bluuebunny/crossref_metadata_2025 huggingface dataset:
52 Should Physiotherapists and Occupational Therapists be Part of the Comprehensive Geriatric Assessment Clinics within the Outpatient Setting?
Authors: Denning-Kemp Alexandra , Melville Hannah , Meldrum Teresa , Wood Carrie-Ann
Published: December 2019

Introduction

The British Geriatric Society (2015) recommends a multidisciplinary team (MDT) Comprehensive Geriatric Assessment (CGA) framework as the Gold standard of care for frail older adults with complex needs. There are currently five Consultant and Nurse-led outpatient CGA clinics in the Older Persons’ Assessment Unit (OPAU), which refer into Physiotherapy (PT) and Occupational Therapy (OT) following their assessments. The aim was to improve the care of patients across the CGA pathway by auditing to establish whether therapists should be involved in the initial assessment of patients in these clinics. Of all new CGA patients in a six month period, only 8% and 2% were referred to PT and OT respectively, warranting further investigation due to the known complexity of this population.

Methods

Set criteria were established, incorporating the core domains of CGA, designed to highlight patients needing therapy assessment, and were screened using patient questionnaires and medical notes review over a three week period.

Results

53 patients were screened against the CGA domains. Rate of completion amongst CGA domains was highly variable: polypharmacy (89%); social (66%); falls (43%); nutrition (43%); continence (25%); mood (23%); cognition (21%); vision (13%); and timed up and go (9%). During the audit, consultants referred four patients to PT and none to OT, compared with screening against the established criteria, which highlighted 28 patients to PT and 22 to OT. Overall, 86% of those screened required therapy intervention.

Discussion

This project identified a substantial number of patients are failing to receive full, effective CGA including onward therapy intervention, which is key in identifying and managing frailty and improved patient outcomes.

Conclusions

This audit highlights the value and need for a multi-disciplinary approach, including PT and OT assessment, within CGA outpatient clinics, to ensure a holistic review of and intervention in the complex needs of older adults.
55 Association between Inflammatory Biomarkers and Severity of Osteoarthritis
Authors: Tong Lynell Roderica Yiu Shyern , Arvindran Vishnu , Mat Sumaiyah , Kioh Sheng Hui , Tan Maw Pin
Published: December 2019

Introduction

Previous studies have found that older adults with osteoarthritis (OA) were more likely to fall. However, the role of inflammation in OA severity, impaired physical function and increased risk of fall remains unclear. Therefore, the aim of this study is to explore the association between the inflammatory biomarkers and OA severity.

Method

This is a cross sectional case-control study which includes 69 individuals aged 55y recruited from orthopaedic clinics, geriatric clinics, primary care and senior citizen groups. Demographic characteristics, medical history, lifestyle factors, Knee Injury and Osteoarthritis Outcome Scores (Koos) were obtained through computer-assisted questionnaires and physical performance were measured. Blood samples were drawn after an overnight fast for a routine laboratory panel. The 20 inflammatory markers were measured and quantified using validated enzyme linked immunosorbent assays included TGFA, IFNG, IL1ra, IL1A, IL1B, IL2, IL3, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12P40, IL12P70, IL13, IL15, IL17A and TNFA.

Results

Of the 69 participants, mean (SD) age being 66.67 (7.605) and 71% women, 18 (26.1%) reported severe, 13(18.8%) moderate, 20 (29.0%) mild and 18 (26.1%) no OA, women. Significant differences in BMI (p-value<0.01), timed-up and go (p-value=0.01), handgrip strength (p-value<0.05), and all KOOS domain scores (p-value<0.01) were found between the four OA severity groups. Of the 20 inflammatory biomarkers tested, only three biomarkers – TGF-A (p=0.01), IL-6 (p<0.01) and IL-8(p=0.03) were significantly associated with severity of osteoarthritis.

Conclusion

More research is needed to see whether this applies to a bigger population and more detailed research needs to be done in regards to TGF-A, IL-6 and IL-8 which shows promise as a severity biomarker for osteoarthritis.
56 Examining Fall-Related HIP Fractures in Long-Term Residential Aged Care and the Community: Trends, Health Outcomes and Treatment Costs
Authors: Mitchell Rebecca , Draper Brian , Harvey Lara , Brodaty Henry , Close Jacqueline
Published: December 2019

Background

Hip fracture risk is higher for older adults living in residential aged care facilities (RACF) and their health outcomes worse compared to older adults living in the community. Pre-hip fracture residential status is not well recorded within hospital records, necessitating linkage of hospital and residential aged care data to better ascertain residential location pre-fracture.

Aim

To examine temporal trends, characteristics and health outcomes following a fall-related hip fracture hospitalisation of people living in RACFs to those living in the community.

Method

A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥65 years during 2008-2013 in New South Wales, Australia. Linked hospitalisation and RACF data were examined. Negative binomial regression examined the significance of hospitalisation temporal trends.

Results

There were 28,897 hip fracture hospitalisations and 32.5% were living in RACFs at time of fracture. The hospitalisation rate was 2,180 per 100,000 (95%CI: 2,097.0-2,263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for the community-living. Over 5 years, the hospitalisation rate for RACF residents declined by 2.9% annually (95%CI: -4.3 to -1.5). Hospital treatment cost for hip fractures was $958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had >1 Charlson comorbidity (37.6% vs 35.6%), and had dementia (58.2% vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community.

