12 research outputs found

    Relationship of physical activity and healthy eating with mortality and incident heart failure among community-dwelling older adults with normal body mass index

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    Aims Normal body mass index (BMI) is associated with lower mortality and may be achieved by physical activity (PA), healthy eating (HE), or both. We examined the association of PA and HE with mortality and incident heart failure (HF) among 2040 community-dwelling older adults aged ≥ 65 years with baseline BMI 18.5 to 24.99 kg/m2 during 13 years of follow-up in the Cardiovascular Health Study. Methods and results Baseline PA was defined as ≥500 weekly metabolic equivalent task-minutes and HE as ≥5 daily servings of vegetable and fruit intake. Participants were categorized into four groups: (i) PA−/HE− (n = 384); (ii) PA−/HE+ (n = 162); (iii) PA+/HE− (n = 992); and (iv) PA+/HE+ (n = 502). Participants had a mean age of 74 (±6) years, mean BMI of 22.6 (±1.5) kg/m2, 61% were women, and 4% African American. Compared with PA−/HE−, age-sex-race-adjusted hazard ratios and 95% confidence intervals for all-cause mortality for PA−/HE+, PA+/HE−, and PA+/HE+ groups were 0.96 (0.76–1.21), 0.61 (0.52–0.71), and 0.62 (0.52–0.75), respectively. These associations remained unchanged after multivariable adjustment and were similar for cardiovascular and non-cardiovascular mortalities. Respective demographic-adjusted hazard ratios (95% confidence intervals) for incident HF among 1954 participants without baseline HF were 1.21 (0.81–1.81), 0.71 (0.54–0.94), and 0.71 (0.51–0.98). These latter associations lost significance after multivariable adjustment. Conclusion Among community-dwelling older adults with normal BMI, physical activity, regardless of healthy eating, was associated with lower risk of mortality and incident HF, but healthy eating had no similar protective association in this cohort

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Digoxin and Hospital Readmission in Older Patients With Heart Failure and Reduced Ejection Fraction Receiving Beta Blockers: a Propensity Matched Study of Medicare Linked Optimize HF

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    Background: In patients with heart failure (HF), digoxin reduces the risk of 30day allcause readmission (PMCID: PMC3929967). In the current study, we examined if digoxin use is associated with lower 30day allcause readmission in hospitalized patients with HF and reduced EF (HFrEF) receiving betablockers (BBs). Methods: In the Medicarelinked OPTIMIZEHF registry, of the 10625 hospitalized patients with HFrEF (EF ≤40%), 7601 received a discharge prescription for BBs. We restricted our analysis to an inception cohort of 5307 patients who were not receiving digoxin on admission. Of these, 1075 received a new discharge prescription for digoxin. Propensity scores for digoxin use, estimated for each of the 5307 patients, were used to assemble a cohort of 1043 pairs of patients, receiving and not receiving digoxin, balanced on 46 baseline characteristics. All results are based on 2086 matched patients who had a mean (±SD) age of 75 (±11) years and EF of 25 (±8) percent, 42% were women, and 13% African American. Results: Digoxin use was associated with a lower risk of HF readmission (HR, 0.85; 95% CI, 0.730.98), allcause readmission (HR, 0.90; 95% CI, 0.800.997), combined endpoint of allcause readmission or mortality (HR, 0.90; 95% CI, 0.820.998) at 1 year, but not allcause mortality (HR, 1.03; 95% CI, 0.871.21). HRs (95% CIs) for allcause and HF readmission and allcause mortality at 30 days were 0.88 (0.731.06), 0.74 (0.550.996), and 0.79 (0.541.14), respectively. Conclusion: In older patients with HFrEF receiving BBs, discharge initiation of digoxin appear to be associated with a lower risk of allcause and HF readmission, but not of mortality

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

    No full text
    Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was coprioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries

    Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

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