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Annals of Geriatric Medicine and... Jul 2024Muscle weakness in older adults elevates mortality risk and impairs quality of life, with the phase angle (PhA) indicating cellular health. Polypharmacy, common in...
BACKGROUND
Muscle weakness in older adults elevates mortality risk and impairs quality of life, with the phase angle (PhA) indicating cellular health. Polypharmacy, common in geriatric care, could influence PhA. This investigates whether the number of medications and polypharmacy with PhA as a biomarker of muscle quality in older inpatients aged ≧ 65 and determines the extent to which multiple medications contribute to the risk of reduced muscle quality.
METHODS
This retrospective cross-sectional study analyzed data from older inpatients requiring rehabilitation. PhA was measured using bioelectrical impedance analysis. The number of medications taken by each patient was recorded at admission. Polypharmacy was defined as the concurrent use of five or more medications at admission.
RESULTS
In this study of 517 hospitalized older adults (median age: 75 years; 47.4% men), 178 patients (34.4%) were diagnosed with sarcopenia. Polypharmacy was present in 66% of patients. The median PhA was 4.9° in men and 4.3° in women. Multivariate linear regression analysis was performed separately for men and women. In men, PhA was negatively correlated with the number of medications (β = -0.104, p=0.041) and polypharmacy (β = -0.045, p=0.383). In women, PhA was negatively correlated with the number of medications (β = -0.119, p=0.026) and polypharmacy (β = -0.098, p=0.063). Analyses were adjusted for age, BMI, sarcopenia, CRP, and hemoglobin levels.
CONCLUSIONS
The number of medications at admission negatively impacted PhA in older inpatients, highlighting the importance of reviewing prescribed drugs and their interactions.
PubMed: 38952330
DOI: 10.4235/agmr.24.0096 -
JMIR Aging Jun 2024Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance...
BACKGROUND
Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood.
OBJECTIVE
This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery.
METHODS
Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework.
RESULTS
The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families.
CONCLUSIONS
In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW.
Topics: Humans; Qualitative Research; Female; Male; Personnel, Hospital; Australia; Adult; Attitude of Health Personnel; Middle Aged
PubMed: 38952009
DOI: 10.2196/54774 -
Injury Epidemiology Jul 2024The purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the...
BACKGROUND
The purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the United States Olympic and Paralympic Committee (USOPC).
METHODS
The development and deployment of the IIS employed a multiphase approach. First, researchers determined variables to include in the IIS using the recommendations from the 2020 IOC consensus statement for reporting sport epidemiological data. Second, the hosting and deployment platforms were comprehensively evaluated for their suitability, ease of use, flexibility, and backend data structure (for both capture and aggregation). Third, focus groups consisting of the Sports Medicine department leadership and clinicians piloted the IIS system and revisions were made based on their feedback. Pilot testing of the IIS and follow-up focus groups were then conducted among all departmental clinicians to solicit additional feedback and drive further revisions. Finally, the IIS system was piloted among providers working during the 2023 Pan American and Parapan American Games to refine the system for future Games. After reviewing all potential software platform options (electronic medical record [EMR] system, athlete management systems, secure data collection platforms), Qualtrics (Qualtrics, Provo, UT, USA) was selected to host the IIS system. This choice was made due to the inability of the EMR and athlete-management systems to make frequent updates, modify existing questions, and provide the necessary form logic for the variety of scenarios in which the IIS system would be deployed. Feedback from the department's leadership and clinicians resulted in a number of changes, most notably being the ability to enter multiple diagnoses for a single injury event. Additionally, clinician feedback resulted in the creation of additional diagnostic codes not currently present in the OSIICS v14.0 diagnostic coding system, adding "non-sport" as an additional variable for injury setting, and developing a system for reporting return-to-sport date for time-loss injuries.
DISCUSSION
A multi-stage process of extensive planning, stakeholder feedback, and ongoing updates is required in order to successfully develop and implement an IIS system within a National Olympic and Paralynpic Committee. This process can be used to inform the development and implementation of IIS systems in other sporting organizations.
PubMed: 38951945
DOI: 10.1186/s40621-024-00514-4 -
Journal of Experimental & Clinical... Jul 2024Leukocyte Ig-like receptor B family 4 (LILRB4) as an immune checkpoint on myeloid cells is a potential target for tumor therapy. Extensive osteolytic bone lesion is the...
