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Courel-Ibáñez J, Pallarés JG. Effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in addition to multicomponent exercise in adults older than 70 years living in nursing homes, a cluster randomized placebo-controlled trial: the HEAL study protocol. BMC Geriatr 2019; 19:188. [PMID: 31277595 PMCID: PMC6612176 DOI: 10.1186/s12877-019-1200-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background Evidence supports the fact that multicomponent exercise and HMB supplementation are, separately, effective in improving older adult’s health and palliate functional metabolic diseases in older people. However, the true effect of HMB supplementation combined with a tailored exercise program in frail older adults is still unknown. Thus, the aim of the HEAL (HMB + Exercise = Adults Living longer) study is to assess the effects of the combination of a daily multicomponent exercise and resistance training (VIVIFRAIL program) intervention in addition to HMB supplementation on older adults’ health. Methods/design A 24-week cluster randomized, double-blind, placebo-controlled study will be conducted on 104 adults ≥70 years. Nursing homes will be randomized to either of four groups: Ex-HMB (exercise intervention with HMB), Ex-Plac (exercise intervention with placebo), NoEx-HMB (no exercise intervention with HMB), and Controls (No exercise and no HMB). Intervention groups which include exercise will complete the individualized multicomponent (strength, balance and cardiovascular exercises) training program VIVIFRAIL. Intervention groups which include HMB supplementation will receive a 3 g/daily dose of free acid HMB in powder form. The primary outcome measure is the functional capacity. Secondary outcome measures are muscle strength and power, frailty and fall risk, body composition, biochemical analyses and cardiometabolic risk factor, disability and comorbidity, cognitive function and depression. Discussion The findings of the HEAL study will help professionals from public health systems to identify cost-effective and innovative actions to improve older people’s health and quality of life, and endorse exercise practice in older adults and people living in nursing homes. Trial registration NCT03827499; Date of registration: 01/02/2019.
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Affiliation(s)
- Javier Courel-Ibáñez
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Calle Argentina, 19, 30720, San Javier, Murcia, Spain.
| | - J G Pallarés
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Calle Argentina, 19, 30720, San Javier, Murcia, Spain
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Dalpé G, Thorogood A, Knoppers BM. A Tale of Two Capacities: Including Children and Decisionally Vulnerable Adults in Biomedical Research. Front Genet 2019; 10:289. [PMID: 31024616 PMCID: PMC6459892 DOI: 10.3389/fgene.2019.00289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/18/2019] [Indexed: 12/13/2022] Open
Abstract
The participation of individuals who lack decision-making capacity is essential for advancing genomics research and neuroscience, but raises ethical and legal challenges relating to vulnerability, consent, and exclusion. Capacity differences between populations and individuals, the dynamics of capacity over time, and evolving legal consent and capacity regimes all raise uncertainty for researchers, institutional review boards, and policy makers. We review international ethical and legal best practices for including children and decisionally vulnerable adults in health research. Research ethics norms and literature tend to split such groups into narrow silos, which results in inconsistency and conceptual confusion, or to lump them together, which fails to take into account morally relevant differences. Through a narrative review of international norms, we identify challenges common to both groups, while drawing out distinctions reflecting their opposite capacity trajectories. Our comparison between these two populations clarifies underlying ethical concepts and offers opportunities for critique. Children need protection to foster their long-term autonomy, while decisionally vulnerable adults need to be provided with support in order to exercise their autonomy. This leads to differences in how researchers determine who lacks capacity, who has authority to consent, and what criteria guide such decision-making. We also consider how capacity issues color contemporary research governance debates over broad consent, data protection compliance, data sharing, and the return of individual research results and incidental findings.
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Affiliation(s)
- Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
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Lhermite A, Munoz Sastre MT, Sorum PC, Mullet E. Decision-Making Capacity Among Elderly People: A Mapping of Health Professionals' and Laypeople's Views. Int J Aging Hum Dev 2018; 89:311-326. [PMID: 30450919 DOI: 10.1177/0091415018811092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The views of laypeople and professionals (nurses, occupational therapists, psychologists, and physicians) on the capacity to make informed decisions of elderly people with depression or dementia were examined. Participants were presented with vignettes created by varying the levels of three factors: (a) the type of decision (e.g., agreeing to surgery), (b) the health problem (e.g., slight depression), and (c) the availability of social support. Through cluster analysis, four different positions were found. Seventeen percent of the participants considered that even persons suffering from slight depression were already quite incapacitated. In contrast, 24% considered that only elderly people suffering from moderate or severe dementia were impaired. The majority of participants (59%) expressed positions that can be considered as pragmatic. Level of impairment was viewed as a function of severity of illness or type of illness. No significant differences were found between health professional and laypeople.
