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This JAMA Insights Clinical Update reviews the clinical use, safety, contraindications, and alternatives to metformin, the first-line treatment for type 2 diabetes. 
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The number of dementia patients requesting euthanasia in the Netherlands has increased over the past five years. We argue that society has a duty to care for patients who suffer from dementia and to make their lives as good and comfortable as possible. We also argue that it can be morally acceptable for those who do not want to continue their life with dementia to choose to die.
Via Cristina Assens Gibert
Cristina Assens Gibert's curator insight,
May 22, 2019 7:28 AM
Can a patient suffering from dementia make an autonomous request?
What is the nature of suffering in dementia, can it be such that one is better off dead?
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Prevalence of priority level and in triage categories differed across the two age groups but only triage categories contributed moderately to explaining the age-related difference in hospitalization rates after the ED visit. Indeed, most of this difference remained unexplained, suggesting that age itself, besides other unmeasured factors, may play a role in explaining the higher hospitalization rate in patients aged 85+ years. Via Cristina Assens Gibert
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Multidrug-resistant (MDR) Pseudomonas aeruginosa is a serious public health threat. The ceftazidime-avibactam-fosfomycin combination possessed synergistic activ Via Marina Roig
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Spontaneous bacterial peritonitis caused by Gram-negative bacteria: an update of epidemiology and antimicrobial treatments. Expert Review of Gastroenterology & Hepatology. Accepted 16 May 2019. Via Marina Roig
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Background: Poor olfaction is common among older adults and has been linked to higher mortality. However, most studies have had a relatively short follow-up and have not explored potential explanations. Objective: To assess poor olfaction in relation to mortality in older adults and t
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This Viewpoint discusses the costs of emerging therapies for conditions prevalent in the US Baby Boomer population now entering old age and proposes principles to ensure the value and accessibility of new expensive drugs including cost-effectiveness (CE) assessments, price-benefit alignment
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"Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice".
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With slow progress being made on a promise to redesign health care for the people who use it, Charlotte Paddison argues for two key changes in how multimorbidity is tackled.
Servicio de Geriatría's curator insight,
April 7, 2019 6:51 PM
MINIMALLY DISRUPTIVE MEDICINE and the SHERPA framework (share, link, and plan)
Menos es más.
"This shift in professional practice needs to focus on doing less, when less is best, given the potentially cumulative impacts of over-investigation and over-treatment for patients with multimorbidity".
Servicio de Geriatría's comment,
April 10, 2019 8:36 AM
Este es un articulo realmente interesante para nosotros en la línea de la flexibilidad, interioperabilidad y la geriatría líquida"
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"Despite a large and growing population of older people with frailty and atrial fibrillation (AF), there is a lack of guidance on optimal AF management in this high risk group"
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Background: Many prognostic models for cardiovascular risk can be used to estimate aspirin's absolute benefits, but few bleeding risk models are available to estimate its likely harms. Objective: To develop prognostic bleeding risk models among persons in whom aspirin might be considered for th
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Front Endocrinol (Lausanne). 2019 Apr 24;10:255. doi: 10.3389/fendo.2019.00255. eCollection 2019. Review Via Maria Armillas
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Acute management of geriatric adult emergencies requires reliable communication between primary care, inpatient and outpatient medical and surgical specialists, rehabilitation medicine, case managers, social workers, pharmacists, and nursing professionals. The ED often serves as the front porch of the hospital, with one foot on the inpatient side and the other foot in the outpatient world. Therefore, a comprehensive geriatric ED guideline document needs to reflect the requisite collaboration in care and the role that contemporary emergency medicine can and should reliably provide to colleagues outside of the ED. Via Cristina Assens Gibert
Cristina Assens Gibert's curator insight,
May 22, 2019 7:14 AM
Geriatric Emergency Department Guidelines disponible en: http://geriatricscareonline.org/ProductAbstract/geriatric-emergency-department-guidelines/CL013
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This preplanned secondary analysis of a multicenter cohort study assesses the association of depression and mortality among older adults undergoing surgical and transcatheter aortic valve replacement. Via Tania Sanchez
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Artículo original de The New England Journal of Medicine - Prevención de fracturas con zoledronato en mujeres mayores con osteopenia Via Tania Sanchez
Servicio de Geriatría's insight:
Pertinente y actual para el Journal Club HGG. Pero atención se centra en la eficacia terapeutica en osteopenia no en osteoporosis. Los criterios establecidos por la OMS para el diagnóstico de OP mediante DXA se basan en la T-score y son los siguientes: t-score mayor de −1 indica masa ósea normal; t-score entre −2,5 y −1 indica baja masa ósea u osteopenia; t-score menor de −2,5 indica OP y t-score menor de −2,5 más una fractura indica OP grave o complicada.
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Geriatr Orthop Surg Rehabil. 2019 May 6;10:2151459319835109. doi: 10.1177/2151459319835109. eCollection 2019. Via Marina Roig
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In their article, Liu and colleagues investigated the factors that explain the relationship between diminished olfaction and risk for death in older adults. The editorialists discuss the findings, which show that olfactory impairment is a significant predictor of mortality, and look forward to research to inform if and ho
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Tuberculosis remains the leading cause of death from an infectious disease among adults worldwide, with more than 10 million people becoming newly sick from tuberculosis each year. Advances in diagnosis, including the use of rapid molecular testing and whole-genome sequencing in both sputum and non-sputum samples, could change this situation. Although little has changed in the treatment of drug-susceptible tuberculosis, data on increased efficacy with new and repurposed drugs have led WHO to recommend all-oral therapy for drug-resistant tuberculosis for the first time ever in 2018.
Servicio de Geriatría's insight:
Unas revisión actualizada de un viejo problema.
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From
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Prasad K, Siemieniuk R, Hao Q, et al. Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline. BMJ. 2018;363:k5130. 30563885
Servicio de Geriatría's insight:
ABCD2 >/= 4...pero solo dentro de las primeras 24 horas?
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Data on how to improve the care of patients with multimorbidity are lacking.1 Evidence-based medicine and the teaching of consultation skills—two of the cornerstones of modern clinical practice—are not sufficient for making decisions with and for patients with multimorbidity. Therefore, we have developed a new model that supports the translation of population-based, evidence-based medicine and complex consultation models into simpler, natural conversations about care appropriate for and agreed with individual patients.
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Background: Urinary incontinence (UI), a common malady in women, most often is classified as stress, urgency, or mixed. Purpose: To compare the effectiveness of pharmacologic and nonpharmacologic interventions to improve or cure stress, urgency, or mixed UI in nonpregnant women." Most nonpharmacologic and pharmacologic interventions are more likely than no treatment to improve UI outcomes. Behavioral therapy, alone or in combination with other interventions, is generally more effective than pharmacologic therapies alone in treating both stress and urgency UI.
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This JAMA Clinical Guidelines Synopsis summarizes the AHA/ACC/HRS 2019 update of the societies’ guideline for managing patients with atrial fibrillation, focusing on use of novel oral anticoagulants (NOACs) and procedural interventions such as left atrial appendage closure (LAAC) an
Servicio de Geriatría's insight:
Ultimo update desde 2014, los NACOs siguen demostrando su seguridad en el tto de la FA y se recominedan sobre warfarina en aquellos pacientes, candidatos a NCOs, con FA
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