Search

OBJECTIVES:. To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES:. A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION:. Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION:. Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS:. One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0–27.8%), 37.3% (95% CI: 34.6–40.1%), 51.6% (95% CI: 46.1–57.0%), 66.1% (95% CI: 59.7–72.2%), and 58.0% (95% CI: 46.9–68.9%), respectively. MV (52.7%, 95% CI: 47.5–58.0% vs 31.3%, 95% CI: 16.1–48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1–73.0% vs 50.3%, 95% CI: 42.4–58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS:. We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.

Background: Naturally occurring retirement communities (NORCs) are geographical areas that have naturally become home to a large concentration of older adults. This density means that NORCs have the potential to become a pillar for aging in place strategies, but at present, there is limited data on residents and their health needs. Our objective was to describe and compare the health and healthcare use of older adults living in high-rise NORC buildings to those in all other housing types in the community., Methods: We conducted a population-based descriptive study of community-dwelling older adults aged ≥65 years by linking a provincial NORC registry in Ontario, Canada with health administrative records. Individuals were classified as NORC residents if their residential postal code on January 1, 2020 matched the NORC registry. Sociodemographic, clinical, and healthcare use characteristics were compared by NORC status using standardized differences (STD) and stratified by rurality, and further by age and sex in urban settings., Results: Overall, 219,995 (7.7%) of 2,869,706 older adults were NORC residents. Compared to community-dwelling older adults, NORC residents were older (mean 77.4 vs 74.6 years; STD 0.34), and more were female (61.8% vs 52.2%; STD 0.19) and had low income (16.0% vs 9.3%; STD 0.11). NORC residents also had more active chronic conditions (mean 1.9 vs 1.5; STD 0.27), medications (mean 3.4 vs 2.8; STD 0.21), home care use (15.3% vs 9.8%; STD 0.17), and primary care visits (mean 9.7 vs 7.6 visits in prior 2 years; STD 0.22). Findings were robust across rurality, age, and sex., Conclusions: Our findings suggest that NORC residents have greater health needs than other older adults living in the community and underscore NORCs as important targets for equity-focused strategies to support aging in place., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

A 79-year-old woman presented with subacutely worsening headaches and right arm weakness. MRI showed diffuse pachymeningeal enhancement. Serologic workup revealed elevated erythrocyte sedimentation rate and C-reactive protein. CSF demonstrated elevated opening pressure, a lymphocytic pleocytosis, and elevated protein. We discuss our differential diagnosis and distinguish between 2 overlapping clinical entities.

Objectives: Medical Assistance in Dying (MAiD) was legalized in Canada in 2016, necessitating greater education and training in MAiD for physicians and nurse practitioners. To meet this need, the Canadian MAiD Curriculum (CMC) was developed to offer a nationally accredited, comprehensive, bilingual, hybrid (synchronous and asynchronous) educational program to support and enhance the practice of MAiD in Canada., Methods: This work describes the process of developing the CMC, including its guiding principles and framework. The CMC was guided by constructivism and adult learning theory, preliminary literature review, 5 key principles based on a needs assessment survey, as well as consultation with diverse partners., Results: Seven modules were developed: (1) foundations of MAiD in Canada, (2) clinical conversations that includes MAiD, (3) how to do an MAiD assessment, (4) capacity and vulnerability, (5) providing MAiD, (6) navigating complex cases with confidence, and (7) MAiD and mental disorders. An eighth topic on clinician resilience and reflection was woven into each of the 7 modules., Conclusion: This curriculum ensures that consistent information is available to healthcare providers concerning the practice of MAiD in Canada. To ensure sustainability, the CMC will continue to be updated alongside the evolution of MAiD policy and services in Canada., Competing Interests: Authors and institutions report honoraria and payment for their work on this project. ML also reports payment for providing expert testimony related to MAiD. All other authors declare no other conflict of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Naturally occurring retirement communities (NORCs) are geographic areas (generally high-rise buildings or neighborhoods) that have a high concentration of individuals 65 years and older. Supportive service programs in NORCs can address resident needs and delay nursing home (NH) admission but understanding what factors are associated with NORC residents requiring NH admission is needed to tailor such programs. Our aim was to examine individual- and neighborhood-level factors associated with NH wait-list status in NORC residents in Ontario., Methods: We conducted a population-based, cross-sectional study of Ontario adults 65 years of age or older living in a NORC building as of January 1, 2020, by linking a provincial registry of NORC high-rise buildings with health administrative data. Older adults were classified as being on the NH wait-list if they had an open application for a NH on the index date. We conducted a multilevel logistic regression analysis using generalized estimating equations to determine individual- and neighborhood-level factors associated with NH wait-list status, including sociodemographic, clinical, healthcare use, and building factors. We explored the role of sex and age through stratification by sex (male, female) and age (65-80 and 80+ years)., Results: Among 220,864 NORC residents, 4710 individuals (2.1%) were on the NH wait-list. Female sex, older age, immigrant status, dementia diagnosis, receiving homecare, multimorbidity, and polypharmacy (five or more unique drug names) were associated with an increased odds of wait-list status. Several neighborhood-level variables were associated with a significantly increased likelihood of wait-list status, including low income, high dependency, high ethnic diversity, and living in a building with supports., Conclusion: NORC supportive service programs can be tailored to account for the factors associated with NH wait-list status, allowing NORC residents who are living in the community to age in their desired place and achieve optimal health outcomes., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Introduction: Fatigue is a common yet not frequently explored complication of diabetes. There are fewer studies available on the impact of diabetes on the severity of fatigue and the functional status of patients., Methods: Fifty individuals meeting the inclusion criteria were included. The individuals were divided into two groups: group A (diabetic elderly individuals) and group B (nondiabetic age and gender-matched individuals). An observational analytical study was conducted. Outcome measures used were: fatigue severity scale (FSS), lower extremity functional scale (LEFS), 6-minute walk distance (6MWD), and 30-second chair stand test. SPSS 16 was used to analyze data., Results: As per the normality test, a between-group comparison of fatigue severity scale (FSS) score, chair stand test score, and LEFS score was carried out by a nonparametric Mann-Whitney test, which showed a statistically significant difference between the groups ( P  < 0.05). Between-group comparison of 6MWD was carried out by parametric unpaired t test. The results showed a statistically significant difference in the distance walked by both groups., Conclusion: Higher levels of fatigue and impaired functional status along with reduced strength and function of lower limbs was seen in elderly patients with type 2 diabetes Inclusion of symptom assessment and strategies to reduce the burden of fatigue in diabetes patient should be incorporated., Competing Interests: None., (© 2024 The Authors. Aging Medicine published by Beijing Hospital and John Wiley & Sons Australia, Ltd.)

