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  1. Article ; Online: Are clinical trials randomising households to lifestyle interventions to delay cognitive decline feasible? A pilot study to determine the beliefs, preferences, and deterrents for households impacted by dementia based on semi-structured interviews.

    Costello, Maria M / Mc Carthy, Christine E / Bosch, Jackie / Robinson, Stephanie / McDermott, Clodagh / Canavan, Michelle D / O'Donnell, Martin J

    BMC geriatrics

    2022  Volume 22, Issue 1, Page(s) 322

    Abstract: Introduction: While lifestyle risk factors are implicated in the development and progression of cognitive impairment, interventional trials of individual participants have yielded unconvincing evidence. We sought to explore the development of lifestyle ... ...

    Abstract Introduction: While lifestyle risk factors are implicated in the development and progression of cognitive impairment, interventional trials of individual participants have yielded unconvincing evidence. We sought to explore the development of lifestyle interventions targeting the household-unit.
    Methods: Semi-structured interviews were carried out among eight households affected by cognitive impairment (i.e. member of the household had cognitive impairment). Interviews took place online using a secure, web-based video platform recommended for patient clinician interaction. Interview content was analysed, and important themes identified.
    Results: Eighteen participants were interviewed within households, of which eight (one per household) had cognitive impairment and others were spouses or first-degree relatives living in the same home. Several themes emerged; 1) household members without cognitive impairment were more likely to report poor sleep habits, and sleep was perceived to be the hardest behaviour to change; 2) diet generated most interest as a potential lifestyle intervention target as most participants believed there is a strong link with nutrition and cognition; 3) physical activity is challenging to adapt due to lack of motivation and focus when individuals are cognitively impaired. Barriers to study participation, including risk of harm, complexity of intervention and deviation from routine emerged during discussions.
    Conclusions: This study identified beliefs and preferences of households towards lifestyle intervention trials. Findings from this study may be used to inform future clinical trial protocols and future qualitative studies should explore acceptability and feasibility of digital intervention applications.
    MeSH term(s) Clinical Trials as Topic ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/prevention & control ; Dementia/epidemiology ; Dementia/prevention & control ; Exercise ; Humans ; Life Style ; Pilot Projects
    Language English
    Publishing date 2022-04-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2059865-8
    ISSN 1471-2318 ; 1471-2318
    ISSN (online) 1471-2318
    ISSN 1471-2318
    DOI 10.1186/s12877-022-02941-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Role of Proxy Respondents in International Stroke Research: Experience of the INTERSTROKE Study.

    Costello, Maria M / Judge, Conor / Reddin, Catriona / Rangarajan, Sumathy / Langhorne, Peter / Zhang, Hongye / Iversen, Helle K / Xavier, Denis / Smyth, Andrew / Canavan, Michelle D / Yusuf, Salim / O'Donnell, Martin J

    Neuroepidemiology

    2022  Volume 56, Issue 5, Page(s) 355–364

    Abstract: Introduction: Measuring patient-reported information in stroke research is challenging. To overcome this, use of proxy respondents is often a necessary strategy. In this study, we report on use and effect of proxy respondents on patient case-mix in a ... ...

    Abstract Introduction: Measuring patient-reported information in stroke research is challenging. To overcome this, use of proxy respondents is often a necessary strategy. In this study, we report on use and effect of proxy respondents on patient case-mix in a large international epidemiologic stroke study (INTERSTROKE).
    Methods: This was a cross-sectional study of 13,458 cases of acute first stroke in 32 countries. A standardized study questionnaire recording behavioural cardiovascular risk factors was administered to the patient, and if unable to communicate adequately, a valid proxy, or both. We used logistic regression to evaluate the association of age, sex, education, occupation, stroke severity, and region with need for proxy respondent, and report odds ratio (OR) with 95% confidence interval (CI).
    Results: Among 13,458 participants with acute stroke, questionnaires were completed by patients alone in 41.4% (n = 5,573), combination of patient and proxy together in 21.7% (n = 2,918), and proxy alone in 36.9% (n = 4,967). Use of proxy alone was greater in participants with severe stroke (4.7% with modified-Rankin score of 0 vs. 80.5% in those with score 5; OR 187.13; 95% CI: 119.61-308.22), older persons (43.8% of those aged 80 years and over vs. 33.2% of those aged less than 40 years; age per decade OR 1.09; 95% CI: 1.06-1.12), women (40.7% vs. 34.3% of men; OR 1.32 95% CI: 1.22-1.43), and those less educated (58.9% of those never educated vs. 25.7% of those who attended third level education; OR 7.84; 95% CI: 6.78-9.08).
    Conclusion: Use of proxy respondents enhances the generalizability of international research studies of stroke, by increasing representation of women, patients with severe stroke, older age, and lower education.
    MeSH term(s) Male ; Humans ; Female ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Stroke/epidemiology ; Stroke/etiology ; Proxy ; Surveys and Questionnaires ; Logistic Models
    Language English
    Publishing date 2022-07-11
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 603189-4
    ISSN 1423-0208 ; 0251-5350
    ISSN (online) 1423-0208
    ISSN 0251-5350
    DOI 10.1159/000525510
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  3. Article ; Online: Virtual geriatric clinics and the COVID-19 catalyst: a rapid review.

