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Article ; Online: The Scottish Intercollegiate Guidelines Network (SIGN) 157

Roy L. Soiza / Phyo K. Myint

Medicina, Vol 55, Iss 8, p

Guidelines on Risk Reduction and Management of Delirium

2019 Volume 491

Abstract: The Scottish Intercollegiate Guidelines Network (SIGN) guideline on delirium is a major advance on existing guidelines on this condition. This is particularly important given the evidence it is frequently under-diagnosed and inadequately managed despite ... ...

Abstract	The Scottish Intercollegiate Guidelines Network (SIGN) guideline on delirium is a major advance on existing guidelines on this condition. This is particularly important given the evidence it is frequently under-diagnosed and inadequately managed despite being common and frequently associated with significant patient and carer distress and poor outcomes. The guidelines recommend using the 4A’s test to help detect delirium. A bundle of mostly non-pharmacological therapies minimise the risk of developing delirium and can help those who develop the condition. The importance of medical optimisation by an experienced professional in those at risk of delirium is highlighted with new recommendations for people in intensive care and surgical settings. There is guidance on follow-up of people with delirium, which should become routine. This commentary piece focusses on areas with the greatest potential to improve the experience and outcomes of those with delirium, and briefly discusses areas of ongoing uncertainty.
Keywords	acute confusion ; ageing ; delirium ; diagnosis ; encephalopathy ; guideline ; treatment ; Medicine (General) ; R5-920
Language	English
Publishing date	2019-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Body Mass Index and Mortality, Recurrence and Readmission after Myocardial Infarction

Lorenzo De Paola / Arnav Mehta / Tiberiu A. Pana / Ben Carter / Roy L. Soiza / Mohannad W. Kafri / John F. Potter / Mamas A. Mamas / Phyo K. Myint

Journal of Clinical Medicine, Vol 11, Iss 2581, p

Systematic Review and Meta-Analysis

2022 Volume 2581

Abstract: The following study aimed to systematically review and meta-analyse the literature on the relations between markers of nutritional status and long-term mortality, recurrence and all-cause hospital readmission following myocardial infarction (MI). Medline, ...

Abstract	The following study aimed to systematically review and meta-analyse the literature on the relations between markers of nutritional status and long-term mortality, recurrence and all-cause hospital readmission following myocardial infarction (MI). Medline, EMBASE and Web of Science were searched for prospective cohort studies reporting the relationship between anthropometric and biochemical markers of nutritional status and nutritional assessment tools on long-term mortality, recurrence and all-cause hospital readmission in adult patients with an MI. Two reviewers conducted screening, data extraction and critical appraisal independently. Random-effects meta-analysis was performed. Twenty-seven studies were included in the qualitative synthesis and twenty-four in the meta-analysis. All eligible studies analysed BMI as their exposure of interest. Relative to normal weight, mortality was highest in underweight patients (adjusted Hazard Ratio (95% confidence interval): 1.42 (1.24–1.62)) and lower in both overweight (0.85 (0.76–0.94)) and obese patients (0.86 (0.81–0.91)), over a mean follow-up ranging from 6 months to 17 years. No statistically significant associations were identified between different BMI categories for the outcomes of recurrence and hospital readmission. Patients with low BMI carried a significant mortality risk post-MI; however due to the known limitations associated with BMI measurement, further evidence regarding the prognostic utility of other nutritional markers is required.
Keywords	systematic review ; BMI ; myocardial infarction ; nutrition ; mortality ; recurrence ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Bioelectrical Impedance Versus Biochemical Analysis of Hydration Status

Adrian D. Wood / Gillian D. Edward / Kirsten Cumming / Mohannad W. Kafri / Roy L. Soiza / Lee Hooper / John F. Potter / Phyo K. Myint

Healthcare, Vol 9, Iss 2, p

Predictive Value for Prolonged Hospitalisation and Poor Discharge Destination for Older Patients

2021 Volume 154

Abstract: Dehydration is prevalent in hospitalised patients and is associated with increased morbidity and mortality, particularly among the elderly (≥65 years). We aimed at comparing the performance of intracellular water to extracellular water ratio (ICW/ECW), ... ...

