Baptist Health South Florida is a faith-based, not-for-profit healthcare organization and clinical care network in Miami as well as Broward and Palm Beach Counties. Baptist Health has 11 hospitals (Baptist Hospital, Baptist Children’s Hospital, Bethesda Hospital East, Bethesda Hospital West, Boca Raton Regional Hospital, Doctors Hospital, Fishermen’s Community Hospital, Homestead Hospital, Mariners Hospital, South Miami Hospital and West Kendall Baptist Hospital) and in excess of 100 physician practices and outpatient facilities.
Background and ObjectivesParkinson disease (PD) pathogenesis remains incompletely understood; beyond nigrostriatal loss, nondopaminergic mechanisms including neurovascular unit dysfunction may contribute to disability. Cerebral small vessel disease (CSVD) burden reflects neurovascular dysfunction in the form of white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMB), and enlarged perivascular spaces (ePVS). In PD cohorts, CSVD burden correlates with worse motor and gait scores. The aim of the study was to explore whether patients with PD exhibit greater CSVD burden than healthy controls (HC).MethodsWe conducted a PRISMA-conformant systematic review and meta-analysis of studies including adults with idiopathic PD and a HC group that presented data comparing CSVD burden in these 2 groups. Six databases (MEDLINE, Embase, CINAHL Plus, CENTRAL, Scopus, and Web of Science) were searched on May 14 and 15, 2024. Two reviewers independently screened records, extracted data, and assessed risk of bias, with discrepancies resolved by consensus. Continuous outcomes were pooled as standardized mean differences (SMD); dichotomous outcomes as odds ratios (ORs). We evaluated small-study effects for pooled analyses with 10 or more studies using funnel plots and Egger regression test.ResultsWe examined 13,403 records. Forty-six studies (45 cross-sectional) met inclusion criteria, totaling 3,817 PD and 2,593 HC (mean ages: 66.9 and 66.5, respectively). WMH volume (k = 21) was higher in PD (SMD 0.36, 95% CI 0.11-0.62). Visual ratings also indicated higher WMH in PD: global (k = 14) SMD 0.27 (95% CI 0.08-0.46); periventricular (k = 11) SMD 0.32 (95% CI 0.12-0.51); deep (k = 8) SMD 0.20 (95% CI 0.09-0.31). Differences in CMB (k = 6; OR 1.18, 95% CI 0.57-2.42) and lacunes (k = 4; OR 1.48, 95% CI 0.58-3.78) were not significant. ePVS results were heterogeneous but trended toward greater burden in PD, most notably in the midbrain (k = 3; SMD 1.80, 0.15-3.44). Overall evidence quality was rated as low, reflecting the observational nature of the included studies.DiscussionOur analysis showed PD to be associated with greater WMH burden and increased midbrain ePVS. Pooled differences in CMB and lacunes were not significant. Substantial heterogeneity and cross-sectional designs limit certainty; standardized imaging and prospective cohorts are needed to define mechanisms and clinical implications.
Background: Falls among hospitalized patients are a substantial cause of adverse health outcomes, making prevention efforts an important priority. The Morse Fall Scale (MFS) is a popular tool to assess fall risk, although its predictive usefulness is limited in certain health care settings. Purpose: We aimed to explore the predictive value of the MFS, as well as additional factors associated with falls in acute care settings. Methods: This retrospective analysis included data from 4,887 adult patients 18 years of age and older stored in the repository of an acute care inpatient hospital. Data were analyzed using multivariate regression models and area under the receiver operating characteristic curves to determine the validity of the MFS as a predictor of falls. Results: Of the 4,887 patients admitted to the acute care hospital setting, 343 (7%) experienced a fall. The median age of the cohort was 70.9 years. After propensity score matching, MFS scores did not differ significantly between those who experienced falls and those who did not. Several variables, such as All Patient Refined Diagnosis Related Group severity, environmental factors, unsteady gait, low bowel continence level, lack of alertness, skin moisture status as either dry or moist, benzodiazepine administration, diabetes, previous drug use, discharge status documented in the electronic health record, sepsis, atrial fibrillation, and hospitalization duration, were significantly associated with a greater risk of falls. Conclusions: The MFS did not adequately predict falls. Several additional factors were associated with a greater risk of falls. Nurses and other clinicians should incorporate these insights into fall prevention protocols. These findings warrant inclusion in fall risk assessment guidelines, protocols, and fall prevention training programs.
Obesity prevention guidelines have stressed the importance of utilizing each patient-physician encounter towards delivering effective weight reduction, exercise, and dietary counseling during patient encounters. The objective of this study was to understand the prevalence and predictors of weight, exercise, and dietary counseling for obese adults using a nationally representative data. We conducted a retrospective cross-sectional analysis of the National Ambulatory Medical Care Survey (2011–2018), of obese patients aged ≥ 18 years who had an office visit. Outcomes were receipt of weight reduction, exercise, dietary, any, and all counseling. Descriptive statistics and multivariable logistic regression were used to identify demographic, clinical, and practice-related predictors. Sampling weights were used to generate national estimates. An estimated 289,667,549 office visits were found among obese adults during the study period. Nearly 21.5
AIM The "2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia" retires and replaces the "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol." METHODS A comprehensive literature search was conducted from October 2024 to December 2024 to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE The focus of this clinical practice guideline is to address the evaluation, management, and monitoring of individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a).
