The effect of systematic functional assessment and immediate rehabilitation on physical performance in acutely admitted older adults with reduced functional performance: a randomised clinical trial

<p><b>Aims:</b> We hypothesised that a systematic functional assessment in a short stay unit at an emergency department (ED) and/or immediate rehabilitation after discharge will result in sustained or improved physical performance in comparison to a regimen in which neither of these interventions is offered.</p> <p><b>Methods:</b> A two-way factorial randomised clinical trial was completed in an ED and the primary sector. We enrolled 336 nonsurgical patients of 65 years or older, scoring eight or less in the 30-s chair stand test. The interventions were: 1) Usual assessment; 2) Usual rehabilitation; 3) A systematic functional assessment performed within 48 h of admission, in order to identify those with loss of functional mobility, or at risk thereof; and 4) Immediate rehabilitation initiated within five days after discharge. The primary outcome was the 30-s chair stand test three weeks after admission. Secondary outcome measures were Barthel, EQ-5D-3L, and length of stay (LOS).</p> <p><b>Results:</b> An intention-to-treat analysis showed no significant difference in the 30-s chair stand test score nor when analysed by groups or by intervention. The changes were approximately 1% when compared to the reference. No significant differences were found in the secondary outcomes. A per-protocol analysis showed that 99% had received assessment as assigned; however, the extent of mobilisation during hospitalisation was not disclosed. Of the patients, 48% were received the post-discharge rehabilitation they were assigned to.</p> <p><b>Conclusions:</b> Systematic functional assessment and immediate rehabilitation led to no significant differences in physical performance. The study was weakened by the incomplete implementation of mobilisation during hospitalisation and low adherence to protocol on immediate rehabilitation.Implications for rehabilitation</p><p>A systematic functional assessment within the first 48 h of hospital admission is suitable for the identification of older adults in need of post-discharge rehabilitation when compared to usual assessment.</p><p>To sustain physical performance in older adults <i>during acute hospitalisation</i>, further research focusing on mobilisation or physical activation is needed in older adults with a loss of functional mobility, or at risk thereof.</p><p>Further research focusing on physical activation during transition is needed to ameliorate tiredness and inactivity in older adults <i>after acute hospitalisation.</i></p><p></p> <p>A systematic functional assessment within the first 48 h of hospital admission is suitable for the identification of older adults in need of post-discharge rehabilitation when compared to usual assessment.</p> <p>To sustain physical performance in older adults <i>during acute hospitalisation</i>, further research focusing on mobilisation or physical activation is needed in older adults with a loss of functional mobility, or at risk thereof.</p> <p>Further research focusing on physical activation during transition is needed to ameliorate tiredness and inactivity in older adults <i>after acute hospitalisation.</i></p

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present