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The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on elderly or other clinical topics then use Trip today.
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Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. The medical, societal, and economic impact of the coronavirus disease 2019 (COVID-19) pandemic has unknown effects on overall population mortality. Previous models of population mortality are based on death over days among infected people, nearly all of whom thus far have underlying conditions. Models have not incorporated information on high-risk (...) by Public Health England guidelines (from March 16, 2020) in individuals aged 30 years or older registered with a practice between 1997 and 2017, using validated, openly available phenotypes for each condition. We estimated 1-year mortality in each condition, developing simple models (and a tool for calculation) of excess COVID-19-related deaths, assuming relative impact (as relative risks [RRs]) of the COVID-19 pandemic (compared with background mortality) of 1·5, 2·0, and 3·0 at differing infection
in systolic blood pressure control or adverse events during 12-week follow-up.The Optimising Treatment for Mild Systolic Hypertension in the Elderly (OPTIMISE) study was a randomized, unblinded, noninferiority trial conducted in 69 primary care sites in England. Participants, whose primary care physician considered them appropriate for medication reduction, were aged 80 years and older, had systolic blood pressure lower than 150 mm Hg, and were receiving at least 2 antihypertensive medications were (...) Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial. Deprescribing of antihypertensive medications is recommended for some older patients with polypharmacy and multimorbidity when the benefits of continued treatment may not outweigh the harms.This study aimed to establish whether antihypertensive medication reduction is possible without significant changes
In older adults with acute ischemic stroke, the Clinical Frailty Scale predicted mortality at 28 days. Evans NR, Wall J, To B, et al. Clinical frailty independently predicts early mortality after ischaemic stroke. AgeAgeing. 2020. [Epub ahead of print]. 31951248.
In older patients in the ED, higher ERA scores were associated with increased risk for mortality and return visits. Espinoza Suarez NR, Walker LE, Jeffery MM, et al. Validation of the Elderly Risk Assessment index in the emergency department. Am J Emerg Med. 2019. [Epub ahead of print]. 31839521.
Efficacy of a tetravalent dengue vaccine in healthy children aged 4-16 years: a randomised, placebo-controlled, phase 3 trial. A substantial unmet need remains for safe and effective vaccines against dengue virus disease, particularly for individuals who are dengue-naive and those younger than 9 years. We aimed to assess the efficacy, safety, and immunogenicity of a live attenuated tetravalent dengue vaccine (TAK-003) in healthy children aged 4-16 years.We present data up to 18 months post (...) -vaccination from an ongoing phase 3, randomised, double-blind trial of TAK-003 in endemic regions of Asia and Latin America (26 medical and research centres across Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). Healthy children aged 4-16 years were randomly assigned 2:1 (stratified by age and region) to receive two doses of TAK-003 or two doses of placebo, 3 months apart. Investigators, participants and their parents or guardians, and sponsor
Safety and immunogenicity of a tetravalent dengue vaccine in children aged 2-17 years: a randomised, placebo-controlled, phase 2 trial. An unmet clinical need remains for an effective tetravalent dengue vaccine suitable for all age groups, regardless of serostatus. We assessed the immunogenicity and safety of three different dose schedules of a tetravalent dengue vaccine (TAK-003) over a 48-month period in children living in dengue-endemic countries.We did a large, phase 2, double-blind (...) , placebo-controlled trial at three sites in the Dominican Republic, Panama, and the Philippines. Healthy participants aged 2-17 years were randomly assigned 1:2:5:1 using an interactive web response system with stratification by age to receive either a two-dose primary series (days 1 and 91), one primary dose (day 1), one primary dose plus booster (days 1 and 365), or placebo. Participants and relevant study personnel were masked to the random assignment until completion of the study at month 48
