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Background: Deprescribing is the planned/supervised method of dose reduction or cessation of medications that might be harmful, or no longer be beneficial. Though benefits of deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number of potentially inappropriate medications, which may potentially reduce the risk of adverse events among hospitalized older adults. With unclear evidence for deprescribing in this population, this study aimed to examine time‐to‐first unplanned healthcare utilization, which included 90‐day emergency department (ED) visits or hospital readmission and associated predictors, during a deprescribing intervention. Methods: A secondary data analysis of a clinical trial (Shed‐MEDS NCT02979353) was performed. Cox regression was used to compare the time‐to‐first 90‐day ED visit/readmission/death from hospital discharge for the intervention and control groups. Additionally, we performed exploratory analysis of predictors (comorbidities, functional health status, drug burden index (DBI), hospital length of stay, health literacy, food insecurity, and financial burden) associated with the time‐to‐first 90‐day ED visit/readmission/death. Results: The hazard of first 90‐day ED visits/readmissions/death was 15% lower in the intervention versus the control group (95% CI: 0.61–1.19, p = 0.352, respectively); however, this difference was not statistically significant. For every additional number of comorbidities (Hazard ratio (HR): 1.12, 95% CI: 1.04–1.21) and each additional day of hospital length of stay (HR: 1.04, 95% CI: 1.01–1.07) were significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the intervention group; whereas for each unit of increase in pre‐hospital DBI score (HR: 1.08 and HR 1.16, respectively) was significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the control group. Conclusions: The intervention and control groups had comparable time‐to‐first 90‐day ED visit/readmission/death during a deprescribing intervention. This finding suggests that deprescribing did not result in a higher risk of ED visit/readmission/death during the 90‐day period following hospital discharge. [ABSTRACT FROM AUTHOR]

The article presents a study which aimed to understand from clinicians and older adults ways to optimize a proposed home-based deprescribing intervention that focuses on tailoring medications based on patient's daily and life goals. Topics include clinicians included in the study, daily activities/goals for older adults, and the need to identify older adults prototypes and design flexible deprescribing interventions that can target a broad range of older adults for maximum impact.

Long-term complications are becoming more important as the survival rate of breast cancer improves. Treatment-related myeloid neoplasm is an important long-term complication in breast cancer survivors as it has a poor prognosis. We evaluated the incidence and risk factors for the development of treatment-related acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS) in patients treated with early breast cancer. We accessed the national Korean database to identify 153,565 patients diagnosed with breast cancer between January 2007 and October 2016 who underwent surgery for breast cancer. We estimated the cumulative incidence of AML/MDS and analysed the risk factors for developing AML/MDS. Of 153,575 patients, 79,321 received anthracycline-based adjuvant therapy, 14,317 received adjuvant therapy without anthracyclines and 46,657 did not receive adjuvant chemotherapy. Overall, 120 developed AML (105 in the anthracycline group, 9 in the non-anthracycline group and 6 in the control group), and 128 developed MDS (96, 9 and 23 in each group). The 10-year cumulative incidence of AML/MDS was the highest in the anthracycline group (0.221% and 0.199%), followed by the non-anthracycline group (0.122% and 0.163%) and the control group (0.024% and 0.089%). The risk of developing AML/MDS was significantly higher in patients treated with anthracyclines (hazard ratio [HR] 9.531; p < 0.0001 for AML and HR 2.559; p < 0.0001 for MDS) compared to patients in the control group. This study found that anthracycline-based adjuvant therapy significantly increased the risk of AML/MDS in Korean breast cancer patients, with the risk persisting for at least 10 years. While the cumulative incidence was low, the long-term risks of AML/MDS should be taken into account considering the poor outcomes associated with these neoplasms. • Therapy-related myeloid neoplasms are increasing as survival rates for breast cancer improve. • Anthracyclines increased the risk of AML/MDS in breast cancer patients. • Chemotherapy without anthracycline also increased the risk of AML. • Despite the low incidence, therapy-related AML/MDS should be kept in mind. [ABSTRACT FROM AUTHOR]

We evaluated the efficacy and safety of MS-10® for the treatment of menopausal symptoms. A double-blind randomized placebo-controlled clinical trial was performed in 71 premenopausal women for 4 and 12 weeks. A total of 12 individual menopausal symptom scores were assessed using the Kupperman index. MS-10 treatment effectively improved the symptoms by ∼48%. In addition, the quality of life of the women improved by 36% from four perspectives: vasomotor, psychosocial, physical, and sexual symptoms as evaluated using the menopause-specific quality of life (MenQoL) questionnaire. Our results show that MS-10 improves insulin-like growth factor-1 (IGF-1) and estrogen utilization through receptor activation, which are thought to have causative therapeutic effects on menopause and aging inhibition in women. Improvement of Enthotheline-1 (ET-1) in the blood after MS-10 intake led to an improvement in menopausal vascular symptoms. Improvements in bone formation and absorption markers such as osteocalcin, bone-specific alkaline phosphatase (BSALP), C-telopeptides of type I collagen (CTx), deoxypyridinoline (deoxyPYD), and N-telopeptides of type I collagen (NTx) in blood or urine indicate that MS-10 fundamentally improves bone health in women. By confirming the improvement of the psychological well-being index based on the improvement of stress hormone cortisol, MS-10 can solve causative psychological and physical stress-related symptoms. Moreover, various safety tests, such as those for female hormones, were confirmed. Therefore, it can be confirmed that MS-10 is a natural pharmaconutraceutical that causatively and safely improves health of women and aids in antiaging processes. [ABSTRACT FROM AUTHOR]

