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Visvanathan R, Lange K, Selvam J, Dollard J, Boyle E, Jones K, Ingram K, Shibu P, Wilson A, Ranasinghe DC, Karnon J, Hill KD. Findings from three methods to identify falls in hospitals: Results from the Ambient Intelligent Geriatric Management system fall prevention trial. Australas J Ageing 2024; 43:199-204. [PMID: 37861202 DOI: 10.1111/ajag.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/21/2022] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports). METHODS A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used. RESULTS Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%). CONCLUSIONS This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.
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Affiliation(s)
- R Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - K Lange
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Selvam
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Dollard
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - E Boyle
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Jones
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - P Shibu
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
| | - A Wilson
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - D C Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - J Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - K D Hill
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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Ahip SS, Theou O, Shariff-Ghazali S, Samad AA, Lukas S, Mustapha UK, Visvanathan R. The Pictorial Fit-Frail Scale Malay Version (PFFS-M): Predictive Validity Testing in Malaysian Primary Care. J Frailty Aging 2024; 13:35-39. [PMID: 38305441 DOI: 10.14283/jfa.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/03/2024]
Abstract
The purpose of this study was to evaluate the association between Pictorial Fit Frail Scale-Malay version (PFFS-M) and adverse outcomes, such as falls, new disability, hospitalisation, nursing home placement, and/or mortality, in patients aged 60 and older attending Malaysian public primary care clinics. We assessed the baseline PFFS-M levels of 197 patients contactable by phone at 18 months to determine the presence of adverse outcomes. 26 patients (13.2%) reported at least one adverse outcome, including five (2.5%) who fell, three (1.5%) who became disabled and homebound, 15 (7.6%) who were hospitalized, and three (1.5%) who died. Using binary multivariable logistic regression adjusted for age and gender, we found that patients who were at-risk of frailty and frail at baseline were associated with 5.97(95% CI [1.89-18.91]; P=0.002) and 6.13 (95% CI [1.86-20.24]; P= 0.003) times higher risk of developing adverse outcomes at 18 months, respectively, than patients who were not frail. The PFFS-M was associated with adverse outcomes.
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Affiliation(s)
- S S Ahip
- Sally Suriani Ahip, Kota Samarahan Health Clinic, Jalan Datuk Mohammad Musa, 94300 Kota Samarahan, Sarawak, Malaysia, , Telephone: +60125880709, Fax number: +6082673632
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Jadczak AD, Verma M, Headland M, Tucker G, Visvanathan R. A Judo-Based Exercise Program to Reduce Falls and Frailty Risk in Community-Dwelling Older Adults: A Feasibility Study. J Frailty Aging 2024; 13:1-9. [PMID: 38305437 DOI: 10.14283/jfa.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 02/03/2024]
Abstract
OBJECTIVES This study aimed to explore the feasibility (including recruitment, safety and adherence) and the effects of a twice weekly supervised Judo-based exercise program over eight weeks on mobility, balance, physical performance, quality of life, fear of falling and physical activity (including by frailty status) in community-dwelling older people aged ≥65 years. DESIGN Pre-post study. PARTICIPANTS A total of 17 participants (mean age 74.3±6.2; range 66-87 years; 76.5% female). INTERVENTION A Judo-based exercise program conducted twice weekly for 60 minutes per session over eight weeks. MEASUREMENTS Pre and post assessments included the Timed Up and Go (TUG); the Berg Balance Scale (BBS); the Short Physical Performance Battery (SPPB); the Short Form Health Survey-36 (SF-36); the Falls Efficiency Scale International (FES-I); and an ActivPal accelerometer to measure participants' physical activity. RESULTS Most participants had low (≤3) Charlson's Comorbidity Index scores (n=17, 100%), were well nourished (n=16, 94.1%), not sarcopenic (n=16, 94.1%), and not cognitively impaired (n=13, 76.5%), anxious or depressed (n=14, 82.4%). Ten participants (58.8%) were non-frail and seven were pre-frail (41.2%). Significant improvements (p<0.05) were seen for mobility (TUG), balance (BBS) and physical performance (SPPB). Pre-frail participants showed greater improvement in mobility (TUG) than non-frail participants (p=0.020). No changes (p≥0.05) were seen in quality of life, fear of falling, or physical activity. Participants' adherence (i.e., attending sessions) was high (i.e., ≥81.2%). No serious adverse events or withdrawals were reported. CONCLUSION Findings suggest that the eight week Judo-based exercise program can be delivered safely to older adults aged ≥65 years, including those at-risk of frailty, as long as there is close supervision with individualisation of the program in response to emergent health symptoms and the program is conducted on requisite Judo mats. This Judo-based exercise program is effective in improving physical function with potential to prevent falls and frailty risk.
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Affiliation(s)
- A D Jadczak
- Dr Agathe Daria Jadczak, PhD, Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia. Basil Hetzel Institute for Translational Health Research, 37 Woodville Rd, Woodville South, South Australia 5011, Australia.
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Goh CY, Visvanathan R, Leong CT, Hooi LS, Ch'ng CC, Yee SY, Abd Manaf KA, Mushahar L, Goh KW, Liew YF, Manocha AB, Ong LM. A prospective study of incidence and outcome of acute kidney injury among hospitalised patients in Malaysia (My-AKI). Med J Malaysia 2023; 78:733-742. [PMID: 38031214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The incidence of acute kidney injury (AKI) among hospitalised patients has not been well studied in Malaysia. MATERIALS AND METHODS We conducted a prospective, multicentre study in seven hospitals in West Malaysia. All the adults admitted in March 2017 fulfilling Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI were included. RESULTS Of the 34,204 patients screened, 2,457 developed AKI (7.18%), 13.1% of which occurred in intensive care unit (ICU). There were 60.2% males with a mean age of 57.8 (±17.5) years. The most common comorbidities were hypertension (55.0%), diabetes (46.6%), ischaemic heart disease (15.1%) and chronic kidney disease (12.0%). The commonest causes of AKI were sepsis (41.7%), pre-renal (24.2%) and cardiorenal syndrome (10.8%). Nephrotoxin exposure was reported in 31%. At diagnosis, the proportion of AKI stages 1, 2 and 3 were 79.1%, 9.7%, 11.2%, respectively. Referral to nephrologists was reported in 16.5%. Dialysis was required in 176 (7.2%) patients and 55.6% were performed in the ICU. Acidosis (46.2%), uraemia (31.6%) and electrolyte disturbance (11.1%) were the commonest indications. Continuous renal replacement therapy (CRRT) was required in 14%. The average length of hospital stay was 9.5 days. In-hospital mortality was 16.4%. Among survivors, full and partial renal recovery was seen in 74.7% and 16.4% respectively while 8.9% failed to recover. After a mean follow-up of 13.7 months, 593 (30.2%) of survivors died and 38 (1.9%) initiated chronic dialysis. Mortality was highest among those with malignancies (Hazard Ratio, HR 2.14), chronic liver disease (HR 2.13), neurological disease (HR 1.56) and cardiovascular disease (HR 1.17). CONCLUSION AKI is common in hospitalised patients and is with associated high mortality during and after hospitalisation.
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Affiliation(s)
- C Y Goh
- Selayang Hospital, Department of Nephrology, Malaysia.
| | - R Visvanathan
- Kuala Lumpur Hospital, Department of Nephrology, Malaysia
| | - C T Leong
- Clinical Research Centre, Penang Hospital, Malaysia
| | - L S Hooi
- Sultanah Aminah Hospital, Department of Medicine, Johor Bahru, Malaysia
| | - C C Ch'ng
- Clinical Research Centre, Penang Hospital, Malaysia
| | - S Y Yee
- Kuala Lumpur Hospital, Department of Nephrology, Malaysia
| | - K A Abd Manaf
- Tengku Ampuan Rahimah Hospital, Department of Nephrology, Klang, Malaysia
| | - L Mushahar
- Tuanku Ja'afar Hospital, Department of Nephrology, Seremban, Malaysia
| | - K W Goh
- Serdang Hospital, Department of Nephrology, Malaysia
| | - Y F Liew
- Penang Hospital, Department of Medicine, Malaysia
| | - A B Manocha
- Seberang Jaya Hospital, Department of Medicine, Malaysia
| | - L M Ong
- Clinical Research Centre, Penang Hospital, Malaysia.
