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Effect of collaborative care with occupational therapy indeterminate for slowing functional decline from dementia

Embargoed news from Annals of Internal Medicine

American College of Physicians

1. Long-term collaborative care and occupational therapy did not slow functional decline in patients with dementia


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Two years of in-home occupational therapy combined with collaborative care did not slow the rate of functional decline among persons with Alzheimer disease. Given that family members often shoulder the burden of caring for patients with dementia, the authors suggest that research is needed to identify strategies to support caregivers in the home. The findings are published in Annals of Internal Medicine.

Alzheimer disease, which leads to dementia and functional decline, has no known cure or disease-modifying treatment. Newer team-based care models emphasize coordination with community-based services, modifications to the patient's home, and movement toward dementia-prepared communities. While this type of collaborative care has been shown to reduce caregiver stress and improve behavioral symptoms for patients, it has not been shown to reduce the rate of functional decline. Several studies over the past decade suggest that home-based interventions could help in this area.

Researchers conducted a randomized, controlled clinical trial consisting of 180 community-dwelling participants with Alzheimer disease and their informal caregivers. All participants received best-practice collaborative care for dementia, and patients in the intervention group (n = 91) also received in-home occupational therapy delivered in 24 sessions over 2 years. At 24 months, both groups showed a decline in scores designed to measure function in daily living. The two groups also did not differ significantly in other common measures of physical function. These findings suggest that a new generation of assistive devices, home modifications, community services, and technologies is needed to make longer-term support in the home a practical reality for patients and families.

2. Zika virus a serious ongoing concern for travelers and pregnant women

Zika is spread through infected mosquitos and may also be sexually transmitted


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Travelers should be advised about the dangers of Zika virus and how to protect themselves from infection before visiting endemic countries, especially pregnant women or those planning to become pregnant. A case series published in Annals of Internal Medicine describes the potentially serious consequences of Zika infection including microcephaly, Guillain-Barre syndrome, and immune-mediated thrombocytopenia.

Zika virus is mainly transmitted through the Aedes aegypti mosquito but may also be spread through sexual contact, blood transfusion, organ transplantation, laboratory exposure, and potentially breast milk and saliva. These nonvector transmission routes, especially through unprotected sex, increase the potential for Zika spread and the complexity of the public health challenge to prevent infections. Public health experts have raised concerns that Zika may spread to the continental United States and southern Europe via travelers to infected areas.

Using data reported by the GeoSentinel Surveillance Network, researchers sought to gain a broader understanding of the extent of Zika virus disease in global travelers from the Americas and the characteristics of travel-acquired infections. They found that most cases of Zika infection tend to be mild and include fever, rash, arthritis, myalgia, and fatigue. However, the case series also included three pregnancies with adverse outcomes (including microcephaly and fetal death), two cases of Guillain-Barre syndrome, and one patient with immune-mediated thrombocytopenia. These serious outcomes emphasize the urgency and relevance of careful pretravel advice for persons planning to visit countries with ongoing Zika virus transmission. Concise, frequently updated messaging is also important for the public, especially with regard to sexual and nonvector Zika virus transmission.


Also new in this issue:

A Reporting Tool for Practice Guidelines in Health Care: The RIGHT Statement

Yaolong Chen, PhD, MMed; Kehu Yang, MMed; Ana Marus?ic´ , MD, PhD; Amir Qaseem, MD, PhD, MHA; Joerg J. Meerpohl, MD; Signe Flottorp, MD, PhD; Elie A. Akl, MD, MPH, PhD; Holger J. Schu¨ nemann, MD, PhD; Edwin S.Y. Chan, PhD; Yngve Falck-Ytter, MD; Faruque Ahmed, PhD; Sarah Barber, PhD; Chiehfeng Chen, MD, MPH, PhD; Mingming Zhang, MSc; Bin Xu, MD; Jinhui Tian, PhD; Fujian Song, PhD; Hongcai Shang, MD, PhD; Kun Tang, PhD; Qi Wang, MMed; and Susan L. Norris, MD, MPH, MSc; for the Reporting Items for Practice Guidelines in Healthcare Working Group‡

Research and Reporting Methods


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