Background: It is unknown whether the annual number of primary care physician (PCP) unique outpatient assessments, which we refer to as clinical volume, translates into better cardiovascular preventive care. We examined the relationship between PCP outpatient clinical volumes and cholesterol testing and major adverse cardiovascular event rates among guideline-recommended eligible patients., Methods: This was a retrospective cohort study conducted as part of the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, a population-based cohort of almost all adult residents of Ontario, Canada, followed from 2008 to 2012. For each clinical volume quintile, we compared cholesterol testing and major adverse cardiovascular events, defined as time to first event of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke., Results: The 10,037 PCPs evaluated had an annualized median volume of 2303 clinical encounters (IQR 1292-3680). Among 4,740,380 patients, 84% underwent guideline-concordant cholesterol testing at least once over 5 years, ranging from 73% with the lowest clinical volume quintile physicians to 86% with the highest. After multivariable adjustment, there was a 10.5% relative increase in the probability of cholesterol testing for every doubling of clinical volumes (95% CI 9.7-11.4; P < 0.001). Patients treated by the lowest volume quintile physicians had the highest rate of major adverse cardiovascular outcomes (compared with the highest volume quintile physicians: adjusted HR 1.15, 95% CI 1.10-1.21; P < 0.001)., Conclusions: Patients of physicians with the lowest clinical volumes received less frequent cholesterol testing and had the highest rate of incident cardiovascular events. Further research investigating the drivers of this relationship is warranted., (Copyright © 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Musculoskeletal disorders (MSDs) are conditions that are caused and/or aggravated by work. The most important reason behind work-related musculoskeletal disorder is abnormal and/or stressful position of joints while working. Physiotherapists are very much prone to develop work-related musculoskeletal disorders, especially while treating neurologically challenged patients. Postural assessment is a key to identify a person at risk of developing work-related musculoskeletal disorders. Proper assessment of some of the areas like neck, spine, upper and lower extremities is the key to get risk factor analysis. REBA (Rapid Entire Body Assessment) is a tool which can be used on field to quantify areas of the body which are more likely to develop work-related musculoskeletal disorders., Aims: To find out risk of MSDs among physiotherapists treating neurologically challenged patients., Study Setting and Design: At neuro-paediatric department of SBB College of Physiotherapy, an observational pilot study was conducted., Materials and Methods: Photographs of the participants were captured with their consent through smart phone camera during treatment of different patients both adult and paediatric. Selected postures were analysed and quantified based on the REBA sheet., Statistical Analysis: Descriptive analysis was done based on areas at higher risk for MSDs according to REBA sheet., Results: More than 50% of participants were at moderate to high risk of developing MSDs., Conclusion: Physiotherapists working with neurological patients were found to be at high to medium risk of work-related musculoskeletal disorders. There is a need to assess MSD risk in detail in all physiotherapists., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Occupational and Environmental Medicine.)