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Sahathevan S, Karupaiah T, Khor BH, Sadu Singh BK, Mat Daud ZA, Fiaccadori E, Sabatino A, Chinna K, Abdul Gafor AH, Bavanandan S, Visvanathan R, Yahya R, Wahab Z, Goh BL, Morad Z, Bee BC, Wong HS. Muscle Status Response to Oral Nutritional Supplementation in Hemodialysis Patients With Protein Energy Wasting: A Multi-Center Randomized, Open Label-Controlled Trial. Front Nutr 2022; 8:743324. [PMID: 34977109 PMCID: PMC8717812 DOI: 10.3389/fnut.2021.743324] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Muscle wasting, observed in patients with end-stage kidney disease and protein energy wasting (PEW), is associated with increased mortality for those on hemodialysis (HD). Oral nutritional supplementation (ONS) and nutrition counseling (NC) are treatment options for PEW but research targeting muscle status, as an outcome metric, is limited. Aim: We compared the effects of combined treatment (ONS + NC) vs. NC alone on muscle status and nutritional parameters in HD patients with PEW. Methods: This multi-center randomized, open label-controlled trial, registered under ClinicalTrials.gov (Identifier no. NCT04789031), recruited 56 HD patients identified with PEW using the International Society of Renal Nutrition and Metabolism criteria. Patients were randomly allocated to intervention (ONS + NC, n = 29) and control (NC, n = 27) groups. The ONS + NC received commercial renal-specific ONS providing 475 kcal and 21.7 g of protein daily for 6 months. Both groups also received standard NC during the study period. Differences in quadriceps muscle status assessed using ultrasound (US) imaging, arm muscle area and circumference, bio-impedance spectroscopy (BIS), and handgrip strength (HGS) methods were analyzed using the generalized linear model for repeated measures. Results: Muscle indices as per US metrics indicated significance (p < 0.001) for group × time interaction only in the ONS + NC group, with increases by 8.3 and 7.7% for quadriceps muscle thickness and 4.5% for cross-sectional area (all p < 0.05). This effect was not observed for arm muscle area and circumference, BIS metrics and HGS in both the groups. ONS + NC compared to NC demonstrated increased dry weight (p = 0.039), mid-thigh girth (p = 0.004), serum prealbumin (p = 0.005), normalized protein catabolic rate (p = 0.025), and dietary intakes (p < 0.001), along with lower malnutrition–inflammation score (MIS) (p = 0.041). At the end of the study, lesser patients in the ONS + NC group were diagnosed with PEW (24.1%, p = 0.008) as they had achieved dietary adequacy with ONS provision. Conclusion: Combination of ONS with NC was effective in treating PEW and contributed to a gain in the muscle status as assessed by the US, suggesting that the treatment for PEW requires nutritional optimization via ONS.
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Affiliation(s)
- Sharmela Sahathevan
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Perak, Malaysia
| | - Tilakavati Karupaiah
- School of BioSciences, Faculty of Health and Medical Sciences, Taylor's University Lakeside, Selangor, Malaysia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Sabah, Malaysia
| | - Birinder Kaur Sadu Singh
- Department of Pharmacy, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Enrico Fiaccadori
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Alice Sabatino
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University Lakeside, Selangor, Malaysia
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sunita Bavanandan
- Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | | | - Rosnawati Yahya
- Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Zaimi Wahab
- Department of Nephrology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Bak-Leong Goh
- Department of Nephrology, Serdang Hospital, Selangor, Malaysia
| | - Zaki Morad
- National Kidney Foundation, Selangor, Malaysia
| | - Boon Cheak Bee
- Department of Nephrology, Selayang Hospital, Selangor, Malaysia
| | - Hin Seng Wong
- Department of Nephrology, Selayang Hospital, Selangor, Malaysia
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Lim SK, Goh BL, Visvanathan R, Kim SH, Jeon JS, Kim SG, Chang JH, Lim CS, Morad Z. Correction to: A multicentre, multi-national, double-blind, randomised, active-controlled, parallel-group clinical study to assess the safety and efficacy of PDA10 (Epoetin-Alfa) vs. Eprex® in patients with anaemia of chronic renal failure. BMC Nephrol 2022; 23:14. [PMID: 34979969 PMCID: PMC8725391 DOI: 10.1186/s12882-021-02651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Soo Kun Lim
- Renal Division, Department of Medicine, Faculty of Medicine, University of Malaya, 59100, Kuala Lumpur, Malaysia.
| | | | | | - Su Hyun Kim
- Chung-Ang University Hospital, Seoul, South Korea
| | - Jin Seok Jeon
- Soonchunhyang University Hospital, Seoul, South Korea
| | - Sung Gyun Kim
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Jae Hyun Chang
- Gil Medical Centre, Gachon University College of Medicine, Incheon, South Korea
| | - Chun Soo Lim
- Seoul National University Boramae Medical Centre, Seoul, South Korea
| | - Zaki Morad
- KPJ Ampang Puteri Specialist Hospital, Ampang, Malaysia
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Daly RM, Iuliano S, Fyfe JJ, Scott D, Kirk B, Thompson MQ, Dent E, Fetterplace K, Wright ORL, Lynch GS, Zanker J, Yu S, Kurrle S, Visvanathan R, Maier AB. Screening, Diagnosis and Management of Sarcopenia and Frailty in Hospitalized Older Adults: Recommendations from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Expert Working Group. J Nutr Health Aging 2022; 26:637-651. [PMID: 35718874 DOI: 10.1007/s12603-022-1801-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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] [Indexed: 12/17/2022]
Abstract
Sarcopenia and frailty are highly prevalent conditions in older hospitalized patients, which are associated with a myriad of adverse clinical outcomes. This paper, prepared by a multidisciplinary expert working group from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), provides an up-to-date overview of current evidence and recommendations based on a narrative review of the literature for the screening, diagnosis, and management of sarcopenia and frailty in older patients within the hospital setting. It also includes suggestions on potential pathways to implement change to encourage widespread adoption of these evidence-informed recommendations within hospital settings. The expert working group concluded there was insufficient evidence to support any specific screening tool for sarcopenia and recommends an assessment of probable sarcopenia/sarcopenia using established criteria for all older (≥65 years) hospitalized patients or in younger patients with conditions (e.g., comorbidities) that may increase their risk of sarcopenia. Diagnosis of probable sarcopenia should be based on an assessment of low muscle strength (grip strength or five times sit-to-stand) with sarcopenia diagnosis including low muscle mass quantified from dual energy X-ray absorptiometry, bioelectrical impedance analysis or in the absence of diagnostic devices, calf circumference as a proxy measure. Severe sarcopenia is represented by the addition of impaired physical performance (slow gait speed). All patients with probable sarcopenia or sarcopenia should be investigated for causes (e.g., chronic/acute disease or malnutrition), and treated accordingly. For frailty, it is recommended that all hospitalized patients aged 70 years and older be screened using a validated tool [Clinical Frailty Scale (CFS), Hospital Frailty Risk Score, the FRAIL scale or the Frailty Index]. Patients screened as positive for frailty should undergo further clinical assessment using the Frailty Phenotype, Frailty Index or information collected from a Comprehensive Geriatric Assessment (CGA). All patients identified as frail should receive follow up by a health practitioner(s) for an individualized care plan. To treat older hospitalized patients with probable sarcopenia, sarcopenia, or frailty, it is recommended that a structured and supervised multi-component exercise program incorporating elements of resistance (muscle strengthening), challenging balance, and functional mobility training be prescribed as early as possible combined with nutritional support to optimize energy and protein intake and correct any deficiencies. There is insufficient evidence to recommend pharmacological agents for the treatment of sarcopenia or frailty. Finally, to facilitate integration of these recommendations into hospital settings organization-wide approaches are needed, with the Spread and Sustain framework recommended to facilitate organizational culture change, with the help of 'champions' to drive these changes. A multidisciplinary team approach incorporating awareness and education initiatives for healthcare professionals is recommended to ensure that screening, diagnosis and management approaches for sarcopenia and frailty are embedded and sustained within hospital settings. Finally, patients and caregivers' education should be integrated into the care pathway to facilitate adherence to prescribed management approaches for sarcopenia and frailty.
