drug Administration today granted accelerated approval to Bavencio (avelumab) for the treatment of adults and pediatric patients 12 years and older with metastatic Merkel cell carcinoma (MCC), including those who have not received prior chemotherapy. This is the first FDA-approved treatment for metastatic MCC, a rare, aggressive form of skin cancer.
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Chlorofields Recalls Asian MIicrogreens Because Of Possible Health Risk - FDA Safety Alerts & Drug Recalls
ChloroFields of Lawrence, KS is recalling 20 cases of Asian Microgreens, because they have 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. Healthy persons infected with Salmonella often experience fever, diarrhea, nausea, vomiting, and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.
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Wednesday, March 22, 2017
Clinical features and viral quasispecies characteristics associated with infection by the hepatitis B virus G145R immune escape mutant
Clinical features and viral quasispecies characteristics associated with infection by the hepatitis B virus G145R immune escape mutant
Emerging Microbes & Infections 6, e15 (March 2017). doi:10.1038/emi.2017.2
Authors: Yuan Xue, Ming-Jie Wang, Zhi-Tao Yang, De-Min Yu, Yue Han, Dao Huang, Dong-Hua Zhang & Xin-Xin Zhang
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Zika virus genome biology and molecular pathogenesis
Zika virus genome biology and molecular pathogenesis
Emerging Microbes & Infections 6, e13 (March 2017). doi:10.1038/emi.2016.141
Authors: Anyou Wang, Stephanie Thurmond, Leonel Islas, Kingyung Hui & Rong Hai
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Variability in H9N2 haemagglutinin receptor-binding preference and the pH of fusion
Variability in H9N2 haemagglutinin receptor-binding preference and the pH of fusion
Emerging Microbes & Infections 6, e11 (March 2017). doi:10.1038/emi.2016.139
Authors: Thomas P Peacock, Donald J Benton, Jean-Remy Sadeyen, Pengxiang Chang, Joshua E Sealy, Juliet E Bryant, Stephen R Martin, Holly Shelton, John W McCauley, Wendy S Barclay & Munir Iqbal
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Tuesday, March 21, 2017
Riviana Foods Inc. Voluntarily Recalls Certain Manufacturing Date And UPC Number Of Ronzoni® Thin Spaghetti Due To Possible Undeclared Egg Allergen - FDA Safety Alerts & Drug Recalls
Houston, Texas (March 20, 2017) – Riviana Foods Inc. is voluntarily recalling 610 cases of certain coded Ronzoni® Thin Spaghetti cartons that may contain an egg fettuccine product. The affected Ronzoni Thin Spaghetti cartons do not declare the allergen “egg”, which is an ingredient in the egg fettuccine product. People who have an allergy or severe sensitivity to egg run the risk of serious or life-threatening allergic reaction if they consume these products. The affected product was processed at a Riviana co-manufacturer’s facility on January 20, 2017
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FDA approves drug to treat Parkinson’s disease - FDA Press Releases
The U.S. Food and Drug Administration today approved Xadago (safinamide) tablets as an add-on treatment for patients with Parkinson’s disease who are currently taking levodopa/carbidopa and experiencing “off” episodes. An “off” episode is a time when a patient’s medications are not working well, causing an increase in Parkinson’s symptoms, such as tremor and difficulty walking.
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Observed Hearing Loss and Incident Dementia in a Multiethnic Cohort - American Geriatric Society
Objectives
To determine whether observed hearing loss (OHL) is associated with incident dementia in a multiethnic population.
Design
Prospective epidemiological cohort study.
Setting
Community in northern Manhattan.
Participants
Participants in the Washington Heights-Inwood Columbia Aging Project, a longitudinal study on aging and dementia in an ethnically diverse community (n = 1,881).
Measurements
OHL was defined when the examiner observed it or according to self-reported hearing aid use. A consensus panel diagnosed dementia using standard research criteria. A Cox proportional hazards model was used to examine the relationship between OHL at baseline and risk of incident dementia (mean 7.3 ± 4.4 years of longitudinal followup, range 0.9–20 years).
