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Yamada M, Lee WJ, Akishita M, Yang M, Kang L, Kim S, Lim JP, Lim WS, Merchant RA, Ong T, Peng LN, Phannarus H, Tan MP, Tay L, Won CW, Woo J, Chen LK, Arai H. Clinical practice for sarcopenia in Asia: Online survey by the Asian Working Group for Sarcopenia. Arch Gerontol Geriatr 2023; 115:105132. [PMID: 37490804 DOI: 10.1016/j.archger.2023.105132] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE This study aimed to (1) investigate the clinical practice for the management of sarcopenia among healthcare professionals in Asia, (2) determine the characteristics of clinical care provided by geriatricians versus by other healthcare professionals, and (3) clarify the awareness of sarcopenia. METHODS From December 1 to 31, 2022, an online survey was completed by 1990 healthcare professionals in Asia. The survey comprises demographics and institutional characteristics, basic sarcopenia-related details, and sarcopenia-related assessment and treatment details. RESULTS The mean respondent age was 44.2 ± 10.7 years, 36.4% of the respondents were women, and the mean years of experience in clinical practice were 19.0 ± 10.6 years. The percentages of respondents who were aware of the term "sarcopenia", its definition and the importance of its management were high, at 99.3%, 91.9%, and 97.2%, respectively. The percentages of respondents who had screened patients for, diagnosed patients with, and treated patients for sarcopenia were 42.4%, 42.9%, and 58.8%, respectively. Medical doctors had higher performance rates compared to allied health professionals (45.5% vs. 40.5% for screening, 56.8% vs. 34.5% for diagnosis, and 65.0% vs. 55.0% for treatment) (P < 0.001). Especially, among medical doctors, geriatricians had significantly higher rates compared to non-geriatricians (64.3% vs. 34.1% for screening; 76.7% vs. 44.8% for diagnosis; 82.7% vs. 54.4% for treatment, respectively) (P < 0.001). CONCLUSION Although the importance of the concept and management of sarcopenia is well recognized, there is a gap in its detection and management in clinical practice between medical doctors and allied health professionals, and also between geriatricians and non-geriatricians. Many geriatricians collaborate with other healthcare professionals to appropriately manage sarcopenia. In the future, educating all medical staff on the proper management of sarcopenia is necessary.
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Affiliation(s)
- Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming Chiao Tung University, No 155, Sec 2 Li-Nong Street, Taipei 112, Taiwan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Lin Kang
- Department of Geriatric Medicine, Peking Union Medical College Hospital, 1#ShuaiFuYuan, DongCheng District, Beijing, 100730, China
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Hoegi 1 dong, Dongdaemungu, Seoul 02447, South Korea
| | - Jun-Pei Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Annex 2 Level 3, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatric Medicine, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Nanyang Technological University, Annex 2 Level 3, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Reshma A Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
| | - Terence Ong
- Department of Medicine, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
| | - Li-Ning Peng
- Aging and Health Research Center, National YaE12:F13ng Ming Chiao Tung University, No. 155, Sec. 2, Linong St. Beitoou Dist., Taipei City, 112304, Taiwan
| | - Harisd Phannarus
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Maw-Pin Tan
- Department of Medicine, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia
| | - Laura Tay
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore, Singapore
| | - Chang-Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Hoegi 1 dong, Dongdaemungu, Seoul 02447, South Korea
| | - Jean Woo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin NT, Hong Kong SAR, China
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei Municipal Gan-Dau Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan.
