Geriatría HGG Journal Club
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Atención sanitaria, coronavirus y residencias – EnR?|

Atención sanitaria, coronavirus y residencias – EnR?| | Geriatría HGG Journal Club | Scoop.it

Las medidas que se plantean para el futuro son conocidas, se han discutido, e incluso evaluado, y ya no admiten demora. Se ha insistido en la integración/coordinación de los servicios sociales y sanitarios, es decir, la colaboración entre la atención primaria y las residencias, así como en los centros de día y la ayuda domicilio, pero también entre las residencias/centros de día y los servicios de centros sanitarios especializados y hospitales; así como el desarrollo efectivo de los servicios de geriatría hospitalarios (Fundación Edad & vida, 2015). La telemedicina podría generar un eficiente uso de los recursos sanitarios y sociales y generar algunos ahorros.

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Noninsulin Diabetes Therapies in Older Adults

Noninsulin Diabetes Therapies in Older Adults | Geriatría HGG Journal Club | Scoop.it

Diabetes risk increases with age due to changes in β-cell function and increased insulin resistance and is one of the most common chronic medical conditions in the elderly.
Diabetes management in this population requires a multidisciplinary, patient-centric approach due to wide heterogeneity in patients’ health and functional capacities.
Meticulous assessment of each patient before formulating a regimen and thorough patient  education are keys to success in achieving glycemic goals, which should be individualized.
           

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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission | Geriatría HGG Journal Club | Scoop.it

The number of older people, including those living with dementia, is rising, as younger age mortality declines. However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health
care, and lifestyle changes. Overall, a growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.

Sergio Ariño Blascos insight:

Probablemente unos de los artículos de revisión más importantes de este año. Una revisión exhaustiva que enfatiza la necesidad de un abordaje multidisciplinar y coordinado en la atención a la demencia. Residentes "it is a must"

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Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults: A Living Systematic Review: Annals of Internal Medicine: Vol 173, No 3

Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults: A Living Systematic Review: Annals of Internal Medicine: Vol 173, No 3 | Geriatría HGG Journal Club | Scoop.it
This living systematic review summarizes current evidence regarding whether the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers increases risk for SARS-CoV-
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Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper

Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper | Geriatría HGG Journal Club | Scoop.it

The number of older people dying in long-term care facilities (LTCFs) is increasing globally, but care quality may be variable. A framework was developed drawing on empirical research findings from the Palliative Care for Older People (PACE) study and a scoping review of literature on the implementation of palliative care interventions in LTCFs.
The PACE study mapped palliative care in LTCFs in Europe, evaluated quality of end-of-life care and quality of dying in a cross-sectional study of deceased residents of LTCFs in 6 countries, and undertook a cluster-randomized control trial that evaluated the
impact of the PACE Steps to Success intervention in 7 countries.

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Drug treatments for covid-19: living systematic review and network meta-analysis | The BMJ

Drug treatments for covid-19: living systematic review and network meta-analysis | The BMJ | Geriatría HGG Journal Club | Scoop.it
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Treatment of Chronic Lymphocytic Leukemia | NEJM

Treatment of Chronic Lymphocytic Leukemia | NEJM | Geriatría HGG Journal Club | Scoop.it
Chronic Lymphocytic Leukemia Treatment of CLL, the most common leukemia in the West, has undergone a revolution in the past few years with the development of agents that target signaling kinase
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Caring for Women Who Are Planning a Pregnancy, Pregnant, or Postpartum During the COVID-19 Pandemic | Infectious Diseases | JAMA | JAMA Network

Caring for Women Who Are Planning a Pregnancy, Pregnant, or Postpartum During the COVID-19 Pandemic | Infectious Diseases | JAMA | JAMA Network | Geriatría HGG Journal Club | Scoop.it
This JAMA Insights Clinical Update discusses what is known about the epidemiology and effects of SARS-CoV-2 infection in pregnancy, and summarizes Centers for Disease Control and Prevention (CDC) and professional organization (AAP and ACOG) recommendations for care of pregnant women with COVID-19.
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Stroke

Stroke | Geriatría HGG Journal Club | Scoop.it

Care for patients with stroke has transformed over the past 5 years, particularly with reperfusion therapies for ischaemic stroke and improved secondary prevention, although large gaps between evidence and practice still exist. Interventions for intracerebral haemorrhage might similarly revolutionise our approach to that condition in the future. There is reinvigorated interest in the fields of cytoprotection and recovery enhancement.