Conclusions

RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve health outcomes should be examined.
59 Falls among the Older Adults: Demographics and Risk Factors Analysis in a Clinic-Based Study
Authors: Pang Gordon Hwa Mang , Quah Jing Yao , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Lee Fatt Soon , Yau Weng Keong
Published: December 2019

Background

The aim of the present study was to analyse the demographic pattern, fall circumstances and identify risk factors associated with the occurrence of falls among older adults presenting to falls clinic Hospital Kuala Lumpur

Setting and design

A clinic-based cross-sectional study in Falls Clinic Hospital Kuala Lumpur

Subjects and Method

Medical records of 113 patients attending the Falls Clinic Hospital Kuala Lumpur were analysed. Data on falls circumstances, socioeconomic/demographic factors were collected, and possible risk factors were tested for possible association with outcome, i.e. Recurrent falls using univariate and multivariate analysis.

Results

Of the 113 patients studied, 37.2% (42) were aged more than 80, female predominant 60.2 % (68). 73.5% (83) had recurrent falls and 80.5% (91) had indoor falls. The 3 most common mechanism of falls were tripped/slipped 39.8% (45), loose balance 38.9% (44) and dizziness 31% (35). 67.3% (76) sustained injuries, of which 27.6% (21) were major injuries. Among major injuries, 76.2% (16) had fractures and 23.8% (5) had ICH. The 3 commonest risk factors are poly-pharmacy (5 or more meds) 83.2% (94), poor vision 77.9% (88) and multiple co-morbidities (3 or more) 77%. After multiple logistic regression analysis, ‘usage of anti-hypertensives’ achieved statistically significance with OR of 3.85 (p value 0.008, 95% CI 1.41-10.52).

Conclusion

The usage of anti-hypertensives is associated with almost 4 times more likely to have recurrent falls after removing cofounding factors from our clinic based study. We should prioritise falls prevention on older adults with polypharmacy, poor vision and multiple comorbidities especially those with anti-hypertensives.
64 Association between Risk of Osteoporotic Fractures with Spinal Morphology, Muscle Strength and Physical Performance
Authors: Chua Siew Kuan , Devinder  , Singh KA , Rajaratnam Bala S , Mokhtar Sabarul Afian , Raymond Lee YW
Published: December 2019

Osteoporotic related fractures (OF) are associated with functional impairments and declined quality of life. Low bone mineral density is one of the main risk factor for OF. However, there is limited information regarding the association of spinal morphology, muscle strength and physical performance with OF. The aim of the study was to examine association between risk of osteoporotic fractures with spinal morphology (thoracolumbar curvature and back extensors muscle strength), muscle strength and physical performance. 105 adults aged 50 years and above (69.3+ 8.5 years) were recruited for this cross-sectional study from a spine orthopaedic clinic. Thoracolumbar curvature, back extensors (BEMS) and handgrip (HGS) muscle strength were measured using an electromagnetic tracking system, a load-cell system and hand-held dynamometer respectively. Physical performance was assessed using Short Physical Performance Battery (SPPB). Participants were categorised for major osteoporotic fracture risk (major OF) with cut-point 10% using fracture risk calculator (FRAX®) with BMD. Student t-test analysis demonstrated that there is a significant (p<0.05) difference between participants with low risk and moderate to high risk of major OF for BEMS, HGS, and SPPB. Adjusted logistic models (forward and backward), showed that lower HGS and physical performance were associated with increased risk of major OF (HGS: OR = 0.18 [95% CI, 0.07–0.48]; SPPB: OR = 0.32[95% CI, 0.13–0.80]). Our study results suggest that declined muscle strength and physical performance is associated with higher risk of OF. It is important to promote optimum muscle strength and physical performance among older adults in the prevention of OF.
65 Fragility Fracture Network (FFN) Malaysia - A Call to Action for Better Outcome in Malaysia
Authors: Khor Hui Min , Lee Joon Kiong , Ch'ng Alan Swee Hock , Khoh Hong , Lee Lawrence , Jalil Elyana , Chong Elizabeth Gar Mit , Kumar C Sankara , Choong Qian Yi , Engkasan Julia anak Patrick , Nadarajah Sivapathasundaram C , Bong Chin Pei , Chung Wai Mun
Published: December 2019

Introduction

The incidences of hip fractures are increasing worldwide and over 50% of all hip fractures are projected to occur in Asia. Malaysia is predicted to have the highest rate of increase in numbers of hip fracture in Asia Pacific by 2050. Despite the health and economic burden associated with fragility fractures, there is limited systematic guidance or nationwide interventions set up to address this foreseeable tsunami in Malaysia. This has called for the formation of a national Fragility Fracture Network to bring together experts from different disciplines nationally to drive policy change and improve quality of care in patients with fragility fracture.

Method

The Asia Pacific Regional Fragility Fracture Summit held in Singapore in May 2018 brought together representatives of regional societies from geriatrics, orthopedic, osteoporosis and rehabilitation to share key challenges in providing optimal fragility fracture care. Three clinicians from Malaysia representing three different societies in Asia Pacific who attended the summit initiated the idea of forming a national multidisciplinary network to focus on improving acute hip fracture care, post-acute care rehabilitation and secondary fracture prevention.