Background: Although the atherogenic index of plasma (AIP) based on a single measurement is a known risk factor for cardiovascular disease (CVD), little is known about whether changes in AIP over time are related to incident CVD. We aimed to determine whether AIP trajectory, which reflects homogenous AIP trends for a particular period, is associated with CVD risk. Methods: Data from 5,843 participants of the Korean Genome and Epidemiology Study (KoGES) were analyzed. The KoGES had been conducted biennially from the baseline survey (2001–2002) to the eighth follow-up survey (2017–2018). The research design specifies the exposure period from baseline to the third follow-up, designates the latent period at the fourth follow-up, and establishes the event accrual period from the fifth to the eighth follow-up. During the exposure period, we identified two trajectories: a decreasing (n = 3,036) and an increasing group (n = 2,807) using latent variable mixture modeling. Information on CVD was collected initially through the self-reporting, followed by in depth person-to-person interview conducted by a well-trained examiner. During the event accrual period, the cumulative incidence rates of CVD between the two AIP trajectory groups were estimated using Kaplan–Meier analysis with the log-rank test. Multiple Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The increasing AIP trajectory group had a significantly higher cumulative incidence rate of CVD than the decreasing AIP trajectory group. Compared to the decreasing AIP trajectory group, the increasing AIP trajectory group had a higher risk of incident CVD (HR: 1.31, 95% CI: 1.02–1.69) after adjusting for confounders. Conclusions: The risk of incident CVD increased when the AIP level showed an increasing trend and remained high over a long period. This suggests that checking and managing the trajectory of the AIP can be a preventive strategy for incident CVD. [ABSTRACT FROM AUTHOR]

Background: Although lesion counting is an evaluation method that effectively analyzes facial acne severity, its usage is limited because of difficult implementation. Objectives: We aimed to develop and validate an automated algorithm that detects and counts acne lesions by type, and to evaluate its clinical applicability as an assistance tool through a reader test. Methods: A total of 20,699 lesions (closed and open comedones, papules, nodules/cysts, and pustules) were manually labeled on 1213 facial images of 398 facial acne photography sets (frontal and both lateral views) acquired from 258 patients and used for training and validating algorithms based on a convolutional neural network for classifying five classes of acne lesions or for binary classification into noninflammatory and inflammatory lesions. Results: In the validation dataset, the highest mean average precision was 28.48 for the binary classification algorithm. Pearson's correlation of lesion counts between algorithm and ground-truth was 0.72 (noninflammatory) and 0.90 (inflammatory), respectively. In the reader test, eight readers (100.0%) detected and counted lesions more accurately using the algorithm compared with the reader-alone evaluation. Conclusions: Overall, our algorithm demonstrated clinically applicable performance in detecting and counting facial acne lesions by type and its utility as an assistance tool for evaluating acne severity. [ABSTRACT FROM AUTHOR]

The objectives of this study are to 1) describe changes in in-person communication/activity and changes in older adult technology use during the COVID-19 pandemic and 2) examine whether less in-person communication/activity mediates the relationship between pandemic-related mental health and technology use. Linear regressions (stratified by age and financial strain) and structural equation modeling were employed using a nationally representative, cross-sectional survey of 3,188 older adults from the 2020 National Health and Aging Trends Study's COVID-19 Questionairre. Older adults engaged in more technology-based activity (b = 0.24; p<.001), more technology-based health care communication (b = 0.22; p<.001), and more technology-based food acquisition (b = 0.21; p<.001) during the COVID-19 pandemic, as compared to before the pandemic. Results indicate that adults <80 years old demonstrated greater increases in technology-based activity, technology-based health communication, and technology-based food acquisition, compared to adults ≥80 years old. Change in in-person communication significantly mediated the relationship between pandemic-related mental health and technology-based communication (standardized coefficient= −0.012; p=.005), and change in in-person activity significantly mediated the relationship between pandemic-related mental health and technology-based activity (standardized coefficient= −0.017; p=.020). This study suggests that older adults are utilizing technology more, and therefore should be considered in technology design and dissemination. Technology use could be an important positive response to help those with pandemic related worries stay safely engaged with friends and family. Technologies should be produced that are modifiable for older adults with disabilities and affordable for older adults with fixed incomes. [ABSTRACT FROM AUTHOR]