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Thorogood A, Mäki‐Petäjä‐Leinonen A, Brodaty H, Dalpé G, Gastmans C, Gauthier S, Gove D, Harding R, Knoppers BM, Rossor M, Bobrow M. Consent recommendations for research and international data sharing involving persons with dementia. Alzheimers Dement 2018; 14:1334-1343. [DOI: 10.1016/j.jalz.2018.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Anna Mäki‐Petäjä‐Leinonen
- Faculty of Social Sciences and Business StudiesLaw SchoolUniversity of Eastern FinlandJoensuuFinland
| | - Henry Brodaty
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
| | - Gratien Dalpé
- Centre of Genomics and PolicyMcGill UniversityMontrealCanada
| | - Chris Gastmans
- Interfaculty Centre for Biomedical Ethics and LawKU LeuvenLeuvenBelgium
| | - Serge Gauthier
- McGill Centre for Studies in AgingMcGill UniversityMontrealCanada
| | | | - Rosie Harding
- Birmingham Law SchoolUniversity of BirminghamBirminghamUnited Kingdom
| | | | - Martin Rossor
- UCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Martin Bobrow
- Department of Medical GeneticsUniversity of CambridgeCambridgeUnited Kingdom
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Pineda C, Sandoval H. Consent for publishing case reports in Rheumatology. REUMATOLOGIA CLINICA 2018; 14:181-182. [PMID: 30075945 DOI: 10.1016/j.reuma.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Carlos Pineda
- División de Enfermedades Musculoesqueléticas y Reumáticas. Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra. Ciudad de México, México.
| | - Hugo Sandoval
- División de Enfermedades Musculoesqueléticas y Reumáticas. Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra. Ciudad de México, México
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Barbic D, Kim B, Salehmohamed Q, Kemplin K, Carpenter CR, Barbic SP. Diagnostic accuracy of the Ottawa 3DY and Short Blessed Test to detect cognitive dysfunction in geriatric patients presenting to the emergency department. BMJ Open 2018; 8:e019652. [PMID: 29549205 PMCID: PMC5857706 DOI: 10.1136/bmjopen-2017-019652] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Cognitive dysfunction (CD) is a common finding in geriatric patients presenting to the emergency department (ED). Our primary objective was to determine the diagnostic accuracy of the Ottawa 3DY (O3DY) and Short Blessed Test (SBT) as screening tools for the detection of CD in the ED. Our secondary objective was to estimate the inter-rater reliability of these instruments. METHODS We conducted a prospective cross-sectional comparative study at an inner-city academic medical centre (annual ED visit census 86 000). Patients aged 75 years or greater were evaluated for inclusion, 163 were screened, 150 were deemed eligible and 117 were enrolled. The research team completed the O3DY, SBT and Mini-Mental State Exam (MMSE) for each participant. Descriptive statistics were calculated. Sensitivity and specificity of the O3DY and SBT were calculated in STATA V.11.2 using the MMSE as our criterion standard. RESULTS We enrolled 117 patients from June to November 2016. The median ED length of stay at the time of completion of all tests was 1:40 (IQR 1:34-1:46). The sensitivity of the O3DY was 71.4% (95% CI 47.8 to 95.1), and specificity was 56.3% (46.7-65.9). Sensitivity of the SBT was 85.7% (67.4-99.9) and specificity was 58.3% (48.7-67.8). The receiver operating characteristic area under the curve was calculated for the O3DY (0.51; 95% CI 0.42 to 0.61) and SBT (0.52; 95% CI 0.43 to 0.61) relative to the MMSE. Inter-rater reliability for the O3DY (k=0.64) and SBT (k=0.63) were good. CONCLUSION In a cohort of geriatric patients presenting to an inner-city academic ED, the O3DY and SBT tools demonstrate moderate sensitivity and specificity for the detection of CD. Inter-rater reliability for the O3DY and SBT were good. Future research on this topic should attempt to derive and validate ED-specific screening tools, which will hopefully result in more robust likelihood ratios for the screening of CD in ED geriatric patients.