Results
OHL was associated with 1.69 (95% confidence interval (CI) = 1.3–2.3, P < .010) times the risk of incident dementia, adjusting for demographic characteristics, cardiovascular risk factors, apolipoprotein E4 genotype, and stroke. When stratified according to race, the association between OHL and incident dementia was high in all groups but was statistically significant only in blacks (hazard ratio = 2.62, 95% CI = 1.5–4.5, P < .010).
Conclusion
OHL was associated with greater risk of incident dementia in a multiethnic cohort. More study is needed to determine whether HL contributes to dementia and whether treating HL can reduce the risk of dementia.
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Surgical Guidelines for Perioperative Management of Older Adults: What Geriatricians Need to Know - American Geriatric Society
A multidisciplinary panel of experts representing surgery, anesthesia, and geriatrics recently published guidelines for surgeons on the optimal perioperative management of older adults, including recommendations on postoperative recovery and posthospital transitions of care. Geriatricians have an important role in the care for older adults in the preoperative period as older adults consider surgical options and prepare for surgical procedures, during the perioperative period as inpatient consultants, and in the postoperative period as older adults transition to rehabilitation facilities or to home. This article outlines the perioperative surgical guidelines and describes how they apply to the role of the geriatrician in the care of older adults during the perioperative period.
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Inflammatory Markers and Frailty in Long-Term Care Residents - American Geriatric Society
Objectives
To determine whether proinflammatory biomarkers are associated with frailty assessed according to functional status, mobility, mental health, and falls over 24 months.
Design
Secondary analysis of a 2-year double-blind clinical trial for osteoporosis.
Setting
Nursing homes and assisted living facilities.
Participants
Women aged 65 and older with osteoporosis in long-term care (LTC) (N = 178).
Measurements
Baseline serum concentrations of proinflammatory cytokines and soluble receptors (high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNFα) and its two receptors (TNFα-R1 and TNFα-R2), interleukin-6 (IL-6), soluble IL-6 receptor (sIL-6R), IL-10), functional status assessed according to activities of daily living, the Nursing Home Physical Performance Test, gait speed, cognitive status, mental health, and falls.
Results
At baseline, older age was moderately associated with higher serum concentrations of hs-CRP (correlation coefficient (r) = 0.22), TNFα-R1 (r = 0.36), TNFα-R2 (r = 0.34), and IL-10 (r = 0.16) (all P < .05). Frail participants had significantly higher hs-CRP, TNFα-R1, TNFα-R2, IL-6, and IL-6-sR levels (all P < .05) than those nonfrail participants. Higher baseline hs-CRP and IL-6 levels were associated with worse physical performance and gait speed at 12 months independent of age, zoledronic acid use, and comorbidity (|r| = 0.25–0.30; all P < .05). Inflammatory markers were not significantly associated with incident falls.
Conclusions
Higher proinflammatory biomarker levels are associated with frailty and poorer function and mobility in older women residing in LTC facilities.
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Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most? - American Geriatric Society
Objectives
To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs (VA) home-based primary care (HBPC) and hospitalization for ambulatory care–sensitive conditions (ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on hospitalizations varies according to clinical condition.
Design
Retrospective cohort study.
Setting
VA and non-VA hospitals.
Participants
VA beneficiaries aged 67 and older with diabetes mellitus and enrolled in Medicare (N = 364,972).
Measurements
Instrumental variables regression models were used to estimate the effect of HBPC enrollment on hospitalization for ACSCs (defined according to the Agency for Healthcare Research and Quality Prevention Quality Indicators) overall and in subgroups stratified according to medical complexity. Models were also estimated for each ACSC to determine which conditions were most sensitive to HBPC. Distance from the veteran's residence to the nearest HBPC site was used as the instrumental variable.
Results
HBPC was associated with fewer ACSC hospitalizations (odds ratio (OR) = 0.35 per person-month, 95% confidence interval (CI) = 0.30–0.42). For veterans in the highest quartile of medical complexity, HBPC enrollment was associated with fewer ACSC hospitalizations (OR = 0.43, 95% CI = 0.19–0.93), whereas for those in the lowest quartile, HBPC was associated with more ACSC hospitalizations (OR = 33.2, 95% CI = 4.6–240.1). HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs.
Conclusion
HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs in veterans with diabetes mellitus but only in the most medically complex individuals. This demonstrates the importance of appropriate targeting and suggests that the effect of HBPC is attributable to its comprehensive approach rather than condition-specific interventions.
