Prolonged Critical Illness and Demoralization: Curative Factors in Hospice Care in the Age of COVID-19.

In this case report, an elderly patient with COVID-19 pneumonia and a protracted intensive care course, who was unable to wean from mechanical ventilation, was transferred to the hospice unit for ventilator withdrawal and end of life care. Although symptom management was anticipated to focus on treating acute dyspnea, conditions mandated a shift to addressing the psychological challenges associated with prolonged critical illness. The interventions typical to hospice care-patient centered, family focused, and culturally sensitive-served to alleviate psychological symptoms of demoralization and despair, contributing to an outcome that pointed beyond pulmonary pathophysiology.

Diflunisal for ATTR cardiac amyloidosis.

Transthyretin (TTR) cardiac amyloidosis is an important, often under-recognized and potentially modifiable cause of heart failure with a preserved ejection fraction. The only proven treatment is liver or combined heart/liver transplantation, which, although effective, is not suitable for the vast majority of older adults with this condition. Diflunisal, a nonsteroidal anti-inflammatory drug, can stabilize the TTR tetramer in vitro and may prevent misfolding monomers and dimers from forming amyloid deposits in the heart.

Maximum daily 6 minutes of activity: an index of functional capacity derived from actigraphy and its application to older adults with heart failure.

Objectives: To compare the correlation between the maximum 6 minutes of daily activity (M6min) and standard measures of functional capacity in older adults with heart failure (HF) with that in younger subjects and its prognostic utility.

Design: Prospective, cohort study.

Setting: Tertiary care, academic HF center.

The prevalence and impact of anergia (lack of energy) in subjects with heart failure and its associations with actigraphy.

Background: Anergia (lack of energy) is a newly delineated, criterion-based geriatric syndrome. Because heart failure (HF) is a common chronic condition among older adults and a because a cardinal symptom of HF is reduced energy, we characterized the degree of anergia in subjects with HF and evaluated its relevance to disease severity, functional performance, and quality of life.

Methods And Results: Prospective 3-month cohort study among a convenience sample of 61 subjects (61 +/- 15 years, 48% women, ejection fraction 41 +/- 16%) with New York Heart Association (NYHA) Class I-III HF were studied.

Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002.

Since publication of CDC's 1993 guidelines (CDC, Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR 1993;42[No. RR-12]:1-39), nucleic acid amplification tests (NAATs) have been introduced as critical new tools to diagnose and treat C.