BACKGROUND
Leukocyte Ig-like receptor B family 4 (LILRB4) as an immune checkpoint on myeloid cells is a potential target for tumor therapy. Extensive osteolytic bone lesion is the most characteristic feature of multiple myeloma. It is unclear whether ectopic LILRB4 on multiple myeloma regulates bone lesion.
METHODS
The conditioned medium (CM) from LILRB4-WT and -KO cells was used to analyze the effects of LILRB4 on osteoclasts and osteoblasts. Xenograft, syngeneic and patient derived xenograft models were constructed, and micro-CT, H&E staining were used to observe the bone lesion. RNA-seq, cytokine array, qPCR, the activity of luciferase, Co-IP and western blotting were used to clarify the mechanism by which LILRB4 mediated bone damage in multiple myeloma.
RESULTS
We comprehensively analyzed the expression of LILRB4 in various tumor tissue arrays, and found that LILRB4 was highly expressed in multiple myeloma samples. The patient's imaging data showed that the higher the expression level of LILRB4, the more serious the bone lesion in patients with multiple myeloma. The conditioned medium from LILRB4-WT not -KO cells could significantly promote the differentiation and maturation of osteoclasts. Xenograft, syngeneic and patient derived xenograft models furtherly confirmed that LILRB4 could mediate bone lesion of multiple myeloma. Next, cytokine array was performed to identify the differentially expressed cytokines, and RELT was identified and regulated by LILRB4. The overexpression or exogenous RELT could regenerate the bone damage in LILRB4-KO cells in vitro and in vivo. The deletion of LILRB4, anti-LILRB4 alone or in combination with bortezomib could significantly delay the progression of bone lesion of multiple myeloma.
CONCLUSIONS
Our findings indicated that LILRB4 promoted the bone lesion by promoting the differentiation and mature of osteoclasts through secreting RELT, and blocking LILRB4 singling pathway could inhibit the bone lesion.
Topics: Multiple Myeloma; Humans; Mice; Animals; Signal Transduction; Receptors, Immunologic; NF-kappa B; Membrane Glycoproteins; Cell Line, Tumor; Osteoclasts; Xenograft Model Antitumor Assays
PubMed: 38951916
DOI: 10.1186/s13046-024-03110-y -
Cardiovascular Diabetology Jul 2024The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine... (Meta-Analysis)
Meta-Analysis Review
The available evidence on the impact of specific non-pharmacological interventions on glycaemic control is currently limited. Consequently, there is a need to determine which interventions could provide the most significant benefits for the metabolic health of young individuals with type 1 diabetes mellitus. The aim of this study was to identify optimal nonpharmacological interventions on glycaemic control, measured by glycated haemoglobin (HbA1c), in children and adolescents with type 1 diabetes. Systematic searches were conducted in PubMed, Web of Science, Scopus, and SPORTDiscus from inception to July 1, 2023. Randomised clinical trials (RCT) investigating nonpharmacological interventions (e.g., physical activity, nutrition, and behavioural therapies) were included. Primary outcome was change in HbA1c levels. Secondary outcome was change in daily insulin dose requirement. Seventy-four RCT with 6,815 participants (49.43% girls) involving 20 interventions were analysed using a network meta-analysis. Most interventions showed greater efficacy than standard care. However, multicomponent exercise, which includes aerobic and strength training (n = 214, standardised mean difference [SMD] =- 0.63, 95% credible interval [95% CrI] - 1.09 to - 0.16) and nutritional supplements (n = 146, SMD =- 0.49, - 0 .92 to - 0.07) demonstrated the greatest HbA1c reductions. These interventions also led to the larger decreases in daily insulin needs (n = 119, SMD =- 0.79, 95% CrI - 1.19 to - 0.34) and (n = 57, SMD =- 0.62, 95% CrI - 1.18 to - 0.12, respectively). The current study underscores non-pharmacological options such as multicomponent exercise and nutritional supplements, showcasing their potential to significantly improve HbA1c in youth with type 1 diabetes. Although additional research to confirm their efficacy is required, these approaches could be considered as potential adjuvant therapeutic options in the management of type 1 diabetes among children and adolescents.
Topics: Humans; Diabetes Mellitus, Type 1; Glycated Hemoglobin; Adolescent; Child; Network Meta-Analysis; Female; Male; Treatment Outcome; Blood Glucose; Randomized Controlled Trials as Topic; Biomarkers; Bayes Theorem; Hypoglycemic Agents; Glycemic Control; Age Factors; Insulin; Dietary Supplements; Exercise Therapy; Exercise; Child, Preschool
PubMed: 38951907
DOI: 10.1186/s12933-024-02301-3 -
Journal of Neuroengineering and... Jul 2024Virtual reality (VR) Rehabilitation holds the potential to address the challenge that patients feel bored and give up long-term rehabilitation training. Despite the...
