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Goh AM, Doyle C, Gaffy E, Batchelor F, Polacsek M, Savvas S, Malta S, Ames D, Winbolt M, Panayiotou A, Loi SM, Cooper C, Livingston G, Low LF, Fairhall A, Burton J, Dow B. Co-designing a dementia-specific education and training program for home care workers: The 'Promoting Independence Through quality dementia Care at Home' project. Dementia (London) 2022; 21:899-917. [PMID: 35135380 DOI: 10.1177/14713012211065377] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/16/2022]
Abstract
Undertaking co-design with the end users of services has rapidly evolved as the best-practice approach to program design, development and implementation. Increased interest in using participatory co-design in dementia care has drawn attention to the need for evidence-informed methods for facilitating the meaningful involvement of people with dementia and their family carers in co-design activities. The aim of this paper is to describe the co-design framework used in the co-design of a dementia specialist training program for home care workers. The Promoting Independence Through quality dementia Care at Home program is a successful example of co-design methodology used across multiple project stages and with various stakeholder groups, including people living with dementia, family carers, home care workers, managers and researchers. Co-design methods were tailored to each stage, purpose, and stakeholder group, and to facilitate the involvement of people living with dementia. Findings provide unique insights into optimising input from co-design partners, including people living with dementia; the methodology, conditions and requirements for participants to co-design and implement ideas; and perspectives on the enablers and challenges of using co-design in this population. In this paper, we present a comprehensive approach for involving people living with dementia as active and equal contributors in inclusive and meaningful participatory co-design.
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Affiliation(s)
- Anita My Goh
- 110764National Ageing Research Institute, Parkville, VIC, Australia.,2281The University of Melbourne, Parkville, VIC, Australia.,548265Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia
| | - Colleen Doyle
- 110764National Ageing Research Institute, Parkville, VIC, Australia
| | - Ellen Gaffy
- 110764National Ageing Research Institute, Parkville, VICAustralia.,2080University, Bundoora, VIC, Australia
| | | | - Meg Polacsek
- 10764National Ageing Research Institute, Parkville, VIC, Australia.,292325Benetas, Melbourne, VIC, Australia
| | - Steven Savvas
- 110764National Ageing Research Institute, Parkville, VIC, Australia
| | - Sue Malta
- 110764National Ageing Research Institute, Parkville, VIC, Australia.,2281The University of Melbourne, Parkville, VIC, Australia
| | - David Ames
- 110764National Ageing Research Institute, Parkville, VIC, Australia.,2281The University of Melbourne, Parkville, VIC, Australia
| | | | - Anita Panayiotou
- 110764National Ageing Research Institute, Parkville, VIC, Australia
| | - Samantha M Loi
- 548265Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia
| | - Claudia Cooper
- Division of Psychiatry, 4919University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, 4919University College London, London, UK
| | - Lee-Fay Low
- 4538University of Sydney, Sydney, NSW, Australia
| | | | | | - Briony Dow
- 110764National Ageing Research Institute, Parkville, VIC, Australia.,2281The University of Melbourne, Parkville, VIC, Australia
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2
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Goh AMY, Polacsek M, Malta S, Doyle C, Hallam B, Gahan L, Low LF, Cooper C, Livingston G, Panayiotou A, Loi SM, Omori M, Savvas S, Burton J, Ames D, Scherer SC, Chau N, Roberts S, Winbolt M, Batchelor F, Dow B. What constitutes 'good' home care for people with dementia? An investigation of the views of home care service recipients and providers. BMC Geriatr 2022; 22:42. [PMID: 35016640 PMCID: PMC8751242 DOI: 10.1186/s12877-021-02727-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objective was to explore what people receiving and providing care consider to be 'good' in-home care for people living with dementia. METHODS We conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke's six-step approach. RESULTS Consensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers' understanding of dementia and its impact; 2) Home care workers' demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers' knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers. CONCLUSIONS It is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services. TRIAL REGISTRATION ACTRN 12619000251123 .
