CULTURAL COMMUNITY, COHESION AND CONSTRAINT: DYNAMICS OF LIFE SATISFACTION AMONG AGED FILIPINO MEN OF HAWAII

In contrast to other elderly Asian-Americans (notably Japanese Americans and Chinese Americans), relatively little is known about aged Filipino Americans (Kalish & Yuen, 1971). This may be partly a function of their population size, as the Filipino aged in America are considerably less numerous than the elderly Japanese and Chinese Americans; the 1970 U.S. Censes (Census) of the Population finds only 21,249 Filipinos aged 65 and over in the U.S., 82% of them men. In addition, low economic and political status, recency of arrival and relative lack of militancy may contribute to this inattention. Kalish and Moriwaki (1973), focusing on elderly Chinese and Japanese Americans, explained their emphasis on the former and apologized for ignoring the Filipino American aged, noting that they understood much less about them

A blood biomarker test for brain amyloid impacts the clinical evaluation of cognitive impairment

OBJECTIVE: The objective of this study was to examine clinicians\u27 patient selection and result interpretation of a clinically validated mass spectrometry test measuring amyloid beta and ApoE blood biomarkers combined with patient age (PrecivityAD® blood test) in symptomatic patients evaluated for Alzheimer\u27s disease (AD) or other causes of cognitive decline. METHODS: The Quality Improvement and Clinical Utility PrecivityAD Clinician Survey (QUIP I, ClinicalTrials.gov Identifier: NCT05477056) was a prospective, single-arm cohort study among 366 patients evaluated by neurologists and other cognitive specialists. Participants underwent blood biomarker testing and received an amyloid probability score (APS), indicating the likelihood of a positive result on an amyloid positron emission tomography (PET) scan. The primary study outcomes were appropriateness of patient selection as well as result interpretation associated with PrecivityAD blood testing. RESULTS: A 95% (347/366) concordance rate was noted between clinicians\u27 patient selection and the test\u27s intended use criteria. In the final analysis including these 347 patients (median age 75 years, 56% women), prespecified test result categories incorporated 133 (38%) low APS, 162 (47%) high APS, and 52 (15%) intermediate APS patients. Clinicians\u27 pretest and posttest AD diagnosis probability changed from 58% to 23% in low APS patients and 71% to 89% in high APS patients (p \u3c 0.0001). Anti-AD drug therapy decreased by 46% in low APS patients (p \u3c 0.0001) and increased by 57% in high APS patients (p \u3c 0.0001). INTERPRETATION: These findings demonstrate the clinical utility of the PrecivityAD blood test in clinical care and may have added relevance as new AD therapies are introduced

J+a+mak+ Rafue Uitoto Com+n+ : cambio cultural en la comunidad indígena Uitoto del corregimiento de Puerto Alegría, Amazonas

El cambio cultural que se ha dado en la comunidad indígena del corregimiento de Puerto Alegría, Amazonas. En la que se identifican los elementos culturales considerados propios por los Uitoto y cuales han sido las causas que ellos asocian con ese proceso de transformación cultural.The cultural change that has occurred in the indigenous community of the township of Puerto Alegría, Amazonas. In which the cultural elements considered own by the Uitoto are identified and what have been the causes that they associate with this process of cultural transformationTrabajador(a) SocialPregrad

The Clinical Utility of a Precision Medicine Blood Test Incorporating Age, Sex, and Gene Expression for Evaluating Women with Stable Symptoms Suggestive of Obstructive Coronary Artery Disease: Analysis from the PRESET Registry.