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Affiliation(s)
- R M Daly
- Professor Robin M. Daly, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria, Australia 3125, Phone: +61 3 9244 6040, , ORCID ID: 0000-0002-9897-1598
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Lim SK, Goh BL, Visvanathan R, Kim SH, Jeon JS, Kim SG, Chang JH, Lim CS, Morad Z. A multicentre, multi-national, double-blind, randomised, active-controlled, parallel-group clinical study to assess the safety and efficacy of PDA10 (Epoetin-alpha) vs. Eprex® in patients with anaemia of chronic renal failure. BMC Nephrol 2021; 22:391. [PMID: 34823497 PMCID: PMC8620966 DOI: 10.1186/s12882-021-02601-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/03/2021] [Indexed: 12/27/2022] Open
Abstract
Background Erythropoietin stimulating agent (ESA) has been standard of care in treating renal anaemia for the past 20 years. Many patients have limited access to ESA in view of long-term costs leading to suboptimal ESA dosage. Biosimilar epoetin is a potential cost-effective alternative to originator for optimal renal anaemia management. Objective To determine efficacy and safety of PDA10 in treating renal anaemia in haemodialysis patients, in comparison to the originator epoetin-α, Eprex®. Methods A phase 3, multicentre, multi-national, double-blind, randomised, active-controlled and parallel group study conducted over 40 weeks in Malaysia and Korea. End stage kidney disease patients undergoing regular haemodialysis who were on erythropoietin treatment were recruited. The study has 3 phases, which included a 12-week titration phase, followed by 28-week double-blind treatment phase and 24-week open-label extension phase. Results The PDA10 and Eprex® were shown to be therapeutically equivalent (p < 0.0001) with mean absolute change in haemoglobin from baseline of − 0.176 (± 0.91) g/dl and − 0.118 (± 1.114) g/dl, respectively. Weekly dose change was 10.01 IU/kg/week in PDA10 group and 10.30 IU/kg/week in Eprex® group, which has no significant difference. There were no significant differences in the safety profile between PDA10 and Eprex® groups. Conclusion This study has confirmed the therapeutic equivalence between PDA10 and Eprex® in terms of efficacy, dosage requirement and safety profile in haemodialysis patients with renal anaemia. Trial registration The study was registered with the National Medical Research Register (NMRR-13-400-16313). This study has been registered retrospectively with Clinical Research Information Service (CRiS), Republic of Korea on 25 March 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02601-w.
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Affiliation(s)
- Soo Kun Lim
- Renal Division, Department of Medicine, Faculty of Medicine, University of Malaya, 59100, Kuala Lumpur, Malaysia.
| | | | | | - Su Hyun Kim
- Chung-Ang University Hospital, Seoul, South Korea
| | - Jin Seok Jeon
- Soonchunhyang University Hospital, Seoul, South Korea
| | - Sung Gyun Kim
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Jae Hyun Chang
- Gil Medical Centre, Gachon University College of Medicine, Incheon, South Korea
| | - Chun Soo Lim
- Seoul National University Boramae Medical Centre, Seoul, South Korea
| | - Zaki Morad
- KPJ Ampang Puteri Specialist Hospital, Ampang, Malaysia
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Liau SJ, Lalic S, Visvanathan R, Dowd LA, Bell JS. The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes. J Nutr Health Aging 2021; 25:1205-1216. [PMID: 34866147 PMCID: PMC8549594 DOI: 10.1007/s12603-021-1694-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To investigate frailty prevalence, cross-sectional associations, predictive validity, concurrent validity, and cross-cultural adaptations of the FRAIL-NH scale. DESIGN Systematic review. SETTING AND PARTICIPANTS Frail residents living in nursing homes. METHODS MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched from January 2015 to June 2021 for primary studies that used the FRAIL-NH scale, irrespective of study designs and publication language. RESULTS Overall, 40 studies conducted across 20 countries utilized the FRAIL-NH scale; majority in Australia (n=14), followed by China (n=6), United States (n=3), and Spain (n=3). The scale has been translated and back-translated into Brazilian Portuguese, Chinese, and Japanese. Various cut-offs have been used, with ≥2 and ≥6 being the most common cut-offs for frail and most frail, respectively. When defined using these cut-offs, frailty prevalence varied from 15.1-79.5% (frail) to 28.5-75.0% (most frail). FRAIL-NH predicted falls (n=2), hospitalization or length of stay (n=4), functional or cognitive decline (n=4), and mortality (n=9) over a median follow-up of 12 months. FRAIL-NH has been compared to 16 other scales, and was correlated with Fried's phenotype (FP), Frailty Index (FI), and FI-Lab. Four studies reported fair-to-moderate agreements between FRAIL-NH and FI, FP, and the Comprehensive Geriatric Assessment. Ten studies assessed the sensitivity and specificity of different FRAIL-NH cut-offs, with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI, while two studies reported an optimal cut-off of ≥2 based on FI and FP, respectively. CONCLUSION In seven years, the FRAIL-NH scale has been applied in 20 countries and adapted into three languages. Despite being applied with a range of cut-offs, FRAIL-NH was associated with higher care needs and demonstrated good agreement with other well-established but more complex scales. FRAIL-NH was predictive of adverse outcomes across different settings, highlighting its value in guiding care for frail residents in nursing homes.
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Affiliation(s)
- S J Liau
- Shin J. Liau, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 407 Royal Parade, Parkville, Victoria 3052, Australia. E-mail:
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Sualeheen A, Khor BH, Balasubramanian GV, Sahathevan S, Ali MSM, Narayanan SS, Chinna K, Daud ZAM, Khosla P, Gafor AHA, Karupaiah T, Cheak BB, Ahmad G, Goh BL, Lim SK, Visvanathan R, Yahya R, Bavanandan S, Morad Z. Habitual Dietary Patterns of Patients on Hemodialysis Indicate Nutritional Risk. J Ren Nutr 2020; 30:322-332. [DOI: 10.1053/j.jrn.2019.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/05/2019] [Accepted: 09/15/2019] [Indexed: 02/07/2023] Open
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Jadczak AD, Visvanathan R. The Sustained Impact of a Medical School-Based Physical Activity Module on Interns' Perceived Competence in Advising Older Adults about Exercise. J Frailty Aging 2020; 9:155-157. [PMID: 32588030 DOI: 10.14283/jfa.2019.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The study aimed to examine the sustained impact of a 1.5-hour medical school-based physical activity (PA) module on interns' perceived competence and importance in advising older adults about exercise. The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered in 2017 (CG: control group) and 2018 (IG: intervention group) two years post-course. The perceived competence of both, CG (n=23) and IG (n=18), decreased significantly over two years (p≤0.05) with no difference between the groups (p>0.05). However, 72.2% (n=13) of the interns who attended the PA module still felt competent in advising older adults about exercise (4.21±0.66) compared to 47.8% (n=11) of the CG (3.89±0.67). The perceived importance decreased significantly in both groups (p≤0.05) with no difference between the groups (p>0.05). However, both groups still perceived exercise for older people as important (CG:4.55±0.61; IG:4.83±0.47). Subsequently, continued professional development is likely to be a key requirement for ensuring sustainability over time.