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Monoclonal Antibodies for Prevention and Treatment of COVID-19 | Infectious Diseases | JAMA | JAMA Network

Monoclonal Antibodies for Prevention and Treatment of COVID-19 | Infectious Diseases | JAMA | JAMA Network | Geriatría HGG Journal Club | Scoop.it
This Viewpoint discusses the potential role of neutralizing monoclonal antibodies (MAbs) as a treatment for coronavirus disease 2019 (COVID-19) and as a means of prevention in high-risk populations, and it also raises possible limitations of the approach that need to be disproven or addresse
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Distal Symmetric Polyneuropathy in 2020 | Neurology | JAMA | JAMA Network

Distal Symmetric Polyneuropathy in 2020 | Neurology | JAMA | JAMA Network | Geriatría HGG Journal Club | Scoop.it
This JAMA Insights Clinical Update reviews the diagnosis and management of distal symmetric neuropathy, including control of risk factors (eg, high glucose in type 1 diabetes, weight loss) and use of nonpharmacologic and pharmacologic therapies (eg, SNRIs, tricyclic antidepressants, gabapentinoids).
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Salut i Treball, Afers Socials i Famílies presenten un pla de contingència per protegir les residències a la tardor - Sala de premsa. Generalitat de Catalunya

Salut i Treball, Afers Socials i Famílies presenten un pla de contingència per protegir les residències a la tardor - Sala de premsa. Generalitat de Catalunya | Geriatría HGG Journal Club | Scoop.it
Notes de premsa · Convocatòries · Acords de govern · Agenda · Fotos i vídeos · Emissions en directe · Rodes de premsa · Galeries de fotos i vídeos.
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Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis | Critical Care Medicine | JAMA Network Open | JAMA...

Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis | Critical Care Medicine | JAMA Network Open | JAMA... | Geriatría HGG Journal Club | Scoop.it
This systematic review and meta-analysis examines the prevalence of reported gastrointestinal symptoms in patients with coronavirus disease 2019 and of viral RNA shedding detected in these patients’ stool.
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The road to renewal: five priorities for health and care

The road to renewal: five priorities for health and care | Geriatría HGG Journal Club | Scoop.it
Covid-19 is the biggest challenge the health and care system has faced in living memory; it's essential that lessons are learned from this experience. So how can the system build on this learning to bring about positive change and renewal? This long read sets out five priorities to help guide the approach to renewal across health and care. 
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Pulmonary embolism: update on management and controversies | The BMJ

Pulmonary embolism: update on management and controversies | The BMJ | Geriatría HGG Journal Club | Scoop.it
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Chronic Obstructive Pulmonary Disease | Annals of Internal Medicine

Chronic Obstructive Pulmonary Disease | Annals of Internal Medicine | Geriatría HGG Journal Club | Scoop.it
Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and progressive airflow obstruction. Tobacco smoking is the leading cause but not the only one.
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Heart Failure With Reduced Ejection Fraction: A Review | Cardiology | JAMA | JAMA Network

Heart Failure With Reduced Ejection Fraction: A Review | Cardiology | JAMA | JAMA Network | Geriatría HGG Journal Club | Scoop.it
This narrative review summarizes the epidemiology, pathophysiology, diagnosis, management, and prognosis of heart failure with reduced ejection fraction.
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COVID-19 in older people: a rapid clinical review | Age and Ageing | Oxford Academic

COVID-19 in older people: a rapid clinical review | Age and Ageing | Oxford Academic | Geriatría HGG Journal Club | Scoop.it

Introduction. the COVID-19 pandemic poses a high risk to older people. The aim of this article is to provide a rapid overview of the COVID-19 literatur

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Cellular immune responses to covid-19 | The BMJ

Cellular immune responses to covid-19 | The BMJ | Geriatría HGG Journal Club | Scoop.it

An effective immune response to SARS-CoV-2 involves four types or subsets of T cells: T helper cells (CD4) are responsible for cellular immunity and for helping B cells to produce neutralising antibodies; cytotoxic or killer T cells (CD8) directly kill infected cells—aided by helper T cells2; other T cells (including T-17 (Th17) cells) drive the inflammatory responses that help to control infections3; and regulatory T cells (T regs) help to contain the immune response, to prevent over-reaction and damage to tissues

Sergio Ariño Blascos insight:

La hipótesis...Pre-existing memory helper T cells specific to SARS-CoV-2 could boost the production of neutralising IgG antibodies in the blood of newly exposed people and could also enhance antibody protection at mucosal surfaces through IgA in saliva, tears, or nasal secretions.131415 Such IgA antibodies act as a protective barrier at common viral entry points. Research is now required to further characterise these possible immune pathways including memory B and T cells in mucosal tissues.