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A Longitudinal Study of the Mini-Mental State Examination in Late Nonagenarians and Its Relationship with Dementia, Mortality, and Education - American Geriatric Society
Objectives
To examine level of and change in cognitive status using the Mini-Mental State Examination (MMSE) in relation to dementia, mortality, education, and sex in late nonagenarians.
Design
Three-year longitudinal study with examinations at ages 97, 99, and 100.
Setting
Trained psychiatric research nurses examined participants at their place of living.
Participants
A representative population-based sample of 97-year-old Swedes (N = 591; 107 men, 484 women) living in Gothenburg, Sweden.
Measurements
A Swedish version of the MMSE was used to measure cognitive status. Geriatric psychiatrists diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Mixed models were fitted to the data to model the longitudinal relationship between MMSE score and explanatory variables.
Results
Individuals with dementia between age 97 and 100 had lower mean MMSE scores than those without dementia. Those who died during the 3-year follow-up had lower MMSE scores than those who survived. MMSE scores at baseline did not differ between those without dementia and those who developed dementia during the 3-year follow-up. Participants with more education had higher MMSE scores, but there was no association between education and linear change.
Conclusion
MMSE score is associated with dementia and subsequent mortality even in very old individuals, although the preclinical phase of dementia may be short in older age. Level of education is positively associated with MMSE score but not rate of decline in individuals approaching age 100.
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National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015 - American Geriatric Society
Objectives
To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care.
Design
Observational study.
Setting
All counties in the United States.
Participants
All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system.
Measurements
County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years.
Results
The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002–2003 and 2014–2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care.
Conclusion
The availability of home health care increased nationwide during the study period, but there was much geographic variation.
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Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study - American Geriatric Society
Background
Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury.
Objective
To identify modifiable risk factors associated with malnutrition in older patients.
Design
Prospective cross-sectional multicenter study.
Setting
3 EDs in the South, Northeast, and Midwest.
Participants
Non-critically ill, English-speaking adults aged ≥65 years.
Measurements
Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor.
Results
In our sample (n = 252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%).
Conclusion
Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.
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Association of Proton Pump Inhibitors Usage with Risk of Pneumonia in Dementia Patients - American Geriatric Society
Objectives
To determine the association between usages of proton pump inhibitors (PPIs) and subsequent risk of pneumonia in dementia patients.
Design
Retrospective cohort study.
Setting
Taiwanese National Health Insurance Research Database.
Participants
The study cohort consisted of 786 dementia patients with new PPI usage and 786 matched dementia patients without PPI usage.
Measurements
The study endpoint was defined as the occurrence of pneumonia. The Cox proportional hazard model was used to estimate the pneumonia risk. Defined daily dose methodology was applied to evaluate the cumulative and dose-response relationships of PPI.
Results
Incidence of pneumonia was higher among patients with PPI usage (adjusted hazard ratio (HR) = 1.89; 95% CI = 1.51–2.37). Cox model analysis also demonstrated that age (adjusted HR = 1.05; 95% CI = 1.03–1.06), male gender (adjusted HR = 1.57; 95% CI = 1.25–1.98), underlying cerebrovascular disease (adjusted HR = 1.30; 95% CI = 1.04–1.62), chronic pulmonary disease (adjusted HR = 1.39; 95% CI = 1.09–1.76), congestive heart failure (adjusted HR = 1.54; 95% CI = 1.11–2.13), diabetes mellitus (adjusted HR = 1.54; 95% CI = 1.22–1.95), and usage of antipsychotics (adjusted HR = 1.29; 95% CI = 1.03–1.61) were independent risk factors for pneumonia. However, usage of cholinesterase inhibitors and histamine receptor-2 antagonists were shown to decrease pneumonia risk.
Conclusion
PPI usage in dementia patients is associated with an 89% increased risk of pneumonia.
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Monday, March 20, 2017
EuroCan Manufacturing Voluntarily Recalling Barnsdale Farms® Pig Ears Because of Possible Salmonella Health Risk - FDA Safety Alerts & Drug Recalls
(March 20, 2017) New Hamburg, Ontario - EuroCan Manufacturing is voluntarily recalling Lot Number 84 consisting of it's individually shrink-wrapped, 6-pack, 12-pack and 25-pack bags of Barnsdale Farms®, HoundsTooth® and Mac's Choice® Pig Ears because they have the potential to be contaminated with Salmonella. Salmonella can affect animals eating the products and there is a risk to humans from handling contaminated pet products, especially if they have not thoroughly washed their hands after having contact with the products or any surfaces exposed to these products.
