1
|
Adherence to CPAP Treatment. JAMA 2024; 331:362. [PMID: 38261050 DOI: 10.1001/jama.2023.25020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
|
2
|
Memory stirs "beneath a pleasant green carpet". J Am Geriatr Soc 2021; 69:1692-1694. [PMID: 33864380 DOI: 10.1111/jgs.17175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/30/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
|
3
|
Acute pancreatitis. Lancet 2021; 397:279-280. [PMID: 33485449 DOI: 10.1016/s0140-6736(21)00093-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022]
|
4
|
Abstract
Advancing age is associated with increasing risk of activities important for independence, such as driving and living alone. Cognitive impairment is more common with older age; financial resources and social support may dwindle. Risk, cognitive impairment, and decisional capacity each change over time. Transparent decision making and harm reduction help balance risk and safety. When a patient lacks decisional capacity, an option that considers the patient's preferences and shows respect for the person is favored. Vulnerable patients making choices that are high risk, and patients for whom others are making such choices, may require state intervention.
Collapse
|
5
|
So-called Urinary Tract Infection in the Era of COVID-19. J Am Geriatr Soc 2020; 68:1927-1928. [PMID: 32557611 PMCID: PMC7323061 DOI: 10.1111/jgs.16685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023]
|
6
|
Altered Risk for Cardiovascular Events With Changes in the Metabolic Syndrome Status. Ann Intern Med 2020; 172:707. [PMID: 32422108 DOI: 10.7326/l20-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
7
|
Dementia. Ann Intern Med 2020; 172:225-226. [PMID: 32016328 DOI: 10.7326/l19-0681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
8
|
|
9
|
Glucose Control in the Perioperative Period. JAMA 2019; 322:82. [PMID: 31265093 DOI: 10.1001/jama.2019.5833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
10
|
Excess Burden of Mental Illness and Hospitalization in Young-Onset Type 2 Diabetes. Ann Intern Med 2019; 171:78. [PMID: 31261390 DOI: 10.7326/l19-0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
11
|
Transthyretin (Prealbumin) and the Ambiguous Nature of Malnutrition. J Hosp Med 2019; 14:257-258. [PMID: 30933681 DOI: 10.12788/jhm.3144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/16/2018] [Indexed: 11/20/2022]
|
12
|
Reply to: When Asymptomatic Bacteriuria Is Not Asymptomatic or “Pseudo-Urinary Tract Infection”. J Am Geriatr Soc 2018; 66:2224. [DOI: 10.1111/jgs.15538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Indexed: 11/28/2022]
|
13
|
Dying of Thirst in Palliative Care. J Am Geriatr Soc 2018; 66:1439. [DOI: 10.1111/jgs.15403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
|
14
|
|
15
|
Response to Teng et al. J Am Geriatr Soc 2018; 66:832. [DOI: 10.1111/jgs.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Abstract
"Urinary tract infection" ("UTI") is an ambiguous, expansive, overused diagnosis that can lead to marked, harmful antibiotic overtreatment. "Significant bacteriuria," central to most definitions of "UTI," has little significance in identifying individuals who will benefit from treatment. "Urinary symptoms" are similarly uninformative. Neither criterion is well defined. Bacteriuria and symptoms remit and recur spontaneously. Treatment is standard for acute uncomplicated cystitis and common for asymptomatic bacteriuria, but definite benefits are few. Treatment for "UTI" in older adults with delirium and bacteriuria is widespread but no evidence supports the practice, and expert opinion opposes it. Sensitive diagnostic tests now demonstrate that healthy urinary tracts host a ubiquitous, complex microbial community. Recognition of this microbiome, largely undetectable using standard agar-based cultures, offers a new perspective on "UTI." Everyone is bacteriuric. From this perspective, most people who are treated for a "UTI" would probably be better off without treatment. Elderly adults, little studied in this regard, face particular risk. Invasive bacterial diseases such as pyelonephritis and bacteremic bacteriuria are also "UTIs." Mindful decisions about antibiotic use will require a far better understanding of how pathogenicity arises within microbial communities. It is likely that public education and meaningful informed-consent discussions about antibiotic treatment of bacteriuria, emphasizing potential harms and uncertain benefits, would reduce overtreatment. Emphasizing the microbiome's significance and using the term "urinary tract dysbiosis" instead of "UTI" might also help and might encourage mindful study of the relationships among host, aging, microbiome, disease, and antibiotic treatment.