Background The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial decreased major adverse cardiovascular events with very low-dose rivaroxaban and aspirin in patients with coronary artery disease and peripheral artery disease. We examined the eligibility and potential real-world impact of this strategy on the COMPASS-eligible population. Methods and Results COMPASS eligibility criteria were applied to the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) registry, a population-based cohort of Ontario adults. We compared 5-year major adverse cardiovascular events and major bleeding rates stratified by COMPASS eligibility and by clinical risk factors. We applied COMPASS trial rivaroxaban/aspirin arm hazard ratios to estimate the potential impact on the COMPASS-eligible cohort. Among 362 797 patients with coronary artery disease or peripheral artery disease, 38% were deemed eligible, 47% ineligible, and 15% indeterminate. Among eligible patients, a greater number of risk factors was associated with higher rates of cardiovascular outcomes, whereas bleeding rates increased minimally. Over 5 years, applying COMPASS treatment effects to eligible patients resulted in a 2.4% absolute risk reduction of major adverse cardiovascular events and a number needed to treat of 42, and a 1.3% absolute risk increase of major bleeding and number needed to harm (NNH) of 77. Those with at least 2 risk factors had a 3.0% absolute risk reduction of major adverse cardiovascular events (number needed to treat =34) and a 1.6% absolute risk increase of major bleeding (number needed to harm =61). Conclusions Implementation of very-low-dose rivaroxaban therapy would potentially impact ≈ $$ \approx $$ 2 in 5 patients with atherosclerotic disease in Ontario. Eligible individuals with ≥ $$ \ge $$ 2 comorbidities represent a high-risk subgroup that may derive the greatest benefit-to-risk ratio. Selection of patients with high-risk predisposing factors appears appropriate in routine practice.

The incidence of new onset visual disturbances in emergency departments across the country is frequent. A detailed history of events and thoughtful physical examination may produce a diagnosis; however, atypical cases may require further diagnostic testing to explain symptoms. We present a case of presumed increased intracranial pressure with atypical findings on diagnostic testing, which allowed our team to explore a broader differential diagnosis. This clinical reasoning article will benefit students, residents, and attendings alike to continue to uncover etiologies for symptoms of increased intracranial pressure and review differential diagnoses in similar presentations., (© 2022 American Academy of Neurology.)

We describe a case with torsional deviation of the eyes from a brainstem lesion. Torsional eye movement refers to changes in the position of the eyes in the roll plane around the visual axis. When the head is tilted laterally (that is, rolled toward the shoulder), the eyes roll in the opposite direction as part of the torsional vestibulo-ocular reflex known as the ocular counter-roll. Pathologies that affect the otolith-ocular pathway can lead to a torsional deviation of the eyes as part of the ocular tilt reaction (OTR) that also causes vertical deviation of the eyes (skew deviation) and head tilt. Lesions caudal to the pontomedullary junction (such as the labyrinth, eighth cranial nerve, or vestibular nucleus) result in an OTR with ipsiversive torsional deviation, whereas lesions rostral to the junction result in an OTR with contraversive torsional deviation. Furthermore, torsional deviation of the eyes in the OTR is conjugate (incyclotorsion in the higher eye and excyclotorsion in the lower eye), whereas torsional deviation from ocular palsy in peripheral lesions is disconjugate (e.g., exyclotorsion only in the higher eye with superior oblique palsy). Therefore, the pattern of torsional eye deviation can be helpful in localizing the lesion. Several techniques including fundus photography, double Maddox rod testing, optical coherence tomography, and video-oculography are used to measure torsional eye position., (© 2022 American Academy of Neurology.)

Purpose: Validation of artificial intelligence (AI) algorithms in digital pathology with a reference standard is necessary before widespread clinical use, but few examples focus on creating a reference standard based on pathologist annotations. This work assesses the results of a pilot study that collects density estimates of stromal tumor-infiltrating lymphocytes (sTILs) in breast cancer biopsy specimens. This work will inform the creation of a validation dataset for the evaluation of AI algorithms fit for a regulatory purpose. Approach: Collaborators and crowdsourced pathologists contributed glass slides, digital images, and annotations. Here, "annotations" refer to any marks, segmentations, measurements, or labels a pathologist adds to a report, image, region of interest (ROI), or biological feature. Pathologists estimated sTILs density in 640 ROIs from hematoxylin and eosin stained slides of 64 patients via two modalities: an optical light microscope and two digital image viewing platforms. Results: The pilot study generated 7373 sTILs density estimates from 29 pathologists. Analysis of annotations found the variability of density estimates per ROI increases with the mean; the root mean square differences were 4.46, 14.25, and 26.25 as the mean density ranged from 0% to 10%, 11% to 40%, and 41% to 100%, respectively. The pilot study informs three areas of improvement for future work: technical workflows, annotation platforms, and agreement analysis methods. Upgrades to the workflows and platforms will improve operability and increase annotation speed and consistency. Conclusions: Exploratory data analysis demonstrates the need to develop new statistical approaches for agreement. The pilot study dataset and analysis methods are publicly available to allow community feedback. The development and results of the validation dataset will be publicly available to serve as an instructive tool that can be replicated by developers and researchers., (© 2022 The Authors.)