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Affiliation(s)
- David Barbic
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Kim
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qadeem Salehmohamed
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Kemplin
- School of Nursing, University of Tennessee Chattanooga, Chattanooga, Tennessee, USA
| | | | - Skye Pamela Barbic
- Department of Occupational Therapy and Occupational Science, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Arendts G, Love J, Nagree Y, Bruce D, Hare M, Dey I. Rates of Delirium Diagnosis Do Not Improve with Emergency Risk Screening: Results of the Emergency Department Delirium Initiative Trial. J Am Geriatr Soc 2017; 65:1810-1815. [DOI: 10.1111/jgs.14904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Glenn Arendts
- Centre for Clinical Research in Emergency Medicine; Harry Perkins Institute for Medical Research; Fiona Stanley Hospital; Murdoch Western Australia Australia
- University of Western Australia; Nedlands Western Australia Australia
| | - Jennefer Love
- Western Australian Department of Health; Perth Western Australia Australia
| | - Yusuf Nagree
- University of Western Australia; Nedlands Western Australia Australia
| | - David Bruce
- University of Western Australia; Nedlands Western Australia Australia
| | - Malcolm Hare
- Western Australian Department of Health; Perth Western Australia Australia
| | - Ian Dey
- Western Australian Department of Health; Perth Western Australia Australia
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Caterino JM, Leininger R, Kline DM, Southerland LT, Khaliqdina S, Baugh CW, Pallin DJ, Stevenson KB. Accuracy of Current Diagnostic Criteria for Acute Bacterial Infection in Older Adults in the Emergency Department. J Am Geriatr Soc 2017; 65:1802-1809. [PMID: 28440855 DOI: 10.1111/jgs.14912] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the accuracy of the Loeb criteria, emergency department (ED) physicians' diagnoses, and Centers for Disease Control and Prevention (CDC) guidelines for acute bacterial infection in older adults with a criterion standard expert review. DESIGN Prospective, observational study. SETTING Urban, tertiary-care ED. PARTICIPANTS Individuals aged 65 and older in the ED, excluding those who were incarcerated, underwent a trauma, did not speak English, or were unable to consent. MEASUREMENTS Two physician experts identified bacterial infections using clinical judgement, participant surveys, and medical records; a third adjudicated in cases of disagreement. Agreement and test characteristics were measured for ED physician diagnosis, Loeb criteria, and CDC surveillance guidelines. RESULTS Criterion-standard review identified bacterial infection in 77 of 424 participants (18%) (18 (4.2%) lower respiratory, 19 (4.5%) urinary tract (UTI), 22 (5.2%) gastrointestinal, 15 (3.5%) skin and soft tissue). ED physicians diagnosed infection in 71 (17%), but there were 33 with under- and 27 with overdiagnosis. Physician agreement with the criterion standard was moderate for infection overall and each infection type (κ = 0.48-0.59), but sensitivity was low (<67%), and the negative likelihood ratio (LR(-)) was greater than 0.30 for all infections. The Loeb criteria had poor sensitivity, agreement, and LR(-) for lower respiratory (50%, κ = 0.55; 0.51) and urinary tract infection (26%, κ = 0.34; 0.74), but 87% sensitivity (κ = 0.78; LR(-) 0.14) for skin and soft tissue infections. CDC guidelines had moderate agreement but poor sensitivity and LR(-). CONCLUSION Emergency physicians often under- and overdiagnose infections in older adults. The Loeb criteria are useful only for diagnosing skin and soft tissue infections. CDC guidelines are inadequate in the ED. New criteria are needed to aid ED physicians in accurately diagnosing infection in older adults.
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Affiliation(s)
- Jeffrey M Caterino
- Department of Emergency Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Robert Leininger
- Division of Infectious Diseases, Wexner Medical Center, The Ohio State University, Columbus, OH, The Ohio State University, Columbus, Ohio
| | - David M Kline
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Lauren T Southerland
- Department of Emergency Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Salman Khaliqdina
- Department of Emergency Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kurt B Stevenson
- Division of Infectious Diseases, Wexner Medical Center, The Ohio State University, Columbus, OH, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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Affiliation(s)
- Jennifer Moye
- a VA Boston Healthcare System and Harvard Medical School , Boston , Massachusetts , USA
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