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Affiliation(s)
- A D Jadczak
- Agathe Daria Jadczak PhD, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital DX 465701, 28 Woodville Road, Woodville South, SA 5011, Australia, Phone: +61 8 8133 4012
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Kondratenko K, Boussoualem Y, Singh DP, Visvanathan R, Duncan AE, Clark NA, Legrand C, Daoudi A. Molecular p-doping in organic liquid crystalline semiconductors: influence of the charge transfer complex on the properties of mesophase and bulk charge transport. Phys Chem Chem Phys 2019; 21:18686-18698. [PMID: 31423509 DOI: 10.1039/c9cp03076j] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We explore the molecular nature of doping in organic semiconductors (OSCs) by employing a liquid crystalline organic semiconductor based on phenyl naphthalene as a model. The mesophase nature of composites that include a charge transfer complex (CTC) between the OSC (8-PNP-O12) and an electron acceptor (F4TCNQ) has been investigated by means of differential scanning calorimetry, polarized optical microscopy and X-ray scattering. Optical and vibrational spectroscopies allow us to explore the characteristics and the amount of charge transfer in the CTC and expose some properties that appear only in the complexed state. We have found this system to exhibit partial charge transfer, which manifests itself in all the phase states of the host 8-PNP-O12, as well as in solution. Due to the lowering of molecular symmetry as a result of the charge transfer, one of the previously IR-only vibrational bands of the nitrile group is found to be now active in the Raman spectrum. We have also made an attempt to further investigate the influence of dopant introduction on the bulk hole mobility of 8-PNP-O12. It is found that the presence of the CTC promotes the hole transport in the Smectic B mesophase, however it seems to have a somewhat negative influence in the less ordered smectic A mesophase. This work aims to establish the link between the inevitable change of molecular geometry that occurs on charge transfer with the results obtained by spectroscopic techniques and electronic charge carrier mobility measurements.
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Affiliation(s)
- K Kondratenko
- Univ. Littoral Côte d'Opale, EA 4476 - UDSMM - Unité de Dynamique et Structure de Matériaux Moléculaires, 59140 Dunkerque, France.
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Taylor D, Barrie H, Lange J, Thompson MQ, Theou O, Visvanathan R. Geospatial modelling of the prevalence and changing distribution of frailty in Australia - 2011 to 2027. Exp Gerontol 2019; 123:57-65. [PMID: 31129145 DOI: 10.1016/j.exger.2019.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Detailed information about the current and future geographic distribution of Australia's frail population provides critical evidence to inform policy, resource allocation and planning initiatives that aim to treat and reverse frailty. Frailty is associated with poor health outcomes, including disability and death. It is also characterised by increased health care usage and costs. Understanding the distribution and growth of frailty is important for planning and budgeting service provision and health interventions aimed to support the needs of Australia's growing ageing population. The objective of this research is to provide baseline mapping and area level population estimates of Australia's current and future frail and pre-frail populations. RESEARCH DESIGN AND METHODS Geospatial modelling was applied to national frailty prevalence rates to provide estimates of the size, distribution and potential growth of Australia's frail and pre-frail population. RESULTS It is estimated that in 2016 approximately 415,769 people living in Australia aged 65 years or more are frail and almost 1.7 million people are pre-frail. In future years, as the population ages, these figures will increase rapidly, reaching 609,306 frail and 2,248,977 pre-frail by 2027, if prevalence continues at current levels. The geographic distribution of this projected growth is not uniform and while the largest frail populations will continue to be located in the major cities, the fastest growth will be in the outer metropolitan, regional and remote areas. DISCUSSION AND IMPLICATIONS The projected growth of frail populations in outer metropolitan, regional and remote areas may be reduced by targeting health interventions in these areas and improving access to support services. Frailty is a dynamic condition that is amenable to intervention. Reducing frailty will lead to benefits in wellbeing for older Australians in addition to reductions in health care costs.
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Affiliation(s)
- D Taylor
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia; Adelaide Geriatrics Training and Research with Aged Care Centre, Adelaide Medical School, University of Adelaide, South Australia, Australia.
| | - H Barrie
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia; Hugo Centre for Migration and Population Research, School of Social Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - J Lange
- Hugo Centre for Migration and Population Research, School of Social Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - M Q Thompson
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia; Adelaide Geriatrics Training and Research with Aged Care Centre, Adelaide Medical School, University of Adelaide, South Australia, Australia.
| | - O Theou
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia; Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - R Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia; Adelaide Geriatrics Training and Research with Aged Care Centre, Adelaide Medical School, University of Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
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Balkrishna SP, Visvanathan R. Hydration kinetics of little millet and proso millet grains: effect of soaking temperature. J Food Sci Technol 2019; 56:3534-3539. [PMID: 31274921 DOI: 10.1007/s13197-019-03789-4] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/26/2022]
Abstract
Hydration characteristics of little millet (Panicum sumatrense) and proso millet (Panicum miliaceum) were studied at different soaking temperatures (30, 40, 50, 60 and 70 °C) and fitted into hydration models. From the initial moisture contents of 11.02 (d.b.) and 10.45% (d.b), little millet and proso millet grains attained the equilibrium moisture content of 38-50.17% (d.b) and 39.11-47.15% (d.b.), respectively. Little millet took 18.5 h to reach equilibrium moisture content at soaking temperature of 30 °C and 3.5 h at 70 °C. For proso millet, it took 4 h at 70 °C and 19 h at 30 °C. The data of moisture content with time fitted to Lewis, Page, modified Page and Peleg models shown higher coefficient of determination values ranging from 0.92 to 0.99. Among the models, the Peleg model is more suitable for the little millet grains and both Page and Peleg models are more suitable for the proso millet grains, to represent the hydration kinetics in the soak water temperature range of 30-70 °C. The dependency of the coefficients of the hydration models with temperature of soaking was found to be linear for both little and proso millets with coefficient of determination values ranging from 0.88 to 0.97.
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Affiliation(s)
- Sagar Patil Balkrishna
- 1Agricultural Engineering College and Research Institute, Tamil Nadu Agricultural University, Coimbatore, 641 003 India
| | - R Visvanathan
- 2A D Agricultural College and Research Institute, Tamil Nadu Agricultural University, Tiruchirappalli, 620 027 India
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Jadczak AD, Tam KL, Visvanathan R. Educating Medical Students in Counselling Older Adults about Exercise: The Impact of a Physical Activity Module. J Frailty Aging 2019; 7:113-119. [PMID: 29741196 DOI: 10.14283/jfa.2017.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Exercise courses during medical school contribute to medical students' confidence in promoting physical activity to their patients. However, there is still a lack of uniform physical activity education across medical school curricula to equip medical students with the necessary skills and knowledge to counsel their patients about exercise. OBJECTIVE To determine the effects of a 1.5-hour physical activity module including a one-hour exercise tutorial combined with a 30-minute practical counselling session on senior medical students' perceptions of the importance of exercise and their perceived competence in advising older people about exercise. DESIGN Pre-post survey. SETTING University campus. PARTICIPANTS 161 senior medical students taking part in the Queen Elizabeth Hospital Geriatric Medicine course in 2015 (control group) and 2016 (intervention group). MEASUREMENT The modified Exercise and Physical Activity Competence Questionnaire (EPACQ) was administered before and after a 4.5-week Geriatric Medicine Course. Scores ranged from 1 (not important or competent) to 6 (very important or competent). The independent T-Test and repeated-measures ANOVA was used to determine differences between intervention and control group. RESULTS Medical students perceived exercise-related skills to be highly important (score ≥4) in both the intervention (4.85 ± 0.37) and control group (4.78 ± 0.67), pre-course. The overall perceived importance could not be significantly increased by the physical activity module (P=0.082). The physical activity module, however, improved medical students' perceived competence in six out of ten exercise-related skills, and increased their overall perceived competence in counselling older people about exercise (P<0.001). CONCLUSION A 1.5-hour physical activity module improves senior medical students' perceived competence in counselling older people about exercise. This research proves that little teaching space is needed to impact positively on medical students' exercise counselling abilities.
