Journal of the American Medical Directors Association最新文献

{"title":"Determinants of Mortality and Causes of Death in Patients With Dementia and Very Severe Challenging Behavior","authors":"Gerrie van Voorden MD ,&nbsp;Richard C. Oude Voshaar MD, PhD ,&nbsp;Raymond T.C.M. Koopmans MD, PhD ,&nbsp;Sytse U. Zuidema MD, PhD ,&nbsp;Alex Verhemel MD ,&nbsp;Anne M.A. van den Brink MD, PhD ,&nbsp;Martin Smalbrugge MD, PhD ,&nbsp;Debby L. Gerritsen PhD","doi":"10.1016/j.jamda.2025.105713","DOIUrl":"10.1016/j.jamda.2025.105713","url":null,"abstract":"<div><h3>Objectives</h3><div>To gain insight into the mortality over time of patients with very severe challenging behavior in dementia when they are temporarily admitted to highly specialized units for treating the behavior.</div></div><div><h3>Design</h3><div>Observational study.</div></div><div><h3>Setting and Participants</h3><div>Eleven highly specialized units throughout the Netherlands participated from December 2020 until December 2022, with a follow-up in September 2023, with 127 patients participating.</div></div><div><h3>Methods</h3><div>General clinical characteristics were collected, such as demographics and cognitive functioning, behavior during the first 2 weeks assessed by the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory Questionnaire (NPI-Q), date of death, and cause of death. Two Cox regression models were estimated, namely prediction models to describe the relationship between some (regular) determinants and mortality over time and association models between behavioral factors and mortality.</div></div><div><h3>Results</h3><div>Of the 127 participants, one-third died during their stay. The most prevalent causes of death were dehydration (often with cachexia) and pneumonia. Mortality over time is best predicted by age (ie, being 80 years or older) and the number of non-psychotropic drugs, as a proxy for somatic disease burden. The 10% of patients scoring highest on the CMAI factor of physically aggressive behavior had a ninefold increased mortality risk during their stay.</div></div><div><h3>Conclusions and Implications</h3><div>A considerable number of patients with very severe challenging behavior in dementia admitted to highly specialized units died during their stay, with a ninefold increased mortality risk over time found in patients with very severe physical aggression. This underlines the need to devote attention to suitable terminal palliative care in clinical practice and research in this patient group.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105713"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Frailty, Illness Severity, and Long-Term Mortality Among Older Adults Admitted to Municipal Acute Care","authors":"Leonor Roa Santervas MD ,&nbsp;Torgeir Bruun Wyller MD, PhD ,&nbsp;Eva Skovlund MSc, PhD ,&nbsp;Espen Saxhaug Kristoffersen MD, PhD ,&nbsp;Rita Romskaug MD, PhD","doi":"10.1016/j.jamda.2025.105718","DOIUrl":"10.1016/j.jamda.2025.105718","url":null,"abstract":"<div><h3>Objectives</h3><div>Important risk factors for mortality include frailty and illness severity. The National Early Warning Score 2 (NEWS2) is widely used to assess acute illness severity and mortality risk, but age and frailty's impact on the association between NEWS2 and mortality is less understood, particularly in nonhospital settings. This study aimed to examine the associations between frailty, NEWS2, and 1-year postdischarge mortality in older adults admitted to the Oslo Municipal In-Patient Acute Care (MipAC) unit.</div></div><div><h3>Design</h3><div>Prospective observational study.</div></div><div><h3>Setting and Participants</h3><div>Patients admitted to the MipAC unit with 1-year follow-up for all-cause mortality.