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Engagement in Advance Care Planning and Surrogates’ Knowledge of Patients’ Treatment Goals - American Geriatric Society
Objectives
A key objective of advance care planning (ACP) is improving surrogates’ knowledge of patients’ treatment goals. Little is known about whether ACP outside of a trial accomplishes this. The objective was to examine patient and surrogate reports of ACP engagement and associations with surrogate knowledge of goals.
Design
Cohort study
Setting
Primary care in a Veterans Affairs Medical Center.
Participants
350 community-dwelling veterans age ≥55 years and the individual they would choose to make medical decisions on their behalf, interviewed separately.
Measurements
Treatment goals were assessed by veterans’ ratings of 3 health states: severe physical disability, cognitive disability, and pain, as an acceptable or unacceptable result of treatment for severe illness. Surrogates had knowledge if they correctly predicted all 3 responses. Veterans and surrogates were asked about living will and health care proxy completion and communication about life-sustaining treatment and quality versus quantity of life (QOL).
Results
Over 40% of dyads agreed that the veteran had not completed a living will or health care proxy and that there was no QOL communication. For each activity, sizeable proportions (18–34%) disagreed about participation. In dyads who agreed QOL communication had occurred, 30% of surrogates had knowledge, compared to 21% in dyads who agreed communication had not occurred and 15% in dyads who disagreed (P = .01). This relationship persisted in multivariable analysis. Agreement about other ACP activities was not associated with knowledge.
Conclusion
Disagreement about ACP participation was common. Agreement about communication regarding QOL was modestly associated with surrogate knowledge of treatment goals. Eliciting surrogates’ perspectives is critical to ACP. Even dyads who agree about participation may need additional support for successful engagement.
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Saturday, March 18, 2017
Nutiva Voluntary Recall for Undeclared Peanuts Organic Plant Based Protein Superfood 30 Shake Vanilla Flavor - FDA Safety Alerts & Drug Recalls
Nutiva, an Organic Superfoods company, has initiated a voluntary product recall of the following Organic Plant Based Protein Superfood 30 Shake - Vanilla Flavor products after identifying that this product may contain peanuts. People who have an allergy or severe sensitivity to peanuts run the risk of serious or life-threatening allergic reaction if they consume this product.
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Colorado unapproved drug and dietary supplement makers ordered to cease operations for federal violations - FDA Press Releases
Yesterday, U.S. District Judge Marcia S. Krieger for the U.S. District Court for Colorado entered a consent decree of permanent injunction against EonNutra LLC, CDSM LLC and HABW LLC, manufacturers and distributors of unapproved drugs and dietary supplements, and their owner, Michael Floren, requiring Floren’s businesses to immediately cease operations until they come into compliance with federal laws.
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Blue Buffalo Voluntarily Recalls One Lot of BLUE Wilderness® Rocky Mountain Recipe TM Red Meat Dinner Wet Food For Adult DogsDue to Potential Health Risk - FDA Safety Alerts & Drug Recalls
Blue Buffalo Company is voluntarily recalling one production lot of BLUE Wilderness® Rocky Mountain RecipeTM Red Meat Dinner Wet Food for Adult Dogs, as the product has the potential to contain elevated levels of naturally- occurring beef thyroid hormones.
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Wellpet Voluntarily Recalls a Limited Amount of One Recipe of Canned Topper For Dogs Due to Potential Elevated Levels of Naturally Occurring Beef Thyroid Hormone - FDA Safety Alerts & Drug Recalls
WellPet has initiated a voluntary recall of a limited amount of one canned topper product due to potential elevated levels of naturally occurring beef thyroid hormone.