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Affiliation(s)
- Anita M Y Goh
- National Ageing Research Institute, Parkville, VIC, Australia. .,The University of Melbourne, Parkville, VIC, Australia. .,Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia. .,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.
| | | | - Sue Malta
- The University of Melbourne, Parkville, VIC, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Brendan Hallam
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - Luke Gahan
- National Ageing Research Institute, Parkville, VIC, Australia.,LaTrobe University, Melbourne, VIC, Australia
| | - Lee Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Anita Panayiotou
- National Ageing Research Institute, Parkville, VIC, Australia.,Safer Care, Melbourne, VIC, Australia
| | - Samantha M Loi
- The University of Melbourne, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, Parkville, VIC, Australia.,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Maho Omori
- Monash University, Clayton, VIC, Australia
| | - Steven Savvas
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Jason Burton
- dementia360, Perth, Western Australia, Australia
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia.,Academic Unit for Psychiatry of Old Age, Kew, VIC, Australia
| | | | - Nadia Chau
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Stefanie Roberts
- The University of Melbourne, Parkville, VIC, Australia.,Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | | | | | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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3
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Brydon A, Bhar S, Doyle C, Batchelor F, Lovelock H, Almond H, Mitchell L, Nedeljkovic M, Savvas S, Wuthrich V. National Survey on the Impact of COVID-19 on the Mental Health of Australian Residential Aged Care Residents and Staff. Clin Gerontol 2022; 45:58-70. [PMID: 34634217 DOI: 10.1080/07317115.2021.1985671] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders' opinions about the impact of COVID-19 on the mental health of aged care residents and staff. METHODS A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed an online survey between 10th September and 31st October 2020. RESULTS On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios. CONCLUSIONS Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities. CLINICAL IMPLICATIONS This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.
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Affiliation(s)
- Aida Brydon
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Melbourne, Australia
| | | | | | - Helen Almond
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Leander Mitchell
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Maja Nedeljkovic
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Steven Savvas
- National Ageing Research Institute, Melbourne, Australia
| | - Viviana Wuthrich
- Department of Psychology, Macquarie University, Sydney, Australia
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Savvas S, Goh AMY, Batchelor F, Doyle C, Wise E, Tan E, Panayiotou A, Malta S, Winbolt M, Clarke P, Burton J, Low LF, Loi SM, Fairhall A, Polacsek M, Stiles J, Muliadi F, Chau N, Scherer S, Ames D, Sousa TV, Dow B. Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial. Trials 2021; 22:949. [PMID: 34930422 PMCID: PMC8687633 DOI: 10.1186/s13063-021-05906-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home. Methods This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision. Discussion Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs. Trial registration anzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019.
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Affiliation(s)
- Steven Savvas
- The National Ageing Research Institute, Parkville, VIC, Australia.
| | - Anita M Y Goh
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Colleen Doyle
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Erica Wise
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Esther Tan
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Anita Panayiotou
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Sue Malta
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | | | | | | | - Lee-Fay Low
- University of Sydney, Sydney, NSW, Australia
| | - Samantha M Loi
- The University of Melbourne, Parkville, VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Meg Polacsek
- The National Ageing Research Institute, Parkville, VIC, Australia.,Benetas, Melbourne, VIC, Australia
| | - Jay Stiles
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Fenny Muliadi
- The National Ageing Research Institute, Parkville, VIC, Australia
| | - Nadia Chau
- The National Ageing Research Institute, Parkville, VIC, Australia
| | | | - David Ames
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | | | - Briony Dow
- The National Ageing Research Institute, Parkville, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
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Omori M, Jayasuriya J, Scherer S, Dow B, Vaughan M, Savvas S. The language of dying: Communication about end-of-life in residential aged care. Death Stud 2020; 46:684-694. [PMID: 32401636 DOI: 10.1080/07481187.2020.1762263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article explores implications of language used in communicating death and dying in residential aged care, which increasingly emphasizes a "family-centered" approach to end-of-life care. Based on focus groups with care professionals and families, our findings reveal a persistent clinical culture that resists frank discussions of dying, with many staff preferring to use euphemisms for dying. Our results emphasize the importance of end-of-life education for families, which families acknowledged was lacking. Cultural change in institutional control over disclosing dying is imperative in order to gain family trust and support in professional care and promote death literacy.