Results

After the first meeting held in June 2018 with only 4 members in Kuala Lumpur, the network has expanded to include members from 7 different states in Malaysia. This has led to the formation of the Fragility Fracture Network (FFN) Malaysia in August 2018. The key goals of the network include the development of clinical hip fracture care pathway, initiating national hip fracture registry and fracture liaison service.

Conclusion

FFN Malaysia serves as a platform to unite healthcare providers and policy makers in prioritizing and having co-ownership in improving fragility fracture care in the country.
66 Short Term Outcomes Following Fragility HIP Fracture in Malaysia
Authors: Khor Hui Min , Teh Hui Xin , Tan Fang Chin , Shanmugam Tharshne , Kumar Sankara C , Tan Kit Mun , Singh Simmrat , Saedon Nor' Izzati , Chin Ai Vyrn , Kamaruzzaman Shahrul B , Tan Maw Pin
Published: December 2019

Introduction

Hip fracture carries huge burden to the older person with 40% of patients unable to walk independently after a year and mortality risk of 30% at one year. The study aims to report short-term outcomes following hip fracture from the experience of a tertiary center in Kuala Lumpur.

Methods

A prospective study was performed in University of Malaya where consecutive patients admitted to the orthopaedic wards with fragility hip fracture from March 2016 to August 2018 were recruited. Information on basic socio-demographics, comorbidities, functional status, pre and post-operative assessments, and discharge details were recorded. Outcome measures include the ability to return to pre-fracture mobility status and mortality in 6 months post fracture.

Results

A total of 302 patients with mean age of 79.8 (SD 7.28) years old were included in the study. 276 (91.4%) underwent surgery with mortality rate of 7% in 30days and 14.4% in 6 months. 16.4% of patients underwent surgery within 48hours of admission. Time to surgery was not associated with morbidity or mortality outcome in our study. In 6 months follow up, 23.6% of patients were freely mobile, 27.1% were mobile with one aid, 35.5% required walking frame and 13.8% were immobile. 41.6% of patients managed to regain prefracture mobility status. Multivariate analysis showed that age, length of hospitalization and prefracture mobility statuses were predictors of mobility recovery after hip fracture.

Conclusion

Fragility hip fracture has devastating consequences from our study. There is an urgent call to improve acute hip fracture care and post-acute care rehabilitation in Malaysia.
69 Falls: A Manifestation of Frailty and Sarcopenia
Authors: Woo Jean
Published: December 2019

Falls is one of the major adverse outcomes of frailty and sarcopenia, and may be considered a downstram consequence of these emerging geriatric syndromes. Frailty consists of both physical and cognitive components, which lead to increased falls risk. Community screening for frailty and sarcopenia may be included as an important public health measure, to be followed by more detailed falls risk assessment requiring various measurements. At the same time falls prevention or rehabilitation programs need to take into account the presence of frailty and/or sarcopenia and their appropriate management, to achieve optimal results.
75 Functional Mobility and Balance Confidence as Correlates of Fall Risk in Older Adults Attending a Primary Health Care Clinic
Authors: Ponvel Pavapriya , Singh Devinder Kaur Ajit , Ng Ee San , Selvam Sheela Bai Pannir
Published: December 2019

Background

Fall is one of the leading cause of unintentional injury among older adults. Information regarding functional mobility and balance confidence as correlates of fall risk in older adults attending a primary health care clinic is limited. This information is vital for fall screening and prevention. We aimed to examine if functional mobility and balance confidence were correlates of fall risk in older adults attending a primary health care clinic.

Methods

106 older adults (≥60 years old) attending a primary health care clinic at Cheras, Malaysia participated in this cross-sectional study. Socio-demographic details and falls history were obtained using a structured questionnaire. Functional mobility and balance confidence were assessed using Timed Up and Go (TUG) test and Activities-Specific Balance Confidence (ABC) scale respectively. Fallers were categorised based on history of at least a fall in the past 12 months. Differences between faller and non-faller groups were distinguished using Independent T and Mann Whitney tests. Binomial logistic regression and receiver operating curve were performed to identify if functional mobility and balance confidence were correlates of falls risk and the cut off values for measures were obtained.

Results

TUG test and ABC scores differed significantly between the two groups (p< 0.05). Both TUG test and ABC scale were identified as correlates of falls risk with r, R2 of 0.98, 0.26 (p< 0.001) and 0.95, 0.12 (p< 0.05) respectively. Cut off value of 9.02 seconds and above for TUG test and 82.81% and below for ABC score were identified as risk factor of falls among older adults.

Conclusion

The cut off values obtained from our study can be used as reference to screen older adults at risk of falls in Malaysian primary health care settings. Early fall risk screening and management is a part of falls prevention strategy in older adults.
76 Comparison of Physical Performance in Older Fallers with and without Mild Cognitive Impairment
Authors: Heaw Yu Chi , Singh Devinder Kaur Ajit , Tan Maw Pin , Kumar Saravana
Published: December 2019

Introduction

While mild cognitive impairment (MCI) is a risk factor for falls in older adults, the effects of MCI on physical performance associated with MCI have not been adequately characterised. The aim of the study was to profile physical performance patterns associated with MCI.

