Rates of 30-day revisit to the emergency department among older adults living with dementia: a systematic review and meta-analysis.

OBJECTIVE: Older adults visit emergency departments (EDs) at higher rates than their younger counterparts. However, less is known about the rate at which older adults living with dementia visit and revisit EDs. We conducted a systematic review and meta-analysis to quantify the revisit rate to the ED among older adults living with a dementia diagnosis. METHODS: We searched MEDLINE, Embase, and CINAHL, as well as gray literature, to identify observational studies reporting on older adults living with dementia that revisited an ED within 30 days of a prior ED visit. We calculated pooled rates of 30-day revisit as percentages using random effects models, and conducted stratified analyses by study data source, study population, and study period. We assessed between-studies heterogeneity using the I2 statistic and considered [Formula: see text] > 50% to indicate substantial heterogeneity. All analyses were performed in R software. RESULTS: We identified six articles for inclusion. Percentages of 30-day ED revisit among older adults living with dementia ranged widely from 16.1% to 58.0%. The overall revisit rate of 28.6% showed significant heterogeneity. Between-studies heterogeneity across all stratified analyses was also high. By data source, 30-day revisit percentages were 52.3% (public hospitals) and 20.0% (administrative databases); by study population, revisit percentages were 33.5% (dementia as main population) and 19.8% (dementia as a subgroup). By study period, revisit percentages were 41.2% (5 years or greater) and 18.9% (5 years or less). CONCLUSION: Existing literature on ED revisits among older adults living with dementia highlights the medical complexities and challenges surrounding discharge and follow-up care that may cause these patients to seek ED care at an increased rate. ED personnel may play an important role in connecting patients and caregivers to more appropriate medical and social resources in order to deliver an efficient and more rounded approach to care.

RéSUMé: OBJECTIFS: Les personnes âgées se rendent aux services d'urgence (SU) à des taux plus élevés que leurs homologues plus jeunes. Cependant, on sait moins à quelle fréquence les personnes âgées vivant avec une démence se rendent et retournent aux SU. Nous avons mené une revue systématique et une méta-analyse pour quantifier le taux de retour aux SU chez les personnes âgées vivant avec un diagnostic de démence. MéTHODES: Nous avons effectué une recherche dans MEDLINE, Embase et CINAHL, ainsi que dans la littérature grise, pour identifier les études observationnelles rapportant sur les personnes âgées vivant avec une démence qui sont retournées aux SU dans les 30 jours suivant une visite antérieure aux SU. Nous avons calculé les taux de retour à 30 jours en pourcentage en utilisant des modèles à effets aléatoires, et nous avons effectué des analyses stratifiées selon la source des données de l'étude, la population de l'étude et la période de l'étude. Nous avons évalué l'hétérogénéité entre les études à l'aide de la statistique I2 et avons considéré I

BMI-for-Age and Weight-for-Length in Children 0 to 2 Years.

OBJECTIVES: To determine the agreement between weight-for-length and BMI-for-age in children 0 to <2 years by using research-collected data, examine factors that may affect agreement, and determine if agreement differs between research- and routinely collected data. METHODS: Cross-sectional data on healthy, term-born children (n = 1632) aged 0 to <2 years attending the TARGet Kids! practice-based research network in Toronto, Canada (December 2008-October 2014) were collected. Multiple visits for each child were included. Length (cm) and weight (kg) measurements were obtained by trained research assistants during research visits, and by nonresearch staff during all other visits. BMI-for-age z-scores were compared with weight-for-length z-scores (the criterion measure). RESULTS: The correlation between weight-for-length and BMI-for-age was strong (r = 0.986, P < .0001) and Bland-Altman plots revealed good agreement (difference = -0.08, SD = 0.20, P = .91). A small proportion (6.3%) of observations were misclassified and most misclassifications occurred near the percentile cutoffs. There were no differences by age and sex. Agreement was similar between research- and routinely collected data (r = 0.99, P < .001; mean difference -0.84, SD = 0.20, P = .67). CONCLUSIONS: Weight-for-length and BMI-for-age demonstrated high agreement with low misclassification. BMI-for-age may be an appropriate indicator of growth in the first 2 years of life and has the potential to be used from birth to adulthood. Additional investigation is needed to determine if BMI-for-age in children <2 years is associated with future health outcomes.

Guanidinoacetate is more effective than creatine at enhancing tissue creatine stores while consequently limiting methionine availability in Yucatan miniature pigs.

Creatine (Cr) is an important high-energy phosphate buffer in tissues with a high energy demand such as muscle and brain and is consequently a highly consumed nutritional supplement. Creatine is synthesized via the S-adenosylmethionine (SAM) dependent methylation of guanidinoacetate (GAA) which is not regulated by a feedback mechanism. The first objective of this study was to determine the effectiveness of GAA at increasing tissue Cr stores. Because SAM is required for other methylation reactions, we also wanted to determine whether an increased creatine synthesis would lead to a lower availability of methyl groups for other methylated products. Three month-old pigs (n = 18) were fed control, GAA- or Cr-supplemented diets twice daily. On day 18 or 19, anesthesia was induced 1-3 hours post feeding and a bolus of [methyl-3H]methionine was intravenously infused. After 30 minutes, the liver was analyzed for methyl-3H incorporation into protein, Cr, phosphatidylcholine (PC) and DNA. Although both Cr and GAA led to higher hepatic Cr concentration, only supplementation with GAA led to higher levels of muscle Cr (P < 0.05). Only GAA supplementation resulted in lower methyl-3H incorporation into PC and protein as well as lower hepatic SAM concentration compared to the controls, suggesting that Cr synthesis resulted in a limited methyl supply for PC and protein synthesis (P < 0.05). Although GAA is more effective than Cr at supporting muscle Cr accretion, further research should be conducted into the long term consequences of a limited methyl supply and its effects on protein and PC homeostasis.