</div></div><div><h3>Methods</h3><div>Frailty was assessed using the Clinical Frailty Scale (CFS). The maximum registered NEWS2 during admission was obtained from patient records. Associations with 1-year mortality were analyzed using a Cox model and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>Among 382 patients (mean age, 84.3 years; 72% female), 58 died during the 1-year follow-up period. Both CFS and NEWS2 were independently associated with 1-year mortality in an age-adjusted Cox proportional hazards model. The adjusted hazard ratios were 1.33 (95% CI, 1.07-1.66) per unit increase in CFS and 1.26 (95% CI, 1.14-1.39) per unit increase in NEWS2. A supplementary analysis of the vital signs contributing to NEWS2 revealed that elevated respiratory rate and hypotension were independently associated with increased 1-year mortality, with adjusted hazards ratios being 2.71 (95% CI, 1.35-5.46) and 3.05 (95% CI, 1.54-6.01), respectively. When combining CFS and NEWS2, moderately to severely frail patients (CFS ≥6) with low NEWS2 (0-4) showed a tendency toward increased mortality, whereas among those with high NEWS2 (≥5), frailty did not appear to further influence mortality risk.</div></div><div><h3>Conclusions and Implications</h3><div>CFS, NEWS2, and the vital signs elevated respiratory rate and hypotension are associated with 1-year mortality in patients admitted to a MipAC unit.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105718"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty, Latent Health Profiles, and Antiretroviral Therapy: Predicting Success of Skilled Nursing Facility Care in an HIV Population","authors":"Brianne L. Olivieri-Mui PhD ,&nbsp;Ellen P. McCarthy PhD ,&nbsp;Sandra M. Shi MD, MPH ,&nbsp;Ira B. Wilson MD ,&nbsp;Jieun Jang PhD ,&nbsp;Gahee Oh MD ,&nbsp;Aneeka Ratnayake PhD ,&nbsp;Chan Mi Park MD ,&nbsp;Dae Hyun Kim MD, ScD","doi":"10.1016/j.jamda.2025.105714","DOIUrl":"10.1016/j.jamda.2025.105714","url":null,"abstract":"<div><h3>Objectives</h3><div>People with HIV (PWH) likely need short-term skilled nursing facility (SNF) care more than people with greater financial and social support to remain home. Therefore, we sought to understand how frailty among health profiles with distinct driving conditions, antiretroviral therapy (ART), and sociodemographic factors relate to success of short-term SNF for PWH.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>Short-term SNF stays for PWH.</div></div><div><h3>Methods</h3><div>Stays (n = 1640) were identified in a 2014–2019 Medicare 5% random sample. Zero-Inflated Poisson regression estimated rate ratios for home time lost in 1-year post-discharge by age (&lt;65 vs 65+), health profiles established by latent profile analysis, frailty, and days covered by ART.</div></div><div><h3>Results</h3><div>Overall, 716 (44%) SNF stays were aged 65+, 1154 (70%) were male, 764 (47%) were Black, 321 (20%) were frail, and 784 (48%) had ART ≥80% of days before admission. There were 3 health profiles: substance use (SU; n = 467), cardiovascular and pulmonary (CV/PULM; n = 665), or multisystem including SU, CV, PULM, and mental health (MULTI; n = 508). Among stays aged &lt;65, SU [rate ratio (95% confidence interval), 1.12 (1.09–1.15)] had more and MULTI [0.87 (0.85–0.89)] had fewer days lost than the CV/PULM group, but any ART carried higher rates of days lost compared with none. Among those aged 65+, SU [0.89 (0.85–0.92)] had fewer days lost, but MULTI [0.97 (0.94–1.00)] was similar in home time loss compared with the CV/PULM group. Having ART &lt;80% of days [1.10 (1.06–1.13)], frailty [1.07 (1.03–1.11)], or pre-frailty [1.07 (1.04–1.10)] had higher rates of days lost.</div></div><div><h3>Conclusions and Implications</h3><div>Although health profiles may help identify conditions most likely impacting health of PWH, frailty may be key to identifying those having the highest needs and at risk for greater home time loss following SNF stays, with this impact varying by age.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105714"},"PeriodicalIF":4.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Vitamin D Supplementation on Cognition in Adults With Mild to Moderate Vitamin D Deficiency: Outcomes From the VitaMIND Randomized Controlled Trial","authors":"Anne Corbett PhD ,&nbsp;Rod Taylor PhD ,&nbsp;David Llewellyn PhD ,&nbsp;Janice M. Ranson PhD ,&nbsp;Adam Hampshire PhD ,&nbsp;Ellie Pickering MSc ,&nbsp;Abbie Palmer BSc ,&nbsp;Dag Aarsland MD ,&nbsp;Dorina Cader PhD ,&nbsp;Diana Frost ,&nbsp;Clive Ballard MD","doi":"10.1016/j.jamda.2025.105711","DOIUrl":"10.1016/j.jamda.2025.105711","url":null,"abstract":"<div><h3>Objectives</h3><div>Preserved cognitive health with ageing is a public health imperative. Vitamin D deficiency is associated with poor cognition, but it is unclear whether supplementation would provide benefit, particularly in individuals with mild/moderate deficiencies which do not have other clinical risks. The objective of this study was to establish the impact of daily vitamin D supplementation on cognition in older adults with mild to moderate vitamin D deficiency.