Methodology

53 older fallers (31 females, 22 males) from the Falls Clinic at Universiti Malaya Medical Centre, aged 60 years and above (76.5±6.6) were screened and categorised into 2 groups – with MCI and non-MCI – using a Visual Cognitive Assessment Test (VCAT) cut-off score of ≥23. Participants’ sociodemographic data were recorded. Participants performed the Senior Fitness Test that consisted of a battery of physical performance tests.

Results

Older fallers with MCI (n=26) had significantly (p<0.05) poorer physical performance compared to the non-MCI (n=27) group in handgrip strength (16.7±4.8 vs 20.7±7.9 kg), Timed Up-and-Go (17.3±9.91 vs 9.54±2.10 s) and 2-minute walk (79.3±29.8 vs MCI 106.3±33.1 m) tests. There were no significant (p>0.05) differences for the 30-second chair stand, chair sit-and-reach and back scratch tests.

Conclusion

Older fallers with MCI had poorer upper body muscle strength, balance and aerobic endurance compared to those with normal cognition. However, flexibility and lower body muscle strength were similar in older fallers with and without MCI. Further studies to evaluate specifically tailored interventions according to the pattern of physical impairment reported with MCI are needed.
77 Comparison between Swiss Ball Exercise and Sling Exercise on Lumbar Stability and Postural Stability in Patients with Non-Specific Chronic Low Back Pain: A Pilot Study
Authors: Jaroenlarp Apinkarn , Fuengjit Pitsinee , Sukeeyuti Jirapat , Sophap Parichart , Chirasaengthong Chadarat
Published: December 2019

Objective

This study was to comparison of level of lumbar stability and postural sway in sagittal plane and coronal plane between exercise with ball and sling in the patients with non-specific chronic low back pain (NCLBP).

Methodology

Twenty participants with NCLBP aged 20 to 55 years were randomly divided into exercise with ball group (BG) and exercise with sling group (SG). Both groups performed 8 exercise sessions; two times per week for four weeks. The visual analog scale (VAS), modified oswestry disability questionnaire (MODQ), modified isometric stability test (MIST) were used to measure at baseline, week 2 and week 4 after exercise. Moreover, the sway area and sway velocity were evaluated at before and after training. Both group performed exercise 15 repetitions per set for 3 sets with 1-minute resting between set. A repeated two-way ANOVA was used to analyze the difference variables between both groups.

Results

The results showed significant difference between pre and post treatment of pain intensity, functional disability, MIST and postural sway in both groups (p<.001). When compared between both groups, the reduction in all parameters for the BG group was significantly higher than the SG group (p<.05). Moreover, the findings represented that the postural sway in both sagittal and coronal plane showed no significant difference between both groups after complete treatment.

Conclusion

The core stabilization exercise with ball and with sling can provided reduction of pain and functional disability. Moreover, the BG group is more effective for decreasing of pain, disability and improving of lumbar stability may described by greater perturbation of the ball. During perform exercise on ball bring to unstable and increasing of neuromuscular control. These results can applied to clinical practice for choosing the appropriate exercise program in the patients with NCLBP.
78 Development of a Multifactorial Assessment of Dizziness for Middle-Aged and Older People
Authors: Menant Jasmine , Meinrath Daniela , Sturnieks Daina , Migliaccio Americo , Close Jacqueline , Lord Stephen , Delbaere Kim , Titov Nickolai
Published: December 2019

Background

More than 10% of people aged 50 years and older report dizziness. Despite available treatments, dizziness remains unresolved for many people due in part to sub-optimal assessment.

Aims

to identify factors associated with dizziness handicap in middle-aged and older people to identify targets for intervention to address this debilitating problem.

Methods

This secondary analysis of baseline and prospective data from a randomised-controlled trial involved 305 individuals aged 50-92 years reporting significant dizziness in the past year. Participants were classified as having either mild or no dizziness handicap (score < 31) or moderate / severe dizziness handicap (score: 31-100) based on the dizziness handicap inventory (DHI). Participants completed health questionnaires and underwent assessments of psychological well-being, lying and standing blood pressure, vestibular function, strength, vision, proprioception, processing speed, balance, stepping and gait. Participants also reported dizziness episodes in monthly diaries for 6 months following baseline assessment. Participants reported dizziness episodes in monthly diaries for six months following baseline assessment.

Results

DHI scores ranged from 0-86 with 95 participants (31%) reporting moderate/severe dizziness handicap. Binary logisitic regression identified a postive Dix-Hallpike test for benign paroxysmal positional vertigo, cardiovascular medicationuse, high postural sway when standing on the floor with eyes closed and severe anxiety, as significant and independent predictors of moderate.severe dizziness handicap. Poor balance (high sway) also significantly identified participants who reported frequent (> or = weekly, n=134) dizziness episodes.

