Nance-Horan syndrome protein (Congenital cataracts and dental anomalies protein)
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Telomerase Activation to Reverse Immunosenescence in Elderly Patients With Acute Coronary Syndrome: Protocol for a Randomized Pilot Trial.
Inflammation plays a key role in the pathophysiology of coronary heart disease (CHD) and its acute manifestation, acute coronary syndrome (ACS). Aging is associated with a decline of the immune system, a process known as immunosenescence. This is characterized by an increase in highly proinflammatory T cells that are involved in CHD progression, plaque destabilization, and myocardial ischemia-reperfusion injury. Telomere dysfunction has been implicated in immunosenescence of T lymphocytes. Telomerase is the enzyme responsible for maintaining telomeres during cell divisions. It has a protective effect on cells under oxidative stress and helps regulate flow-mediated dilation in microvasculature. The TACTIC (Telomerase ACTivator to reverse Immunosenescence in Acute Coronary Syndrome) trial will investigate whether a telomerase activator, TA-65MD, can reduce the proportion of senescent T cells in patients with ACS with confirmed CHD. It will also assess the effect of TA-65MD on decreasing telomere shortening, reducing oxidative stress, and improving endothelial function. The study was designed as a single-center, randomized, double-blind, parallel-group, placebo-controlled phase II trial. Recruitment started in January 2019. A total of 90 patients, aged 65 years or older, with treated ACS who have had CHD confirmed by angiography will be enrolled. They will be randomized to one of two groups: TA-65MD oral therapy (8 mg twice daily) or placebo taken for 12 months. The primary outcome is the effect on immunosenescence determined by a decrease in the proportion of CD8 TEMRA (T effector memory cells re-expressing CD45RA [CD45 expressing exon A]) cells at 12 months. Secondary outcomes include leukocyte telomere length, endothelial function, cardiac function as measured by echocardiography and NT-proBNP (N-terminal fragment of the prohormone brain-type natriuretic peptide), systemic inflammation, oxidative stress, and telomerase activity. The study received National Health Service (NHS) ethics approval on August 9, 2018; Medicines and Healthcare products Regulatory Agency approval on October 19, 2018; and NHS Health Research Authority approval on October 22, 2018. The trial began recruiting participants in January 2019 and completed recruitment in March 2020; the trial is due to report results in 2021. This pilot trial in older patients with CHD will explore outcomes not previously investigated outside in vitro or preclinical models. The robust design ensures that bias has been minimized. Should the results indicate reduced frequency of immunosenescent CD8 T cells as well as improvements in telomere length and endothelial function, we will plan a larger, multicenter trial in patients to determine if TA-65MD is beneficial in the treatment of CHD in elderly patients. ISRCTN Registry ISRCTN16613292; http://www.isrctn.com/ISRCTN16613292 and European Union Drug Regulating Authorities Clinical Trials Database (EudraCT), European Union Clinical Trials Register 2017-002876-26; https://tinyurl.com/y4m2so8g. DERR1-10.2196/19456.
Keywords
- acute coronary syndrome
- coronary heart disease
- immunosenescence
- telomerase activator
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Factors associated with COVID-19-related death using OpenSAFELY.
Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide . There is unprecedented urgency to understand who is most at risk of severe outcomes, and this requires new approaches for the timely analysis of large datasets. Working on behalf of NHS England, we created OpenSAFELY-a secure health analytics platform that covers 40% of all patients in England and holds patient data within the existing data centre of a major vendor of primary care electronic health records. Here we used OpenSAFELY to examine factors associated with COVID-19-related death. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59 (95% confidence interval 1.53-1.65)); greater age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors (HR 1.48 (1.29-1.69) and 1.45 (1.32-1.58), respectively). We have quantified a range of clinical factors associated with COVID-19-related death in one of the largest cohort studies on this topic so far. More patient records are rapidly being added to OpenSAFELY, we will update and extend our results regularly.
MeSH Terms
- Adolescent
- Adult
- African Continental Ancestry Group
- Age Distribution
- Age Factors
- Aged
- Aged, 80 and over
- Aging
- Asian Continental Ancestry Group
- Asthma
- Betacoronavirus
- COVID-19
- Cohort Studies
- Coronavirus Infections
- Diabetes Mellitus
- Female
- Humans
- Hypertension
- Male
- Middle Aged
- Pandemics
- Pneumonia, Viral
- Proportional Hazards Models
- Risk Assessment
- SARS-CoV-2
- Sex Characteristics
- Smoking
- State Medicine
- Young Adult
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Advanced ophthalmic nurse practitioners: the potential to improve outcomes for older people with cataracts.
An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a negative effect on older people's quality of life but can be corrected by surgery. It is imperative that older people have access to cataract surgery and, given government objectives of NHS efficiency gains, advanced level nurse practitioners have the potential to increase capacity for and access to cataract surgery. This article outlines the aetiology of cataracts, developments in ophthalmic nursing and the broadened scope of practice of advanced ophthalmic nurse practitioners (AONPs). It explores how the AONP is well-placed to provide high quality care to the older person who requires cataract surgery. Professional drivers for role development are explored in relation to older people.