</div></div><div><h3>Design</h3><div>Two-arm, parallel, 24-month randomized controlled trial, with vitamin D supplementation compared with a placebo.</div></div><div><h3>Setting and Participants</h3><div>This was a remote trial, completed from home involving 620 adults, aged ≥ 50 years, with mild to moderate vitamin D deficiency and early cognitive impairment.</div></div><div><h3>Methods</h3><div>The primary outcome was executive function measured through Trail Making Test Part B and other secondary measures of cognition, function, and well-being.</div></div><div><h3>Results</h3><div>Vitamin D supplementation conferred no significant benefit to executive function compared with placebo at follow-up on the primary outcome (between-group difference, 5770; 95% CI, −2189 to 13,730) or cognition, function, or well-being. Secondary analyses in defined subgroups and a per-protocol analysis also showed no significant impact on any outcome measures.</div></div><div><h3>Conclusions and Implications</h3><div>Vitamin D supplementation produced no measurable improvement in cognitive outcomes in older adults with mild to moderate vitamin D deficiency. The remote trial methodology provides an innovative approach to large-scale trials.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105711"},"PeriodicalIF":4.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Turnover Contemplation in Long-Term Care: Examining Personal and Structural Variables in Canada","authors":"Guytano Virdo PhD,&nbsp;Tamara Daly PhD","doi":"10.1016/j.jamda.2025.105710","DOIUrl":"10.1016/j.jamda.2025.105710","url":null,"abstract":"<div><h3>Objectives</h3><div>There are high rates of turnover documented among frontline care work staff in long-term residential care (LTC). Turnover has been associated with negative organizational outcomes. This study examined turnover contemplation among LTC workers in several Canadian provinces.</div></div><div><h3>Design</h3><div>A questionnaire including closed- and open-ended questions was sent out to Canadian LTC workers. Workers received a hard copy of the survey through mail and were able to send the hard copy back or complete the survey online.</div></div><div><h3>Setting and Participants</h3><div>Canadian LTC workers (N = 347) were surveyed about their work using open- and closed-ended questions. This included demographic information and variables related to working conditions, interactions with supervisors and colleagues, and resident care.</div></div><div><h3>Methods</h3><div>Data were analyzed in IBM SPSS Statistics. Descriptive statistics and a binary logistic regression were performed using turnover contemplation as the outcome variable.</div></div><div><h3>Results</h3><div>Among Canadian LTC workers, contemplating leaving their current position is significantly and positively associated with lower support from immediate supervisors, working in a non–government-owned facility, and having less autonomy to perform more social care tasks.</div></div><div><h3>Conclusions and Implications</h3><div>LTC facilities, and systems more broadly, could improve worker retention rates by improving supervisory support and allowing workers to spend more time meaningfully interacting with patients.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 7","pages":"Article 105710"},"PeriodicalIF":4.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Nursing Staff Wages on Nursing Home Quality: An Instrumental Variable Approach","authors":"Rohit Pradhan PhD ,&nbsp;Akbar Ghiasi PhD ,&nbsp;Robert Weech-Maldonado PhD","doi":"10.1016/j.jamda.2025.105705","DOIUrl":"10.1016/j.jamda.2025.105705","url":null,"abstract":"<div><h3>Objective</h3><div>Nursing staff are central to ensuing high-quality care in nursing homes (NHs), yet their wages often lag behind those in other health care settings. This study aimed to examine whether higher wages for nursing staff—registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs)—were associated with better NH quality.