Collapse
|
17
|
|
18
|
|
19
|
“Beneficial” Effects of Early Insulin? J Am Geriatr Soc 2016; 64:243-4. [DOI: 10.1111/jgs.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Treatment of Pressure Ulcers. Ann Intern Med 2015; 163:647. [PMID: 26502126 DOI: 10.7326/l15-5148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
21
|
Serum Albumin and Prealbumin in Calorically Restricted, Nondiseased Individuals: A Systematic Review. Am J Med 2015; 128:1023.e1-22. [PMID: 25912205 DOI: 10.1016/j.amjmed.2015.03.032] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Undernutrition is often suspected in patients when serum albumin or prealbumin levels are low. We asked whether these measures are indeed low in undernourished people if no inflammatory illness is present. METHODS We did a systematic review to identify otherwise healthy subjects who were severely nutrient-deprived due to poor access to food or unwillingness to eat. We excluded children and pregnant women. We tabulated available measures of nutrient intake, anthropometry, serum albumin and prealbumin, and, when available, changes in these measures during nutritional intervention. RESULTS In otherwise healthy subjects, serum albumin and prealbumin levels remained normal despite marked nutrient deprivation until the extremes of starvation, that is, body mass index <12 or more than 6 weeks of starvation. CONCLUSIONS In these otherwise healthy subjects, serum albumin and prealbumin levels are not "markers of nutritional status." The "markers" failed to identify subjects with severe protein-calorie malnutrition until extreme starvation. That is, they failed to identify healthy individuals who would benefit from nutrition support, becoming abnormal only when starvation was already obvious. In contrast, serum albumin and prealbumin levels are known to fall promptly with injury or illness regardless of nutrient intake. They are negative acute-phase reactants. When these measures are low in sick patients, this cannot be assumed to reflect nutritional deprivation. Decisions about nutrition support should be based on evidence of meaningful benefit from this treatment rather than on assessment of "nutritional markers."
Collapse
|
22
|
|
23
|
The above letter was referred to the author of the original paper, and Dr. Finucane's reply follows. J Am Geriatr Soc 2015. [DOI: 10.1111/j.1532-5415.1991.tb03587.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
24
|
|
25
|
Coherent Patients and Good Outcomes. J Am Geriatr Soc 2015; 63:203. [DOI: 10.1111/jgs.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Learning From Experience and Making Plans? J Am Geriatr Soc 2015; 63:204. [DOI: 10.1111/jgs.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
27
|
The reply. Am J Med 2014; 127:e17. [PMID: 25311070 DOI: 10.1016/j.amjmed.2014.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 11/15/2022]
|
28
|
Definitions of tremor. JAMA 2014; 312:191. [PMID: 25005664 DOI: 10.1001/jama.2014.6222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
29
|
|
30
|
Goals of palliative care. Ann Intern Med 2014; 160:656. [PMID: 24798535 DOI: 10.7326/l14-5009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
31
|
|
32
|
A tool to strengthen the older patient-companion partnership in primary care: results from a pilot study. J Am Geriatr Soc 2014; 62:312-9. [PMID: 24417565 DOI: 10.1111/jgs.12639] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the acceptability of a pre-consultation checklist for older adults who attend medical visits with an unpaid companion and to evaluate its effects on visit communication. DESIGN Randomized controlled pilot study. SETTING Academic geriatrics ambulatory clinic. PARTICIPANTS Thirty-two individuals aged 65 and older and their unpaid companions. INTERVENTION A self-administered checklist was compared with usual care. The checklist was designed to elicit and align patient and companion perspectives regarding health concerns to discuss with the doctor and stimulate discussion about the companion's role in the visit. MEASUREMENT PRIMARY OUTCOME ratio of patient-centered communication, coded from visit audiotapes. SECONDARY OUTCOMES checklist acceptability; visit duration; patient-companion verbal activity; patient- and physician-reported perspectives of the visit. RESULTS All intervention patients and companions (n = 17) completed the checklist, and all participants (n = 32 dyads) completed the study. Patients and companions stated that the checklist was easy to complete (88%) and useful (91%), and they uniformly (100%) recommended it to other patients. Communication was significantly more patient-centered in intervention group visits (ratio of 1.22 vs 0.71; P = .03). Visit duration (35.0 and 30.6 minutes; P = .34) and percentage of total verbal activity contributed by patients and companions (58.2% and 56.3% of visit statements; P = .50) were comparable in the intervention and control groups, respectively. Physicians were more likely to indicate that intervention companions "helped them provide good care to the patient" (94% vs 60%; P = .02). Intervention patients were more likely to indicate that they "better understood their doctor's advice and explanations" because their companion was present (82% vs 47%; P = .03). CONCLUSION A checklist to elicit and align perspectives of older adults and their companions resulted in enhanced patient-centered medical visit communication.
