Background Cognitive decline has been reported after coronary artery revascularization, but whether it reflects procedure-specific effects or the burden of underlying vascular disease remains uncertain. Objectives To determine whether incident dementia risk differs according to coronary revascularization strategy among older adults with acute coronary syndrome (ACS). Methods We conducted a longitudinal cohort study among adults aged ≥65 years hospitalized for ACS between 2010 and 2020 (n = 25,176). Patients underwent percutaneous coronary intervention (n = 8,043), coronary artery bypass grafting (n = 797), or received no revascularization (n = 16,336). A second comparator cohort included patients with stable coronary artery disease (CAD) without revascularization (n = 154,299). The primary outcome was incident dementia identified using validated International Classification of Diseases codes after a 1-year washout. Propensity-matched analyses used Cox models accounting for the competing risk of death. Results Revascularized patients were younger (74.8 ± 6.9 vs 77.1 ± 8.2 years), more often male (66.2% vs 54.0%), and had lower Elixhauser multimorbidity scores (4.6 ± 2.8 vs 5.4 ± 3.0, all P < 0.001). Over a median 4.8 years of follow-up, 9.0% of ACS patients developed dementia. Revascularization was not associated with increased dementia risk compared with ACS without revascularization (sub-hazard ratio: 1.05; 95% CI: 0.95-1.17) or stable CAD. Dementia risk was also similar between percutaneous coronary intervention and coronary artery bypass grafting. Conclusions We found that among older adults with ACS, coronary revascularization was not statistically significantly associated with increased dementia risk compared with no revascularization or stable CAD. These findings reflect the hypothesis that the majority of dementia risk is potentially driven more by cumulative vascular and systemic factors than by procedure-specific neurotoxicity.
Over the past 15 years, a large health care organization has embraced Caring Science as a unifying framework. Nearly 200 Caritas Coaches have been trained, and more than 1100 nurses have advanced their academic degrees through Caring Science-aligned programs. The integration of Dr Jean Watson's Theory of Human Caring has helped shift the culture toward one grounded in love, compassion, and healing-from the bedside to the boardroom. This manuscript describes the organization's strategic investment in developing Caritas Coaches, embedding Caring Science into onboarding, leadership development, and unit-level practices. Amid the COVID-19 pandemic, Caring Science emerged as a powerful anchor for resilience, purpose, and staff retention. Exemplars illustrate how executive leaders operationalized Caritas Principles to transform care delivery, create psychologically safe environments, and foster belonging. The results demonstrate that when organizations prioritize care for the caregiver, measurable improvements in staff satisfaction, patient experience, and clinical quality follow. Caring Science offers a replicable model for health systems seeking to restore humanity in health care.
BACKGROUND:Dementia is increasingly common among older adults (≥ 65 years) and is associated with poor outcomes. However, little is known about its baseline prevalence in patients hospitalized with acute coronary syndrome (ACS), particularly across revascularization strategies. METHODS:The authors conducted a cross-sectional analysis from a current longitudinal cohort study of Kaiser Permanente Northern California members hospitalized with ACS between January 2010 and December 2020. Dementia diagnoses and subtypes were identified using International Classification of Diseases 9/10 codes. Baseline prevalence was compared across revascularization strategies: percutaneous coronary intervention, coronary artery bypass grafting, or no revascularization. RESULTS:Among 26,749 patients with ACS, the mean age was 76.7 ± 8.0 years; patients not revascularized were older than those who were (77.7 ± 8.3 vs 74.9 ± 7.0 years; P < .001). Overall, 57.4% were male, with a higher proportion among revascularized patients. The overall baseline prevalence of dementia was 5.9%, substantially lower among revascularized (1.9%) vs nonrevascularized patients (7.9%; P < .001). Dementia prevalence was 2.0% for percutaneous coronary intervention, 0.6% for coronary artery bypass grafting, and 7.9% for no revascularization. Alzheimer's disease was the most common subtype (85.7%), followed by vascular (5.7%), Lewy body/Parkinson's (3.7%), frontotemporal (1.0%), and unspecified types (3.9%). CONCLUSION:One in 17 older adults hospitalized with ACS had a documented diagnosis of dementia at baseline, with substantial variation by revascularization strategy. These findings highlight the baseline burden of dementia in this high-risk population and support the need for future research on the incidence and progression of cognitive impairment after ACS.
Background: Professional pilots and long-haul truck drivers represent populations at extreme risk for chronic low back pain (LBP) due to prolonged static sitting, whole-body vibration, and cumulative mechanical exposure. Traditional ergonomics focuses on posture, but does not address the progressive mechanical "creep" and shear amplification occurring at the L5/S1 segment. Objective: To evaluate a novel intervention—Scheduled Intermittent Compression-Decompression (SICD) therapy—in reducing the rate of L5/S1 shear amplification during a standardized 30-day occupational cycle. Methods: A randomized crossover trial with 20 professional participants. Biomechanical load was normalized (N/kg body mass). Primary outcomes included estimated L5/S1 shear forces, multifidus muscle thickness via ultrasound, and autonomic markers (HRV RMSSD). Results: SICD therapy reduced Day 30 shear amplification by 10.4% compared to controls (2.24 vs 2.50 N/kg, p < 0.05). Multifidus atrophy was significantly mitigated in the intervention group. Conclusion: SICD acts as a "mechanical reset," preventing the accumulation of shear forces beyond structural thresholds, providing a citable framework for industrial health interventions.
Background: Cognitive decline has been reported after coronary artery revascularization, but whether it reflects procedure-specific effects or the burden of underlying vascular disease remains uncertain. Objectives: To determine whether incident dementia risk differs according to coronary revascularization strategy among older adults with acute coronary syndrome (ACS). Methods: We conducted a longitudinal cohort study among adults aged ≥65 years hospitalized for ACS between 2010 and 2020 (n = 25,176). Patients underwent percutaneous coronary intervention (n = 8,043), coronary artery bypass grafting (n = 797), or received no revascularization (n = 16,336). A second comparator cohort included patients with stable coronary artery disease (CAD) without revascularization (n = 154,299). The primary outcome was incident dementia identified using validated International Classification of Diseases codes after a 1-year washout. Propensity-matched analyses used Cox models accounting for the competing risk of death. Results: Revascularized patients were younger (74.8 ± 6.9 vs 77.1 ± 8.2 years), more often male (66.2% vs 54.0%), and had lower Elixhauser multimorbidity scores (4.6 ± 2.8 vs 5.4 ± 3.0, all P < 0.001). Over a median 4.8 years of follow-up, 9.0% of ACS patients developed dementia. Revascularization was not associated with increased dementia risk compared with ACS without revascularization (sub-hazard ratio: 1.05; 95% CI: 0.95-1.17) or stable CAD. Dementia risk was also similar between percutaneous coronary intervention and coronary artery bypass grafting. Conclusions: We found that among older adults with ACS, coronary revascularization was not statistically significantly associated with increased dementia risk compared with no revascularization or stable CAD. These findings reflect the hypothesis that the majority of dementia risk is potentially driven more by cumulative vascular and systemic factors than by procedure-specific neurotoxicity.