BSPED Interim Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis BSPED Interim Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis The previous guideline for the management of DKA has been revised by the BSPED special interest group in diabetic ketoacidosis following a series of meetings. The relatively limited evidence regarding the management of DKA has been reviewed. Where (...) young peopleaged 16-18 years are managed by adult medical teams because of local arrangements, it is considered appropriate for them to be managed using local adult guidelines that the teams are familiar with rather than using potentially unfamiliar paediatric guidelines. Where individuals aged 16-18 are managed by Paediatric teams the Paediatric guidelines should be followed. 2) The ISPAD definition for DKA with acidosis and a bicarbonate of 3.0 mmol per litre has been adopted. The previous BSPED
the review as the impact of the intervention on only the ASD sample would be impossible to isolate. To be included in the review, either all participants in a study had to be of mainstream school age or a majority of participants had to be of mainstream school age. This meant that while most studies involved young peopleaged 6–16 years, one study (Piravej_2009) included some younger children (minimum 3 years old) and six studies included slightly older participants (MacKinnon_2014, Pryor_2016 (...) of anxiety for those with ASD varies widely (e.g., from 13% to 84%), the majority of studies suggest that a realistic estimate is between 40% and 50% (van Steensel, Bögels, & Perrin, ). The majority of studies undertaken exploring anxiety and ASD have focused on very young children, or older adolescents and adults. Fewer studies have been undertaken with school‐aged children, but those studies that have been conducted suggest a high co‐occurrence of anxiety in ASD populations of this age group (Ashburner
in nAMD and occurs in response to abnormally high levels of vascular endothelial growth factor (VEGF). Left untreated, AMD can lead to rapid, irreversible vision loss. nAMD is the leading cause of severe vision loss and legal blindness among individuals aged >65 years in Europe, North America, Australia and Asia (2, 3). Prevalence estimates suggest that nAMD affects approximately 1.7 million people in Europe (4, 5). The estimated incidence of late AMD in Europe in 2013 was between 2.9 and 3.7 per 1000 (...) , 8.1 6.4, 8.8 LSMD (SE) ?0.2 (1.00) ?0.7 (0.86) 95% CI for LSMD ?2.1, 1.8 ?2.4, 1.0 p-value for treatment difference (2-sided) 0.8695 0.4199 p-value for noninferiority (4- letter margin; 1-sided) 65 years in Europe, North America, Australia and Asia, and impacts an estimated 20–25 million people worldwide (2, 3). Prevalence reports have estimated that nAMD affects approximately 1.7 million people in Europe (4, 5). In developed nations, the estimated increase in population ageing is a contributing
Nuchal Translucency Evaluation at 11 to 14 Weeks Gestational Age New 2020 ACR Appropriateness Criteria ® 1 Nuchal Translucency Evaluation American College of Radiology ACR Appropriateness Criteria ® Nuchal Translucency Evaluation at 11 to 14 Weeks Gestational Age Variant 1: Routine nuchal translucency measurement at 11 to 14 weeks of gestation for single or twin gestations. Initial imaging. Procedure Appropriateness Category Relative Radiation Level US pregnant uterus transabdominal Usually (...) at the back of the fetal neck is a normal ultrasound (US) finding at 11 to 14 weeks of gestation; above this threshold, the fetus is considered to have an increased nuchal translucency, which is a marker for fetal aneuploidy, genetic syndromes, structural anomalies, and intrauterine demise . Fetal nuchal translucency increases with crown-rump length, so gestational age must be taken into account when determining whether a given nuchal translucency thickness is increased. It is customary to quantify
PMCID: DOI: Item in Clipboard Full-text links Cite Abstract Background: Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation. Methods and findings: We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian (...) hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist
or fortified foods as well continued electrolyte and micronutrient management. Following recovery, caregivers are given appropriate nutritional training to avoid similar recurrences and instructed on the importance of sensory stimulation in children for continued emotional and physical development (Ashworth, ). SAM among children under 6 months of age is increasingly being associated with higher mortality than in older infants and children (WHO, ). The WHO guideline suggests that in infants who are under 6 (...) months of age with SAM should receive the same general medical care as infants with SAM who are 6 months of age or older with increased focus on establishing, or re‐establishing, effective exclusive breastfeeding by the mother or other caregiver (WHO, ). In this review, we will assess the effectiveness of various community‐based and facility‐based strategies to identify and manage MAM and SAM; including the community‐based screening, identification management of SAM and MAM, relative effectiveness