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Advanced Fresh Concepts Franchise Corp. Voluntarily Recalls Edamame Due to Potential Health Risk - FDA Safety Alerts & Drug Recalls
Advanced Fresh Concepts Franchise Corp. (“AFC”) of Rancho Dominguez, California is recalling its Edamame (Soybeans) – UPC 0-23012-00261-9, dated between 01/03/2017 and 03/17/2017 because it has the potential to be contaminated with Listeria monocytogenes. Contamination was discovered via random testing under AFC’s Quality Assurance Program.
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Aroma Imports Inc. Recalls Nabelsi brand Thyme Because of Possible Health Risk - FDA Safety Alerts & Drug Recalls
Aroma Imports Inc. of Dearborn Heights, MI, is recalling 450 g and 4.5 kg packages of Nabelsi brand Thyme because the products have the potential to contain excessive levels of lead. The recall was initiated after it was discovered that product contained high levels of lead (422 PPM) based on sampling by U.S. Food and Drug Administration and Illinois Department of Public Health, Environmental Health Protection.
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Dolcetta Artisan Sweets Issues Allergy Alert on Undeclared Soy and Milk in Chocolate Confections - FDA Safety Alerts & Drug Recalls
Dolcetta Artisan Sweets of Seattle, WA is recalling Dolcetta branded chocolate confections because they may contain undeclared soy and milk.
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Whole Foods Market Expands Vulto Creamery Recall Because of Public Health Risk - FDA Safety Alerts & Drug Recalls
In response to Vulto Creamery’s expanded recall of raw milk cheeses, Whole Foods Market is voluntarily expanding its recall to include Andes, Hamden and Walton Umber cheeses sold in eight stores in Massachusetts, New Jersey and New York. The cheeses have the potential to be contaminated with Listeria monocytogenes. Listeria monocytogenes is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, pregnant women and others with weakened immune systems.
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Vulto Creamery Voluntarily Expands Their Recall of All Raw Milk Cheeses Because of Possible Listeria Monocytogenes Contamination - FDA Safety Alerts & Drug Recalls
Vulto Creamery, Walton, New York, is out of an abundance of caution expanded the recall to include all lots for four additional cheeses which include, by name the following: Andes, Blue Blais, Hamden & Walton Umber. In summary, Vulto Creamery has recalled the following eight cheese items: Heinennellie, Miranda,, Willowemoc, Ouleout , Andes, Blue Blais, Hamden & Walton Umber due to potential contamination of Listeria monocytogenes.
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Friday, March 17, 2017
Advanced Fresh Concepts Franchise Corp. Voluntarily Recalls Edamame Due to Potential Health Risk - FDA Safety Alerts & Drug Recalls
Advanced Fresh Concepts Franchise Corp. (“AFC”) of Rancho Dominguez, California is recalling its Edamame (Soybeans) – UPC 0-23012-00261-9, dated between 01/03/2017 and 03/17/2017 because it has the potential to be contaminated with Listeria monocytogenes. Contamination was discovered via random testing under AFC’s Quality Assurance Program.
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Aroma Imports Inc. Recalls Nabelsi brand Thyme Because of Possible Health Risk - FDA Safety Alerts & Drug Recalls
Aroma Imports Inc. of Dearborn Heights, MI, is recalling 450 g and 4.5 kg packages of Nabelsi brand Thyme because the products have the potential to contain excessive levels of lead. The recall was initiated after it was discovered that product contained high levels of lead (422 PPM) based on sampling by U.S. Food and Drug Administration and Illinois Department of Public Health, Environmental Health Protection.
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Medicare Access and CHIP Reauthorization Act: What do Geriatrics Healthcare Professionals Need to Know About the Quality Payment Program? - American Geriatric Society
Commencing in 2017, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 will change how Medicare pays health professionals. By enacting MACRA, Congress brought an end to the (un)sustainable growth rate formula while also setting forth a vision for how to transform the U.S. healthcare system so that clinicians deliver higher-quality care with smarter spending by the Centers for Medicare and Medicaid Services (CMS). In October 2016, CMS released the first of what stakeholders anticipate will be a number of (annual) rules related to implementation of MACRA. CMS received extensive input from stakeholders including the American Geriatrics Society. Under the Quality Payment Program, CMS streamlined multiple Medicare value-based payment programs into a new Merit-based Incentive Payment System (MIPS). CMS also outlined how it will provide incentives for participation in Advanced Alternative Payment Models (called APMs). Although Medicare payments to geriatrics health professionals will not be based on the new MIPS formula until 2019, those payments will be based upon performance during a 90-day period in 2017. This article defines geriatrics health professionals as clinicians who care for a predominantly older adult population and who are eligible to bill under the Medicare Physician Fee Schedule. Given the current paucity of eligible APMs, this article will focus on MIPS while providing a brief overview of APMs.