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Affiliation(s)
- Maho Omori
- School of Social Sciences, Faculty of Arts, Monash University, Clayton, Victoria, Australia
| | - Jude Jayasuriya
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Sam Scherer
- Royal Freemasons Limited, Melbourne, Victoria, Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Marie Vaughan
- Royal Freemasons Limited, Melbourne, Victoria, Australia
| | - Steven Savvas
- National Ageing Research Institute, Parkville, Victoria, Australia
- Royal Freemasons Limited, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
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6
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Polacsek M, Goh A, Malta S, Hallam B, Gahan L, Cooper C, Low LF, Livingston G, Panayiotou A, Loi S, Omori M, Savvas S, Batchelor F, Ames D, Doyle C, Scherer S, Dow B. 'I know they are not trained in dementia': Addressing the need for specialist dementia training for home care workers. Health Soc Care Community 2020; 28:475-484. [PMID: 31646701 DOI: 10.1111/hsc.12880] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/12/2019] [Accepted: 09/27/2019] [Indexed: 05/22/2023]
Abstract
Global population ageing has meant a rapid increase in the numbers of older people with dementia, most of whom live in their own homes. Staying at home is an important determinant of health and well-being. As care needs increase, the quality of community support which older people receive directly influences their capacity to remain in their own homes. While many are supported informally by family carers, formal support provided by home care workers often enables them to remain at home for longer period. However, providing community-based care for people with dementia can be challenging. Workers often lack training in dementia-specific care for clients with increasingly complex needs, and typically work without direct supervision. As the demand for person-centred home care for people with dementia increases, specialist dementia training for home care workers is urgently needed. In this qualitative study, we used in-depth interviews of a purposive sample, comprising 15 family carers and four older people with dementia, to understand the experience of receiving community care. Data analysis was guided by Braun and Clarke's approach to thematic analysis and revealed the following five overlapping themes, relating to home care workers' understanding of dementia, person-centred care, communication and rapport, mutual collaboration, and the influence of organisational constraints on continuity of care. Although participants acknowledged that service providers operated under challenging circumstances, they were frustrated with home care workers' lack of dementia knowledge and inconsistent staff rostering. Conversely, an understanding of the lived experience of dementia, effective communication and rapport, and continuity of care contributed significantly to a positive experience of receiving care. The findings of this study will be used to inform the essential elements of a training program aimed at enabling and empowering a skilled, specialist home care workforce to support older people with dementia to live well at home for as long as possible.
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Affiliation(s)
- Meg Polacsek
- National Ageing Research Institute, Parkville, Vic., Australia
- Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - Anita Goh
- National Ageing Research Institute, Parkville, Vic., Australia
- The University of Melbourne, Parkville, Vic., Australia
- NorthWestern Mental Health, Parkville, Vic., Australia
| | - Sue Malta
- The University of Melbourne, Melbourne, Vic., Australia
| | | | - Luke Gahan
- The Australian Red Cross Blood Service, Melbourne, Vic., Australia
- La Trobe University, Melbourne, Vic., Australia
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
| | - Lee-Fay Low
- Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | | | - Samantha Loi
- Department of Psychiatry, University of Melbourne and NorthWestern Mental Health, Parkville, Vic., Australia
| | - Maho Omori
- National Ageing Research Institute, Parkville, Vic., Australia
| | - Steven Savvas
- National Ageing Research Institute, Parkville, Vic., Australia
- Royal Freemasons, Melbourne, Vic., Australia
| | | | - David Ames
- National Ageing Research Institute, Parkville, Vic., Australia
- The University of Melbourne, Parkville, Vic., Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Vic., Australia
| | - Colleen Doyle
- National Ageing Research Institute, Parkville, Vic., Australia
| | - Sam Scherer
- Royal Freemasons, Melbourne, Vic., Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Vic., Australia
- The University of Melbourne, Parkville, Vic., Australia
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7