Abstract	Dehydration is prevalent in hospitalised patients and is associated with increased morbidity and mortality, particularly among the elderly (≥65 years). We aimed at comparing the performance of intracellular water to extracellular water ratio (ICW/ECW), calculated through a bioelectrical impedance analysis (BIA) of blood urea nitrogen, with the creatinine ratio (BUN/Cr) to predict poor outcomes in a cohort of prospectively identified patients. Data were combined from a cohort of elderly patients (≥65 years) admitted to hospital with fragility fracture ( n = 125) and older adults aged ≥50 years admitted to hospital with stroke ( n = 40). The association between hydration status and study outcomes (unfavourable discharge destination (rehabilitation, another ward, or death) and prolonged hospitalisation (>10 days)) was examined using logistic regression. The overall diagnostic accuracy of each hydration status measurement was assessed using the area under the receiver operating characteristic (ROC) curve. In 165 participants (mean age (SD) of 76.7 (9.2) years), an ICW/ECW ratio below the 25th percentile was associated with increased odds of poor discharge destination (OR (95% CI) = 4.25 (1.59–11.34)). Neither the relationship between the BUN/Cr ratio and prolonged stay nor discharge destination was significant. A BIA could be used utilised in conjunction with biochemical measurements to inform patient prognosis.
Keywords	dehydration ; bioelectrical impedance ; intracellular ; extracellular ; blood urea nitrogen ; creatinine ; Medicine ; R
Subject code	616
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Prevalence, incidence and etiology of hyponatremia in elderly patients with fragility fractures.

Kirsten Cumming / Graeme E Hoyle / James D Hutchison / Roy L Soiza

PLoS ONE, Vol 9, Iss 2, p e

2014 Volume 88272

Abstract: Introduction Hyponatremia (serum sodium<135 mMol/L) is the commonest electrolyte imbalance encountered in clinical practice. It is associated with multiple poor clinical outcomes including increased mortality, longer hospital stay, falls and fractures. ... ...

Abstract	Introduction Hyponatremia (serum sodium<135 mMol/L) is the commonest electrolyte imbalance encountered in clinical practice. It is associated with multiple poor clinical outcomes including increased mortality, longer hospital stay, falls and fractures. Prevalence is higher in frail patient groups, and elderly patients with fragility fractures (EPFF) are particularly susceptible. Euvolemic hyponatremia due to syndrome of inappropriate anti-diuretic hormone (SIADH) is widely assumed to be the commonest cause. However, little is known about the epidemiology and etiology of hyponatremia in EPFF. This study established prevalence, incidence and etiology of hyponatremia in EPFF. Methods Prospective observational study of consenting adults aged ≥65 years admitted with a fragility fracture to a university hospital between 7th January and 4th April 2013. Prevalence of hyponatremia on admission and incidence of cases developing in hospital were reported. Etiology of cases of hyponatremia was determined by consensus of an expert panel using pre-specified data collected daily. Results 127/212 (60%) EPFF were recruited (mean age 79 yrs, 78% female). Two participants withdrew mid-study. Of those not recruited, 66 had incapacity to consent and 19 refused participation. Point prevalence of hyponatremia on admission was 13.4% and a further 12.6% developed hyponatremia during admission. Hypovolemic hyponatremia was predominant (70%). 73% of cases were multi-factorial in etiology. The commonest potentially causative factors in cases of hyponatremia were thiazide diuretics (76%), dehydration (70%), proton pump inhibitors (70%), SIADH (27%) and mirtazapine (15%). Conclusion Hyponatremia is highly prevalent in EPFF, seen in 26% of cases. Dehydration and prescription of thiazide diuretics and proton pump inhibitors were the commonest potentially causative factors, not SIADH.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hyponatremia

Roy L. Soiza / Kirsten Cumming / Jennifer M. Clarke / Karen M. Wood / Phyo K. Myint

Journal of Clinical Medicine, Vol 3, Iss 3, Pp 944-

Special Considerations in Older Patients

2014 Volume 958

Abstract: Hyponatremia is especially common in older people. Recent evidence highlights that even mild, chronic hyponatremia can lead to cognitive impairment, falls and fractures, the latter being in part due to bone demineralization and reduced bone quality. ... ...