</div></div><div><h3>Design</h3><div>This was an observational study using panel data from 2020 to 2022.</div></div><div><h3>Setting and Participants</h3><div>The study included all Centers for Medicare and Medicaid Services–certified US NHs. The analytic data file comprised 37,577 facilities.</div></div><div><h3>Methods</h3><div>This study used multiple secondary datasets, including the Payroll-Based Journal, Medicare Cost Reports, Care Compare: Five-Star Quality Rating System (Five-Star QRS), and LTCFocus.org. The primary outcome was NH quality, operationalized through the quality domain of the Five-Star QRS. The primary independent variables were the facility-level average hourly wages for RNs, LPNs, and CNAs, adjusted for inflation. To address potential endogeneity, average nursing staff wages at the county level, excluding the index facility, were used as an instrument for wages.</div></div><div><h3>Results</h3><div>A 1-dollar increase in wages for RNs, LPNs, and CNAs was associated with 12% (95% CI, 1.07–1.17), 10% (95% CI, 1.05–1.15), and 8% (95% CI, 1.07–1.45) higher odds, respectively, of obtaining a higher star rating (<em>P</em> &lt; .001). Marginal effects analysis showed that a 1-dollar increase in wages was associated with a 2.4%, 2.0%, and 1.8% higher likelihood of achieving a 5-star rating for RNs, LPNs, and CNAs, respectively.</div></div><div><h3>Conclusions and Implications</h3><div>Higher nursing staff wages were associated with increased odds of achieving a higher quality rating. NHs need to offer competitive wages as part of broader efforts to improve quality. Targeted reimbursement strategies may be necessary to support wage increases, especially for facilities serving a high proportion of vulnerable residents.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105705"},"PeriodicalIF":4.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Plant-Based Dietary Patterns and the Long-Term Trajectory of Depressive Symptoms: A 10-Year Longitudinal Study","authors":"Wenhao Zhou ME ,&nbsp;Huanting Zhang ME ,&nbsp;Jianan He ME ,&nbsp;Jie Shen PhD","doi":"10.1016/j.jamda.2025.105712","DOIUrl":"10.1016/j.jamda.2025.105712","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies have analyzed associations between plant-based dietary patterns and depressive symptoms. However, little is known about the association of plant-based dietary patterns with the long-term trajectory of depressive symptoms in older Chinese adults.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 1666 individuals aged &gt;65 years during the period from 2008 to 2018 were included, who had complete dietary data and complete evaluations of depressive symptoms in 4 waves.</div></div><div><h3>Methods</h3><div>Data from the Chinese Longitudinal Health and Longevity Survey (CLHLS) were used in this study. We used the simplified Food Frequency Questionnaire at baseline to assess the overall Plant-based Diet index and unhealthy Plant-based Diet Index. Depressive symptoms were assessed by participants' responses to 5 questions. We used a group-based trajectory model to determine the trajectory of depressive symptoms and used multiple logistic regression to analyze the association of plant-based dietary patterns with the long-term trajectory of depressive symptoms in older Chinese adults.</div></div><div><h3>Results</h3><div>The study included 1666 older adults. We identified 3 trajectories of depressive symptoms. The results showed that participants with the highest quintile of Plant-based Diet index were less likely to be on a moderate depression trajectory [odds ratio (OR), 0.597; 95% CI, 0.358-0.994] or a highly progressive depression trajectory (OR, 0.344; 95% CI, 0.171-0.692) than those with the lowest quintile. In contrast, the odds of the highest unhealthy Plant-based Diet Index quintile being on a moderate depression trajectory (OR, 2.750; 95% CI, 1.555-4.863) or a highly progressive depression trajectory (OR, 6.168; 95% CI, 3.014-12.623) were increased.</div></div><div><h3>Conclusions and Implications</h3><div>Adherence to plant-based dietary patterns was associated with a lower likelihood of being on an unfavorable depressive trajectory, whereas an unhealthy plant-based diet was associated with an increased likelihood of being on an unfavorable depressive trajectory.