    Murphy, Robert P / Dennehy, Karen A / Costello, Maria M / Murphy, Evelyn P / Judge, Conor S / O'Donnell, Martin J / Canavan, Michelle D

    Age and ageing

    2020  Volume 49, Issue 6, Page(s) 907–914

    Abstract: Background: During the current COVID-19 health crisis virtual geriatric clinics have become increasingly utilised to complete outpatient consultations, although concerns exist about feasibility of such virtual consultations for older people. The aim of ... ...

    Abstract Background: During the current COVID-19 health crisis virtual geriatric clinics have become increasingly utilised to complete outpatient consultations, although concerns exist about feasibility of such virtual consultations for older people. The aim of this rapid review is to describe the satisfaction, clinic productivity, clinical benefit, and costs associated with the virtual geriatric clinic model of care.
    Methods: A rapid review of PubMed, MEDLINE and CINAHL databases was conducted up to April 2020. Two independent reviewers extracted the information. Four subdomains were focused on: satisfaction with the virtual geriatric clinic, clinic productivity, clinical benefit to patients, costs and any challenges associated with the virtual clinic process.
    Results: Nine studies with 975 patients met our inclusion criteria. All were observational studies. Seven studies reported patients were satisfied with the virtual geriatric clinic model of care. Productivity outcomes included reports of cost-effectiveness, savings on transport, and improved waiting list metrics. Clinical benefits included successful polypharmacy reviews, and reductions in acute hospitalisation rates. Varying challenges were reported for both clinicians and patients in eight of the nine studies. Hearing impairments and difficulty with technology added to anxieties experienced by patients. Physicians missed the added value of a thorough physical examination and had concerns about confidentiality.
    Conclusion: Virtual geriatric clinics demonstrate evidence of productivity, benefit to patients, cost effectiveness and patient satisfaction with the treatment provided. In the current suboptimal pandemic climate, virtual geriatric clinics may allow Geriatricians to continue to provide an outpatient service, despite the encountered inherent challenges.
    MeSH term(s) Aged ; Ambulatory Care Facilities/statistics & numerical data ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Disease Transmission, Infectious/prevention & control ; Humans ; Pandemics ; Patient Satisfaction ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Referral and Consultation ; SARS-CoV-2 ; Telemedicine/methods
    Keywords covid19
    Language English
    Publishing date 2020-08-11
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afaa191
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  4. Article ; Online: Household-level lifestyle interventions for the prevention of cognitive decline; A Systematic review.

    Costello, Maria M / McCarthy, Christine E / Judge, Conor / Dennehy, Karen / Dermott, Clodagh Mc / Flatharta, Tomás Ó / O'Donnell, Martin J / Canavan, Michelle D

    Archives of gerontology and geriatrics

    2021  Volume 98, Page(s) 104565

    Abstract: Background: Lifestyle interventions targeting households may be an effective means of promoting healthier cognitive function in later life, with extended benefit to other household members. In this systematic review and meta-analysis, we sought to ... ...

