Effect of a group-based exercise program on balance in elderly

Tatjana Bulat, Stephanie Hart-Hughes, Shahbaz Ahmed, Pat Quigley, Polly Palacios, Dennis C Werner, Philip FoulisVISN 8 Patient Safety Center, James A. Haley VA Hospital, 11605 North Nebraska Ave. Tampa, FL 33612, USAObjective: To determine the effectiveness of 8-week group functional balance training classes on balance outcomes in community-dwelling veterans at risk for falls.Design: Pre-test, post-test using retrospective data.Setting: VISN 8 Patient Safety Center at James A. Haley Veterans Hospital in Tampa, FL, USA.Participants: Fifty one community living veterans with mean age of 78 at risk for falls.Intervention: Participants received a weekly 1-hour functional balance training class for 8 weeks in a small group setting (4–5 participants).Measurements: Pre and post intervention measures included Berg Balance Scale, Limits of Stability (LOS) and modified Clinical Test of Sensory Interaction on Balance (mCTSIB).Results: Eighty four percent of the participants completed 5 or more weekly classes. Peripheral neuropathy was the most common risk factor among the participants. There was a significant improvement in the Berg (p < 0.0001) and Composite Reaction Time (p < 0.0004) after the intervention.Conclusion: An eight week group functional balance training class was safe and effective in improving balance outcomes in a cohort of elderly veterans at risk for falls.Keywords: functional balance training, exercis

Uric Acid and Acute Kidney Injury in the Critically Ill.

Rationale & objectiveUric acid is excreted by the kidney and accumulates in acute kidney injury (AKI). Whether higher plasma uric acid level predisposes to AKI or its complications is not known.Study designProspective observational cohort study.Setting & participants2 independent cohorts of critically ill patients: (1) 208 patients without AKI admitted to the intensive care unit (ICU) at Brigham & Women's Hospital between October 2008 and December 2016; and (2) 250 participants with AKI requiring renal replacement therapy (RRT) who had not yet initiated RRT enrolled in the Acute Renal Failure Trial Network (ATN) Study.ExposurePlasma uric acid level upon ICU admission and before RRT initiation in the ICU and ATN Study cohorts, respectively.OutcomesIncident AKI and 60-day mortality in the ICU and ATN Study cohorts, respectively.Analytical approachLogistic regression models were used to test the association of plasma uric acid level with incident AKI and 60-day mortality.ResultsIn the ICU cohort, median plasma uric acid level was 4.7 (interquartile range [IQR], 3.6-6.4) mg/dL, and 40 patients (19.2%) developed AKI. Higher plasma uric acid levels associated with incident AKI, but this association was confounded by serum creatinine level and was not significant after multivariable adjustment (adjusted OR per doubling of uric acid, 1.50; 95% CI, 0.80-2.81). In the ATN Study cohort, median plasma uric acid level was 11.1 (IQR, 8.6-14.2) mg/dL, and 125 participants (50.0%) died within 60 days. There was no statistically significant association between plasma uric acid levels and 60-day mortality in either unadjusted models or after multivariable adjustment for demographic, severity-of-illness, and kidney-specific covariates (adjusted OR per doubling of uric acid, 1.15; 95% CI, 0.71-1.86).LimitationsHeterogeneity of ICU patients.ConclusionsPlasma uric acid levels upon ICU admission or before RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients

Secrecy, disclosure and everything in-between: Decisions of parents of children conceived by donor insemination, egg donation and surrogacy

Abstract This study examined families where children lack a genetic and/or gestational link with their parents. A total of 101 families (36 donor insemination families, 32 egg donation families and 33 surrogacy families) were interviewed when the child was aged 7 years. Despite a shift in professional attitudes towards openness, about half of the children conceived by egg donation and nearly three-quarters of those conceived by donor insemination remained unaware that the person they know as their mother or father is not, in fact, their genetic parent. By contrast, almost all the surrogacy parents had told their child how they were born. A majority of parents who planned never to tell their child about their conception had told at least one other person. However, qualitative data indicated that to categorize families as 'secret' or 'open' is inadequate. In fact many parents engage in 'layers' of disclosure about their child's conception, both with their child and with family and friends. © 2011, Reproductive Healthcare Ltd. All rights reserved