Competing Interests: There are no conflicts of interest.

Objective: This qualitative study explored occupational therapy practitioners' perspectives about integrating principles from the field of disability studies (DS) into clinical education and practice., Methods: After a conference presentation about DS, three simultaneous focus groups were conducted with 27 occupational therapy practitioners. A constant comparative, grounded-theory approach was used to identify themes across groups., Results: Identified themes included convergences and divergences between the profession of occupational therapy and the field of disability studies, influence of perspectives of disability on service delivery, clinician navigation of systemic barriers, and incorporation of DS-aligned intervention strategies into practice., Conclusion: Despite points of alignment, occupational therapy has not fully addressed DS critiques. Practitioners recognized professional, systemic, and societal barriers and the need for more educational experiences, resources, and professional reflexivity and dialogue to inform the integration of DS concepts into practice., (Copyright © 2019 by the American Occupational Therapy Association, Inc.)

Introduction: Tobacco use usually starts in the adolescent age group and continues in adulthood. This study's aim was to identify knowledge regarding the adverse effects of tobacco and areca-nut use among high school children of Ahmedabad, India., Methods: An anonymous self-administered close-ended questionnaire was designed for the study. Principals of 9 schools, 3 municipal and 6 government-aided, were approached and written informed consent was obtained. A total of 3055 students studying in grades 7-12 were included. Data were analyzed using Microsoft Excel and SPSS 16.0. Chi-squared test was applied to investigate any differences between the responses of consumers and non-consumers, while Cramer's V was applied to analyze the strength of association between the awareness of ill-effects and tobacco product consumption., Results: Of the 3055 children, 3% felt that tobacco use was definitely not harmful to health while 84% felt that it was. In all, 65% of respondents were aware that tobacco use caused cancer, 7% answered that it caused breathing problems, 5% said it caused heart problems, 0.3% answered that it caused paralysis, 4.3% felt it caused no health problems, whereas 18% thought that it caused multiple issues. With regards to the role of media, 78% had seen many anti-smoking warnings in the media, 15% had seen a few, 5% had seen none. There was a statistically significant difference between the tobacco users and and non-users with regards to exposure to media (p<0.001), discussions in class (p<0.001) and general awareness (p<0.001), but a weak association between awareness and tobacco consumption was identified (p<0.05)., Conclusions: Awareness about the harmful effects of tobacco is high among school children of Ahmedabad, though use may still be prevalent., Competing Interests: Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2018 Rangey P. S.)

Context: Areca nut is chewed by itself and in various scented preparations. Areca nut chewing is widely practiced in many parts of Asia, including India. Users often consider it harmless and report a sense of well-being, but evidence has shown that it is far from harmless and can have multiple oral health implications such as oral submucosal fibrosis posing difficulty in opening mouth and carcinogenesis. Studies in India have reported increasing prevalence of this habit among schoolgoing children. The objectives of the study were to find the effect of areca nut chewing on mouth opening, compare it with the children not having this habit, and to find correlation between maximal mouth opening (MMO) and months of areca nut chewing., Aims: The aim of this study is to find the effect of areca nut chewing on MMO in schoolgoing children in Ahmedabad., Settings and Design: An observational analytical study was conducted across various schools of Ahmedabad., Subjects and Methods: A total of eighty male students of 12-14-year-old were included in the study. Group A included children having the habit of eating areca nut for 6 months or more, and Group B had children who did not have the habit of areca nut chewing. Children who had just started eating for <6 months were excluded from the study. MMO was calculated as distance from the edge of the upper incisor teeth to the edge of the lower incisor teeth using a calibrated fiber ruler., Statistical Analysis Used: Statistical analysis was performed by SPSS software version 20.0, with level of significance set at 5%., Results: Mean and standard deviation of MMO for Group A was 3.69 ± 0.5 cm and for Group B was 4.46 ± 0.4 cm. Statistically significant difference was found using Mann-Whitney U-test with U = 239.500 and P = 0.0001. Pearson's coefficient r = -0.623 and P = 0.0001 showed moderate correlation between months of chewing and MMO. The mean duration of chewing was found to be 1.5 years., Conclusion: There is difference in MMO between children chewing areca nut and not chewing it with a moderate correlation between months of eating areca nut and MMO., Competing Interests: There are no conflicts of interest.