Improving Function in Older Adults With Hospital-Associated Deconditioning: Lessons Learned Comparing a Randomized Controlled Trial to Real World Practice.

Objective: The optimal approach for improving physical function following acute hospitalization is unknown. A recent clinical trial of home health physical therapy compared a high-intensity, progressive, multi-component (PMC) intervention to enhanced usual care (EUC). While both groups improved in physical function, no between-group differences were observed.

Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Hospitalization: Randomized Clinical Trial.

Objectives: Reduced physical function following hospitalization places older adults at risk of adverse health events. Many older adults receive home health physical therapy to reverse their deconditioning; however, optimal approaches to improve physical function are currently not known. This study aimed to evaluate the effectiveness of a home health care approach comprised of high-intensity exercise, enhanced care transition, and protein supplementation.

Exploring Dual-Task Performance Relationships for Veterans with Lower-Limb Amputation.

Adults with lower-limb (LL) amputation have difficulty dual-tasking which may elicit falls and is required for instrumental activities of daily living (IADLs). The purpose of this study was to explore the relationships between dual-task performance, falls, and IADLs for Veterans with LL amputation. A cross-sectional study was completed with dual-task performance, retrospective fall reporting, and participation in IADLs.

Incorporating staffing instability in the nursing home Five-Star Staffing Composite.

Staffing is an important indicator of nursing home quality and resident health outcomes. The Five-Star staffing ratings in Nursing Home Care Compare, the report card published by the Centers for Medicare and Medicaid Services, is based on average hours per resident-day and turnover measures. Studies have shown that a new measure of staffing instability, capturing day-to-day staffing variation, is associated with resident outcomes and provides additional information about quality not reflected in the current Five-Star staffing ratings.

Population Pharmacokinetics of Meropenem Across the Adult Lifespan.

Background And Objective: We conducted an opportunistic pharmacokinetic study to evaluate the population pharmacokinetics of meropenem, an antimicrobial commonly used to treat Gram-negative infections in adults of different ages, including older adults, and determined optimal dosing regimens.

Methods: A total of 99 patients were included. The population pharmacokinetic models used had two compartments: zero-order input and linear elimination.

Proximal Muscle Resistance Training to Improve Walking in People With Multiple Sclerosis: A Pilot Study.

Background And Purpose: This pilot study examined the feasibility of a proximal muscle resistance training program to improve walking in people with multiple sclerosis using a combination of in-person, virtual, and independent exercise sessions.

Methods: People with multiple sclerosis (Expanded Disability Status Scale Score is <6.0) were recruited to a study of resistance training exercises targeting hip abduction and trunk muscles for 10 weeks.

Patient-psychologist telemedicine interactions in an intensive care unit recovery clinic: Qualitative secondary analysis.

Objectives: We aimed to describe the content of patient-psychologist mental health related dialogues during a telemedicine intensive care unit recovery clinic visit.

Research Methodology/design: Qualitative descriptive study nested within a randomized controlled pilot trial to assess a telemedicine intensive care unit recovery clinic feasibility and preliminary efficacy. Participants included adults hospitalized with sepsis and/or respiratory failure.

Symptom prevalence in patients with advanced heart failure and its association with quality of life and activities of daily living.

Background: Quality of life (QOL) and functional status are two key outcomes for patients with advanced heart failure (HF). We examined the association of eleven symptoms with QOL and functional status impairment in patients with advanced HF.

Methods And Results: This was a retrospective analysis of baseline data from a multi-center, cluster-randomized controlled trial (NCT01459744) which enrolled patients with an implanted cardioverter-defibrillator and advanced HF at high-risk for mortality.

Protocol for remote Tai Chi and wellness for PTSD and pain in veterans.

Posttraumatic stress disorder (PTSD) is a debilitating psychological disorder that is associated with a host of psychosocial and health ailments, including chronic pain. Although evidence-based psychological therapies are recommended as first-line PTSD treatments, a large proportion of individuals either drop out and/or do not achieve a therapeutic response. PTSD is increasingly recognized as a systemic disorder that impacts both physical and mental health, and mind-body approaches, such as Tai Chi, have shown promise.

Long COVID elevated MMP-9 and release from microglia by SARS-CoV-2 Spike protein.

Objective: Long COVID is a major health concern because many patients develop chronic neuropsychiatric symptoms, but the precise pathogenesis is unknown. Matrix metalloproteinase-9 (MMP-9) can disrupt neuronal connectivity and be elevated in patients with long COVID.

Methods: In this study, MMP-9 was measured in the serum of long COVID patients and healthy controls, as well as in the supernatant fluid of cultured human microglia cell line stimulated by recombinant severe acute respiratory syndrome coronavirus 2 Spike protein, as well as lipopolysaccharide (LPS) and neurotensin (NT) used as positive controls.

Hospital 4Ms: Documentation and association with patient characteristics.

Background: For the thousands of health systems recognized as Age-Friendly, considerable progress has been made to integrate 4Ms into clinical care. This study evaluated associations between 4Ms documentation and patient characteristics in an inpatient setting.

Methods: In this prospective cohort, hospitalizations included were from patients in an Acute Care for Elders (ACE) unit where the 4Ms were adopted and implemented.

Interpretable machine learning uncovers epithelial transcriptional rewiring and a role for Gelsolin in COPD.

Transcriptomic analyses have advanced the understanding of complex disease pathophysiology including chronic obstructive pulmonary disease (COPD). However, identifying relevant biologic causative factors has been limited by the integration of high dimensionality data. COPD is characterized by lung destruction and inflammation, with smoke exposure being a major risk factor.

Fibroblast-derived extracellular vesicles contain SFRP1 and mediate pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a lethal chronic lung disease characterized by aberrant intercellular communication, extracellular matrix deposition, and destruction of functional lung tissue. While extracellular vesicles (EVs) accumulate in the IPF lung, their cargo and biological effects remain unclear. We interrogated the proteome of EV and non-EV fractions during pulmonary fibrosis and characterized their contribution to fibrosis.

Teatime: epigallocatechin gallate targets fibroblast-epithelial cell crosstalk to combat lung fibrosis.

Epigallocatechin gallate (EGCG) is a polyphenol plant metabolite abundant in tea that has demonstrated antifibrotic properties in the lung. In this issue of the JCI, Cohen, Brumwell, and colleagues interrogated the mechanistic action of EGCG by investigating lung biopsies of patients with mild interstitial lung disease (ILD) who had undergone EGCG treatment. EGCG targeted the WNT inhibitor SFRP2, which was enriched in fibrotic fibroblasts and acted as a TGF-β target, with paracrine effects leading to pathologic basal metaplasia of alveolar epithelial type 2 cells.

The use of dual β-lactams to restore susceptibility of complex.

Background: The complex (MAC) are non-tuberculous mycobacteria responsible for chronic and debilitating conditions. Guideline-recommended therapy for MAC is a combination of clarithromycin/azithromycin, ethambutol and a rifamycin. However, culture conversion rates with this regimen are 67%.