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Exclusion of Elderly People from Randomized Clinical Trials of Drugs for Ischemic Heart Disease - American Geriatric Society
Objectives
To measure exclusion of elderly adults from randomized trials studying drug interventions for ischemic heart disease (IHD) and describe the characteristics of these trials.
Design
Cross-sectional analysis.
Setting
Interventional clinical trials studying a drug intervention for IHD that started in 2006 and after were identified in ClinicalTrials.gov. Data were extracted on study features, including age-based inclusion criteria. Data on participants and their age distribution were collected from trial publications, investigator inquiry, and result data in ClinicalTrials.gov.
Participants
Individuals aged 65 and older.
Measurements
Proportion of trials excluding individuals based on age, mean age of trial participants, and proportion of enrolled participants aged 65 and older and 75 and older.
Results
Of 839 identified trials, 446 (53%) explicitly excluded elderly adults. The most-frequent upper age limits were 80 (n = 164) and 75 (n = 114), with a median upper age limit of 80 (interquartile range 75–80). Trials with upper age limit exclusions tended to be smaller (median number of participants 100 vs 201, P < .001) and were more likely to be funded primarily by nonindustry sources (78.3% vs 70.0%, P = .006). The overall mean age of trial participants was 62.7 (mean maximum age 74). The estimated proportion of participants aged 65 and older was 42.5% and the estimated proportion aged 75 and older was 12.3%.
Conclusion
Despite the high burden of IHD in elderly adults, the majority of drug trials do not enroll participants reflective of age-related prevalence of the disease.
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Early Functional Limitations in Cognitively Normal Older Adults Predict Diagnostic Conversion to Mild Cognitive Impairment - American Geriatric Society
Objectives
To examine whether specific types of early functional limitations in cognitively normal older adults are associated with subsequent development of mild cognitive impairment (MCI), as well as the relative predictive value of self versus informant report in predicting diagnostic conversion to MCI.
Design
As a part of a longitudinal study design, participants underwent baseline and annual multidisciplinary clinical evaluations, including a physical and neurological examination, imaging, laboratory work, and neuropsychological testing.
Setting
Data used in this study were collected as part of longitudinal research at the University of California, Davis Alzheimer's Disease Center.
Participants
Individuals diagnosed as having normal cognition at study baseline who had an informant who could complete informant-based ratings and at least one follow-up visit (N = 324).
Measurements
Participants and informants each completed the Everyday Cognition Scale (ECog), an instrument designed to measure everyday function in six cognitively relevant domains.
Results
Self- and informant-reported functional limitations on the ECog were associated with significantly greater risk of diagnostic conversion to MCI (informant: hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3–3.2, P = .002), with self-report having a slightly higher hazard (HR = 2.3, 95% CI = 1.4–3.6, P < .001). When controlling for baseline cognitive abilities, the effect remained significant for self- and informant-reported functional limitations.
Conclusion
Deficits in everyday memory and executive function domains were the strongest predictors of diagnostic conversion to MCI. Detection of early functional limitations may be clinically useful in assessing the future risk of developing cognitive impairment in cognitively normal older adults.
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John A. Hartford Foundation Centers of Excellence Program: History, Impact, and Legacy - American Geriatric Society
The John A. Hartford Foundation (JAHF) created the Centers of Excellence in Geriatric Medicine and Geriatric Psychiatry in 1988 with the goal of establishing academic training environments to increase geriatrics-trained faculty. The initiative identified medical schools with the necessary components for training academic geriatricians. JAHF grants provided the resources to create a cadre of physicians whose research, teaching and practice leads to substantial contributions in geriatrics. Results from two evaluations show that the program has successfully increased geriatrics-prepared faculty who have achieved promotion and institutional retention, success in winning competitive research grants, and positions of leadership. The initiative strengthened the national network of geriatrics programs and served as a major driver of increased prestige for the fields of geriatric medicine and psychiatry.