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Assantachai P, Niyomnaitham S, Chatthanawaree W, Intalapaporn S, Muangpaisan W, Phannarus H, Saichompoo RB, Sura-amonrattana U, Wongprompitak P, Toh ZQ, Licciardi PV, Srisutthisamphan K, Chokephaibulkit K. Immunogenicity and Reactogenicity of Messenger RNA Coronavirus Disease 2019 Vaccine Booster Administered by Intradermal or Intramuscular Route in Thai Older Adults. J Infect Dis 2023; 228:868-877. [PMID: 37141388 PMCID: PMC10547455 DOI: 10.1093/infdis/jiad133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/23/2023] [Accepted: 05/02/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Intradermal (ID) vaccination may alleviate COVID-19 vaccine shortages and vaccine hesitancy. METHODS Persons aged ≥65 years who were vaccinated with 2-dose ChAdOx1 12-24 weeks earlier were randomized to receive a booster vaccination by either ID (20 µg mRNA-1273 or 10 µg BNT162b2) or intramuscular (IM) (100 µg mRNA-1273 or 30 µg BNT162b2) route. Anti-receptor-binding domain (RBD) immunoglobulin G (IgG), neutralizing antibody (NAb), and interferon gamma (IFN-γ)-producing cells were measured at 2-4 weeks following vaccination. RESULTS Of 210 participants enrolled, 70.5% were female and median age was 77.5 (interquartile range, 71-84) years. Following booster dose, both ID vaccinations induced 37% lower levels of anti-RBD IgG compared with IM vaccination of the same vaccine. NAb titers against ancestral and Omicron BA.1 were highest following IM mRNA-1273 (geometric mean, 1718 and 617), followed by ID mRNA-1273 (1212 and 318), IM BNT162b2 (713 and 230), and ID BNT162b2 (587 and 148), respectively. Spike-specific IFN-γ responses were similar or higher in the ID groups compared with IM groups. ID route tended to have fewer systemic adverse events (AEs), although more local AEs were reported in the ID mRNA-1273 group. CONCLUSIONS Fractional ID vaccination induced lower humoral but comparable cellular immunity compared to IM and may be an alternative for older people. CLINICAL TRIALS REGISTRATION TCTR20220112002.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Patimaporn Wongprompitak
- Department of Immunology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Kanjana Srisutthisamphan
- National Center for Genetic Engineering and Biotechnology, National Science Development Agency, Pathum-thani
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Wongmek A, Wongviriyawong T, Pitiyarn S, Siritipakorn P, Phannarus H, Muangpaisan W. Effect of the COVID-19 Pandemic on the Self-Perceived Change of Caregivers' Burden in Providing Care for People With Dementia. Gerontol Geriatr Med 2023; 9:23337214231176698. [PMID: 37266392 PMCID: PMC10230307 DOI: 10.1177/23337214231176698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/09/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Objectives: To explore how the COVID-19 pandemic affects caregiver (CG) burden, the quality of care provided to people with dementia (PwD) and their perceived changes between before and during the pandemic. Methods: A cross-sectional study surveyed primary CGs about burden and self-perceived change in multidimensional domains and compared these before and during the pandemic. Results: About 135 primary CGs of PwD were enrolled at Siriraj Hospital's Geriatric Clinic in Thailand and assessed using various online platforms. About 13.8% of CGs had a "mild to moderate" burden. The NPI-Q score and level of functional capacity of the PwD declined during the COVID-19 pandemic (p-value .001 and .001, respectively). The CG-associated factors that related to a higher CG burden were younger age (mean age of 54.2 years old), female (76.3%), and high educational level (80.7%). Conflict between CG and PwD was associated with an increase in CG burden (p-value .004; 95% CI [1.19, 6.12]). Regarding the COVID-19-related factors, there was no association between CG burden and the PwD's characteristics or COVID-19-related concerns. Conclusions: The COVID-19 pandemic was associated with a higher CG burden. Identifying the related factors in an unusual situation may help reduce the CG burden and improve the care of PwD.
