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1.
Considerations for physical employment standards in the aging workforce.
Flower, DJC, Tipton, MJ, Milligan, GS
Work (Reading, Mass.). 2019;(4):509-519
Abstract
BACKGROUND If current population and health trends continue, workplace demographics will look significantly different by the turn of the century. Organizations will no longer have a steady pipeline of younger workers and will likely need to rely on older workers to remain competitive in the global marketplace. The future multi-generational workforce will bring with it the challenge of maximizing contributions from each generation whilst at the same time addressing the health, safety and wellbeing needs of all workers. OBJECTIVE This review provides an insight into aging and older workers, and presents recommendations to promote worker longevity. METHODS This narrative review draws on evidence from 108 published sources. RESULTS The relationship between age and work is not simple; factors including the physical nature of the job and worker's health and fitness interact with age to either increase or decrease the potential effect of age. Evidence suggests that the issues arising from an aging workforce can be managed through polices that focus on active aging through: attitude management; flexible working and the provision of occupational health. CONCLUSION The integration of such interventions would require company and organizational commitment from the top down with educational programs at all levels to ensure understanding and participation.
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2.
Anemia in Older Adults.
Lanier, JB, Park, JJ, Callahan, RC
American family physician. 2018;(7):437-442
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Abstract
Anemia is associated with increased morbidity and mortality in older adults. Diagnostic cutoff values for defining anemia vary with age, sex, and possibly race. Anemia is often asymptomatic and discovered incidentally on laboratory testing. Patients may present with symptoms related to associated conditions, such as blood loss, or related to decreased oxygen-carrying capacity, such as weakness, fatigue, and shortness of breath. Causes of anemia in older adults include nutritional deficiency, chronic kidney disease, chronic inflammation, and occult blood loss from gastrointestinal malignancy, although in many patients the etiology is unknown. The evaluation includes a detailed history and physical examination, assessment of risk factors for underlying conditions, and assessment of mean corpuscular volume. A serum ferritin level should be obtained for patients with normocytic or microcytic anemia. A low serum ferritin level in a patient with normocytic or microcytic anemia is associated with iron deficiency anemia. In older patients with suspected iron deficiency anemia, endoscopy is warranted to evaluate for gastrointestinal malignancy. Patients with an elevated serum ferritin level or macrocytic anemia should be evaluated for underlying conditions, including vitamin B12 or folate deficiency, myelodysplastic syndrome, and malignancy. Treatment is directed at the underlying cause. Symptomatic patients with serum hemoglobin levels of 8 g per dL or less may require blood transfusion. Patients with suspected iron deficiency anemia should be given a trial of oral iron replacement. Lower-dose formulations may be as effective and have a lower risk of adverse effects. Normalization of hemoglobin typically occurs by eight weeks after treatment in most patients. Parenteral iron infusion is reserved for patients who have not responded to or cannot tolerate oral iron therapy.
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Behavioral economics and diabetic eye exams.
Williams, AM, Liu, PJ, Muir, KW, Waxman, EL
Preventive medicine. 2018;:76-87
Abstract
Diabetic retinopathy is a common microvascular complication of diabetes mellitus and is the leading cause of new blindness among working-age adults in the United States. Timely intervention to prevent vision loss is possible with early detection by regular eye examinations. Unfortunately, adherence to recommended annual diabetic eye exams is poor. Public health interventions have targeted traditional barriers to care, such as cost and transportation, with limited success. Behavioral economics provides an additional framework of concepts and tools to understand low screening rates and to promote regular diabetic eye exams for populations at risk. In particular, behavioral economics outlines biases and heuristics that affect decision-making and underlie pervasive barriers to care, such as not viewing diabetic eye exams as a priority or perceiving oneself as too healthy to need an examination. In this review, we examine the literature on the use of behavioral economics interventions to promote regular diabetic eye exams. From the results of the included studies, we outline how concepts from behavioral economics can improve eye examination rates. In particular, the default bias, present bias, and self-serving bias play a significant role in precluding regular diabetic eye examinations. Potential tools to mitigate these biases include leveraging default options, using reminder messages, providing behavioral coaching, applying commitment contracts, offering financial incentives, and personalizing health messages. When combined with traditional public health campaigns, insights from behavioral economics can improve understanding of pervasive barriers to care and offer additional strategies to promote regular preventive eye care for patients with diabetes.
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Reliability of a Skin Diagnostic Device in Assessing Hydration and Erythema.