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Gerber K, Craanen R, James N, Savvas S, Hayes B, Brijnath B. A New Plea to Focus on the End-of-Life Needs of People with Severe Mental Illnesses. Issues Ment Health Nurs 2019; 40:827-828. [PMID: 31322981 DOI: 10.1080/01612840.2019.1630536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Katrin Gerber
- National Ageing Research Institute , Melbourne , Australia
| | | | - Natalie James
- National Ageing Research Institute , Melbourne , Australia
| | - Steven Savvas
- National Ageing Research Institute , Melbourne , Australia
| | | | - Bianca Brijnath
- National Ageing Research Institute , Melbourne , Australia.,School of Occupational Therapy and Social Work, Curtin University , Perth , Australia.,Department of General Practice, Monash University , Notting Hill , Australia
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8
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Omori M, Baker C, Jayasuriya J, Savvas S, Gardner A, Dow B, Scherer S. Maintenance of Professional Boundaries and Family Involvement in Residential Aged Care. Qual Health Res 2019; 29:1611-1622. [PMID: 30931823 DOI: 10.1177/1049732319839363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The importance of family's involvement in care planning has been stressed to cater individualized, person-centered care in residential aged care. However, in reality, there are numerous structural obstacles and barriers that limit opportunities for their involvement. The aim of this article is to explore what they are. The findings based on the 12 focus groups, six groups of care professionals and six groups of family/relatives, reveal that the narrow pathway of communication between staff and families, which is hierarchically structured, one-directional, and clinically driven, enables the former to maintain and control professional boundaries between formal and informal care-giving. Such communication style delimits an opportunity for families to engage in quality discussion about care planning for their loved ones with care staff. Communication within residential aged care facilities embodies complex dynamics of care expectations and responsibilities held by care staff and families.
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Affiliation(s)
- Maho Omori
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Courtney Baker
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Jude Jayasuriya
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Steven Savvas
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
- 2 Royal Freemasons Ltd, Melbourne, Victoria, Australia
- 3 The University of Melbourne, Parkville, Victoria, Australia
| | - Anastasia Gardner
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Briony Dow
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
- 3 The University of Melbourne, Parkville, Victoria, Australia
| | - Sam Scherer
- 2 Royal Freemasons Ltd, Melbourne, Victoria, Australia
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9
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Goh AM, Dow B, Polacsek M, Doyle C, Ames D, Winbolt M, Savvas S, Malta S, Low LF, Clarke P, Cooper C, Panayiotou A, Livingston G, Lyketsos C, Gahan L, Batchelor F, Loi SM, Burton J, Hallam B, Scherer S, Gaffy E. F3-04-03: STAKEHOLDER PERSPECTIVES ON HOW THE HOME CARE SECTOR CAN SUPPORT PEOPLE TO LIVE WELL WITH DEMENTIA. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4610] [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: 11/15/2022]
Affiliation(s)
- Anita M.Y. Goh
- National Ageing Research Institute; Parkville Australia
- University of Melbourne; Parkville Australia
- Melbourne Health; Parkville Australia
| | - Briony Dow
- University of Melbourne; Parkville Australia
- National Ageing Research Institute; Parkville Australia
| | - Meg Polacsek
- National Ageing Research Institute; Parkville Australia
| | - Colleen Doyle
- National Ageing Research Institute; Parkville Australia
| | - David Ames
- National Ageing Research Institute; Parkville Australia
- The University of Melbourne; Parkville Australia
- AIBL Research Group; Perth and Melbourne Australia
- The University of Melbourne; Parkville Australia
| | | | - Steven Savvas
- National Ageing Research Institute; Parkville Australia
| | - Susan Malta
- University of Melbourne; Parkville Australia
| | - Lee-Fay Low
- The University of Sydney; Lidcombe Australia
| | - Philip Clarke
- University of Melbourne; Parkville Australia
- Oxford University; Oxford United Kingdom
| | | | | | - Gill Livingston
- University College London; London United Kingdom
- Camden and Islington NHS Foundation Trust; London United Kingdom
| | | | - Luke Gahan
- National Ageing Research Institute; Parkville Australia
| | | | - Samantha M. Loi
- University of Melbourne; Parkville Australia
- Melbourne Health; Parkville Australia
| | | | | | | | - Ellen Gaffy
- National Ageing Research Institute; Parkville Australia
- La Trobe University; Melbourne Australia
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10
