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The use of extracorporeal membrane oxygenation (ECMO) in trauma patients with severe acute respiratory distress syndrome (ARDS) continues to evolve. The objective of this study was to perform a comparative analysis of trauma patients with ARDS who received ECMO to a propensity matched cohort of patients who underwent conventional management. The Trauma Quality Improvement Program (TQIP) database was queried from 2013 to 2016 for all patients with ARDS and those who received ECMO. Demographics, as well as clinical, injury, intervention, and outcome data were collected and analyzed. Patients with ARDS were divided into two groups, those who received ECMO and those who did not. A propensity score analysis was performed using the following criteria: age, gender, vital signs (HR, SBP) and GCS on admission, Injury Severity Score (ISS), and Abbreviated Injury Scale (AIS) score in several body regions. Outcomes between the groups were subsequently compared using univariate as well as Cox regression analyses. Secondary outcomes such as hospitalization (HLOS), ICU length-of-stay (LOS) and ventilation days stratified for patient demographics, timing of ECMO and anticoagulation status were compared. Over the 3-year study period, 8990 patients with ARDS were identified from the TQIP registry. Following exclusion, 3680 were included in the final analysis, of which 97 (2.6%) received ECMO. On univariate analysis following matching, patients who underwent ECMO had lower overall hospital mortality (23 vs 50%, p < 0.001) with higher rates of complications (p < 0.005), including longer HLOS. In those undergoing ECMO, early initiation (<7 days) was associated with shorter HLOS, ICU LOS, and fewer ventilator days. No difference was observed between the two groups with regard to anticoagulation. Extracorporeal membrane oxygenation use in trauma patients with ARDS may be associated with improved survival, especially for young patients with thoracic injuries, early in the course of ARDS. Anticoagulation while on circuit was not associated with increased risk of hemorrhage or mortality, even in the setting of head injuries. The mortality benefit suggested with ECMO comes at the expense of a potential increase in complication rate and prolonged hospitalization.

Abstract Comprehensive Geriatric Assessment (CGA) is a process where healthcare professionals evaluate and develop a management strategy for older adults who may have multiple multifactorial illnesses and geriatric syndromes. CGA has traditionally been a labor-intensive process that assesses many factors at a specific point in time. Its availability and feasibility in busy clinical settings is remains limited. Artificial Intelligence (AI) can potentially expand the accessibility and effectiveness of this currently limited resource. By integrating large numbers of longitudinal data sets, AI can evaluate in real time a broad array of ever-changing factors that include medical assessments, diagnostic testing/imaging, laboratory analysis, nursing evaluations, behavioral health interventions, social determinants, electronic monitoring, wearables, community resources, and caregiver support. A geriatric AI framework will need develop computational models that integrate changing biologic, sociodemographic, and mental health factors. The framework could also account for the changing availability of local resources and plan eligibility. The integration of large longitudinal datasets would allow for prediction modeling related to diagnosis, management strategies, and outcomes. Treatment protocols can be automated too. Machine learning will allow for the adjustment of medical alert thresholds to minimize alert fatigue that plaques current electronic health record systems. Just-in-time information can identify appropriate home technology equipment and referrals for community services. An AI framework potentially offers a more comprehensive and longitudinal geriatric evaluation that avoids delays in care while waiting for a single physician to “get to see the patient.”

Abstract In coordination with the Florida Department of Health, the VA Sunshine Healthcare Network (VISN 8) established Long-Term Care Strike Teams to provide services to the LTC facilities most affected by the COVID-19 pandemic across the state of Florida. Between April 2020 through September 2020, the Strike Teams provided direct patient care to community residents, infection control/ prevention education, and patient/staff COVID-19 swabbing. We encountered facilities with large numbers of staff infected with COVID-19 and agency staff that were refusing to come to \"COVID-infected\" facilities. Remaining staff, including the administrators, were under much psychological distress. However, our experience supporting the long-term care facilities also had a major impact on our own perceptions of nursing home care. The bravery, dedication, and caring that we witnessed reinforced that the health care workers in long-term care facilities are true heroes.