Huimin, K, Rowledge, AM, Borzdynski, CJ, Miller, C, Frescos, N, McKenzie, G, Perry, E, McGuiness, W
Advances in skin & wound care. 2017;(10):452-459
Abstract
OBJECTIVE To examine the reliability of a skin diagnostic device, the SD202 (Courage+Khazaka GmBH, Cologne, Germany), in assessing hydration and erythema of periwound skin and pressure injury-prone areas. DESIGN Intrarater reliabilities from 3 cross-sectional and prospective studies are reported. SETTING AND PARTICIPANTS Patients attending an outpatient, nurse-led wound dressing clinic (n = 16), a podiatrist-led high-risk foot clinic (n = 17), and residents (n = 38) at a single residential aged-care facility. MAIN OUTCOME MEASURE Skin hydration and erythema levels assessed using the SD202. MAIN RESULTS High internal consistency was maintained for consecutive skin hydration and erythema measures at a single point on the venous leg ulcer periwound (α > .996 and α > .970 for hydration and erythema, respectively) and for the pressure-prone areas of the sacrum (α > .916), right (α > .994) and left (α > .967) ischium, right (α > .989) and left (α > .916) trochanter, right (α > .985) and left (α > .992) calcaneus, and right (α > .991) and left (α > .990) lateral malleolus. High consistency was also found for the measures obtained at 4 different locations around the periwound for the venous leg ulcer (α > .935 and α > .870 for hydration and erythema, respectively). In diabetic foot ulcer assessment, acceptable internal consistency of hydration measures around the periwound was observed (α > .634). Internal consistency of erythema measures was variable, ranging from low to high reliability, particularly among predebridement measures. CONCLUSIONS Using the protocols outlined in this study, the SD202 demonstrates high reliability for assessing skin hydration and erythema levels. It is possible that the SD202 can be used in clinical practice as an appropriate tool for skin hydration and erythema assessment.
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[How to Define Significant Changes in Laboratory Test Results in Health Screening].
Kawano, R, Ichihara, K, Wada, T
Rinsho byori. The Japanese journal of clinical pathology. 2016;(3):284-97
Abstract
It is necessary to judge the significance of changes in laboratory test results, especially in health screening. For this purpose, the reference change value (RCV) was proposed, which is the (1- α) 100% confidence limit of differences between any two measurements: RCV = √2 z(α) x CV(I), where CV(I) represents intra-individual CV and α = 0.05. However, RCV is not commonly employed because: (1) it assumes constant CV(I) regardless of test levels, and (2) it often results in conservative judgements about the changes due to the blind use of 95% as its confidence probability (CP). Recently, we evaluated the level dependency of CV(I) in common laboratory tests and sought an appropriate CP for computing RCV through systematic analysis of a large long-term health-screening database. The dataset used contained data from approximately 14,000 individuals who underwent annual health-checks repeatedly. None of them were taking any medications or showed unnatural changes in BMI. The level of dependency of CV(I) was clearly observed for test items which showed skewed, logarithmic normal distributions but not for those with normal distributions, indicating the need to compute RCV according to the test level for the former items. To assess the choice of practical CP for RCV, we introduced a metabolic syndrome score (sMS) derived by logistic regression analysis. AsMS was used as an external criterion of changes in the nutritional status of individuals in relation to changes in laboratory tests. We evaluated the sensitivity and specificity of RCV at various CPs for detecting significant changes in ΔsMS. The analysis revealed that CP of 80-90% for computing RCV markedly enhanced the sensitivity of detecting ΔsMS without compromising the specificity. We provide a table listing appropriate RCVs for typical levels of common screening tests obtained from the analysis.
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Bedside nutrition evaluation and physical assessment techniques in critical illness.
Simpson, F, Doig, GS
Current opinion in critical care. 2016;(4):303-7
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight emerging techniques used to determine body composition early in ICU stay, their prediction of poor outcome, and what is required before they can be more widely used. RECENT FINDINGS Opportunistic use of imaging techniques to assess muscle mass shows promise with regard to predicting patient outcomes; however, some of these techniques are expensive. Mid-arm muscle circumference and physical assessments of muscle wasting and subcutaneous fat loss using the subjective global assessment (SGA) are simple cheap tools that can be undertaken at the ICU patient bedside. Furthermore, each of these simple measures is a better predictor of patient outcome than BMI. SUMMARY Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting have each been found to be better predictors of poor outcome than BMI in ICU patients.Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting may be able to identify patients who are most likely to benefit from enhanced nutrition support.We need further research incorporating the use of these simple measures to evaluate their ability to accurately identify patients most likely to benefit from enhanced nutritional support.