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Vitamin D testing and treatment: a narrative review of current evidence in: Endocrine Connections Volume 8 Issue 2 (2019)

Vitamin D testing and treatment: a narrative review of current evidence in: Endocrine Connections Volume 8 Issue 2 (2019) | Geriatría HGG Journal Club | Scoop.it

If vitamin D deficiency, classified as serum 25(OH)D <50nmol/L, is detected in such individuals, it is recommended to supplement vitamin D to achieve serum 25(OH)D concentrations of at least 75nmol/L. In detail, vitamin D-deficient adults should be treated with 1250μg (50,000IU) vitamin D once a week for 8 weeks or its equivalent of 150μg (6000IU) daily, followed by a maintenance dose of 37.5–50μg (1500–2000IU) daily

Sergio Ariño Blascos insight:

Una revisión actualizada con más de 180 referencias. 

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Palliative care for patients with severe covid-19 | The BMJ

Palliative care for patients with severe covid-19 | The BMJ | Geriatría HGG Journal Club | Scoop.it

 Many patients with severe covid-19 experience distressing symptoms, including breathlessness and agitation. Palliation of suffering is an important part of care irrespective of prognosis

• Patients with severe covid-19 may deteriorate rapidly. It is therefore useful to have a strategy in place for managing deterioration and potential death (for those not suitable for escalation to intensive care), which runs alongside the acute medical management plan

• Clear and timely communication with the patient (if they are able) and their carers is essential. Conveying hope that treatments will help needs to be sensitively balanced with explicit acknowledgement that patients are sick enough to die

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Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection | Infectious Diseases | JAMA | JAMA Network

Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection | Infectious Diseases | JAMA | JAMA Network | Geriatría HGG Journal Club | Scoop.it
In the context of potential aerosol spread of SARS-CoV-2 infection, this Viewpoint argues for use of upper-room germicidal UV (GUV) fixtures as a means to disinfect circulating air and prevent spread of COVID-19 and other infections in health care settings.
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Acute Ischemic Stroke | NEJM

Acute Ischemic Stroke | NEJM | Geriatría HGG Journal Club | Scoop.it
Key Clinical Points Acute Ischemic Stroke Treatment for patients with acute ischemic stroke is guided by the time from the onset of stroke, the severity of neurologic deficit, and findings o
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Alternatives to Invasive Ventilation in the COVID-19 Pandemic | Critical Care Medicine | JAMA | JAMA Network

Alternatives to Invasive Ventilation in the COVID-19 Pandemic | Critical Care Medicine | JAMA | JAMA Network | Geriatría HGG Journal Club | Scoop.it
Since its invention in the 1940s, the positive pressure ventilator has always been known to have both risks and benefits. Although mechanical ventilation is unquestionably lifesaving, there are numerous associated drawbacks. Beyond the obvious and immediate limitations that patient

 

For instance, perhaps lung injury that is nonresponsive to PEEP is best served with a trial of HFNC. Alternatively, NIV may be considered if the lung injury seems PEEP responsive, with milder hypox emia (PaO2:FIO2 ratio >200) reserved for the face mask inter face and severe hypoxemia with a prolonged need of NIV ap plication reserved for helmet.

 

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Using Insulin to Treat Poorly Controlled Type 2 Diabetes in 2020 | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network

Using Insulin to Treat Poorly Controlled Type 2 Diabetes in 2020 | Clinical Pharmacy and Pharmacology | JAMA | JAMA Network | Geriatría HGG Journal Club | Scoop.it
This JAMA Insights Clinical Update reviews indications and timing of insulin therapy for management of type 2 diabetes, emphasizing the likely benefit of its use as first-line therapy in patients with HbA1c levels less than 9.0%.
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