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Anpalahan M, Savvas S, Lo KY, Ng HY, Gibson S. Chronic idiopathic normocytic anaemia in older people: the risk factors and the role of age-associated renal impairment. Aging Clin Exp Res 2017; 29:147-155. [PMID: 27038455 DOI: 10.1007/s40520-016-0563-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterise the risk factors for chronic idiopathic normocytic anaemia (CINA) in older people, particularly the role of age-associated renal impairment. METHODS Patients aged ≥65 years admitted to a medical unit over 12 months were assessed. Those with secondary causes of anaemia including chronic kidney disease (CKD) were excluded. CINA was defined as a haemoglobin <130 g/l for men and <120 g/l for women for at least 6 months without any apparent cause. Renal function was determined by estimating creatinine clearance (CrCl) using Cockcroft-Gault formula, and glomerular filtration rate (GFR) using modification of diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas. RESULTS 116 had CINA. Controls were 572. The mean estimates of renal function were significantly lower in cases as compared with controls (P < 0.001). The risk of CINA increased by 12.6, 10.4 and 12 %, respectively, for each unit decrease in CrCl, MDRD-eGFR and CKD-EPI-eGFR, independent of age and other covariates. The adjusted odds ratios for CINA in those with CrCl, MDRD or CKD-EPI eGFR <60 ml/min/1.73 m2 were 2.68 (CI 1.53-4.70); 2.70 (CI 1.57-4.62) and 2.12 (CI 1.46-3.74), respectively. Other covariates in the model that were independently associated with CINA included advanced age, diabetes mellitus (DM), use of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), history of dementia and living in a residential care facility. CONCLUSIONS Age-associated renal impairment independently contributes to CINA. Other potential risk factors for CINA include advanced age, DM and ACEI or ARB use.
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Affiliation(s)
- Mahesan Anpalahan
- Department of General Medicine, Western Health, Melbourne, Australia.
- Department of Medicine, North West Academic Centre, The University of Melbourne, Melbourne, Australia.
- Department of General Internal Medicine, Eastern Health, Albert Street, Melbourne, VIC, 3156, Australia.
| | - Steven Savvas
- National Ageing Research Institute (NARI), Melbourne, Australia
| | - Kar Yan Lo
- Department of General Medicine, Western Health, Melbourne, Australia
| | - Hui Yi Ng
- Department of General Internal Medicine, Eastern Health, Albert Street, Melbourne, VIC, 3156, Australia
| | - Stephen Gibson
- National Ageing Research Institute (NARI), Melbourne, Australia
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11
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Ahamed S, Anpalahan M, Savvas S, Gibson S, Torres J, Janus E. Hyponatraemia in older medical patients: implications for falls and adverse outcomes of hospitalisation. Intern Med J 2015; 44:991-7. [PMID: 25039672 DOI: 10.1111/imj.12535] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 03/18/2014] [Accepted: 07/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent evidence suggests an association between hyponatraemia and falls. AIMS To determine the association of hyponatraemia with admission-associated falls (i.e. falls as part of the presenting complaint or during admission) and predefined adverse outcomes of hospitalisation. METHODS A case-control study of patients aged ≥65 years admitted with hyponatraemia during a 6-month period was conducted. The relevant data were collected by review of medical records and analysed in univariate and multivariate models. RESULTS The prevalence of hyponatraemia was 22% and more likely to be associated with the admission diagnoses of cardiovascular (P = 0.04) and metabolic disorders (P < 0.001), use of diuretics (P = 0.037) and a higher Charlson comorbidity score (P = 0.035). Hyponatraemia was independently associated with admission-associated falls (odds ratio (OR) 3.12, confidence interval (CI) 1.84-4.38, P < 0.001). The increased odds of falling were similar for mild (OR 3.15, CI 1.75-5.66) vs moderate to severe hyponatraemia (OR 3.07, CI 1.57-6.03). Although hyponatraemia had a significant independent association with increased length of stay (LOS) (OR 1.48, CI 1.22-1.79, P < 0.001) and change in residential care status to a more dependent category at discharge (OR 4.28, CI 1.68-10.859, P = 0.002), it was not associated with mortality or time to first unplanned readmission. Hyponatraemia was significantly associated with the need for inpatient rehabilitation; however, this was no longer significant when adjusted for falls. CONCLUSION Hyponatraemia is independently associated with increased risk of admission-associated falls. The degree of falls risk is similar regardless of the severity of hyponatraemia. Hyponatraemia is also an important determinant of many adverse outcomes of hospitalisation.