Virtual reality (VR) Rehabilitation holds the potential to address the challenge that patients feel bored and give up long-term rehabilitation training. Despite the introduction of gaming elements by some researchers in rehabilitation training to enhance engagement, there remains a notable lack of in-depth research on VR rehabilitation serious game design methods, particularly the absence of a concrete design framework for VR rehabilitation serious games. Hence, we introduce the Clinical-Function-Interesting (CFI): a VR rehabilitation serious game design framework, harmonizing rehabilitation function and game design theories. The framework initiates with clinic information, defining game functions through the functional decomposition of rehabilitation training. Subsequently, it integrates gaming elements identified through the analysis and comparison of related literature to provide enduring support for long-term training. Furthermore, VR side-effect and enhancement are considered. Building upon this design framework, we have developed an upper limb VR rehabilitation serious game tailored for mild to moderate stroke patients and aligned our framework with another developed VR rehabilitation serious game to validate its practical feasibility. Overall, the proposed design framework offers a systematic VR rehabilitation serious game design methodology for the VR rehabilitation field, assisting developers in more accurately designing VR rehabilitation serious games that are tailored to specific rehabilitation goals.
Topics: Humans; Stroke Rehabilitation; Video Games; Upper Extremity; Virtual Reality
PubMed: 38951891
DOI: 10.1186/s12984-024-01373-2 -
BMC Musculoskeletal Disorders Jul 2024
PubMed: 38951805
DOI: 10.1186/s12891-024-07611-x -
BMC Cancer Jul 2024Physical activity is associated with improved disease progression and cancer-specific survival in patients with prostate cancer (PCa). However, the mechanisms underlying...
INTRODUCTION
Physical activity is associated with improved disease progression and cancer-specific survival in patients with prostate cancer (PCa). However, the mechanisms underlying these associations remain unclear, while the relative impact of exercise modes is unknown. This study aims to examine the differential impact of exercise mode on tumour-suppressive skeletal muscle-associated systemic molecules as well as their delivery mechanism. This study will compare the effects of the two main exercise modes, aerobic and resistance, on (1) circulatory myokine levels, (2) skeletal muscle-induced extracellular vesicle abundance and cargo contents, and (3) uptake of extracellular vesicles (EVs) in PCa cells in patients with localised or advanced PCa.
METHODS
A single-group cross-over design will be used for patients at opposite ends of the disease spectrum. A total of 32 patients (localised PCa, n = 16; metastatic castrate-resistant PCa, n = 16) will be recruited while capitalising on two ongoing studies. Ethics amendment has been approved for two ongoing trials to share data, implement the acute exercise sessions, and collect additional blood samples from patients. The patients will undertake two exercise sessions (aerobic only and resistance only) in random order one week apart. Blood will be collected before, after, and 30 min post-exercise. Circulating/EV-contained myokine levels (irisin, IL-6, IL-15, FGF-21, and SPARC) and plasma skeletal muscle-induced EVs will be measured using ELISA and flow cytometry. PCa cell line growth with or without collected plasma will be examined using PCa cell lines (LNCaP, DU-145, and PC-3), while evaluating cellular uptake of EVs. Ethics amendments have been approved for two capitalising studies to share data, implement acute exercise sessions and collect additional samples from the patients.
DISCUSSION
If findings show a differential impact of exercise mode on the establishment of an anti-cancer systemic environment, this will provide fundamental knowledge for developing targeted exercise prescriptions for patients with PCa across different disease stages. Findings will be reported in peer-reviewed publications and scientific conferences, in addition to working with national support groups to translate findings for the broader community.
TRIAL REGISTRATION
The registration for the two capitalising studies are NCT02730338 and ACTRN12618000225213.
Topics: Humans; Male; Extracellular Vesicles; Cross-Over Studies; Prostatic Neoplasms; Exercise; Muscle, Skeletal; Exercise Therapy; Cytokines; Aged; Middle Aged; Myokines
PubMed: 38951803
DOI: 10.1186/s12885-024-12530-0 -
BMC Neurology Jun 2024The Stroke Self-Efficacy Questionnaire (SSEQ) measures the self-confidence of the individual in functional activities after a stroke. The SSEQ is a self-report scale...