    Abstract Background: Lifestyle interventions targeting households may be an effective means of promoting healthier cognitive function in later life, with extended benefit to other household members. In this systematic review and meta-analysis, we sought to assess the effect of targeting lifestyle behaviours of households on cognitive outcomes METHODS: An electronic search strategy was designed to identify randomised controlled trials (RCTs) where households were randomised to receive a lifestyle intervention for the prevention of cognitive decline, from database inception until April 2020. Our initial search identified no eligible studies, so we revised our search strategy to include trials enroling dyads. We reported the cognitive outcomes, functional outcomes, caregiver outcomes and long-term care (LTC) admissions for eligible studies.
    Findings: We identified no RCTs which randomised households to receive a lifestyle intervention for preventing cognitive decline. We identified five RCTs (n = 1721, with mean follow-up of 9.6 months) which randomised dyads, which evaluated diet (two trials) and physical activity (three trials).
    Conclusion: Trials evaluating dietary and exercise interventions in dyads were identified. No trial demonstrated a significant association of interventions with change in cognitive testing, functional outcomes or long-term care admissions, although trials were small with short-term follow-up. Future studies should consider targeting lifestyle behaviours of households for prevention of dementia.
    MeSH term(s) Cognition ; Cognitive Dysfunction/prevention & control ; Diet ; Exercise ; Humans ; Life Style
    Language English
    Publishing date 2021-10-30
    Publishing country Netherlands
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 603162-6
    ISSN 1872-6976 ; 0167-4943
    ISSN (online) 1872-6976
    ISSN 0167-4943
    DOI 10.1016/j.archger.2021.104565
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    Zs.A 1729: Show issues Location:
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  5. Article ; Online: Increased Salt Intake for Orthostatic Intolerance Syndromes: A Systematic Review and Meta-Analysis.

    Loughlin, Elaine A / Judge, Conor S / Gorey, Sarah E / Costello, Maria M / Murphy, Robert P / Waters, Ruairi F / Hughes, Diarmaid S / Kenny, Rose Ann / O'Donnell, Martin J / Canavan, Michelle D

    The American journal of medicine

    2020  Volume 133, Issue 12, Page(s) 1471–1478.e4

    Abstract: Background: Guidelines recommend increased salt intake as a first-line recommendation in the management of symptomatic orthostatic hypotension and recurrent syncope. There have been no systematic reviews of this intervention. We sought to summarize the ... ...

    Abstract Background: Guidelines recommend increased salt intake as a first-line recommendation in the management of symptomatic orthostatic hypotension and recurrent syncope. There have been no systematic reviews of this intervention. We sought to summarize the evidence for increased salt intake in patients with orthostatic intolerance syndromes.
    Methods: We conducted a systematic review and meta-analysis of studies in PubMed, EMBASE, and CINAHL. Interventional studies that increased salt intake in individuals with orthostatic intolerance syndromes were included. Primary outcome measures included incidence of falls and injuries, and rates of syncope and presyncope. Secondary outcome measures included other orthostatic intolerance symptoms, blood pressure, and heart rate.
    Results: A total of 14 studies were eligible, including participants with orthostatic hypotension, syncope, postural orthostatic tachycardia syndrome, and idiopathic orthostatic tachycardia (n = 391). Mean age was 35.6 (± 15) years. All studies were small and short-term (<60 mins-90 days). No study reported on the effect of increased salt intake on falls or injuries. Meta-analysis demonstrated that during head-up tilt, mean time to presyncope with salt intake increased by 1.57 minutes (95% confidence interval [CI], 1.26-1.88), mean systolic blood pressure increased by 12.27 mm Hg (95% CI, 10.86-13.68), and mean heart rate decreased by -3.97 beats per minute (95% CI, -4.08 to -3.86), compared with control. Increased salt increased supine blood pressure by 1.03 mm Hg (95% CI, 0.81 to 1.25). Increased salt intake resulted in an improvement or resolution of symptoms in 62.3% (95% CI, 51.6 to 72.6) of participants in short-term follow-up studies (mean follow-up of 44.3 days, 6 studies; n=91). Methodological quality of studies were low with high statistical heterogeneity in all meta-analyses.
    Conclusions: Our meta-analysis provides low-quality evidence of a short-term improvement in orthostatic intolerance with increased salt intake. There were no clinical trials demonstrating the efficacy and safety of increased salt intake on long-term clinical outcomes. Overall, there is a paucity of clinical trial evidence to support a cornerstone recommendation in the management of orthostatic intolerance syndromes.
    MeSH term(s) Adult ; Humans ; Middle Aged ; Orthostatic Intolerance/diet therapy ; Sodium Chloride, Dietary/administration & dosage ; Young Adult
    Chemical Substances Sodium Chloride, Dietary
    Language English
    Publishing date 2020-06-27
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2020.05.028
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  6. Article: Virtual geriatric clinics and the COVID-19 catalyst: a rapid review

    Murphy, Robert P / Dennehy, Karen A / Costello, Maria M / Murphy, Evelyn P / Judge, Conor S / O039, / Donnell, Martin J / Canavan, Michelle D

    Age Ageing

    Abstract: BACKGROUND: During the current COVID-19 health crisis virtual geriatric clinics have become increasingly utilised to complete outpatient consultations, although concerns exist about feasibility of such virtual consultations for older people. The aim of ... ...