Covid-19: Guidance for admissions into aged residential care facilities COVID-19 Guidance for admissions into aged residential care facilities 27 APRIL 2020 Aged residential care (ARC) services, excluding deferrable respite, are essential services. This means they continue to operate, accepting referrals from both the community and from hospital. It is essential to ensure that people who do not need to be in hospital do not remain there unnecessarily. Admissions from the community ARC can (...) accept admissions from the community if the person has not had contact with anyone who has been overseas in the last 14 days or been overseas themselves, has not been in contact with anyone with confirmed, suspect or probable COVID-19 and does not have any acute respiratory symptoms (cough, fever, sore throat, or running nose). All people, prior to admission, must be screened by a General Practitioner/Nurse Practitioner or Community Based Assessment service for COVID-19 to determine
Covid-19: Alert Level 3 guidance for providers of services for olderpeople, including aged care and home and community support service Alert Level 3 guidance for providers of services for olderpeople, including aged care and home and community support service 5 May 2020 The following guidance is to help support a safe transition to Alert Level 3 for providers of olderpeople services, including aged care and home and community support services. Essential and ‘safe’ services under Alert Level (...) modifications that may safely proceed at alert level 3 will commence. • Vehicle modification requests will be considered on a case by case basis. Services not seen as essential Day services and programmes will remain suspended at Alert Level 3. People are encouraged to consider alternative ways to connecting, for example virtual supports. Health promotion activities for olderpeople continue to be provided on a different non-contact basis, e.g. by phone. Guidelines for at risk staff There may be some
Covid-19: Advice for aged care providers – residents with dementia Advice for aged care providers – residents with dementia 27 APRIL 2020 This advice provides information that may help to: i. reduce transmission of COVID-19 from resident to resident in aged residential care ii. maintain care and quality of life for residents with dementia or cognitive impairment. This advice is additional to, and should be read alongside, other guidance provided for health professionals and specifically (...) for aged residential care, which can be found on health.govt.nz/covid-19. Preventing COVID-19 in residents with dementia COVID-19 is highly contagious. We recognise that social distancing for residents with dementia may be difficult to maintain, and may heighten their anxiety and agitation. Increased staffing may be needed. You and your staff are in a good position to manage the care and wellbeing of your residents with dementia. This includes thinking about, preparing and communicating with residents
your situation further. Staying in contact with whanau, family and friends During all Alert Levels, visitors to Aged Care Residential facilities will be restricted. These extra precautions are needed to ensure people in a facility are safe, particularly those who are more at risk of infection and severe illness. Contact the provider to discuss other options to maintain contact. More information For the latest advice, information and resources, go to health.govt.nz/covid-19 or covid19.govt.nz (...) COVID-19 interNASC transfers – Aged Residential Care COVID-19 interNASC transfers – Aged Residential Care Information for transferring between District Health Boards 28 April 2020 An interNASC transfer is when a person moves between District Health Boards. In Aged Residential Care this means moving from one facility to another in a different region. Transfers from one Aged Residential Care facility to another is restricted The restrictions on transfers will depend on the Alert Level. This may
Covid-19: Guidance for preventing and controlling COVID-19 outbreaks in New Zealand aged residential care Health Quality & Safety Commission | Guidance for preventing and controlling COVID-19 outbreaks in New Zealand aged residential care Rārangi matua Main Menu Mortality review committees are statutory committees that review particular deaths, or the deaths of particular people, in order to learn how to best prevent these deaths. › › › Aged Residential Care Navigation Menu Projects Guidance (...) for preventing and controlling COVID-19 outbreaks in New Zealand aged residential care 3 Apr 2020 | This guidance document and supporting resources provide practical assistance to aged residential care facilities in response to the global COVID-19 pandemic. Please note: These documents are being updated regularly and links may change. Instead of downloading the documents, please use and share the link to this page and return here to get the most recent versions. We welcome all feedback on the guide