Virtual cognitively enhanced tai chi program improves cognition and executive function in older adults with mild cognitive impairment

Embargoed for release until 5:00 p.m. ET on Monday 30 October 2023
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Virtual cognitively enhanced tai chi program improves cognition and executive function in older adults with mild cognitive impairment  

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1603   

URL goes live when the embargo lifts  

A study of more than 300 older adults experiencing mild cognitive impairment or self-reported memory concerns found that cognitively enriched tai ji quan, also known as tai chi, was superior to standard tai ji quan or stretching for improving global cognition and reducing walking interference associated with dual tasking. The authors note that the virtual, home-based exercise program also had high fidelity and adherence, suggesting that it could be a feasible, acceptable exercise-based therapy for older adults concerned about cognitive impairment. The findings are published in Annals of Internal Medicine.  

Mild cognitive impairment is characterized by decline in functional cognition and affects 16 to 20 percent of people aged older than 65 years. The condition can cause memory and thinking problems and impair dual-task performance and, consequently, interfere with complex tasks of daily living. Both cognitive decline and impaired dual-task performance are associated with a higher risk for falls, increased health care costs, and increased mortality. Current clinical guidelines recommend exercise to preserve cognitive function and mitigate decline in older adults, but the effects of cognitively enhanced tai chi are not fully understood. 

Researchers from Oregon Research Institute randomly assigned 318 adults with self-reported memory decline and a Clinical Dementia Rating (CDR) global score of 0.5 or lower at baseline to engage in cognitively enhanced tai ji quan, standard tai ji quan, or stretching 1 hour twice weekly for 24 weeks via videoconferencing to compare the effectiveness of the interventions for improving global cognition and reducing dual-task walking costs. The authors found that cognitively enhanced tai ji quan significantly improved global cognition and lowered cognitive costs associated with dual-task walking at 24 weeks compared with standard tai ji quan or stretching. Favorable improvements were also seen in cognition and function, executive function, and working memory compared with the other two interventions and the effects were sustained at 48 weeks. The intervention was safe, with few mild adverse events reported.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with an author from the study, please contact Dr. Peter Harmer at pharmer@willamette.edu.

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2. New ACP position paper addresses the ethical concepts related to health as a human right 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1900

Editorial : https://www.acpjournals.org/doi/10.7326/M23-2606   
URL goes live when the embargo lifts 
The American College of Physicians (ACP) today issued a new position paper addressing health as a human right and examining the intersection of human rights, ethical obligations, and health reform in recognizing health as a human right. The position paper is published in Annals of Internal Medicine.

The concept of health as a human right is complex. Rights, human rights, and ethical obligations are not synonymous. ACP has longstanding policy on the ethical responsibility of physicians to provide care for all and maintain the patient-physician relationship as central to care; the ethical obligation of society to provide equitable and universal access to appropriate health care; and the continuing need for health reform in the United States to increase access to care. By recognizing health as a human right and supporting the patient–physician relationship and health systems that promote access to care, the United States can move closer to respecting, protecting, and fulfilling for all the opportunity for health. 

Developed by ACP’s Ethics, Professionalism and Human Rights Committee, ACP’s positions state the following:  

• ACP views health as a human right based in the intrinsic dignity and equality of all patients.  
• ACP recognizes that implementing health as a human right requires ethical and evidence-based medical care but also, the consideration of social determinants of health and states that health is more than health services, providing a benchmark for health equity. 
• ACP understands that health as a human right can inform the ethical design, implementation, and evaluation of health care delivery. Viewing health care as human right does not directly imply a particular health system design but can be translated to practical actions and accountability measures to assess health care performance striving for the well-being of individuals and communities.  

• ACP believes that health as a human right aligns with – but does not fully encompass – the ethical obligations of physicians, the medical profession, and a just society and stresses the urgency and importance of health as part of a physician’s commitment to the best in patient interests, thus empowering them to make choices in pursuing their health.    

An accompanying editorial, “ACP and the Human Right to Health” is published with the paper.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andy Hachadorian at ahachadorian@acponline.org.

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3. Teamwork interventions may have a positive effect on hospital climate for nurses but do not improve patient outcomes 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-0953  

URL goes live when the embargo lifts  
A pragmatic controlled trial found interventions to redesign care for hospitalized medical patients helped to improve the perceived level of teamwork from nurses' perspectives but did not seem to affect patient outcomes. According to the authors, health care leaders should consider these findings in the context of their improvement priorities before implementing similar interventions. The study is published in Annals of Internal Medicine.  

Medically challenging patients require care from multiple teams across several professions in one hospital. Teams providing care to hospitalized medical patients are large, team membership changes continually, and physicians often care for patients across multiple units simultaneously. A growing body of research has evaluated individual interventions to address these challenges by redesigning aspects of the care delivery system. The interventions seem to improve interprofessional teamwork, but the evidence that patient outcomes are improved is unclear.  

Researchers from Northwestern University studied medical units at 4 U.S. hospitals to evaluate the effect of combined interventions to redesign hospital care delivery on teamwork and patient outcomes. Each hospital selected one unit for implementation of interventions and a second to serve as a control. Interventions included unit-based physician teams, unit nurse-physician co-leadership, enhanced interprofessional rounds, unit-level performance reports, and patient engagement activities. After implementation of the complementary interventions to redesign care, nurses gave higher ratings to their teamwork climate score. While the authors hypothesized that greater teamwork and interprofessional communication would improve patient outcomes, they found that adverse events, length of stay, 30-day readmissions, and reported patient experience did not improve. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Kevin J. O’Leary, MD, MS, please contact Kevin.OLeary@nm.org.

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4. Nirmatrelvir-ritonavir not effective for reducing most post-COVID-19 conditions 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1394   
URL goes live when the embargo lifts  
A trial emulation study of veterans with COVID-19 found that the use of the antiviral nirmatrelvir–ritonavir was not effective for reducing the risk for many post-COVID-19 conditions, including cardiac, pulmonary, renal, gastrointestinal, neurologic, mental health, musculoskeletal, or endocrine symptoms. Nirmatrelvir–ritonavir was associated only with a reduced risk for combined thromboembolic events. The study is published in Annals of Internal Medicine.  

A study from the Centers for Disease Control and Prevention suggested that 1 in 5 COVID-19 survivors aged 18 to 64 years and 1 in 4 survivors aged 65 years or older experienced an incident condition that was potentially attributable to previous COVID-19 infection. Nirmatrelvir–ritonavir is often recommended to nonhospitalized persons with symptomatic COVID-19 who are at high risk for severe COVID-19. However, its ability to reduce risk for post-COVID-19 conditions is unknown.  

Researchers from the Veterans Administration Puget Sound Healthcare System evaluated 9,593 nonhospitalized patients treated with nirmatrelvir-ritonavir and their matched untreated cohorts for 31 PCCs to measure the effectiveness of outpatient treatment of COVID-19 with nirmatrelvir–ritonavir in preventing PCCs. No differences were observed between the two groups except for a lower combined risk for venous thromboembolism and pulmonary embolism. According to the authors, their results suggest that considerations about PCCs may not be an important factor in COVID-19 treatment decisions. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, George N. Ioannou, BMBCh, MS, please contact George.Ioannou@va.gov.

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