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Affiliation(s)
- A D Jadczak
- Agathe Daria Jadczak, Aged and Extended Care Services - The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia 5011, Australia, Tel: +61 8 8133 4012; Fax: +61 8 8222 7872;
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Abstract
The anorexia of aging affects approximately a quarter of older people and is a major contributor to the development of under-nutrition and many other adverse health outcomes in older people. Despite the high prevalence, the anorexia of aging is frequently overlooked by clinicians and, of even more concern, it is commonly accepted as inevitable and a part of 'normal' aging. Early identification of risk coupled with efforts to mitigate these risks through appropriate interventions might stem the deleterious consequences of the anorexia of aging. This review aims to provide an update on the current knowledge base whilst making some practical suggestions that may be of use in clinical practice. Interventions such as exercise and good nutrition remain the preferred treatment while pharmacological options, whilst they continue to be trialed, are not currently recommended for routine clinical use.
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Affiliation(s)
- A D Jadczak
- Agathe Daria Jadczak, University of Adelaide, South Australia, Australia,
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Visvanathan R, Amare AT, Wesselingh S, Hearn R, McKechnie S, Mussared J, Inacio MC. Prolonged Wait Time Prior to Entry to Home Care Packages Increases the Risk of Mortality and Transition to Permanent Residential Aged Care Services: Findings from the Registry of Older South Australians (ROSA). J Nutr Health Aging 2019; 23:271-280. [PMID: 30820516 PMCID: PMC6399871 DOI: 10.1007/s12603-018-1145-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Older Australians prefer to live in their own homes for longer and reforms have attempted to increase the volume of home care packages (HCPs) accordingly but there remains a queue with the longer-term consequences unclear. OBJECTIVES This study aims to characterise older Australians according to their wait times for a home care package (HCP), evaluate the association between wait time and mortality and evaluate the association between wait time and transition to permanent residential aged care services after HCP. DESIGN A retrospective cohort study using data from the National Historical cohort (2003-2014) of the Registry of Older South Australians (ROSA) was conducted. SETTING Home based aged care services, national cohort. METHODS Wait time was estimated from approval date to date of receiving a HCP. Descriptive, survival estimates (95% confidence intervals (CIs)), and multivariable survival analyses (Cox-regression) were conducted to evaluate the risk of mortality and transition to permanent residential aged care services by quartiles of wait time for HCP. RESULTS The cohort was followed for 4.0 years (interquartile range IQR (1.8-7.2)) and 38% were alive at the end of the study period with a median wait time for HCP of 62 (21-187) days. From 178,924 older people who received a HCP during the study period (2003-2013), 33.2% people received HCP within 30 days, 74.3% within 6 months and 25.7% after 6 months. The effect of wait time on risk of mortality was time-dependent, with longer wait times associated with higher mortality in the longer term. Compared to people who waited ≤30 days for a HCP, individuals who waited more than 6 months had an almost 20% excess risk of death (adjusted hazard ratio (aHR), 95%CI = (1.18, 1.16-1.21)) 2 years after entry into a HCP. Those who waited more than 6 months also had a 10% (1.10, 1.06-1.13) higher risk of transition to permanent residential aged care services after two years. CONCLUSION Prolonged wait times for HCP is associated with a higher risk of long-term mortality as well as transition to permanent residential aged care. It remains to be seen if a shortening of this wait time translates into better health outcomes.
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Affiliation(s)
- R Visvanathan
- Professor Renuka Visvanathan, The Queen Elizabeth Hospital, Level 8B, 28 Woodville Road, Woodville South, SA 5011, Australia, , Tel- +618 82226000
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Zanker J, Scott D, Reijnierse EM, Brennan-Olsen SL, Daly RM, Girgis CM, Grossmann M, Hayes A, Henwood T, Hirani V, Inderjeeth CA, Iuliano S, Keogh JWL, Lewis JR, Maier AB, Pasco JA, Phu S, Sanders KM, Sim M, Visvanathan R, Waters DL, Yu SCY, Duque G. Establishing an Operational Definition of Sarcopenia in Australia and New Zealand: Delphi Method Based Consensus Statement. J Nutr Health Aging 2019; 23:105-110. [PMID: 30569078 DOI: 10.1007/s12603-018-1113-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Globally there are several operational definitions for sarcopenia, complicating clinical and research applications. OBJECTIVE The objective of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Task Force on Diagnostic Criteria for Sarcopenia was to reach consensus on the operational definition of sarcopenia for regional use by clinicians and researchers. METHOD A four-Phase modified Delphi process was undertaken in which 24 individuals with expertise or a recognised interest in sarcopenia from different fields across Australia and New Zealand were invited to be Task Force members. An initial face-to-face meeting was held in Adelaide, South Australia, in November 2017, followed by two subsequent online Phases conducted by electronic surveys. A final Phase was used to approve the final statements. Responses were analysed using a pre-specified strategy. The level of agreement required for consensus was 80%. RESULTS In Phase 2, 94.1% of Task Force respondents voted in favour of adopting an existing operational definition of sarcopenia. In Phase 3, 94.4% of respondents voted in favour of adopting the European Working Group on Sarcopenia in Older People (EWGSOP) definition as the operational definition for sarcopenia in Australia and New Zealand. CONCLUSION With consensus achieved, the ANZSSFR will adopt, promote and validate the EWGSOP operational definition of sarcopenia for use by clinicians and researchers in Australia and New Zealand.
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Affiliation(s)
- J Zanker
- Prof. Gustavo Duque, MD, PhD, FRACP, FGSA, Australian Institute for Musculoskeletal Science (AIMSS), 176 Furlong Road, St. Albans, VIC, Australia 3021, e-mail: , phone: +61 8395 8121
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Abstract
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
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Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Level 1, 220 Victoria Square, Adelaide, Australia 5000, Phone: +61 8 8 113 7823,
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Arakawa Martins B, Barrie H, Dollard J, Mahajan N, Visvanathan R. Older Adults' Perceptions of the Built Environment and Associations with Frailty: A Feasibility and Acceptability Study. J Frailty Aging 2018; 7:268-271. [PMID: 30298177 DOI: 10.14283/jfa.2018.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It is essential to evaluate frail older adults understanding and execution of survey tools to improve data quality and accurate representation in research. The study tested the feasibility and acceptability of a survey that assesses various measures of functional status in frail older people. The study evaluated: 1) recruitment rate; 2) time to complete questionnaires and difficulties encountered; and 3) acceptability by participants. Validated tools including: FRAIL Scale, EuroQoL 5D-5L, Charlson's Comorbidities Index, Baecke's Physical Activity Questionnaire, Life-Space Assessment, Katz and Lawton ADL and NEWS Walkability Scale were assessed. Twenty-five older patients (63% recruitment rate) of a post-acute restorative program (residential Transition Care Program) in Adelaide, South Australia were interviewed. Although not statistically different, time to complete the overall questionnaire differed between robust, pre-frail and frail participants. Overall, the survey was considered acceptable and feasible, with consideration with NEWS and Life-Space assessment regarding length, phrasing and layout.
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Affiliation(s)
- B Arakawa Martins
- Beatriz Arakawa Martins, The Basil Hetzel Institute and University of Adelaide 37, Woodville Road, Woodville South SA 5011, Australia, + 61 08 8222 7676
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Archibald M, Kitson A, Frewin D, Visvanathan R. Transdisciplinary Research In Frailty: Knowledge Translation To Inform New Models of Care. J Frailty Aging 2018; 6:62-64. [PMID: 28555704 DOI: 10.14283/jfa.2017.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transforming care for frail older adults requires more than rigorous research. While preventing, identifying and managing frailty are critical to reducing the personal and health systems impact of frailty worldwide, collaborative approaches to research and research application that reflect stakeholder perspectives and priorities are necessary to create meaningful solutions to frailty-related challenges. In South Australia, a new Centre for Research Excellence in Frailty was recently launched with funding from the National Health and Medical Research Council of Australia. Comprised of a national team with international partnerships and expertise spanning geriatric medicine, nursing, general practice, health economics, pharmacy and rehabilitation medicine, the team is working across traditional disciplinary silos to achieve system level improvements. Drawing from this exemplar, we discuss how a co-design approach to knowledge translation underpins this transdisciplinary research, and how successfully restructuring health services to meet the physical, emotional and social needs of older adults hinges upon such collaboration.