Background: Evaluating women with symptoms suggestive of coronary artery disease (CAD) remains challenging. A blood-based precision medicine test yielding an age/sex/gene expression score (ASGES) has shown clinical validity in the diagnosis of obstructive CAD. We assessed the effect of the ASGES on the management of women with suspected obstructive CAD in a community-based registry. Materials and Methods: The prospective PRESET (A Registry to Evaluate Patterns of Care Associated with the Use of Corus® CAD in Real World Clinical Care Settings) Registry (NCT01677156) enrolled 566 patients presenting with symptoms suggestive of stable obstructive CAD from 21 United States primary care practices from 2012 to 2014. Demographics, clinical characteristics, and referrals to cardiology or further functional and/or anatomical cardiac studies after ASGES testing were collected for this subgroup analysis of women from the PRESET Registry. Patients were followed for 1-year post-ASGES testing. Results: This study cohort included 288 women with a median age 57 years. The median body mass index was 29.2, with hyperlipidemia and hypertension present in 48% and 43% of patients, respectively. Median ASGES was 8.5 (range 1-40), with 218 (76%) patients having low (≤15) ASGES. Clinicians referred 9% (20/218) low ASGES versus 44% (31/70) elevated ASGES women for further cardiac evaluation (odds ratio 0.14, p < 0.0001, adjusted for patient demographics and clinical covariates). Across the score range, higher ASGES were associated with a higher likelihood of posttest cardiac referral. At 1-year follow-up, low ASGES women experienced fewer major adverse cardiac events than elevated ASGES women (1.3% vs. 4.2% respectively, p = 0.16). Conclusions: Incorporation of ASGES into the diagnostic workup demonstrated clinical utility by helping clinicians identify women less likely to benefit from further cardiac evaluation

Literature Review on the Effectiveness of POC Lactate Tests for Post-Operative Sepsis Discharge

Background: Every year in the USA, there are at least two million surgery-related infections; around 11% are derived from decompression spinal cord surgery. Generally, later detection of sepsis leads to significant burdens on the healthcare system; this manifests financially, temporally, and in poorer patient outcomes. “SepsisCheckToGo” is a toolkit aimed to minimize the number of sepsis complications in spinal surgery patients postoperatively; the kit would include a pulse oximeter, thermometer, and fingertip POC lactate tests to detect early sepsis signs after discharge and before the follow-up visit (which would occur around one month after initial discharge). Methods: Our team did a literature review on NIH PubMed; we aimed to gather existing information on the effectiveness of point-of-care lactate tests. After compiling relevant data, our team analyzed each article for statistics on the effectiveness of point-of-care lactate tests in the context of post-surgical usage. These findings were analyzed for any relevant information on sepsis prevention. Results: Data from many different studies showed that point-of-care finger lactate tests have reliable accuracy in blood lactate values. The tools were compared to gold-standard tests and maintained accuracy while being easy to use. However, there is a significant lack of evidence for the contribution of point-of-care lactate testing in improving rates of post-operative sepsis. Conclusion: Point-of-care lactate tests are simple for healthcare providers to use in a variety of different contexts; thus, they are reliable for quick measurements of lactate levels. Unfortunately, there is lack of evidence that this has much utility in patient diagnosis/management to cause any significant changes in patient outcome, particularly in the detection/prevention of genuine sepsis. Therefore, this tool may not be useful for the “SepsisCheckToGo” kit, as it could increase healthcare costs and add unnecessary steps to patients’ post-surgery steps without real evidence of alleviated outcomes

Quality Improvement Toward Decreasing High-Risk Medications for Older Veteran Outpatients

To examine the effectiveness of a quality improvement program to decrease prescribing of high-risk medications. DESIGN : Single cohort, pre- and postintervention. SETTING : Regional network of Department of Veterans Affairs medical facilities. PARTICIPANTS : Outpatient veterans aged 65 and older who received one or more high-risk medications and the prescribing clinicians. INTERVENTION : A two-stage intervention was implemented. First, a real-time warning message to prescribers appeared whenever one of the high-risk drugs was ordered; second, a personally addressed letter from the Chief Medical Officer asking prescribers to consider discontinuing the high-risk medication along with a copy of the Beers criteria article, a list of suggested alternatives to high-risk medications, and a list of older patients receiving the high-risk medications who had upcoming appointments with these prescribers. MEASUREMENTS : The primary outcome was the absence of prescribed high-risk medications for all patients in the cohort during the postintervention period. For a subgroup of the cohort whose prescribers received the second-stage intervention, an additional outcome was the absence of prescribed high-risk medications within the subgroup. RESULTS : Two thousand seven hundred fifty-three unique patients were identified in the cohort; 1,396 (50.7%) had high-risk medications discontinued, resulting in a significant decrease in the number of patients prescribed high-risk medications from the preintervention period to the postintervention period ( P <.001). Of the 801 patients in the subgroup, 72.0% (n=577) had high-risk medications discontinued ( P <.001). CONCLUSION : This multimethod intervention significantly decreased prescribing of high-risk medications to older patients. Further studies are needed to confirm the findings.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65236/1/j.1532-5415.2008.01772.x.pd