Collapse
|
33
|
|
34
|
|
35
|
Strangers in Strange Lands: The Serial Transfer of Individuals with Severe Dementia. J Am Geriatr Soc 2013; 61:1804-5. [DOI: 10.1111/jgs.12483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
The Real Research Question About Diabetes Mellitus in Older Adults. J Am Geriatr Soc 2013; 61:843. [DOI: 10.1111/jgs.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Antipsychotics in adults with schizophrenia: does sponsorship of research articles affect the findings? Ann Intern Med 2013; 158:362. [PMID: 23460064 DOI: 10.7326/0003-4819-158-5-201303050-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
38
|
Abstract
The term "plastic surgeon" is oddly uninformative, although it seems likely that most people know what plastic surgeons do. How well can a sample of individuals encountered on the street describe what geriatricians do? To answer this question, we strolled through downtown Baltimore's Inner Harbor, armed with a video camera and picture identification cards to ask the following question: "What is a geriatrician?" Two of us (PA, JY), from the Johns Hopkins Division of Geriatric Medicine and Gerontology, surveyed a convenience sample of people aged 18-80. To further enhance this survey, a video of the interviews was produced (available in online version of article). We entered this exercise having recently joined the ranks of geriatricians-prepared to improve the health and quality of care of our elderly patients. Our naive excitement at entering this noble specialty was trampled by the reality that virtually no one we interviewed knew what a geriatrician was. Answers like, "somebody who works for Ben and Jerry's ice cream" were amusing but at the same time typical and sobering. This simple survey reveals a distressing gap in the public's knowledge of the field of geriatrics and the need for better understanding of its importance to public health and individual health. After all, if people do not know what a geriatrician is, how can they support the growth of geriatrics or seek care from us?
Collapse
|
39
|
|
40
|
|
41
|
Cardiovascular mortality in women with obstructive sleep apnea with or without continuous positive airway pressure treatment. Ann Intern Med 2012; 156:838; author reply 838. [PMID: 22665819 DOI: 10.7326/0003-4819-156-11-201206050-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
42
|
Tube feeding and pressure ulcers: comment on "Feeding tubes and the prevention or healing of pressure ulcers". ARCHIVES OF INTERNAL MEDICINE 2012; 172:701-703. [PMID: 22782197 DOI: 10.1001/archinternmed.2012.1207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
43
|
Post hoc ergo propter hoc: Complications and Death after Gastrostomy Placement. J Am Med Dir Assoc 2012; 13:197-8. [DOI: 10.1016/j.jamda.2011.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 11/16/2022]
|
44
|
|
45
|
Abstract
A cornerstone of American medical ethics is the right to say, "Keep your hands off of me," to decline medical treatment. A central problem is how to decide about individuals who have become incapacitated and can no longer request or refuse potentially life-sustaining treatment. An advance directive is a formal attempt to protect people's right to autonomy when they are no longer autonomous. As such, it assumes that previously expressed wishes are precise and immutable, but many families make decisions together, and individuals may negotiate, compromise, and modify their genuine preferences, especially when novel threats arise, and the stakes are high. The current article describes a case in which two daughters overruled a patient's explicit preference to refuse life-sustaining treatment, leading to burdensome illness before death. In the end, the mother seemed to understand her children's needs and seemed willing, at least in retrospect, to have met those needs. After the death of this individual, we continued to talk with the daughters and videotaped an interview in which they shared their perspectives on the case. The daughters consented to be videotaped and to share the video with the medical community (available in online version of article). Their forceful devotion to their mother and their search in retrospect for what could have been done differently has completely changed our understanding of events. We believe that the daughters' behavior is not the indefensible breach of respect for person that it seemed to be. Their mother's true wishes might well have included a desire to help her children during her own dying. Family members' preferences are likely to be important considerations for many people, although the possibility of coercion has to be acknowledged as well. Accommodating this level of decision-making complexity is highly problematic for our understanding of advance directives.
Collapse
|
46
|
Progression from precursor disease to multiple myeloma. JAMA 2011; 305:1095; author reply 1095. [PMID: 21406644 DOI: 10.1001/jama.2011.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
47
|
Abnormal dental status? J Am Geriatr Soc 2011; 59:379. [PMID: 21314667 DOI: 10.1111/j.1532-5415.2011.03250.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
48
|
Trans-Pacific parallels. Lancet 2011; 377:208. [PMID: 21237399 DOI: 10.1016/s0140-6736(11)60048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
49
|
|
50
|
Cognitively impaired older drivers, risk assessment, and physician responsibility. JAMA 2010; 304:744; author reply 744-5. [PMID: 20716736 DOI: 10.1001/jama.2010.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|