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Affiliation(s)
- M Archibald
- Mandy Archibald, School of Nursing, University of Adelaide, Level 3, Eleanor Harrald Building, The University of Adelaide, SA 5005 Australia, , +61 088 313 1309
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Jadczak AD, Mahajan N, Visvanathan R. The Feasibility of Standardised Geriatric Assessment Tools and Physical Exercises in Frail Older Adults. J Frailty Aging 2018; 6:195-198. [PMID: 29165535 DOI: 10.14283/jfa.2017.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Geriatric assessment tools are applicable to the general geriatric population; however, their feasibility in frail older adults is yet to be determined. The study aimed to determine the feasibility of standardised geriatric assessment tools and physical exercises in hospitalised frail older adults. Various assessment tools including the FRAIL Screen, the Charlson Comorbidity Index, the SF-36, the Trail Making Test (TMT), the Rapid Cognitive Screen, the Self Mini Nutritional Assessment (MNA-SF) and the Lawton iADL as well as standard physical exercises were assessed using observational protocols. The FRAIL Screen, MNA-SF, Rapid Cognitive Screen, Lawton iADL and the physical exercises were deemed to be feasible with only minor comprehension, execution and safety issues. The TMT was not considered to be feasible and the SF-36 should be replaced by its shorter form, the SF-12. In order to ensure the validity of these findings a study with a larger sample size should be undertaken.
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Affiliation(s)
- A D Jadczak
- Agathe Daria Jadczak, Aged and Extended Care Services - The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia 5011, Australia, Tel: +61 8 8133 4012; Fax: +61 8 8222 7872;
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Nadlacki B, Horton D, Labrosciano C, Hossain S, Hariharaputhiran S, Aliprandi-Costa B, Adams R, Visvanathan R, Ranasinghe I. Long-Term Mortality Following Acute Myocardial Infarction in Australia and New Zealand: a Population-Wide Study. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, Pahor M, Clark BC, Cesari M, Ruiz J, Sieber CC, Aubertin-Leheudre M, Waters DL, Visvanathan R, Landi F, Villareal DT, Fielding R, Won CW, Theou O, Martin FC, Dong B, Woo J, Flicker L, Ferrucci L, Merchant RA, Cao L, Cederholm T, Ribeiro SML, Rodríguez-Mañas L, Anker SD, Lundy J, Gutiérrez Robledo LM, Bautmans I, Aprahamian I, Schols JMGA, Izquierdo M, Vellas B. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging 2018; 22:1148-1161. [PMID: 30498820 DOI: 10.1007/s12603-018-1139-9] [Citation(s) in RCA: 447] [Impact Index Per Article: 74.5] [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] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). METHODS To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. RECOMMENDATIONS We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.
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Affiliation(s)
- E Dent
- Dr. Elsa Dent, , Torrens University Australia, Wakefield Street, Adelaide, SA, Australia
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Tan M, Glendon Lau S, Han W, Ross N, Visvanathan R, Ngau Y. 070 ACUTE KIDNEY INJURY IN CORONARY CARE UNIT: PREVALENCE, AETIOLOGIES AND OUTCOMES. Kidney Int Rep 2017. [DOI: 10.1016/j.ekir.2017.06.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Asiah U, Suhaidarwani A, Wan Hazlina W, Norazinizah A, Abdul Wahab MZ, Visvanathan R. 142 TIMING OF NEPHROLOGY REFERRAL AND OUTCOME IN ACUTE KIDNEY INJURY PATIENTS RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY. Kidney Int Rep 2017. [DOI: 10.1016/j.ekir.2017.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Norazinizah A, Asiah U, Hazlina W, Suhaidarwani A, Abdul Wahab MZ, Visvanathan R. 137 RISK FACTORS FOR MORTALITY IN RELATION WITH TIMING TO NEPHROLOGY CONSULTATION ON AKI IN ICU SETTING, SINGLE CENTER EXPERIENCE, HOSPITAL HOSPITAL KUALA LUMPUR. Kidney Int Rep 2017. [DOI: 10.1016/j.ekir.2017.06.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Goh C, Visvanathan R, Ong L, Manocha A, Mushahar L, Goh B, Leong C, Ch'ng C, Wong H, Tan C. 105 A PROSPECTIVE, MULTICENTRE, OBSERVATIONAL STUDY TO DETERMINE THE INCIDENCE AND OUTCOME OF ACUTE KIDNEY INJURY AMONG HOSPITALISED PATIENTS IN MALAYSIA. Kidney Int Rep 2017. [DOI: 10.1016/j.ekir.2017.06.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yee S, Abdul Wahab MZ, Visvanathan R, Yahya R, Bavanandan S, Ahmad G. 090 INCIDENCE AND OUTCOME OF PATIENTS WITH ACUTE KIDNEY INJURY IN HOSPITAL KUALA LUMPUR. Kidney Int Rep 2017. [DOI: 10.1016/j.ekir.2017.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jadczak A, Dollard J, Mahajan N, Visvanathan R. THE PERSPECTIVES OF OLDER PEOPLE AT- RISK OF FRAILTY ON BEING ADVISED ABOUT EXERCISE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A.D. Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia,
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia,
- National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
| | - J. Dollard
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia,
- National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
| | - N. Mahajan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia,
| | - R. Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia,
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia,
- National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, South Australia, Australia
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Theou O, Sluggett J, Bell J, Tan E, Emery T, Morley J, Rockwood K, Visvanathan R. FRAILTY IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES: RELATIONSHIP WITH ONE-YEAR OUTCOMES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O. Theou
- Dalhousie University, Halifax, Nova Scotia, Canada,
| | - J. Sluggett
- Monash University, Melbourne, Victoria, Australia,
| | - J. Bell
- Monash University, Melbourne, Victoria, Australia,
| | - E.C. Tan
- Monash University, Melbourne, Victoria, Australia,
| | - T. Emery
- Resthaven Incorporated, Adelaide, South Australia, Australia,
| | - J.E. Morley
- Saint Louis University, Saint Louis, Missouri
| | - K. Rockwood
- Dalhousie University, Halifax, Nova Scotia, Canada,
| | - R. Visvanathan
- University of Adelaide, Adelaide, South Australia, Australia,
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McNally C, Khow K, Shibu P, Liberali S, Adams R, Visvanathan R. THE ORAL HEALTH STATUS OF OLDER PATIENTS IN THE ACUTE CARE HOSPITAL SETTING: A PILOT STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. McNally
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia,
- Special Needs Unit, Adelaide Dental Hospital, South Australian Dental Service, Adelaide, South Australia, Australia,
| | - K. Khow
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care Centre, Adelaide, South Australia, Australia,
- Aged and Extended Care Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia,
| | - P. Shibu
- NHMRC Centre of Research Excellence Transdisciplinary Frailty Research To Achieve Healthy Aging, Adelaide, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care Centre, Adelaide, South Australia, Australia,
- Aged and Extended Care Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia,
| | - S. Liberali
- Special Needs Unit, Adelaide Dental Hospital, South Australian Dental Service, Adelaide, South Australia, Australia,
| | - R. Adams
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- General Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia,
| | - R. Visvanathan
- NHMRC Centre of Research Excellence Transdisciplinary Frailty Research To Achieve Healthy Aging, Adelaide, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care Centre, Adelaide, South Australia, Australia,
- Aged and Extended Care Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia,
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Khow K, Smyth C, Theou O, Chehade M, Visvanathan R. COACHING TO REDUCE SEDENTARY TIME IN OLDER PEOPLE WITH FAL.LS: RANDOMIZED CONTROLLED STUDY PROTOCOL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K. Khow
- Aged and Extended Care, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide, South Australia, Australia,
| | - C. Smyth
- Aged and Extended Care, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide, South Australia, Australia,
| | - O. Theou
- Dalhousie University, Halifax, Nova Scotia, Canada,
| | - M. Chehade
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - R. Visvanathan
- Aged and Extended Care, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, Adelaide, South Australia, Australia,
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Thompson M, Theou O, Yu S, Lange K, Adams R, Visvanathan R. FRAILTY IN THE NORTH WEST ADELAIDE HEALTH STUDY USING THE FRAILTY PHENOTYPE AND INDEX APPROACHES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M.Q. Thompson
- University of Adelaide, Adelaide, South Australia, Australia,
| | - O. Theou
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - S.C. Yu
- University of Adelaide, Adelaide, South Australia, Australia,
| | - K. Lange
- University of Adelaide, Adelaide, South Australia, Australia,
| | - R. Adams
- University of Adelaide, Adelaide, South Australia, Australia,
| | - R. Visvanathan
- University of Adelaide, Adelaide, South Australia, Australia,
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Naganathan V, Piantadosi C, Chapman I, Hunter P, Cameron I, Visvanathan R. RECRUITING OLDER PEOPLE AT NUTRITIONAL RISK FOR CLINICAL TRIALS: WHAT HAVE WE LEARNED? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V. Naganathan