Conclusion

Assessment of cardiovascular medication use, benign paroxysmal positional vertigo, anxiety and postural sway identify middle aged and older people with significant dizziness handicap. A multifactorial assessment including these facotrs may assist in tailoring evidence-based therapies to alleviate dizziness handicap in this group.
82 Effects of Whole Body Vibration Training using Side-Alternating Vibration Platform with Tilt Table in Hospitalized Older Adults with Sarcopenia : A Randomized Controlled Pilot Study
Authors: Seo Kyoung-Ho , Sin Deoksu , Ju Eun Pyo , Lim Jae-Young
Published: December 2019

Background and Aims

Sarcopenia is defined as the loss of skeletal muscle mass and strength with increased age. Increased activity following whole body vibration (WBV) has been reported in patients with chronic illness, but few studies reported the effect of WBV on the physical function of patients with acute illness. This study aimed to investigate the effects of WBV training using vibration platform with tilt table on muscle mass and physical performance in adults with sarcopenia.

Methods

Inclusion criteria were as follow : 1) age more than 70 years old 2) unable to independently ambulate due to long term hospitalized care 3) patient who was diagnosed as sarcopenia. Participants were randomly allocated into WBV group using side-alternating vibration platform with tilt table vs. conventional physical therapy. In WBV group, subjects lied down on tilt table at 60 degree with bare foot. Then, subjects stood on the platform board which could vibrate. Initial evaluation included muscle power, muscle mass, hand grip force, balance test using Leonardo mechanography, Berg balance scale (BBS), timed get up & go (TUG) test, gait speed and activities of daily living (ADL). Muscle power was evaluated using manual muscle test (MMT). In balance test using mechanography, as a center of path parameters, standard ellipse area (SEA), path length (PL) were evaluated. After 2 weeks, 2nd evaluation was conducted.

Results

A total of 15 were enrolled. There were no significant differences between two groups in demographic characteristics. At initial assessment, there were no significant differences in both groups except for SEA. After intervention, WBV group showed improvements in muscle mass, SEA, BBS, TUG, gait speed, ADL. However, there were no statistically significant differences in all outcomes at 2nd evaluation.

Conclusion

WBV training may improve muscle mass, ability of ambulation and ADL in hospitalized older adults with sarcopenia.
86 Developing the Adapted Lifestyle - Integrated Functional Exercise Programme in Thai Context (TLIFE) to Prevent Falls among Older Adults in Thailand: A Mixed Methods Study
Authors: Ounjaichon Sasiporn , Todd Chris , Stanmore Emma , Boulton Elisabeth
Published: December 2019

Introduction

Falls are the leading cause of injuries in older Thai adults. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in Thai context (TLiFE) among older Thai adults.

Methods

Based on the findings of a prior qualitative study, a feasibility randomised controlled trial (RCT) of TLiFE was conducted among community-dwelling older adults, comparing the TLiFE intervention group with a usual care control group. Outcome measures were analysed at baseline, 3 months, and after 6 months of the intervention.

Results

We recruited a total of 72 older adults into the RCT, randomised to TLiFE (n=36) and control (n=36). The retention rate at 6 months was 91.7%. Attendance in the intervention group (3 home visits and 4 follow-up calls) was 82.9%. There were no differences in fall incidence between the groups. The acceptability survey reveals TLiFE is easy to perform in daily life, safe, and useful. No adverse events were reported.

Conclusion

The TLiFE programme appears to be acceptable and feasible to deliver to community-dwelling older Thai adults. This feasibility study was not powered to detect a difference between groups. A further fully powered definitive randomised controlled trial of TLiFE is needed to evaluate long-term outcomes and cost-effectiveness before it is integrated within the healthcare system in Thailand.
87 Epidemiology Study of Elderly Patients with Acute Myeloid Leukaemia at a Haematological Tertiary Referral Centre
Authors: Yeak Raymond D K , Yap Yee Yee , Tan Sen Mui , Ong Tee Chuan , Tan Jerome T C , Sathar Jameela
Published: December 2019

Introduction

Acute Myeloid Leukemia (AML) is a rare disease with a high incidence in the elderly. Our aim is to report the incidence of elderly patients with AML at a haematological tertiary referral centre.

Method

We have collected data from 2007 till 2017 from the main Malaysian haematological tertiary referral centre involving all the 1225 AML patients. Out of those, 182 elderly patients aged 65 and above with AML were examined. The patients had at least 2 years follow-up.

Results

The elderly represented 14.9% of the 1225 patients who presented with acute myeloid leukemia to the centre. There were 182 elderly patients with AML which were subdivided to the unspecified AML of 154 patients, 1 patient with M1, 4 patients with M2, 6 patients with M3, 5 patients with M4, 8 patients with M5, 2 patients with M6 and 2 patients with M7. There were 109 males and 73 females. The majority of the patients were Chinese (n=85) representing 46.7% of the patients, followed by the Malay (n=76), Indian (n=19) and lastly others (n=2). The average age at diagnosis was 71 years. There were 136 deaths and the mortality rate was 74.7%. The average age of the patients who had passed away (n=136) was 71.4 years. The average age of the patients who are still living (n=42) was 76.5 years.