    Abstract BACKGROUND: During the current COVID-19 health crisis virtual geriatric clinics have become increasingly utilised to complete outpatient consultations, although concerns exist about feasibility of such virtual consultations for older people. The aim of this rapid review is to describe the satisfaction, clinic productivity, clinical benefit, and costs associated with the virtual geriatric clinic model of care. METHODS: A rapid review of PubMed, MEDLINE and CINAHL databases was conducted up to April 2020. Two independent reviewers extracted the information. Four subdomains were focused on: satisfaction with the virtual geriatric clinic, clinic productivity, clinical benefit to patients, costs and any challenges associated with the virtual clinic process. RESULTS: Nine studies with 975 patients met our inclusion criteria. All were observational studies. Seven studies reported patients were satisfied with the virtual geriatric clinic model of care. Productivity outcomes included reports of cost-effectiveness, savings on transport, and improved waiting list metrics. Clinical benefits included successful polypharmacy reviews, and reductions in acute hospitalisation rates. Varying challenges were reported for both clinicians and patients in eight of the nine studies. Hearing impairments and difficulty with technology added to anxieties experienced by patients. Physicians missed the added value of a thorough physical examination and had concerns about confidentiality. CONCLUSION: Virtual geriatric clinics demonstrate evidence of productivity, benefit to patients, cost effectiveness and patient satisfaction with the treatment provided. In the current suboptimal pandemic climate, virtual geriatric clinics may allow Geriatricians to continue to provide an outpatient service, despite the encountered inherent challenges.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #727030
    Database COVID19

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  7. Article ; Online: Virtual geriatric clinics and the COVID-19 catalyst

    Murphy, Robert P / Dennehy, Karen A / Costello, Maria M / Murphy, Evelyn P / Judge, Conor S / O’Donnell, Martin J / Canavan, Michelle D

    Age and Ageing

    a rapid review

    2020  Volume 49, Issue 6, Page(s) 907–914

    Abstract: Abstract Background During the current COVID-19 health crisis virtual geriatric clinics have become increasingly utilised to complete outpatient consultations, although concerns exist about feasibility of such virtual consultations for older people. The ... ...

    Abstract Abstract Background During the current COVID-19 health crisis virtual geriatric clinics have become increasingly utilised to complete outpatient consultations, although concerns exist about feasibility of such virtual consultations for older people. The aim of this rapid review is to describe the satisfaction, clinic productivity, clinical benefit, and costs associated with the virtual geriatric clinic model of care. Methods A rapid review of PubMed, MEDLINE and CINAHL databases was conducted up to April 2020. Two independent reviewers extracted the information. Four subdomains were focused on: satisfaction with the virtual geriatric clinic, clinic productivity, clinical benefit to patients, costs and any challenges associated with the virtual clinic process. Results Nine studies with 975 patients met our inclusion criteria. All were observational studies. Seven studies reported patients were satisfied with the virtual geriatric clinic model of care. Productivity outcomes included reports of cost-effectiveness, savings on transport, and improved waiting list metrics. Clinical benefits included successful polypharmacy reviews, and reductions in acute hospitalisation rates. Varying challenges were reported for both clinicians and patients in eight of the nine studies. Hearing impairments and difficulty with technology added to anxieties experienced by patients. Physicians missed the added value of a thorough physical examination and had concerns about confidentiality. Conclusion Virtual geriatric clinics demonstrate evidence of productivity, benefit to patients, cost effectiveness and patient satisfaction with the treatment provided. In the current suboptimal pandemic climate, virtual geriatric clinics may allow Geriatricians to continue to provide an outpatient service, despite the encountered inherent challenges.
    Keywords Ageing ; Geriatrics and Gerontology ; General Medicine ; covid19
    Language English
    Publisher Oxford University Press (OUP)
    Publishing country uk
    Document type Article ; Online
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afaa191
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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