- University of Sydney, Sydney, New South Wales, Australia
| | - C. Piantadosi
- University of Adelaide, Adelaide, South Australia, Australia,
| | - I. Chapman
- University of Adelaide, Adelaide, South Australia, Australia,
| | - P. Hunter
- Alfred Health, Caulfield, Victoria, Australia,
| | - I. Cameron
- University of Sydney, Sydney, New South Wales, Australia
| | - R. Visvanathan
- University of Adelaide, Adelaide, South Australia, Australia,
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Umapathysivam K, Tufanaru C, Visvanathan R, Yu S. ANTHROPOMETRIC MEASUREMENTS OF APPENDICULAR SKELETAL MUSCLE MASS IN OLDER PEOPLE: A SCOPING REVIEW. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C. Tufanaru
- University of Adelaide, Adelaide, South Australia, Australia
| | - R. Visvanathan
- University of Adelaide, Adelaide, South Australia, Australia
| | - S.C. Yu
- University of Adelaide, Adelaide, South Australia, Australia
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Yu S, Nguyen T, Adams R, Visvanathan R. THE ASSOCIATION BETWEEN SARCOPENIA AND LUNG FUNCTION IN OLDER AUSTRALIANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S.C. Yu
- National Health and Medical Council Centre of Research Excellence Trans-disciplinary Frailty Research To Achieve Health Aging, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia,
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, South Australia, Adelaide, South Australia, Australia,
| | - T. Nguyen
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia,
| | - R. Adams
- Health Observatory, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia
| | - R. Visvanathan
- National Health and Medical Council Centre of Research Excellence Trans-disciplinary Frailty Research To Achieve Health Aging, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia,
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, South Australia, Adelaide, South Australia, Australia,
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Khow K, McNally C, Shibu P, Yu S, Chehade M, Visvanathan R. A RETROSPECTIVE COHORT STUDY OF DISCHARGE HEMOGLOBIN IN OLDER PATIENTS AFTER HIP FRACTURE SURGERY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K. Khow
- Aged and Extended Care, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - C. McNally
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - P. Shibu
- Aged and Extended Care, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - S.C. Yu
- Aged and Extended Care, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - M. Chehade
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - R. Visvanathan
- Aged and Extended Care, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia,
- Discipline of Orthopaedics and Trauma, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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Hendrix I, Visvanathan R. APPROPRIATENESS OF PROTON PUMP INHIBITOR USE IN A PSYCHOGERIATRIC POPULATION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I. Hendrix
- The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia,
| | - R. Visvanathan
- The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia,
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Yu S, Nguyen T, Adams R, Visvanathan R. THE IMPACT OF SARCOPENIA DEFINITIONS AND THE ASSOCIATION WITH LUNG FUNCTION IN OLDER AUSTRALIANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S.C. Yu
- National Health and Medical Council Centre of Research Excellence Trans-disciplinary Frailty Research To Achieve Health Aging and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, South Australia, Adelaide, South Australia, Australia,
- Aged & Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, South Australia, Adelaide, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, SA 5000, Australia, Adelaide, South Australia, Australia,
| | - T. Nguyen
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, SA 5000, Australia, Adelaide, South Australia, Australia,
| | - R. Adams
- Health Observatory, School of Medicine, Faculty of Health Sciences, University of Adelaide, South Australia, Adelaide, South Australia, Australia
| | - R. Visvanathan
- National Health and Medical Council Centre of Research Excellence Trans-disciplinary Frailty Research To Achieve Health Aging and the Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health Sciences, University of Adelaide, South Australia, Adelaide, South Australia, Australia,
- Aged & Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, South Australia, Adelaide, South Australia, Australia,
- Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, SA 5000, Australia, Adelaide, South Australia, Australia,
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Visvanathan R, Theou O. TRANS-DISCIPLINARY RESEARCH IN FRAILTY TO ACHIEVE HEALTHY AGEING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R. Visvanathan
- University of Adelaide, Adelaide, South Australia, Australia
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Theou O, Chapman I, Wijeyaratne L, Piantadosi C, Lange K, Naganathan V, Hunter P, Cameron ID, Rockwood K, Visvanathan R. Can an Intervention with Testosterone and Nutritional Supplement Improve the Frailty Level of Under-Nourished Older People? J Frailty Aging 2017; 5:247-252. [PMID: 27883172 DOI: 10.14283/jfa.2016.108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine whether a testosterone and a high calorie nutritional supplement intervention can reduce frailty scores in undernourished older people using multiple frailty tools. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS 53 community-dwelling, undernourished men and women aged >65 years from South Australia, Victoria and New South Wales. INTERVENTION Intervention group received oral testosterone undecanoate and a high calorie supplement (2108-2416 kJ/day) whereas the control group received placebo testosterone and low calorie supplement (142-191 kJ/day). MEASUREMENTS Frailty was operationalized using three frailty indices (FI-lab, FI-self-report, FI-combined) and the frailty phenotype. RESULTS There were no significant differences in changes in frailty scores at either 6 or 12 months follow up between the two treatment groups for all scales. Participants at the intervention group were 4.8 times more likely to improve their FI-combined score at both time points compared to the placebo group. CONCLUSION A testosterone and a high calorie nutritional supplement intervention did not improve the frailty levels of under-nourished older people. Even so, when frailty was measured using a frailty index combining self-reported and lab data we found that participants who received the intervention were more likely to show persistent improvement in their frailty scores.
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Affiliation(s)
- O Theou
- Olga Theou, Dalhousie University and Nova Scotia Health Authority, Suite 1313, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada. Tel: 902-473-4846, e-mail:
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Khow KSF, Shibu P, Yu SCY, Chehade MJ, Visvanathan R. Epidemiology and Postoperative Outcomes of Atypical Femoral Fractures in Older Adults: A Systematic Review. J Nutr Health Aging 2017; 21:83-91. [PMID: 27999854 DOI: 10.1007/s12603-015-0652-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To review the literature on epidemiology and postoperative outcomes particularly surgical, functional and quality of life of atypical femoral fractures (AFFs) in the older population (aged ≥65 years) using the first and second American Society of Bone Mineral Research (ASBMR) Task Force consensus definition. METHODS Electronic search for articles on AFFs and bisphosphonates published in English was performed. Eligible studies were reviewed systematically in relation to (a) the epidemiology of AFFs in older people and (b) postoperative outcomes of AFFs. RESULTS Twenty-three studies on AFFs were included: 14 on epidemiology and 11 on treatment outcomes (two articles reported on both aspects). The epidemiological studies showed that the incidence of AFFs is low (3.0-9.8 per 100,000 person-years) but relative risk increased with longer duration of bisphosphonates use, especially after more than three years. Most cases of AFFs occurred in older people aged 65 years and above. However, in six studies, the mean age of patients with bisphosphonate-related AFFs is younger than those with typical proximal femoral fractures (mean age range of 66-75 years versus 75-89 years respectively). Varying postoperative and functional outcomes have been reported but differences in study population, management approaches and endpoints may account for these variations. For incomplete AFFs, prophylactic surgical intervention is potentially beneficial. CONCLUSION The benefits of bisphosphonates in reducing osteoporotic fractures still outweigh the risk of AFFs in view of its low absolute risk, when the ASBMR Task Force criteria for this type of fracture were applied. The risk of AFFs in different age groups is not well defined but tends to affect the younger patients more (aged <65 years) as compared to the older population (aged ≥65 years). Evidence supporting different types of treatment in AFFs such as intramedullary or extramedullary surgical devices and the use of teriparatide, a parathyroid hormone analogue, is not yet well established.