Conclusion

The incidence of elderly AML is increasing. The younger patients with AML are known to have better survival rate in comparison to the elderly. More research is needed to explore the reasons for the higher mortality in the elderly and the ways to improve the outcome of this elderly population as our lifespan increases and Malaysia heads towards an ageing nation.
88 Prospective Association of Obesity and Falls among Malaysian Community-Dwelling Older Adults
Authors: Kioh Sheng Hui , Mat Sumaiyah , Myint Phyo , Kamaruzzaman Shahrul B , Tan Maw Pin
Published: December 2019

Background

Cross-sectional studies linking the association between obesity and falls are limited and their results are somewhat conflicting. The inconsistent evidence between obesity and falls could be explained by the utilization of different measures of obesity including BMI, WC, waist hip ratio (WHR) and percentage body fat (%BF) in different studies.

Aims

To examine the prospective association between various measures of obesity and falls among community-dwelling older adults.

Methods

We utilized data from the wave 1 and wave 2 of the Malaysian Elder’s Longitudinal Research Study (MELoR). Basic demographic characteristics, medical history, lifestyle factors and falls history in preceding 12 months was recorded by computer assisted questionnaire in participant’s home while anthropometric measurements, body composition assessments and physical performance were collected at the hospital during a hospital check-up at baseline. The main exposure variables were increased body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and percentage body fat (%BF) and the main outcome was self-report falls in the preceding 12 months at time of follow-up.

Results

Among 746 participants at baseline and follow-up (mean age 68.9 ± 7.3 years, old, 56.7% women), 150(20.1%) individuals had ≥1 time of fall at follow-up. No differences in mean age and proportion of men and women among fallers and non-fallers. However, fallers were found to have higher WHR, lower percentage muscle mass and performed poorer in physical performance (p-value<0.01). Of the four obesity indicators, higher WHR at baseline was associated with increased risk of fall 12 months later even after adjustment for all potential confounders (aOR= 2.01; 95%CI= 1.26-3.18).

Conclusions

In conclusion, our findings suggest that WHR is the measure of adiposity most likely to differentiate fallers from non-fallers prospectively. Future studies should evaluate the mechanisms underlying the increased risk of falls associated with increased WHR.
93 An Epidemiological Study of Falls Presentations in the Elderly in a Regional Hospital
Authors: Bhattacharya Joyita , Craswell Alison , Grimley Rohan
Published: December 2019

Aims

To identify the characteristics and outcomes for older people who present to a regional hospital Emergency Department (ED) with a fall and to determine factors associated with admission and representation.

Methods

In this retrospective cohort study, data for patients with falls (>= 65 years) who presented to the ED was collected from 01/06/2014-30/11/2014 and 01/06/2015-30/11/2015

Falls episodes were reviewed for: Place and time of fall; polypharmacy and medication subtypes; comorbidity count; cognitive impairment; ED assessments; Major injury; Representations and readmissions within 90 days and review by Geriatric Emergency Department Intervention (GEDI) nurse. Characteristics of persons admitted and discharged after a fall was compared. Characteristics associated with representation and admissions were reviewed with a logistic regression analysis.

Results

Episodes of older people with falls presenting to the ED (n=280) had high prevalence of complex multimorbidity (82.8%) and polypharmacy (66.4%), more so in episodes resulting in admission and representation. Most falls occurred indoors, presented to the ED during daytime and arrived by ambulance. 50% of episodes resulted in admission. Investigations in the ED regardless of need for discharge or admission showed only 4% having postural blood pressures recorded, 22% had a physiotherapy review and 31% had a GEDI nurse review. Though 86% of falls episodes had a primary ED diagnoses recorded as falls-related injury, two thirds of admitted episodes did not have a diagnosis of major injury. There were 80 representations. Polypharmacy and prior ED presentations were associated with representation. Comorbidity, previous falls and major injury were associated with admission.

Conclusions

Older adults who present to the ED after a fall were complex and had high rates of admission and representation. The focus of clinical assessments was on injuries. This profile enables building future interventions that address risk factors and falls prevention.
94 Association between Dual-Task Timed “UP and GO” Test and Occurrence of Falls According to Age Group (Young-Older or Old-Older Adults): A Longitudinal Observation Study
Authors: Asai Tsuyoshi , Oshima Kensuke , Fukumoto Yoshihiro , Misu Shogo
Published: December 2019

Aim

To elucidate the association between the occurrence of falls and timed “up and go” (TUG) test score in a dual-task condition among community-dwelling older adults by age group.

Methods

This longitudinal observation study included 987 community-dwelling older adults at baseline. A TUG test (single-TUG) and a TUG test while counting aloud backward from 100 (dual-TUG) were conducted at baseline. The dual-task cost (DTC) value was computed from these results. Data on fall history were obtained using a self-administered questionnaire at the 1-year follow-up. At follow-up, 322 participants had dropped out and six participants had missing data for falls. The final analysis included 658 individuals (follow-up rate: 658/987, 67%) divided into a young-older adult group (aged 60–74 years) and an old-older adult group (aged 75 years or older). Associations between the occurrence of falls and TUG-related values were analyzed by age group using multivariate logistic regression models.

Results

For old-older adults, there were significant associations between the occurrence of falls and DTC value (odds ratio [OR] 0.981, 95% confidence interval [CI]: 0.963–0.999, p = 0.040) and single-TUG score (OR 1.129, 95% CI: 1.006–1.268, p = 0.039). However, no significant associations were observed for young-older adults.