The authors sought to determine the incidence of suicide and its relevant correlates among men with prostate cancer. This was a population-based, retrospective cohort review of men age 65 and older, residing in South Florida between 1983 and 1993. Average annual suicide rate was calculated for prostate cancer-related suicides and contrasted with age and gender-specific rates in the same geographic area. Of 667 completed suicides, 20 were prostate cancer-related (3% of the total male suicide sample). The average annual incidence of suicide for men was 55.32 per 100,000 persons, but for men with prostate cancer, the rate was 274.7 per 100,000. The risk of suicide in men with prostate cancer was 4.24 times that of an age- and gender-specific cohort. The clinical correlates included depression (70%), cancer diagnosis within 6 months of suicide (80%), physician visit within 1 month of suicide (60%), and being foreign-born (70%). The incidence of suicide among older men with prostate cancer is higher than previously recognized. Depression, recent diagnosis, pain, and being foreign-born are important clinical correlates. Screens for depression and suicide in older men with prostate cancer should be done after diagnosis and redone during the first 6 months regularly, particularly in the primary-care setting. Public education is needed to decrease the stigma associated with having a cancer diagnosis.

The enactment of the Patient Protection and Affordable Care Act (ACA) has been expected to improve the coverage of health insurance, particularly as related to the coordination of seamless care and the continuity of elder care among Medicare beneficiaries. The analysis of longitudinal data (2007 through 2013) in rural areas offers a unique opportunity to examine trends and patterns of rural disparities in hospital readmissions within 30 days of discharge among Medicare beneficiaries served by rural health clinics (RHCs) in the eight southeastern states of the Department of Health & Human Services (DHHS) Region 4. The purpose of this study is twofold: first, to examine rural trends and patterns of hospital readmission rates by state and year (before and after the ACA enactment); and second, to investigate how contextual (county characteristic), organizational (clinic characteristic) and ecological (aggregate patient characteristic) factors may influence the variations in repeat hospitalizations. The unit of analysis is the RHC. We used administrative data compiled from multiple sources for the Centers of Medicare and Medicaid Services for a period of seven years. From 2007 to 2008, risk-adjusted readmission rates increased slightly among Medicare beneficiaries served by RHCs. However, the rate declined in 2009 through 2013. A generalized estimating equation of sixteen predictors was analyzed for the variability in risk-adjusted readmission rates. Nine predictors were statistically associated with the variability in risk-adjusted readmission rates of the RHCs pooled from 2007 through 2013 together. The declined rates were associated with by the ACA effect, Georgia, North Carolina, South Carolina, and the percentage of elderly population in a county where RHC is located. However, the increase of risk-adjusted rates was associated with the percentage of African Americans in a county, the percentage of dually eligible patients, the average age of patients, and the average clinical visits by African American patients. The sixteen predictors accounted for 21.52 % of the total variability in readmissions. This study contributes to the literature in health disparities research from the contextual, organizational and ecological perspectives in the analysis of longitudinal data. The synergism of multiple contextual, organizational and ecological factors, as shown in this study, should be considered in the design and implementation of intervention studies to address the problem of hospital readmissions through prevention and enhancement of disease management of rural Medicare beneficiaries.