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Affiliation(s)
- K S F Khow
- Dr Kareeann Khow, Aged and Extended Care Services, Level 8B Main Building, The Queen Elizabeth Hospital, 21 Woodville Road, Woodville South, SA 5011, Australia, Tel: +61 8 8222 8178, Fax: +61 8 8222 8593,
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Woo T, Yu S, Visvanathan R. Systematic Literature Review on the Relationship Between Biomarkers of Sarcopenia and Quality of Life in Older People. J Frailty Aging 2016; 5:88-99. [PMID: 27224499 DOI: 10.14283/jfa.2016.93] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sarcopenia is a multi-faceted geriatric syndrome that is prevalent in the older population. It is an independent risk factor for a variety of devastating health outcomes that threaten the independence of older people. Quality of life is also very important to older people. The objective of this systematic review therefore was to determine the relationship between the biomarkers of sarcopenia (or sarcopenia) and health related quality of life in older people. Systematic searches were done using the electronic databases from MEDLINE and EMBASE. Search terms included sarcopenia, biomarkers of sarcopenia (e.g. muscle mass, grip strength, muscle performance), and health related quality of life. A total of 20 studies were finally included in this review. Only four studies were deemed of good quality. Sarcopenia was associated with poor health related quality of life in both genders from the one cross sectional study defining sarcopenia as per consensus definition. One high quality longitudinal study demonstrated that better physical performance and muscle strength was associated with a slower rate of decline in health related quality of life over six years. Muscle performance and strength were associated with health related quality of life but muscle mass was not in cross-sectional studies. Good quality and longitudinal studies where sarcopenia is defined as per consensus guidelines are required if the impact of the disease on quality of life is to be clarified.
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Affiliation(s)
- T Woo
- Dr Tsung Woo (, Phone +61-8-8222 6000, Fax +61-8-8222 8593)
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Arjuna T, Visvanathan R, Soenen S, Miller M, Chapman I, Ueno T, Luscombe-Marsh N. Effects of standard and fortified ‘Meals-on-wheels’ meals on clinical outcomes of nutritionally at risk elderly. Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Visvanathan R, Yu S, Field J, Chapman I, Adams R, Wittert G, Visvanathan T. Appendicular Skeletal Muscle Mass: Development and Validation of Anthropometric Prediction Equations. J Frailty Aging 2016; 1:147-51. [PMID: 27093315 DOI: 10.14283/jfa.2012.23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Sarcopenia is the loss of muscle mass and function seen with increasing age. Central to making the diagnosis of sarcopenia is the assessment of appendicular skeletal muscle mass (ASM). The objective of this study was to develop and validate novel anthropometric prediction equations (PEs) for ASM that would be useful in primary or aged care. DESIGN PEs were developed using best subset regression analysis. Three best performing PEs (PE1, PE2, PE3) were selected and validated using the Bland-Altman and Sheiner and Beal methods. SETTING Community dwelling adults in South Australia. PARTICIPANTS 188 healthy subjects were involved in the development study. 2275 older(age ≥ 50years) subjects were involved in the validation study. MEASUREMENTS ASM was assessed using dual x-ray abosrptiometry (DEXA). Weight and height was measured and body mass index (BMI) estimated. RESULTS A strong correlation between PE derived ASM and the DEXA derived ASM was seen for the three selected PEs. PE3: ASM= 10.047427 + 0.353307(weight) - 0.621112(BMI) - 0.022741(age) + 5.096201(if male) performed the best. PE3 over-estimated (P<0.001) ASM by 0.36 kg (95% CI 0.28-0.44 Kg) and the adjusted R2 was 0.869. The 95% limit of agreement was between -3.5 and 4.35 kg and the standard error of the estimate was 1.95. The root mean square error was 1.91(95% CI 1.80-2.01). PE3 also performed the best across the various age (50-65, 65-<80, 80+ years) and weight (BMI <18.5, 18.5-24.9, 25-29.9, ≥30 kg/m2) groups. CONCLUSIONS A new anthropometric PE for ASM has been developed for use in primary or aged care but is specific to Caucasian population groups.
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Affiliation(s)
- R Visvanathan
- 1. Renuka Visvanathan MBBS PhD, Aged and Extended Care Services, Level 8B Main Building, The Queen Elizabeth Hospital, 21 Woodville Road, Woodville South, South Australia 5011. University of Adelaide, Adelaide, South Australia, Phone:+61 8 8222 8592; Fax:+61 8 8222 8593, Email :
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Visvanathan R, Piantadosi C, Lange K, Naganathan V, Hunter P, Cameron ID, Chapman I. The Randomized Control Trial of the Effects of Testosterone and a Nutritional Supplement On Hospital Admissions in Undernourished, Community Dwelling, Older People. J Nutr Health Aging 2016; 20:769-79. [PMID: 27499311 DOI: 10.1007/s12603-016-0689-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In a pilot single centre study we found that treatment of undernourished older, community dwelling people for one year with oral testosterone (placebo-controlled) and a nutritional supplement (no control) was associated with a significant reduction in hospitalizations. A larger, multicentre study was conducted to investigate further this potentially important finding. DESIGN One year, randomized, placebo-controlled, multi-centre, double-blind, trial. SETTING Community. PARTICIPANTS 53 undernourished men and women aged 65 years and older. INTERVENTION Oral testosterone undecanoate (40 mg/day women, 160 mg/day men) and high energy oral nutritional supplement (2108-2416 kJ/day) or placebo medication and low energy (142-191 kJ/day) "placebo" oral nutritional supplementation. MEASUREMENTS Hospital admissions, falls and other variables were assessed. RESULTS 53 subjects were recruited (64% male and mean age 77 years), which was substantially less than planned. Sixteen subjects (30%) were admitted to hospital at least once, with a total of 29 admissions. Eight subjects (32%) in the placebo arm were admitted to hospital, whilst in the intervention group also there were eight (29%) subjects admitted to hospital during the study period. There was no difference in the number of hospitalisations (P = 0.842), length of hospitalization (P=0.645) or quality of life [mental health P=0.195 and physical health P=0.451) between the treatment arms. CONCLUSIONS In undernourished older people, treatment with testosterone and a nutritional supplementation did not reduce the number and length of hospitalisations or improve quality of life.
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Affiliation(s)
- R Visvanathan
- Professor Renuka Visvanathan, University of Adelaide and The Queen Elizabeth Hospital, Department of Medicine and The Aged and Extended Care Services, Address: Level 8B, The Queen Elizabeth Hospital, Woodville South, SA 5011, Telephone No: 08-82226887, Fax No: 08-82228593, e-mail:
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Gupta A, Visvanathan R. Botulinum toxin for foot dystonia in patients with Parkinson’s disease having deep brain stimulation: A case series and a pilot study. J Rehabil Med 2016; 48:559-62. [DOI: 10.2340/16501977-2094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yu S, Powell A, Khow K, Visvanathan R. P-234: Prediction of appendicular skeletal muscle mass using bioelectrical impedance analysis equations in Australians. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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