Conclusions

Slower single-TUG test score and lower DTC value are associated with the occurrence of falls among old-older adults but not among young-older adults. Dual task assessment is useful for predicting falls in TUG fall assessment for old-older adults.
96 Kuala Lumpur Hospital Fall Preventive Measures, for a Better Tommorow
Authors: Menon Denesh , Mit Elizabeth Chong Gar , Mosa Nor Hayaniza Awang , Toor Amarneet Kaur
Published: December 2019

Introduction

Hospital Kuala Lumpur is the largest tertiary hospital under the MoH. Inpatient falls is a setback in every health institution with ramifications to the patient’s well-being and the health organization image.

Methodology

This is a retrospective, cross-sectional and descriptive report conducted from January 2014 till December 2018. Data collected from submitted IR forms.

Results

942 cases of falls were reported last 5 years with an exponential increase from 63 cases in 2014 to 386 cases in 2018. 81% (758) falls involved medical-based divisions, 17% (163) falls involved surgical based division and 2.2% (21) falls involved allied health. 59% (556) involving male patient and 41% (386) involving female patients. Prevailing age groups are from 61 to 70 y.o with 28.2% (266) falls. Highest number of falls is observed during night shift 40.6% (382) falls. 58.3% (549) patients escaped with no injuries, however, 3.5% (33) falls sustained severe injuries requiring prolonged stay and treatment.

Discussion

Highest falls were reported at Department of Internal Medicine 60% (564) falls, followed by Department of Orthopaedics 8.8% (83) and 2.6% (24) falls reported at Department of Rehabilitative Medicine in the last 5 years. The embodiment of FIT team was inevitable with the increase in falls at HKL whereby they assume the responsibility in designing fall prevention and awareness program in HKL. The FIT Team represents a multi-disciplinary team consisting of doctors, nurses, and allied health supports. The FIT team has conducted multiple sessions of “Training of Trainers” empowering health staff in improving patient safety. Quality Management team educates health staff on accurate reporting using the IR form and conducts regular audits at wards, concerning patient safety. The collaboration of this both entities have created an immense awareness in regards to patient safety, hence spike in numbers of notification. Thus, patient safety is the epitome and cornerstone of all health institution.
98 Falls among Hospitalized Patients in Hospital Sungai Buloh
Authors: Nordin Nordiana , Osman Linda , Liew Chiat Fong , Sa'at Nadiah , Shariff Siti Mallissa Mohd , Asmungin Hasliza
Published: December 2019

Introduction

There is very minimal data documented on inpatient falls and characteristics in Malaysia. In 2017, Falls Incident Report Form (HSB-MED-FORM-017 Pin.1/18) is made mandatory to be filled up in Hospital Sungai Buloh (HSB), following each incident of falls in order to get a better and concrete data on the characteristic of falls.

Objectives

To capture data on incidence of inpatient falls in HSB in the year 2018.

Method

This is a prospective, observational study of all in-patient falls in the 783 bedded hospitals in the year 2018. Data were collected, documented and subsequently analyzed via SPSS Ver 23.

Result

The falls rate is 0.89 per 1000 bed days. There are a total of 123 fallers (including Paediatrics). 37/113 (33%) were above 65 years old, and 82 were males. 43 (38%) fell on night shift.

84 (74%) fell in the 4 bedded area. 60% of the fallers were in the high risk group of Morse fall score (MFS), of which 49/71(69%) fell at bedside (p<0.007). 25/64 (39%) with high MFS fell despite bed railing was up (p<0.05). There was no association between age group and location of falls. 32/33 (97%) of those attempting to get out of bed, also fell at bedside (p<0.001).

Majority fallers [31(27.2%)] were on anti-hypertensives. 23.9% were on 2 or more high risk falls drugs. There was no association between medications with age or MFS. 59/113 (52.2%) had no injuries, 18% sustained lacerations. 1 case sustained an intracranial bleed and succumbed.

Conclusion

Accidental fall is a common problem in adults. In this study, the majority of fallers are in the younger age group. We confirmed a higher incidence of falls in those classified in the high risk category. These possibly explains the correct usage of MFS in all admissions, hence an effective falls prevention and education programme.
Ectopic expression of the sesame MYB transcription factor SiMYB305 promotes root growth and modulates ABA-mediated tolerance to drought and salt stresses in Arabidopsis
Authors: Dossa Komivi , Mmadi Marie A , Zhou Rong , Liu Aili , Yang Yuanxiao , Diouf Diaga , You Jun , Zhang Xiurong
Published: December 2019

An increasing number of candidate genes related to abiotic stress tolerance are being discovered and proposed to improve the existing cultivars of the high oil-bearing crop sesame (Sesamum indicum L.). However, the in planta functional validation of these genes is remarkably lacking. In this study, we cloned a novel sesame R2-R3 MYB gene SiMYB75 which is strongly induced by drought, sodium chloride (NaCl), abscisic acid (ABA) and mannitol. SiMYB75 is expressed in various sesame tissues, especially in root and its protein is predicted to be located in the nucleus. Ectopic over-expression of SiMYB75 in Arabidopsis notably promoted root growth and improved plant tolerance to drought, NaCl and mannitol treatments. Furthermore, SiMYB75 over-expressing lines accumulated higher content of ABA than wild-type plants under stresses and also increased sensitivity to ABA. Physiological analyses revealed that SiMYB75 confers abiotic stress tolerance by promoting stomatal closure to reduce water loss; inducing a strong reactive oxygen species scavenging activity to alleviate cell damage and apoptosis; and also, up-regulating the expression levels of various stress-marker genes in the ABA-dependent pathways. Our data suggested that SiMYB75 positively modulates drought, salt and osmotic stresses responses through ABA-mediated pathways. Thus, SiMYB75 could be a promising candidate gene for the improvement of abiotic stress tolerance in crop species including sesame.
Giving away home field advantage: the misguided attack on confidentiality in international commercial arbitration
Authors: Foden Timothy , Repousis Odysseas G
Published: December 2019