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Affiliation(s)
- S Ahamed
- General Medicine Unit, Western Health, Melbourne, Victoria, Australia
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Savvas S, Gibson S. Pain management in residential aged care facilities. Aust Fam Physician 2015; 44:198-203. [PMID: 25901403] [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: 06/04/2023]
Abstract
BACKGROUND Persistent pain is prevalent in aged care facilities and there are a number of barriers that make effective pain management more difficult to achieve in this setting. OBJECTIVE The aim of this article is to provide an evidence-based approach to assessment and management of pain experienced by residents of aged care facilities. DISCUSSION Barriers to effective pain management in residential aged care facilities include patient beliefs and attitudes towards pain, communication deficits and cognitive impairment, frailty and its effect on pharmacotherapy, and limited evidence of comprehensive pain management strategies for people with dementia. Education programs, developments in observational behaviour scales and stepwise pain management protocols have enabled good progress to be made in addressing these obstacles and improving patient outcomes.
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Affiliation(s)
- Steven Savvas
- PhD, Research Officer, Clinical Division, National Ageing Research Institute, University of Melbourne, Parkville, VIC
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Savvas S, Toye C, Beattie E, Gibson SJ. Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities. Pain Manag Nurs 2014; 15:819-25. [PMID: 24675280 DOI: 10.1016/j.pmn.2013.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/02/2013] [Accepted: 09/05/2013] [Indexed: 10/25/2022]
Abstract
Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice.
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Affiliation(s)
- Steven Savvas
- National Ageing Research Institute, Victoria, Australia.
| | - Christine Toye
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Formerly (now adjunct) School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Western Australia, Australia
| | - Elizabeth Beattie
- Dementia Collaborative Research Centre: Carers and Consumers, School of Nursing, Faculty of Health, Queensland University of Technology, Queensland, Australia
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Abstract
OBJECTIVES To examine the effects that variant descriptor labels on cigarette packs have on smokers' perceptions of those packs and the cigarettes contained within. METHOD As part of two larger web-based studies (each involved 160 young adult ever-smokers 18-29 years old), respondents were shown a computer image of a plain cigarette pack and sets of related variant descriptors. The sets included terms that varied in terms of descriptors of colours as names, flavour strength, degrees of filter venting, filter types, quality, type of cigarette and numbers. For each set, respondents rated the highest and lowest of two or three of the following four characteristics: quality, strongest or weakest in taste, delivers most or least tar/nicotine, and most or least level of harm. RESULTS There were significant differences on all four ratings. Quality ratings were the least differentiated. Except for colour descriptors, where 'Gold' rated high in quality but medium in other ratings, ratings of quality, harm, strength and delivery were all positively associated when rated on the same descriptors. CONCLUSIONS Descriptor labels on cigarette packs, can affect smokers' perceptions of the characteristics of the cigarettes contained within. Therefore, they are a potential means by which product differentiation can occur. In particular, having variants differing in perceived strength while not differing in deliveries of harmful ingredients is particularly problematic. Any packaging policy should take into account the possibility that variant descriptors can mislead smokers into making inappropriate product attributions.