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Affiliation(s)
- Apichaya Wongmek
- Department of Medicine, Faculty of
Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Titima Wongviriyawong
- Department of Medicine, Faculty of
Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sutisa Pitiyarn
- Department of Nursing, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
| | | | - Harisd Phannarus
- Department of Preventive and Social
Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| | - Weerasak Muangpaisan
- Department of Preventive and Social
Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
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Somnuke P, Limprapassorn P, Srinonprasert V, Wongviriyawong T, Suraarunsumrit P, Morkphrom E, Sura-amonrattana U, Phannarus H, Choorerk D, Radtke FM, Chaiwat O. The Thai version of the nursing delirium screening scale-Thai: Adaptation and validation study in postoperative patients. Front Med (Lausanne) 2022; 9:956435. [PMID: 36213680 PMCID: PMC9537571 DOI: 10.3389/fmed.2022.956435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Nursing Delirium Screening Scale (Nu-DESC) is an effective instrument for assessing postoperative delirium (POD). This study translated the Nu-DESC into Thai (“Nu-DESC-Thai”), validated it, and compared its accuracy with the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).MethodsThe translation process followed the International Society for Pharmacoeconomics Outcome Research guidelines. Recruited participants were ≥ 70 years old, fluent in Thai, and scheduled for surgery. The exclusion criteria were cancellation or postponement of an operation, severe visual or auditory impairment, and patients with a Richmond Agitation Sedation Scale score of –4 or less before delirium assessment. Post-anesthesia care unit (PACU) nurses and residents on wards each used the Nu-DESC to assess delirium in 70 participants (i.e., 140 assessments) after the operation and after patient arrival at wards, respectively. Geriatricians confirmed the diagnoses using video observations and direct patient contact.ResultsThe participants’ mean age was 76.5 ± 4.6 years. The sensitivity and specificity of the Nu-DESC-Thai at a threshold of ≥ 2 were 55% (95% CI, 31.5–76.9%) and 90.8% (84.2–95.3%), respectively, with an area under a receiver operating characteristic curve (AUC) of 0.73. At a threshold of ≥ 1, the sensitivity and specificity were 85% (62.1–96.8%) and 71.7% (62.7–79.5%), respectively (AUC, 0.78). Adding 1 point for failing backward-digit counting (30–1) to the Nu-DESC-Thai and screening at a threshold of ≥ 2 increased its sensitivity to 85% (62.1–96.8%) with the same specificity of 90.8% (84.2–95.3%).ConclusionThe Nu-DESC-Thai showed good validity and reliability for postoperative use. Its sensitivity was inadequate at a cutoff ≥ 2. However, the sensitivity improved when the threshold was ≥ 1 or with the addition of backward counting to Nu-DESC-Thai and screening at a threshold of ≥ 2.
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Affiliation(s)
- Pawit Somnuke
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peleen Limprapassorn
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine, Integrated Perioperative Geriatric Excellent Research Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Titima Wongviriyawong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patumporn Suraarunsumrit
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkaphop Morkphrom
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Unchana Sura-amonrattana
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Harisd Phannarus
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Duangcheewan Choorerk
- Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Finn M. Radtke
- Department of Anaesthesia and Intensive Care, Nykoebing Hospital, University of Southern Denmark (SDU), Odense, Denmark
| | - Onuma Chaiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine, Integrated Perioperative Geriatric Excellent Research Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- *Correspondence: Onuma Chaiwat,
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Phannarus H, Muangpaisan W, Siritipakorn P, Pianchob S, Supapueng O. Development of a Thai tool for assessing behavioral and psychological symptoms of dementia: A confirmatory factor analysis. Brain Behav 2020; 10:e01816. [PMID: 32857486 PMCID: PMC7667320 DOI: 10.1002/brb3.1816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/11/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The early recognition and management of the behavioral and psychological symptoms of dementia (BPSD) are important to inform treatment decisions. Current BPSD screening tools are time-consuming and require advanced skills, limiting their application in routine clinical practice. An easier and quicker tool for use by nonphysician healthcare personnel is needed. METHODS A 14-item, Thai-language, BPSD scoring system for