Life's recurring challenges and the fundamental dimensions: An integration and its implications for cultural differences and similarities

We propose that two psychological dimensions, one relevant to relationships and group life (communion, C) and the other to skill acquisition, talent, and accomplishment (agency, A), aid people in interpreting their social worlds. Moreover, our analysis demonstrates the privileged nature of the C dimension and its relative stability compared to the A dimension across contexts and cultures. In Study 1 we use a standard compilation of culturally universal practices and show that the C dimension accounts for the majority of these universals, implying that the meaning of A traits varies more across cultures than that of C traits. In Studies 2 and 3, we provide evidence for this proposal using different judgment paradigms and cultural groups. The findings indicate that there is greater similarity and consensus in how people make sense of and judge information from the C than A dimension. We discuss the findings in terms of the recurring challenges people face over time as a result of living in groups. Copyright © 2008 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61327/1/559_ftp.pd

Effects of an interactive CD-program on 6 months readmission rate in patients with heart failure – a randomised, controlled trial [NCT00311194]

BACKGROUND: Disease-management programmes including patient education have promoted improvement in outcome for patients with heart failure. However, there is sparse evidence concerning which component is essential for success, and very little is known regarding the validity of methods or material used for the education. METHODS: Effects of standard information to heart failure patients given prior to discharge from hospital were compared with additional education by an interactive program on all-cause readmission or death within 6 months. As a secondary endpoint, patients' general knowledge of heart failure and its treatment was tested after 2 months. RESULTS: Two hundred and thirty patients were randomised to standard information (S) or additional CD-ROM education (E). In (S) 52 % reached the endpoint vs. 49 % in (E). This difference was not significant. Of those who completed the questionnaire (37 %), patients in (E) achieved better knowledge and a marginally better outcome. CONCLUSION: The lack of effect on the readmission rate could be due to an insufficient sample size but might also indicate that in pharmacologically well-treated patients there is little room for altering the course of the condition. As there was some indication that patients who knew more about their condition might fare better, the place for intensive education and support of heart failure patients has yet to be determined

Clinical Implications of Referral Bias in the Diagnostic Performance of Exercise Testing for Coronary Artery Disease

BackgroundExercise testing with echocardiography or myocardial perfusion imaging is widely used to risk‐stratify patients with suspected coronary artery disease. However, reports of diagnostic performance rarely adjust for referral bias, and this practice may adversely influence patient care. Therefore, we evaluated the potential impact of referral bias on diagnostic effectiveness and clinical decision‐making.Methods and ResultsSearching PubMed and EMBASE (1990–2012), 2 investigators independently evaluated eligibility and abstracted data on study characteristics and referral patterns. Diagnostic performance reported in 4 previously published meta‐analyses of exercise echocardiography and myocardial perfusion imaging was adjusted using pooled referral rates and Bayesian methods. Twenty‐one studies reported referral patterns in 49 006 patients (mean age 60.7 years, 39.6% women, and 0.8% prior history of myocardial infarction). Catheterization referral rates after normal and abnormal exercise tests were 4.0% (95% CI, 2.9% to 5.0%) and 42.5% (36.2% to 48.9%), respectively, with odds ratio for referral after an abnormal test of 14.6 (10.7 to 19.9). After adjustment for referral, exercise echocardiography sensitivity fell from 84% (80% to 89%) to 34% (27% to 41%), and specificity rose from 77% (69% to 86%) to 99% (99% to 100%). Similarly, exercise myocardial perfusion imaging sensitivity fell from 85% (81% to 88%) to 38% (31% to 44%), and specificity rose from 69% (61% to 78%) to 99% (99% to 100%). Summary receiver operating curve analysis demonstrated only modest changes in overall discriminatory power but adjusting for referral increased positive‐predictive value and reduced negative‐predictive value.ConclusionsExercise echocardiography and myocardial perfusion imaging are considerably less sensitive and more specific for coronary artery disease after adjustment for referral. Given these findings, future work should assess the comparative ability of these and other tests to rule‐in versus rule‐out coronary artery disease

Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental study

BACKGROUND: Drug utilization review (DUR) programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing. METHODS: We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test. RESULTS: The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing. CONCLUSION: Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs