DermHelpCentral

About Frailty

Deciding When Older Patients Should have an Operation, by Paula Span, NY Times, October 31, 2017.

Full NY Times Article

In geriatrics, frail is not merely an adjective. A syndrome marked by slowness, weakness, fatigue and often weight loss, frailty tells doctors a lot about their patients’ likely futures. It can, for example, predict how well older patients rebound from physical stresses — like surgery.

The “timed up-and-go,” test measures how long it takes someone to rise from a chair, walk 10 feet, turn around, walk back and sit down again. This is a simple and important test.

A study that Dr. Seib and her colleagues published in JAMA Surgery (October 2017) shows that frailty is associated with increased perioperative morbidity in common ambulatory general surgery operations, independent of age, type of anesthesia, and other comorbidities. Surgeons should consider frailty rather than chronological age when counseling and selecting patients for elective ambulatory surgery.

Even for out-patient surgery, it is important to take frailty into account for any operation, big or small. One should screen for frailty before any procedure.

Here is a free online article from the Journal of Gerontology (11/2015) Frailty in Older Adults: A Nationally Representative Profile in the United States.

Information About Moisturizers from JAMA and the New York Times (2017)

“Faced with the dizzying array of choices on store shelves, how is the consumer to select a moisturizer likely to be effective and unlikely to cause an unwanted reaction?”

Consumer Preferences, Product Characteristics, and Potentially

Allergenic Ingredients in Best-Selling Moisturizers

Shuai Xu, et. al. Free link.

You can access the article here: http://sci-hub.cc/10.1001/jamadermatol.2017.3046

Conclusions: Best-selling moisturizers vary widely by price and product characteristics. Given the lack of readily available comparison data on moisturizer efficacy, dermatologists should balance consumer preference, price, and allergenicity in their recommendations.

Moisturizer use represents an effective and readily available strategy to manage many common dermatological conditions such as xerosis (dry skin), winter itch, and AD. Our analysis of best-selling moisturizers across 3 major online retailers reveals products that differ substantially in price and characteristics. A large percentage contained at least 1 ingredient in the NACDG series, most commonly fragrances and preservatives. For patients with sensitive skin or existing skin conditions, dermatologists should consider balancing the risk of allergenicity and irritancy with affordability, availability, and consumer preferences. Given the wide number of product choices and inherent challenges in interpreting ingredient lists for consumers, dermatologists may have to provide specific product and manufacturer recommendations to guide patients toward the most appropriate moisturizers.

This article was discussed in detail by Jane Brody in the October 17^th NY Times: It’s Time to Moisturize. But How to Choose?

“Much of the labeling of products as hypoallergenic is nonsense. If you use a product long or often enough, you can become vulnerable to an allergic reaction. It’s not that the product is mislabeled – it’s that you can become allergic to almost anything, especially if you have a predisposition.”

Remember: “moisturizers are best applied on damp skin within minutes of bathing, after patting the skin dry, to lock in moisture. Also helpful is to bathe or shower in warm, not hot, water.”

Bottom Line:  It's a confusing subject. You can't really trust the advertising (duh!).  Most people like the CeraVE product line, Vanicream products, and a few others.  Purists prefer Vaseline.  If you have a proven contact allergy, you will need to read the ingredient list carefully.