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Affiliation(s)
- Ron Borland
- The Cancer Council Victoria, , Melbourne, Victoria, Australia
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Hadjigeorgiou C, Tornaritis M, Savvas S, Solea A, Kafatos A. Obesity and psychological traits associated with eating disorders among Cypriot adolescents: comparison of 2003 and 2010 cohorts. East Mediterr Health J 2012; 18:842-9. [DOI: 10.26719/2012.18.8.842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVES To examine the extent that novel cigarette pack shapes and openings have on smokers' perceptions of those packs and the cigarettes contained within. METHOD Using a web-based survey, 160 young adult ever-smokers (18-29 years) were shown computer images of plain packaged cigarette packs in five different shapes. This was followed by packs illustrating five different methods of opening. Brand (prestige or budget) and size of the health warnings (30% or 70% warning size) were between-subject conditions. Respondents ranked packs on attractiveness, perceived quality of the cigarettes contained within and extent that the pack distracted from health warnings. RESULTS Ratings of attractiveness and perceived quality were significantly associated in both substudies, but tendency to distract from warnings was more independent. Significant differences were found between the pack shapes on attractiveness, perceived quality and distraction from warnings. Standard, 2×10 and 4×5 packs were ranked less attractive than Bevelled and Rounded packs. 2×10 and 4×5 packs were also perceived as lower quality than Bevelled and Rounded packs. The Standard pack was less distracting to health warnings than all other shapes except the 2×10 pack. Pack openings were perceived as different on quality of cigarettes contained and extent of distraction to warnings. The Standard Flip-top was rated significantly lower in distracting from warnings than all other openings. CONCLUSIONS Pack shape and pack opening affect ever-smokers' perceptions of the packs and the cigarettes they contain. This means that they have the potential to create appeal and differentiate products and thus should be regulated.
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Affiliation(s)
- Ron Borland
- VicHealth Centre for Tobacco Control, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, Melbourne, VIC 3053, Australia.
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Iliana C, Savvas S. Epidemiological study of injuries in greek taekwondo athletes. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2010.081554.50] [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: 11/03/2022]
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Koskinas J, Kilidireas C, Karandreas N, Kountouras D, Savvas S, Hadziyannis E, Archimandritis AJ. Severe hepatitis C virus-related cryoglobulinaemic sensory-motor polyneuropathy treated with pegylated interferon-a2b and ribavirin: clinical, laboratory and neurophysiological study. Liver Int 2007; 27:414-20. [PMID: 17355465 DOI: 10.1111/j.1478-3231.2006.01436.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND/AIMS Severe involvement of central and/or peripheral nervous system is a rare complication of hepatitis C virus (HCV)-related cryoglobulinaemia. METHOD Four patients with HCV-related type II/III cryoglobulinaemia (three males with genotype 1, one female with genotype 3) who presented with severe sensory-motor polyneuropathy, one with central nervous system involvement as well, were treated with pegylated IFNa-2b 1.5 microg/kg/week and ribavirin 10.6 mg/kg/daily for 48 weeks. Neurological evaluation involved detailed clinical motor and sensory scores/scales and neurophysiological studies before and after treatment. RESULTS/CONCLUSION Three out of four patients had undetectable serum HCV-RNA, normal levels of aminotransferases and substantially lower or undetectable levels of cryoglobulins at the end of treatment and at 24 weeks follow-up period. Treatment was well tolerated and all patients exhibited significant improvement of neuropathy based on solid clinical and laboratory criteria that was associated with the virological response.
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Affiliation(s)
- J Koskinas
- 2nd Department of Medicine and Department of Neurology, Medical School, University of Athens, Athens, Greece.