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105712"},"PeriodicalIF":4.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Better Way to Care for Long-Term Care Residents in Times of Medical Urgency: An Implementation Intervention Using a Stepped-Wedge Design to Reduce Unnecessary Acute Care Transfers","authors":"Abraham Munene PhD ,&nbsp;Leanna Wyer MSc ,&nbsp;Patrick McLane PhD ,&nbsp;Vivian Ewa MD ,&nbsp;Eddy Lang MD ,&nbsp;Peter Faris PhD ,&nbsp;Shawna Reid RN ,&nbsp;Tatiana Penconek RN ,&nbsp;Greta Cummings RN, PhD ,&nbsp;Guanmin Chen MPH, PhD ,&nbsp;Jillian Walsh MD ,&nbsp;Eldon Spackman PhD ,&nbsp;Marian George ,&nbsp;Jayna Holroyd-Leduc MD","doi":"10.1016/j.jamda.2025.105716","DOIUrl":"10.1016/j.jamda.2025.105716","url":null,"abstract":"<div><h3>Objective</h3><div>Approximately 25% of long-term care (LTC) residents are transferred to an emergency department (ED) when experiencing an acute change in health status. This can place strain on health care resources and negatively impact residents. Many residents’ conditions could be managed within LTC if appropriate supports were provided. This implementation study objective was to optimize and evaluate processes followed when considering acute care management and transfer decisions for residents in LTC.</div></div><div><h3>Design</h3><div>A randomized stepped-wedge design was used to implement a standardized LTC-to-ED care and referral pathway, supported by 2 INTERACT tools. The pathway was implemented within 9 cohorts of (4-5) LTC facilities every 3 months, supported by an implementation coach. Implementation strategies considered local LTC context and barriers, as well as pandemic-related challenges.</div></div><div><h3>Setting and Participants</h3><div>40 LTC facilities and 4 EDs within Calgary, Canada.</div></div><div><h3>Methods</h3><div>The primary outcome was change in transfers from LTC to ED; secondary outcomes included hospital admissions, use of facilitated telephone consultation between LTC and ED physicians, and community paramedic visits. Analysis used negative binomial regression to estimate the incident rate (per 1000 residents), while adjusting for the different cohorts. An economic evaluation was conducted using a unit cost analysis.</div></div><div><h3>Results</h3><div>A reduction in the incident rate of LTC-to-ED transfers was observed with the intervention (1.70 postintervention vs 1.91 preintervention; <em>P</em> &lt; .001), along with reduction in hospital admission (0.94 vs 1.08; <em>P</em> &lt; .001). There was an increase in use of facilitated telephone consultations between MDs but no increase in community paramedic visits. The intervention saved the health care system CAD$7.9 million over the postimplementation evaluation period.</div></div><div><h3>Conclusion and Implications</h3><div>Implementation of a standardized LTC-to-ED care and referral pathway appears to reduce ED transfers and hospitalizations among LTC residents, while realizing cost savings to the health care system. Reducing unnecessary transfers from LTC to ED, and instead focusing on earlier identification and management of acute medical issues within LTC, looks to be a feasible, patient-centered, and resource-optimized approach to care.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105716"},"PeriodicalIF":4.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Prediction Models for Sarcopenia: A Systematic Review and Meta-Analysis","authors":"Xiangyu Zhang BS ,&nbsp;Rongna Lian MD ,&nbsp;Huiyu Tang MD ,&nbsp;Shuyue Luo MD ,&nbsp;Xiaoyan Chen MD ,&nbsp;Jing Lu PhD ,&nbsp;Ming Yang MD","doi":"10.1016/j.jamda.2025.105698","DOIUrl":"10.1016/j.jamda.2025.105698","url":null,"abstract":"<div><h3>Objectives</h3><div>Early detection and diagnosis of sarcopenia remain challenging. Despite significant progress in predictive modeling, there is no comprehensive evaluation of their diagnostic performance and methodologic quality across different modeling approaches and populations. This study aims to systematically evaluate the diagnostic accuracy of prediction models for sarcopenia across different modeling approaches and reference standards.