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Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review.
Armstrong, S, Lazorick, S, Hampl, S, Skelton, JA, Wood, C, Collier, D, Perrin, EM
Pediatrics. 2016;(2):e20151766
Abstract
Overweight and obesity affects 1 in 3 US children and adolescents. Clinical recommendations have largely focused on screening guidelines and counseling strategies. However, the physical examination of the child or adolescent with obesity can provide the clinician with additional information to guide management decisions. This expert-based review focuses on physical examination findings specific to children and adolescents with obesity. For each physical examination element, the authors define the finding and its prevalence among pediatric patients with obesity, discuss the importance and relevance of the finding, describe known techniques to assess severity, and review evidence regarding the need for additional evaluation. The recommendations presented represent a comprehensive review of current evidence as well as expert opinion. The goal of this review is to highlight the importance of conducting a targeted physical examination during pediatric weight management visits.
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Diagnosis and management of hair loss in children.
Castelo-Soccio, L
Current opinion in pediatrics. 2016;(4):483-9
Abstract
PURPOSE OF REVIEW Hair loss is common in infants and children and the ability to distinguish why a child is losing hair enables providers to distinguish hair loss that is related to infection, autoimmune conditions, nutrition, medications, trauma/traction, or underlying genetic disorders such as ectodermal dysplasias. Making these distinctions leads to best management and guidance for patients and their families. RECENT FINDINGS Careful physical examination of the hair, scalp, skin, and nails coupled with dermoscopy or trichoscopy, or both, can yield more accurate and faster diagnosis. Biopsy is rarely needed in children for hair loss conditions. SUMMARY Hair loss, particularly on the scalp, can affect all ages and can impact patients socially and emotionally. The majority of hair loss in children is nonscarring. Diagnosis begins with a good history, including personal and family history, medication use, a thorough physical examination, and use of dermoscopy or trichoscopy, or both. With these, providers can begin to divide hair loss into congenital vs. acquired, and then further subdivide into focal vs. diffuse and scarring vs. nonscarring. Secondary change, including scale and erythema, can further help with diagnosis.
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9.
Improvement of cardiac screening in amateur athletes.
Schmied, CM
Journal of electrocardiology. 2015;(3):351-5
Abstract
Although not performing on a professional level, amateur athletes, nevertheless, are participating in competitive sports and thus underlie a relevant risk for exercise-related SCD which implicates the need for an adequate pre-competition cardiac screening. As many amateur athletes belong to the category of "older" individuals, particularly CAD among male athletes with risk factors has to be targeted by the screening. However, the detection of clinically silent underlying coronary heart disease is challenging and cannot be accurately achieved by a standard screening provided to young athletes (history, clinical status, ECG). An extended work-up, at least, mandates the detection of cholesterol levels to estimate the individual cardiovascular risk. The fact that only less than 10% of Swiss amateur athletes have undergone cardiac screening led to various promising approaches to improve the awareness of the issue. Exemplarily, we successfully invented an "on-site" prevention campaign that positively influenced the attitude of the athletes towards cardiac screening.
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10.
Nutrition-focused physical examination in pediatric patients.
Green Corkins, K
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2015;(2):203-9
Abstract
A complete nutrition assessment includes several components: medical record review, anthropometric measurements, diet/nutrition intake, interview, and physical examination. The nutrition-focused physical examination (NFPE) can identify or confirm muscle wasting, subcutaneous fat loss, and edema and clarify information gathered during the medical record review. The physical examination component of the nutrition assessment is more critical in pediatric patients because pediatric patients can become malnourished more quickly than adults and because prolonged malnutrition can negatively affect growth and development. In addition, case studies of micronutrient deficiencies, essential fatty acid deficiency, and protein-calorie malnutrition with skin manifestations have been reported in developed countries. The etiologies of the deficiencies are chronic disease, long-term tube feedings, or long-term parenteral nutrition. An NFPE involves an in-depth examination of the patient from head to toe by a trained nutrition professional. Nutrition professionals recognize the importance and value of an NFPE, yet it is seldom completed, particularly in pediatrics, most likely due to lack of training and lack of pediatric-specific information or training opportunities. Although there are similarities between NFPE in pediatric and adult patients such as the techniques used (inspection, palpation, percussion, and auscultation), there are important differences related to growth and development. This review provides an overview of nutrition assessment with focus on the NFPE and aspects unique to the pediatric patient.