Background Gut microbiota is crucial in nutrient extraction, metabolism, cognition, and immune function. Consequently, the increasing number of microbiome studies aims to link specific bacteria, fungi, and viruses with various cognitive disease outcomes. Unfortunately, clinical studies often exclude many older adults with Alzheimer's Disease and Related Dementia who are homebound or from racially/ethnically diverse populations. The homebound older adult population is estimated to be three times larger than the equally impaired and chronically ill nursing home population. People of color often hesitate to participate in clinical trials due to mistrust, logistical barriers, and lack of awareness. Recruiting a diverse group of patients has been challenging. Method We review the literature using CINAL, PubMed, Medline, PsycINFO, and Embase to highlight evidence‐based strategies for promoting inclusivity among homebound and minority communities in microbiome studies. Additionally, we discussed the inclusion and exclusion criteria necessary for clinical trials. Results We identified strategies such as community engagement, culturally appropriate assistance, mobile health units, and strategic partnerships with feedback mechanisms to improve recruitment and retention of underserved populations. We also discussed inclusion and exclusion criteria while highlighting factors that can confound results. While these criteria may complicate trials involving vulnerable populations, they are essential for optimizing outcomes. We must recognize and adequately support these populations while keeping these criteria in mind. Conclusion This review emphasized recruitment strategies for underrepresented groups in microbiome studies and underscores the importance of inclusion and exclusion criteria to ensure robust study results. Without inclusivity in microbiota clinical trials, we cannot effectively address health inequities or ensure the generalizability of findings. The complexity and long‐term nature of these trials suggest that additional support for patients and caregivers may be necessary for participants with cognitive decline. Diverse participation helps uncover variations in disease prevalence, progression, and treatment responses among different populations, leading to more personalized and effective healthcare solutions. It also enhances the overall quality of research by incorporating a wide range of perspectives and experiences.

Military personnel are exposed to unique environmental hazards and psychological stressors during their service to our nation. As a result, military service personnel are at high risk not only for physical injury but for psychological trauma as well that may result in post-traumatic stress disorder, depression, substance abuse, and homelessness. These medical and psychosocial issues may hasten the development of life-limiting illnesses and may complicate the delivery of end-of-life care. Community-based hospice agencies often lack the resources and expertise to address the special needs of veterans. This article highlights the efforts of the Department of Veterans Affairs to provide comprehensive and co-ordinated end-of-life support for \"those who served.\"

Potentially avoidable hospitalizations are associated with high costs and an increased risk for iatrogenic conditions in older adult patients. Although care managers may be aware of the common potential pitfalls that may arise in the transfer of patients to and from the hospital, defining best practice models has been difficult. Many current models of geriatric care have had little or no impact on lowering the rates of hospitalizations and rehospitalizations when formally studied. Health care reform legislation mandates initiatives involving new models of coordinated or guided care such as the medical home model and the accountable care organization. These new models too will face significant challenges in their attempt to provide the financial incentives and systematic changes needed to successfully address transitional care in older adults.

Gut microbiota is crucial in nutrient extraction, metabolism, cognition, and immune function. Consequently, the increasing number of microbiome studies aims to link specific bacteria, fungi, and viruses with various cognitive disease outcomes. Unfortunately, clinical studies often exclude many older adults with Alzheimer's Disease and Related Dementia who are homebound or from racially/ethnically diverse populations. The homebound older adult population is estimated to be three times larger than the equally impaired and chronically ill nursing home population. People of color often hesitate to participate in clinical trials due to mistrust, logistical barriers, and lack of awareness. Recruiting a diverse group of patients has been challenging. We review the literature using CINAL, PubMed, Medline, PsycINFO, and Embase to highlight evidence-based strategies for promoting inclusivity among homebound and minority communities in microbiome studies. Additionally, we discussed the inclusion and exclusion criteria necessary for clinical trials. We identified strategies such as community engagement, culturally appropriate assistance, mobile health units, and strategic partnerships with feedback mechanisms to improve recruitment and retention of underserved populations. We also discussed inclusion and exclusion criteria while highlighting factors that can confound results. While these criteria may complicate trials involving vulnerable populations, they are essential for optimizing outcomes. We must recognize and adequately support these populations while keeping these criteria in mind. This review emphasized recruitment strategies for underrepresented groups in microbiome studies and underscores the importance of inclusion and exclusion criteria to ensure robust study results. Without inclusivity in microbiota clinical trials, we cannot effectively address health inequities or ensure the generalizability of findings. The complexity and long-term nature of these trials suggest that additional support for patients and caregivers may be necessary for participants with cognitive decline. Diverse participation helps uncover variations in disease prevalence, progression, and treatment responses among different populations, leading to more personalized and effective healthcare solutions. It also enhances the overall quality of research by incorporating a wide range of perspectives and experiences.