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Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study - American Geriatric Society
Objective
To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality.
Design
Nationally representative cohort study.
Setting
Health and Retirement Study.
Participants
7,492 U.S. adults aged ≥65 years.
Measurements
Grip strength was measured by a hand dynamometer and classified as normal (≥16 kg for female; ≥26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (≥0.60 m/s for female; ≥0.52 m/s for male) and slow.
Results
Over an average follow-up time of 6.0 years, 1,870 (25.0%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (≥150 mmHg) and DBP (≥90 mmHg) was associated with a 24% (95% CI, 7–43%) and 25% (95% CI, 5–49%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6% (95% CI, 31 to −27%) and a 16% (95% CI, 46 to −26%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death was 0.85 (95% CI, 0.56–1.29) and 0.53 (95% CI, 0.30–0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, associations of BP with death varied modestly by gait speed.
Conclusion
Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death.
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The Attributable Burden of Clostridium difficile Infection to Long-Term Care Facilities Stay: A Clinical Study - American Geriatric Society
Background
Advanced age, history of hospitalization, and antibiotic consumption are associated with the pathogenesis of Clostridium difficile infection (CDI). Long-term care facilities (LTCFs) represent a setting where CDI has been increasingly reported. We aimed to estimate the actual attributable burden of CDI to LTCF stay and determine the characteristics of the disease epidemiology in this setting.
Design
IRB-approved retrospective cohort study.
Setting
LTCF and community.
Participants
One thousand seven hundred and sixty-one patients.
Measurements/Results
The prevalence of CDI among LTCF residents was 22.4%, whereas the prevalence of CDI among community residents was 6.7% (P < .001). The prevalence of CDI among LTCF residents was significantly higher in both the 18–64 (P < .001) and the ≥65 age groups (P < .010). Measures of hospital exposure and antibiotic consumption between LTCF and community residents prior to CDI diagnosis were non-significant. A strict matching (1:2) between LTCF and community residents adjusting for age, total number of hospital admissions and antibiotic consumption showed that the odds of CDI for an LTCF resident were 6.89 times larger than the odds for a community resident (OR = 6.89, 95%, 4.67–10.17). For an LTCF resident with CDI, the odds of manifesting severe disease were 3.25 times larger than the odds for a community resident with CDI (OR = 3.25, 95%, 1.81–5.86). LTCF residents were more frequently hospitalized (P = .002) required longer hospital stays for their CDI management (P = .03) and had more recurrent CDI cases than community residents (P = .04).
Conclusions
Our study highlights the increased burden of CDI among LTCF residents independently of age, antibiotic, and hospitalization background. Severe CDI disease and recurrences are more frequent in LTCFs.
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Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults - American Geriatric Society
Objectives
To determine the effect of chronic disorders and their co-occurrence on survival and functioning in community-dwelling older adults.
Design
Population-based cohort study.
Setting
Kungsholmen, Stockholm, Sweden.
Participants
Individuals aged 78 and older examined by physicians four times over 11 years (N = 1,099).
Measurements
Chronic diseases (grouped according to 10 organ systems according to the International Classification of Diseases, Tenth Revision, code) and multimorbidity (≥2 coexisting chronic diseases) were evaluated in terms of mortality, population attributable risk of death, median years of life lost, and median survival time with and without disability (need of assistance in ≥1 activities of daily living).
Results
Approximately one in four deaths were attributable to cardiovascular and one in six to neuropsychiatric diseases. Malignancy was the condition with the shortest survival time (2.5 years). Malignancies and cardiovascular disorders each accounted for approximately 5 years of life lost. In contrast, neurosensorial and neuropsychiatric conditions had the longest median survival time (>6 years), and affected people were disabled for more than half of this time. The most-prevalent and -burdensome condition was multimorbidity, affecting 70.4% of the population, accounting for 69.3% of total deaths, and causing 7.5 years of life lost. Finally, people with multimorbidity lived 81% of their remaining years of life with disability (median 5.2 years).
Conclusion
Survival in older adults differs in length and quality depending on specific conditions. The greatest negative effect at the individual (shorter life, greater dependence) and societal (number of attributable deaths, years spent with disability) level was from multimorbidity, which has made multimorbidity a clinical and public health priority.
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