Keywords
- advanced practice
- gerontology
- older people
- patient outcomes
- patients
- practice development
- professional
- professional issues
- quality of life
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Patient Satisfaction in the Spanish National Health Service: Partial Least Squares Structural Equation Modeling.
The aim of this article was to determine which key indicators influence patient satisfaction with the Spanish NHS to provide useful information for policy decision-making. A total of 33 variables for each of the 17 Spanish autonomous communities were collected from the statistical portal of the Spanish Ministry of Health, Social Services, and Equality between 2005 and 2016. A cross-sectional study was applied using Partial Least Squares to a Structural Equation Model (PLS-SEM). The influence of expenditures, resource allocation, and safety were hypothesized about patient satisfaction. Gross Domestic Product (GDP) and life expectancy were used as control variables. Moreover, the influence of resource allocation on use was tested. The model explained 57.1% of patient satisfaction with the Spanish NHS. It was positively influenced mainly by resource allocation and expenditures, followed by safety and life expectancy. Additionally, resources directly influenced the level of use. The number of hospital beds, hemodialysis equipment, rate of adverse drug reactions, and expenditure positively influenced patient satisfaction. In contrast, the number of posts in day hospitals, the hospital infection rate, and the percentage of pharmacy spending negatively influenced patient satisfaction.
MeSH Terms
- Cross-Sectional Studies
- Gross Domestic Product
- Health Care Rationing
- Health Expenditures
- Humans
- Latent Class Analysis
- Least-Squares Analysis
- Life Expectancy
- Patient Safety
- Patient Satisfaction
- Spain
- State Medicine
Keywords
- National Health Service
- health policy
- partial least squares structural equation modeling (PLS-SEM)
- patient satisfaction
- quality of healthcare
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Heart failure with preserved ejection fraction (HFpEF) pathophysiology study (IDENTIFY-HF): does increased arterial stiffness associate with HFpEF, in addition to ageing and vascular effects of comorbidities? Rationale and design.
There has been a paradigm shift proposing that comorbidities are a major contributor towards the heart failure with preserved ejection fraction (HFpEF) syndrome. Furthermore, HFpEF patients have abnormal macrovascular and microvascular function, which may significantly contribute towards altered ventricular-vascular coupling in these patients. The IDENTIFY-HF study will investigate whether gradually increased arterial stiffness (in addition to ageing) as a result of increasing common comorbidities, such as hypertension and diabetes, is associated with HFpEF. In our observational study, arterial compliance and microvascular function will be assessed in five groups (Groups A to E) of age, sex and body mass index matched subjects (age ≥70 years in all groups):Group A; normal healthy volunteers without major comorbidities such as hypertension and diabetes mellitus (control). Group B; patients with hypertension without diabetes mellitus or heart failure (HF). Group C; patients with hypertension and diabetes mellitus without HF. Group D; patients with HFpEF. Group E; patients with heart failure and reduced ejection fraction (parallel group). Vascular function and arterial compliance will be assessed using pulse wave velocity, as the primary outcome measure. Further outcome measures include cutaneous laser Doppler flowmetry as a measure of endothelial function, transthoracic echocardiography and exercise tolerance measures. Biomarkers include NT-proBNP, high-sensitivity troponin T, as well as serum galectin-3 as a marker of fibrosis. The study was approved by the regional research ethics committee (REC), West Midland and Black Country 17/WM/0039, UK, and permission to conduct the study in the hospital was also obtained from the RDI, UHCW NHS Trust. The results will be published in peer-reviewed journals and presented in local, national and international medical society meetings. NCT03186833.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Biomarkers
- Comorbidity
- Diabetes Mellitus
- Echocardiography
- Exercise Tolerance
- Female
- Heart Failure
- Heart Ventricles
- Humans
- Hypertension
- Male
- Observational Studies as Topic
- Prospective Studies
- Pulse Wave Analysis
- Research Design
- Stroke Volume
- Vascular Stiffness
Keywords
- arterial stiffness
- comorbidities
- heart failure with preserved ejection fraction
- pathophysiology
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Challenges to concordance: theories that explain variations in patient responses.
To meet the challenges of an increasingly ageing and multimorbid population, patients must be fully engaged to work in partnership with their health professional (HP) in the management of their condition(s). The NHS Long Term Plan (2019) outlines goals to manage the increasing demands on the health service-hospital admission avoidance, shorter length of hospital stays through enhanced recovery pathways, increased management of patients within primary care and ensuring a person-centred approach to care provision. Meeting these goals is predicated on HPs being equipped to activate patients using the skills of motivational interviewing, person-centred care and a willingness to share decision making. This article presents a range of psychological theories that could explain the everyday challenges faced in care delivery. Awareness of these theories may help HPs target their approach to care delivery more effectively, to understand patient responses and, therefore, optimise the provision of person-centred care.