dementia (BPSD-T) was developed, based on clinical surveys and modifications after a pilot study. The Neuropsychiatric Inventory (NPI), BPSD-T, Thai Mental State Examination (TMSE), Clinical Dementia Rating Scale (CDR), and Barthel Index were performed. BPSD-T and NPI scores were compared, and test validity and reliability were analyzed. RESULTS A total of 168 people with dementia (mean age, 80.7 ± 6.7 years) and their primary caregivers were recruited. A total of 105 (62.5%) subjects were diagnosed with Alzheimer's disease (AD), and 31 (18.5%) with AD with small-vessel disease. The Global CDR was 0.5-1 for 73.8% of subjects, and 2-3 for 26.2%. The BPSD-T content validity index was 0.80-0.98, with high inter-rater and test-retest reliability. Confirmatory factor analysis showed the goodness of fit of 5 clusters of BPSD-T included a psychomotor syndrome (aggression, irritability, delusions, insomnia), an affective syndrome (apathy, repeating, anxiety, depression), a psychosis syndrome (misidentification, hallucinations), a behavior syndrome (hoarding, rummaging, wandering), and a euphoria syndrome (euphoria). Convergent validity showed a high correlation of the frequency score (r = 0.66) and caregiver distress score (r = 0.76) with the NPI. The BPSD-T score was significantly higher with more severe dementia. The average completion time for the BPSD-T (230.9 ± 65.5 s) was significantly less than that for NPI (506 ± 196.9 s; p < .001). CONCLUSIONS BPSD-T is a quick, reliable, and valid test to evaluate BPSD from the common dementia subtypes and severity, with a good correlation with the NPI. Its application in routine clinical practice will enable earlier recognition, targeted intervention, improved quality of care, and reduced caregiver burden.
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Affiliation(s)
- Harisd Phannarus
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pitiporn Siritipakorn
- Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sudarat Pianchob
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Orawan Supapueng
- Division of Clinical Epidemiology, Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Phannarus H, Muangpaisan W, Siritipakorn P, Chotinaiwattarakul W. Cognitive profiles and optimal cut-offs for routine cognitive tests in elderly individuals with Parkinson's disease, Parkinson's disease dementia, Alzheimer's disease, and normal cognition. Psychogeriatrics 2020; 20:20-27. [PMID: 30912230 DOI: 10.1111/psyg.12451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022]
Abstract
AIM The cognitive impairment seen in Parkinson's disease (PD) results in patient disability and reduced quality of life. However, using cognitive screening scales specific to PD in routine clinical practice is difficult because of limited time, resources, and skills. We studied the ability of routine cognitive tests to differentiate between Parkinson's disease dementia (PDD) and PD and among the neuropsychological profiles of elderly individuals with PD, PDD, Alzheimer's disease (AD), and normal cognition. METHODS This cross-sectional study involved 124 subjects. Subjects were 35 cognitively normal elderly and 37 elderly individuals with PD, 22 with PDD, and 30 with AD. All subjects were diagnosed by a specialist using standard criteria. Clinically relevant data and scores from the Montreal Cognitive Assessment and the Thai Mental State Examination were collected. Cognitive test scores were compared among groups. Receiver operating characteristic curves were constructed for a range of cut-off points to explore the sensitivity and specificity of the screening tools to detect PDD. RESULTS There were 74 female subjects (59.7%), and the average age of all subjects was 75.6 years. The median score on the modified Hoehn and Yahr scale was 2.5 in subjects with PD and 4 in those with PDD (P < 0.001). The cut-offs for differentiating PDD from PD were 25 on the Thai Mental State Examination and 14 on the Montreal Cognitive Assessment. The sensitivity of the Thai Mental State Examination was 78.4%, and the specificity was 66.7% (area under the curve: 0.828). The sensitivity of the Montreal Cognitive Assessment was 81.1%, and the specificity was 75% (area under the curve: 0.876). There was a significant difference in the memory and language subdomains between AD and PDD (P < 0.05). CONCLUSIONS The cut-offs used to differentiate PDD from PD were not the same as routine cut-offs in distinguishing AD from normal elderly. The cognitive profile deficit in PDD differed from that in AD. Interpretations of positive screenings test should take this finding into consideration.
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Affiliation(s)
- Harisd Phannarus
- Departments of Preventive and Social Medicine, Mahidol University, Bangkok, Thailand
| | - Weerasak Muangpaisan
- Departments of Preventive and Social Medicine, Mahidol University, Bangkok, Thailand
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