Challenging the “jolly fat” hypothesis among older adults: High body mass index predicts increases in depressive symptoms over a 5-year period

Several investigators have observed lowered risk of depression among obese older adults, coining the “jolly fat” hypothesis. We examined this hypothesis using baseline and a 5-year follow-up body mass index, depressive symptoms, and covariates from 638 community-based older adults. High objectively measured body mass index and functional limitations predicted increased future depressive symptoms. However, symptoms did not predict future body mass index. Self-reported body mass index showed similar associations despite underestimating obesity prevalence. Results did not differ on the basis of gender. Results for this study, the first longitudinal reciprocal risk analysis between objectively measured body mass index and depressive symptoms among older adults, do not support the “jolly fat” hypothesis

Medical Student and Resident Foley Catheterization training program to decrease Post-Operative Catheter Associated Urinary Tract Infections

Objective: Determine whether a more comprehensive medical student urinary catherer training curriculum can be successful in decreasing post-operative CAUTI rates in general and vascular surgery patient populations. Primary target: Reduce post-operative UTI rates by 0.5% over 6 months Secondary targets: Achieve 100% medical student confidence in Foley catheter placement, understanding indications and contraindications to urinary catheterization. Improve objective performance of urinary catheterization skills as determined by objective clinical skills exam (OSCE) scores.https://jdc.jefferson.edu/patientsafetyposters/1000/thumbnail.jp

Association Between Physician Online Rating and Quality of Care

Background: Patients are increasingly using physician review websites to find &ldquo;a good doctor.&rdquo; However, to our knowledge, no prior study has examined the relationship between online rating and an accepted measure of quality. Objective: The purpose of this study was to assess the association between online physician rating and an accepted measure of quality: 30-day risk-adjusted mortality rate following coronary artery bypass graft (CABG) surgery. Methods: In the US states of California, Massachusetts, New Jersey, New York, and Pennsylvania&mdash;which together account for over one-quarter of the US population&mdash;risk-adjusted mortality rates are publicly reported for all cardiac surgeons. From these reports, we recorded the 30-day mortality rate following isolated CABG surgery for each surgeon practicing in these 5 states. For each surgeon listed in the state reports, we then conducted Internet-based searches to determine his or her online rating(s). We then assessed the relationship between physician online rating and risk-adjusted mortality rate. Results: Of the 614 surgeons listed in the state reports, we found 96.1% (590/614) to be rated online. The average online rating was 4.4 out of 5, and 78.7% (483/614) of the online ratings were 4 or higher. The median number of reviews used to formulate each rating was 4 (range 1-89), and 32.70% (503/1538) of the ratings were based on 2 or fewer reviews. Overall, there was no correlation between surgeon online rating and risk-adjusted mortality rate (P=.13). Risk-adjusted mortality rates were similar for surgeons across categories of average online rating (P&gt;.05), and surgeon average online rating was similar across quartiles of surgeon risk-adjusted mortality rate (P&gt;.05). Conclusions: In this study of cardiac surgeons practicing in the 5 US states that publicly report outcomes, we found no correlation between online rating and risk-adjusted mortality rates. Patients using online rating websites to guide their choice of physician should recognize that these ratings may not reflect actual quality of care as defined by accepted metrics.</p

Clinical Outcomes of Primary Stenting versus Balloon Angioplasty in Patients with Myocardial Infarction: A Meta-analysis of Randomized Controlled Trials

PURPOSE: To examine whether primary stenting as compared with primary balloon angioplasty reduces clinical outcomes in patients with myocardial infarction. METHODS: Major medical databases from 1979 to March 2002 were searched for randomized controlled trials that compared primary stenting with balloon angioplasty in patients with myocardial infarction. Two independent reviewers selected and extracted data from identified trials. The outcomes were mortality at 30 days, 6 months, and 12 months; recurrent events; and bleeding. RESULTS: Nine trials with a total of 4433 patients fulfilled the inclusion criteria. The odds ratios for mortality after stenting as compared with balloon angioplasty were 1.17 (95% confidence interval [CI]: 0.78 to 1.74) at 30 days, 1.07 (95% CI: 0.76 to 1.52) at 6 months, and 1.09 (95% CI: 0.80 to 1.50) at 12 months (P for heterogeneity Ͼ0.1 for each comparison). The odds ratios for reinfarction after stenting as compared with balloon angioplasty were 0.52 (95% CI: 0.31 to 0.87) at 30 days, 0.67 (95% CI: 0.45 to 1.00) at 6 months, and 0.67 (95% CI: 0.45 to 0.99) at 12 months; for target vessel revascularization, they were 0.46 (95% CI: 0.34 to 0.61) at 30 days, 0.42 (95% CI: 0.35 to 0.51) at 6 months, and 0.48 (95% CI: 0.39 to 0.59) at 12 months (P for heterogeneity Ͼ0.1 for all estimates with the exception of reinfarction at 12 months where P ϭ 0.08). The odds ratio for postinterventional bleeding complications after stenting as compared with balloon angioplasty was 1.34 (95% CI: 0.95 to 1.88; P for heterogeneity Ͼ0.1). CONCLUSION: Compared with balloon angioplasty, primary stenting is not associated with lower mortality, but is associated with a lower risk of reinfarction and target vessel revascularization. Am J Med. 2004;116:253-262. ©2004 by Excerpta Medica Inc. I n patients with myocardial infarction, balloon angioplasty reduces short-term death, nonfatal myocardial infarction, and stroke when compared with thrombolytic reperfusion (1). Still, the clinical efficacy of balloon angioplasty is limited by the development of late restenosis in up to 50% of patients, and by recurrent myocardial infarction in 3% to 5% of patients (2-5). Primary stenting may offer additional benefits. However, a recent meta-analysis of clinical trials found no difference in mortality and reinfarction rates among patients undergoing stenting or balloon angioplasty (6). We conducted a meta-analysis based on published and unpublished trial data to investigate whether primary stenting as compared with balloon angioplasty reduces mortality, recurrent events, and the risk of bleeding in patients with myocardial infarction. METHODS Data Search and Trial Selection We searched MEDLINE, EMBASE, Pascal, Index Medicus, the Cochrane Library, and abstracts from cardiology conferences from 1979 to March 2002 to identify all randomized controlled trials that compared primary stenting with balloon angioplasty in patients with myocardial infarction. We used the following search terms: angioplasty transluminal percutaneous coronary, stents, randomized controlled trials, clinical trials, coronary artery dilatation, transluminal coronary angioplasty, and random. We also searched all references of relevant articles for additional trials. If necessary, authors of identified trials were contacted for additional information

Medicine Posters - 2019

Medicine Posters - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1004/thumbnail.jp