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis of diagnostic test accuracy studies.</div></div><div><h3>Setting and Participants</h3><div>Both men and women at any age and ethnicity with sarcopenia, regardless of comorbidities.</div></div><div><h3>Methods</h3><div>We systematically searched Ovid MEDLINE, Embase, and Cochrane Central databases until June 2024. Studies developing or validating prediction models for sarcopenia diagnosis were included. We performed a bivariate random-effects meta-analysis and used hierarchical summary receiver operating characteristic models to synthesize diagnostic accuracy data.</div></div><div><h3>Results</h3><div>Thirteen studies comprising 122,252 participants were included. The prediction models demonstrated robust overall performance in development sets [sensitivity, 82%; 95% CI, 75%-87%; specificity, 84%; 95% CI, 74%-90%; area under curve (AUC), 0.89; 95% CI, 0.86-0.91) and internal validation sets (AUC, 0.86; 95% CI, 0.83-0.89]. In validation sets, traditional statistical models maintained consistent performance (sensitivity, 86%; 95% CI, 80%-91%; specificity, 72%; 95% CI, 67%-77%), whereas machine learning approaches achieved higher specificity (84%; 95% CI, 71%-91%) despite moderate sensitivity (70%; 95% CI, 56%-81%). Only one study conducted external validation, reporting moderate sensitivity (71%; 95% CI, 62%-78%) and excellent specificity (98%; 95% CI, 96%-99%) with an AUC of 0.97.</div></div><div><h3>Conclusions and Implications</h3><div>Current prediction models show promising diagnostic accuracy for sarcopenia, with different modeling approaches having complementary strengths. However, further research is needed to address the limitations of existing models, including methodologic heterogeneity and limited external validation, before clinical implementation can be recommended.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":"26 8","pages":"Article 105698"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usage and Costs of Regular Acetaminophen (Paracetamol) in Canadian Long-Term Care Facilities.","authors":"Roni Y Kraut, Xueyi Chen, Scott R Garrison, Erik Youngson, Cheryl A Sadowski, Christian Ono, Andrea Gruneir","doi":"10.1016/j.jamda.2025.105722","DOIUrl":"https://doi.org/10.1016/j.jamda.2025.105722","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence suggests that the use of regular acetaminophen (paracetamol) in long-term care (LTC) is a low-value intervention, that it does not improve pain or quality of life, and that it has the potential for adverse effects. Our objective was to assess the usage of regular acetaminophen in Canadian LTC facilities as well as the costs associated with its use.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting and participants: </strong>Canadian LTC facilities serviced by a national LTC pharmacy provider in 2022.</p><p><strong>Methods: </strong>Descriptive statistics were used to characterize prevalence, dosing, dispensation frequency, type, and costs of regular acetaminophen dispensations (cost of tablets, carbon emissions, and nursing dispensation time).</p><p><strong>Results: </strong>The data set included 49,419 residents (median age: 86, women: 65%) from British Columbia (5.5%), Alberta (7.1%), Manitoba (23.0%), and Ontario (64.4%). The mean prevalence of regular acetaminophen dispensations was 45.7%. Among residents dispensed regular acetaminophen, 85% of residents were dispensed >1000 mg of acetaminophen/day, the mean defined daily dose per 1000 residents per 1 day was 317 (standard deviation [SD] 56), 59.3% were dispensed acetaminophen ≥3 times per day, and dispensations were approximately evenly split between 325- and 500-mg tablets. The 27.8 million tablets of acetaminophen dispensed in 2022 cost $870,000; had a carbon footprint of 54.8 tonnes of carbon dioxide equivalents (CO₂e); and required 191,000 nursing hours, the equivalent of 92 nurses working full-time for 1 year.</p><p><strong>Conclusion and implications: </strong>Regular acetaminophen use is highly prevalent in LTC and has substantial costs. It would be advantageous to re-examine acetaminophen use in LTC facilities.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":" ","pages":"105722"},"PeriodicalIF":4.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}