An acclaimed feature of international arbitration is confidentiality. Almost universally, handbooks on international arbitration celebrate confidentiality as a characteristic of arbitration, often when contrasting arbitration with litigation or when discussing the four key selling points of arbitration, namely, speed, cost, confidentiality, and enforceability. Yet, owing to the backlash against investment treaty arbitration, critics have started to suggest that confidentiality in commercial arbitration is a bad thing. But confidentiality is of fundamental importance when it comes to commercial arbitration and the criticism levied at commercial arbitration by reference to transparency considerations in investment arbitration is misplaced. Setting out from this premise, this article first identifies those reasons or perceived shortcomings of confidentiality that according to critics justify a presumption in favour of transparency and publication. Secondly, this article shows that for the most part, the ongoing vilification of confidentiality is the outcome of a worrying trend that risks sacrificing the interests of clients on the altar of a ‘one size fits all’ approach to transparency. This is a false premise and a reminder that attempts to ‘reform’ can have the opposite effect, especially when reformists overlook the needs of the users and the specificities of commercial arbitration.
Fast closed testing for exchangeable local tests
Authors: Dobriban E
Published: December 2019

Multiple hypothesis testing problems arise naturally in science. This note introduces a new fast closed testing method for multiple testing which controls the familywise error rate. Controlling the familywise error rate is state-of-the-art in many important application areas and is preferred over false discovery rate control for many reasons, including that it leads to stronger reproducibility. The closure principle rejects an individual hypothesis if all global nulls of subsets containing it are rejected using some test statistics. It takes exponential time in the worst case. When the tests are symmetric and monotone, the proposed method is an exact algorithm for computing the closure, is quadratic in the number of tests, and is linear in the number of discoveries. Our framework generalizes most examples of closed testing, such as Holm’s method and the Bonferroni method. As a special case of the method, we propose the Simes and higher criticism fusion test, which is powerful both for detecting a few strong signals and for detecting many moderate signals.
Cellular Immunity to Predict the Risk of Cytomegalovirus Infection in Kidney Transplantation: A Prospective, Interventional, Multicenter Clinical Trial
Authors: Jarque Marta , Crespo Elena , Melilli Edoardo , Gutiérrez Alex , Moreso Francesc , Guirado Lluís , Revuelta Ignacio , Montero Nuria , Torras Joan , Riera Lluís , Meneghini Maria , Taco Omar , Manonelles Anna , Paul Javier , Seron Daniel , Facundo Carme , Cruzado Josep M , Gil Vernet Salvador , Grinyó Josep M , Bestard Oriol
Published: December 2019

Background

Improving cytomegalovirus (CMV) immune-risk stratification in kidney transplantation is highly needed to establish guided preventive strategies.

Methods

This prospective, interventional, multicenter clinical trial assessed the value of monitoring pretransplant CMV-specific cell-mediated immunity (CMI) using an interferon-γ release assay to predict CMV infection in kidney transplantation. One hundred sixty donor/recipient CMV-seropositive (D+/R+) patients, stratified by their baseline CMV (immediate-early protein 1)–specific CMI risk, were randomized to receive either preemptive or 3-month antiviral prophylaxis. Also, 15-day posttransplant CMI risk stratification and CMI specific to the 65 kDa phosphoprotein (pp65) CMV antigen were investigated. Immunosuppression consisted of basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids in 80% of patients, whereas 20% received thymoglobulin induction therapy.

Results

Patients at high risk for CMV based on pretransplant CMI developed significantly higher CMV infection rates than those deemed to be at low risk with both preemptive (73.3% vs 44.4%; odds ratio [OR], 3.44 [95% confidence interval {CI}, 1.30–9.08]) and prophylaxis (33.3% vs 4.1%; OR, 11.75 [95% CI, 2.31–59.71]) approaches. The predictive capacity for CMV-specific CMI was only found in basiliximab-treated patients for both preemptive and prophylaxis therapy. Fifteen-day CMI risk stratification better predicted CMV infection (81.3% vs 9.1%; OR, 43.33 [95% CI, 7.89–237.96]).

Conclusions

Pretransplant CMV-specific CMI identifies D+/R+ kidney recipients at high risk of developing CMV infection if not receiving T-cell–depleting antibodies. Monitoring CMV-specific CMI soon after transplantation further defines the CMV infection prediction risk. Monitoring CMV-specific CMI may guide decision making regarding the type of CMV preventive strategy in kidney transplantation.

Clinical Trials Registration

NCT02550639.