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Papatheodoridis GV, Chrysanthos N, Savvas S, Sevastianos V, Kafiri G, Petraki K, Manesis EK. Diabetes mellitus in chronic hepatitis B and C: prevalence and potential association with the extent of liver fibrosis. J Viral Hepat 2006; 13:303-10. [PMID: 16637860 DOI: 10.1111/j.1365-2893.2005.00677.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus has been reported to have an increased prevalence and to be associated with more severe fibrosis in patients with chronic hepatitis C. We evaluated the prevalence of diabetes mellitus in patients with chronic hepatitis B or C as well as the possible association between presence of diabetes and extent of liver fibrosis. In total, 434 consecutive patients with histologically documented hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (n = 174) or chronic hepatitis C (n = 260) were studied. The relationships of diabetes and epidemiological, somatomorphic, laboratory and histological patient characteristics were evaluated. Liver histological lesions were blindly evaluated according to the Ishak's classification. Diabetes was present in 58 (13%) patients, without any difference between those with chronic hepatitis B (14%) or C (13%). Diabetes was observed significantly less frequently in patients with fibrosis score 0-2 (7.7%) than 3-4 (10.4%) than 5-6 (29.2%) (P < 0.001). The presence of diabetes was independently associated with higher gamma-glutamyl-transpeptidase (GGT) levels and more severe fibrosis or presence of cirrhosis (P < 0.001) as well as with presence of hepatic steatosis and increased serum triglycerides levels (P < 0.02). In the noncirrhotic patients, diabetes was significantly associated with older age and higher GGT levels, but not with the extent of fibrosis. In conclusion, diabetes mellitus is observed in more than 10% of patients with either HBeAg-negative chronic hepatitis B or chronic hepatitis C. The presence of diabetes is strongly associated with more severe liver fibrosis, but such an association may be related to the high prevalence of diabetes in patients with cirrhosis.
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Affiliation(s)
- G V Papatheodoridis
- Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece.
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Stiakaki E, Savvas S, Lydaki E, Bolonaki I, Kouvidi E, Dimitriou H, Kambourakis A, Kalmanti M. Ondansetron and tropisetron in the control of nausea and vomiting in children receiving combined cancer chemotherapy. Pediatr Hematol Oncol 1999; 16:101-8. [PMID: 10100270 DOI: 10.1080/088800199277425] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Ondansetron (Zofron, Glaxo) and tropisetron (Navoban, Sandoz) are selective serotonin (5HT3) antagonists that have proven very effective in the prevention of vomiting and nausea in adults and children receiving cancer chemotherapy. This study compared the efficacy of the two agents in the prevention of vomiting and nausea in children receiving chemotherapy for solid tumors and blood malignancies. A total of 23 children were studied in 205 chemotherapeutic cycles (116 one-day regimens and 89 multiple-day regimens). In 102 chemotherapeutic cycles the children received ondansetron as an antiemetic agent in a dose of 5 mg/m2 30 min before chemotherapy was given and then 4 mg/m2 every 8 h i.v. (group A) and in 103 cycles they received tropisetron in one dose of 0.2 mg/kg 24 h-1 i.v. (max dose 5 mg) 30 min before cytotoxic drugs administration every day they received chemotherapy (group B). The response was defined as complete in the absence of nausea and vomiting per 24 h of chemotherapy, as partial given the presence of 1-4 events of vomiting and/or nausea less than 5 h per 24 h, and as failure if there were more than 4 events of vomiting and/or nausea for more than 5 h per 24 h of chemotherapy. The response of the two groups was studied independently and depending on the degree of emetogenicity of the chemotherapeutic agents, which were divided into mildly, moderately, and highly emetogenic. The comparison of the two groups not taking into consideration the emetogenicity of the chemotherapeutic agents showed that ondansetron was more effective in 1-day regimens (P = .023), whereas the two agents were equally effective in multiple-day regimens (P = .2). The statistical analysis depending on the emetogenicity of the chemotherapeutic agents showed increased efficacy of ondansetron in mild (P = .017) and moderately emetogenic chemotherapeutic agents, whereas there was no difference in the highly emetogenic drug group. Ondansetron is found to be more effective than tropisetron in controlling acute nausea and vomiting in children receiving mild and moderately emetogenic chemotherapeutic drugs, although there is no difference in the efficacy of both antiemetic agents when highly emetogenic drugs are administered.
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Affiliation(s)
- E Stiakaki
- Department of Pediatric Hematology/Oncology, University Hospital of Heraklion, Crete, Greece
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Studd JWW, Brincat M, Savvas S, Dooley M, Montgomery JC. Osteoporosis: cause and management. West J Med 1987. [DOI: 10.1136/bmj.294.6578.1032-d] [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: 11/04/2022]
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