MeSH Terms
- Aging
- Benchmarking
- Communication Barriers
- Community Health Nursing
- Humans
- Nurse-Patient Relations
- State Medicine
- United Kingdom
Keywords
- Concordance
- Decision making
- Person-centred care
- Psychological theories
- Self-management
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Optimism is associated with exceptional longevity in 2 epidemiologic cohorts of men and women.
Most research on exceptional longevity has investigated biomedical factors associated with survival, but recent work suggests nonbiological factors are also important. Thus, we tested whether higher optimism was associated with longer life span and greater likelihood of exceptional longevity. Data are from 2 cohorts, women from the Nurses' Health Study (NHS) and men from the Veterans Affairs Normative Aging Study (NAS), with follow-up of 10 y (2004 to 2014) and 30 y (1986 to 2016), respectively. Optimism was assessed using the Life Orientation Test-Revised in NHS and the Revised Optimism-Pessimism Scale from the Minnesota Multiphasic Personality Inventory-2 in NAS. Exceptional longevity was defined as survival to age 85 or older. Primary analyses used accelerated failure time models to assess differences in life span associated with optimism; models adjusted for demographic confounders and health conditions, and subsequently considered the role of health behaviors. Further analyses used logistic regression to evaluate the likelihood of exceptional longevity. In both sexes, we found a dose-dependent association of higher optimism levels at baseline with increased longevity ([i]P[/i] trend < 0.01). For example, adjusting for demographics and health conditions, women in the highest versus lowest optimism quartile had 14.9% (95% confidence interval, 11.9 to 18.0) longer life span. Findings were similar in men. Participants with highest versus lowest optimism levels had 1.5 (women) and 1.7 (men) greater odds of surviving to age 85; these relationships were maintained after adjusting for health behaviors. Given work indicating optimism is modifiable, these findings suggest optimism may provide a valuable target to test for strategies to promote longevity.
MeSH Terms
- Adult
- Aged
- Aged, 80 and over
- Aging
- Female
- Health Behavior
- Humans
- Logistic Models
- Longevity
- Longitudinal Studies
- Male
- Middle Aged
- Odds Ratio
Keywords
- aging
- longevity
- longitudinal study
- optimism
- psychological well-being
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Reducing readmission rates through a discharge follow-up service.
Approximately 15% of elderly patients are readmitted within 28 days of discharge. This costs the NHS and patients. Previous studies show telephone contact with patients -post-discharge can reduce readmission rates. This service -evaluation used a cohort design and compared 30-day emergency readmission rate in patients identified to receive a community nurse follow-up with patients where no attempt was made. 756 patients across seven hospital wards were -identified; 303 were identified for the intervention and 453 in a -comparison group. Hospital admission and readmission data was extracted over 6 months. Where an attempt to contact a patient was made post-discharge, the readmission rate was 9.24% compared to 15.67% where no attempt to -contact was made (p=0.011). After adjustment for -confounding using logistic regression, there was evidence of reduced readmissions in the 'attempt to contact' group odds ratio = 1.93 (95% c-onfidence interval = 1.06-3.52, p=0.033). Of the patients who community nurses attempted to contact, 288 were contacted, and 202 received a home visit with general practitioner -referral and medications advice being the most common -interventions initiated. This service evaluation shows that a simple intervention where community nurses attempt to contact and visit geriatric patients after discharge causes a significant reduction in 30-day hospital readmissions.
Keywords
- Discharge
- geriatrics
- readmission
- telephone contract
{{medline-entry
|title=The cost burden of falls in people with glaucoma in National Health Service Hospital Trusts in the UK.
|pubmed-url=https://pubmed.ncbi.nlm.nih.gov/31322025
|abstract= Falls have devastating consequences in older people with a considerable cost burden. Glaucoma is a risk factor for falls, and patients with glaucoma who fall are at high risk of hospital admission. The aim was to quantify the cost burden of falls to NHS Trusts in people with glaucoma in the UK. Financial data were used to identify non-elective episodes and associated costs from 2012 to 2018, for all admissions where glaucoma was recorded as a secondary diagnosis and admissions for falls (all, with and without a glaucoma secondary diagnosis). A secondary diagnosis is only recorded by the admitting clinician if it is clinically relevant; therefore, a secondary diagnosis of glaucoma was used as a proxy for glaucoma as a contributory factor to falls. Use of financial records means that data on other falls risk factors was unavailable and we cannot be certain that glaucoma was the only relevant factor in all falls. Although this methodology is imperfect, case capture was biased towards cases with clinically significant glaucoma, and financial data is robust. Potential coding errors mean that we may have excluded patients in whom glaucoma was a factor in their fall. At Maidstone and Tunbridge Wells (MTW) NHS Trust, 11.7% (95% confidence intervals [CI] = 10.7-12.8) of admissions for falls were in patients with a secondary diagnosis of glaucoma. This extrapolates to an estimated annual 10,056 admissions at a cost of £28.6 million across the UK. This is an under-estimate of cost, as A