1. A structured exercise program provides mobility benefits to all older patients, regardless of frailty status
Abstract: http://annals.org/aim/article/doi/10.7326/M16-2011
Editorial: http://annals.org/aim/article/doi/10.7326/M17-3048
FREE Summary for Patients: http://annals.org/aim/article/doi/10.7326/P17-9052
URLs go live when the embargo lifts
Physicians should prescribe physical activity to all older patients, regardless of frailty status. A structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over 2 years among sedentary older adults; however, it did reduce major mobility disability in both frail and nonfrail patients. Findings from a secondary analysis of the LIFE (Lifestyle Interventions and Independence for Elders) trial are published in Annals of Internal Medicine.
Researchers from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Geneva University Hospitals analyzed data for 1,635 community-dwelling adults, aged 70 to 89 years, with functional limitations to determine whether a long-term, structured, moderate-intensity physical activity program is associated with a lower risk for frailty and whether frailty status alters the effect of physical activity on the reduction in major mobility disability risk. Participants were randomly assigned to a program consisting of aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercise. Over 2 years follow-up, the risk for frailty was not statistically significantly different in the physical activity versus the health education group. Using a defined measure of frailty, the physical activity intervention was associated with improvement in the inability to rise from a chair. These findings suggest that physical activity can benefit all older patients.
Media contacts: For an embargoed PDF, please contact Angela Collom. For an interview with Andrea Trombetti, MD, please contact Alexandra Mandofia at alexandra.mandofia@unige.ch or Agnes Reffet at Agnes.Reffet@hcuge.ch. To interview Roger A. Fielding, PhD, please contact Sioban Gallagher at Siobhan.Gallagher@tufts.edu or 617-636-6586.
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2. CDC's seven 'banned' words could have seven serious consequences
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3410
URLs go live when the embargo lifts
Banning seven words from official U.S. Centers for Disease Control and Prevention (CDC) budget documents may have at least seven serious consequences, experts warn. A commentary from Emory University is published in Annals of Internal Medicine.
On December 15, 2017, the Washington Post reported that the that the words "vulnerable," "entitlement," "diversity," "transgender," "fetus," "evidence-based," and "science-based," would be omitted from official CDC budget proposals. If true, experts warn that such omissions could jeopardize the work of the government-funded healthcare practitioners and professional organizations. The CDC is trusted by healthcare practitioners and others as a source of credible information about population health and disease morbidity trends, outbreak response, reference laboratory diagnostic capacity, and evidence-based guidelines. The authors outline the seven harmful consequences or "seven deadly sins," that may stem from adherence to the proposed word ban.
Media contacts: For an embargoed PDF, please contact Angela Collom. For an interview with Kenneth G. Castro, MD, FIDSA, please contact Melva Robertson at melva.robertson@emory.edu or 404-727-5692.
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3. Compared with medical treatment, percutaneous closure procedures prevent recurrent stroke in patients with patent foramen ovale
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3033
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2679
URLs go live when the embargo lifts
Two systematic evidence reviews and meta-analyses show that percutaneous closure procedures prevent recurrent stroke in patients with patent foramen ovale (PFO) compared with medical treatment alone. The first review was conducted by researchers from Magna Graecia University in Catanzaro, Italy and the second by researchers from the University of Tennessee, School of Medicine. Both are published in Annals of Internal Medicine.
PFO is a common congenital heart abnormality that increases the risk for cardioembolic cerebrovascular incidents, such as stroke, or transient ischemic attacks (TIAs), but most PFO carriers remain asymptomatic and do not develop serious complications. However, because PFO is associated with cryptogenic stroke, particularly in young patients, it has been suggested that fixing the abnormality through surgical procedure could be warranted.
Both teams of researchers reviewed 4 randomized controlled trials comparing PFO closure using a currently available device with medical treatment alone to compare risks for recurrent stroke. The studies evaluated were PC (2013), RESPECT (2013), REDUCE (2017), and CLOSE (2017). The data showed that PFO closure reduced the risk for stroke or TIA and increased the risk for peri-procedural atrial fibrillation or atrial flutter. The authors of both reviews conclude that percutaneous PFO closure is superior to medical therapy for preventing recurrent stroke or TIA, but patients should be selected carefully considering the potential risks.
According to the authors, these results demand a revision of current practice guidelines to include a positive outlook for PFO closure for prevention of recurrent cryptogenetic stroke.
Media contacts: For an embargoed PDF, please contact Angela Collom. For an interview with Ciro Indolfi, MD of Magna Graecia University, please email indolfi@unicz.it. For an interview with Rahman Shah, MD from the University of Tennessee, please email shahcardiology@yahoo.com.
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Also new in this issue:
The CVS-Aetna Merger: Another Large Bet on the Changing U.S. Health Care Landscape
Austin B. Frakt, PhD; Craig Garthwaite, PhD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3319
Opioids and Chest Wall Rigidity During Mechanical Ventilation
Jeffrey P. Roan, DO; Navin Bajaj, MD; Field A. Davis, DO; Natalie Kandinata, BS
Case Report
Abstract: http://annals.org/aim/article/doi/10.7326/L17-0612
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Angela Collom
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