BACKGROUND
The Stroke Self-Efficacy Questionnaire (SSEQ) measures the self-confidence of the individual in functional activities after a stroke. The SSEQ is a self-report scale with 13 items that assess self-efficacy after a stroke in several functional domains.
OBJECTIVE
The purpose was to translate the Stroke Self-Efficacy Questionnaire into Urdu Language and to find out the validity and reliability of Urdu SSEQ among stroke patients.
METHODS
The cross-cultural validation study design was used. Following COSMIN guidelines, forward and backward translation protocols were adopted. After pilot testing on 10 stroke patients, the final Urdu version was drafted. A sample of 110 stroke patients was used to evaluate the validity and reliability of the SSEQ-U. Content and Concurrent validity were determined. The intraclass correlation coefficient and Cronbach's alpha were used to measure internal consistency and test-retest reliability. Data analysis was performed using SPSS 25.
RESULTS
The final version was drafted after application on 10 stroke patients. Content validity was analyzed by a content validity index ranging from 0.87 to 1. The internal consistency was calculated by Cronbach's alpha (α > 0.80). Test-retest reliability was determined by the Intra-class correlation coefficient (ICC=0.956). Concurrent validity was determined by correlations with other scales by using the Spearman correlation coefficient; moderate to strong correlations (positive and negative) were found with the Functional Independence Measure (r = 0.76), Beck Depression Inventory (r=-0.54), Short Form of 12-item Scale (r = 0.68) and Fall Efficacy Scale (r = 0.82) with p < 0.05.
CONCLUSION
The Urdu version was linguistically acceptable and accurate for stroke survivors for determining self-efficacy. It showed good content and concurrent validity, internal consistency and test-retest reliability.
Topics: Humans; Female; Male; Stroke; Self Efficacy; Middle Aged; Reproducibility of Results; Surveys and Questionnaires; Aged; Cross-Cultural Comparison; Adult; Psychometrics; Translations; Language
PubMed: 38951800
DOI: 10.1186/s12883-024-03704-1 -
BMC Anesthesiology Jun 2024Awake extubation and deep extubation are commonly used anesthesia techniques. In this study, the safety of propofol-assisted deep extubation in the dental treatment of... (Observational Study)
Observational Study
PURPOSE
Awake extubation and deep extubation are commonly used anesthesia techniques. In this study, the safety of propofol-assisted deep extubation in the dental treatment of children was assessed.
MATERIALS AND METHODS
Children with severe caries who received dental treatment under general anesthesia and deep extubation between January 2017 and June 2023 were included in this study. Data were collected on the following variables: details and time of anesthesia, perioperative vital signs, and incidence of postoperative complications. The incidence of laryngeal spasm (LS) was considered to be the primary observation indicator.
RESULTS
The perioperative data obtained from 195 children undergoing dental treatment was reviewed. The median age was 4.2 years (range: 2.3 to 9.6 years), and the average duration of anesthesia was 2.56 h (range 1 to 4.5 h). During intubation with a videoscope, purulent mucus was found in the pharyngeal cavity of seven children (3.6%); LS occurred in five of them (2.6%), and one child developed a fever (T = 37.8 °C) after discharge. Five children (2.6%) experienced emergence agitation (EA) in the recovery room. Also, 13 children (6.7%) experienced epistaxis; 10 had a mild experience and three had a moderate experience. No cases of airway obstruction (AO) and hypoxemia were recorded. The time to open eyes (TOE) was 16.3 ± 7.2 min. The incidence rate of complications was 23/195 (11.8%). Emergency tracheal reintubation was not required. Patients with mild upper respiratory tract infections showed a significantly higher incidence of complications (P < 0.001).
CONCLUSIONS
Propofol-assisted deep extubation is a suitable technique that can be used for pediatric patients who exhibited non-cooperation in the outpatient setting. Epistaxis represents the most frequently encountered complication. Preoperative upper respiratory tract infection significantly increases the risk of complications. The occurrence of EA was notably lower than reported in other studies.
Topics: Humans; Airway Extubation; Child, Preschool; Retrospective Studies; Propofol; Child; Male; Female; Anesthetics, Intravenous; Anesthesia, General; Postoperative Complications; Laryngismus; Intubation, Intratracheal; Anesthesia, Dental
PubMed: 38951786
DOI: 10.1186/s12871-024-02599-2