Abstract	Hyponatremia is especially common in older people. Recent evidence highlights that even mild, chronic hyponatremia can lead to cognitive impairment, falls and fractures, the latter being in part due to bone demineralization and reduced bone quality. Hyponatremia is therefore of special significance in frail older people. Management of hyponatremia in elderly individuals is particularly challenging. The underlying cause is often multi-factorial, a clear history may be difficult to obtain and clinical examination is unreliable. Established treatment modalities are often ineffective and carry considerable risks, especially if the diagnosis of underlying causes is incorrect. Nevertheless, there is some evidence that correction of hyponatremia can improve cognitive performance and postural balance, potentially minimizing the risk of falls and fractures. Oral vasopressin receptor antagonists (vaptans) are a promising innovation, but evidence of their safety and effect on important clinical outcomes in frail elderly individuals is limited.
Keywords	aging ; arginine vasopressin ; geriatrics ; hyponatremia ; old ; salt ; sodium ; Medicine ; R
Language	English
Publishing date	2014-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Non-pharmacological interventions for the improvement of post-stroke activities of daily living and disability amongst older stroke survivors

Carrie Stewart / Selvarani Subbarayan / Pamela Paton / Elliot Gemmell / Iosief Abraha / Phyo Kyaw Myint / Denis O'Mahony / Alfonso J Cruz-Jentoft / Antonio Cherubini / Roy L Soiza

PLoS ONE, Vol 13, Iss 10, p e

A systematic review.

2018 Volume 0204774

Abstract: Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is ... ...

Abstract	Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is largely unknown. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [http://www.senator-project.eu]. A Delphi panel of European geriatric experts agreed activities of daily living and disability to be of critical importance as stroke rehabilitation outcomes. A comprehensive search strategy was developed and five databases (Pubmed, CINAHL, Embase, PsycInfo and Cochrane Database of Systematic Reviews) searched for eligible systematic reviews. Primary studies meeting our criteria (non-pharmacologic interventions, involving stroke survivors aged ≥65 years, assessing activities of daily living and/or disability as outcome) were then identified from these reviews. Eligible papers were double reviewed, and due to heterogeneity, narrative analysis performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence, allowing us to make recommendations regarding specific non-pharmacologic rehabilitation in older stroke survivors. In total, 72 primary articles were reviewed spanning 14 types of non-pharmacological intervention. Non-pharmacological interventions based on physiotherapy and occupational therapy techniques improved activities of daily living amongst older stroke survivors. However, no evidence was found to support use of any non-pharmacological approach to benefit older stroke survivors' disability. Evidence was limited by poor study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such ...
Keywords	Medicine ; R ; Science ; Q
Subject code	590
Language	English
Publishing date	2018-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: ACE I/D genotype associates with strength in sarcopenic men but not with response to ACE inhibitor therapy in older adults with sarcopenia

Christos Rossios / Tufail Bashir / Marcus Achison / Simon Adamson / Asangaedem Akpan / Terry Aspray / Alison Avenell / Margaret M Band / Louise A Burton / Vera Cvoro / Peter T Donnan / Gordon W Duncan / Jacob George / Adam L Gordon / Celia L Gregson / Adrian Hapca / Cheryl Hume / Thomas A Jackson / Simon Kerr /

Alixe Kilgour / Tahir Masud / Andrew McKenzie / Emma McKenzie / Harnish Patel / Kristina Pilvinyte / Helen C Roberts / Avan A Sayer / Karen T Smith / Roy L Soiza / Claire J Steves / Allan D Struthers / Divya Tiwari / Julie Whitney / Miles D Witham / Paul R Kemp

PLoS ONE, Vol 18, Iss 10, p e

Results from the LACE trial.

2023 Volume 0292402

Abstract: Background Angiotensin II (AII), has been suggested to promote muscle loss. Reducing AII synthesis, by inhibiting angiotensin converting enzyme (ACE) activity has been proposed as a method to inhibit muscle loss. The LACE clinical trial was designed to ... ...

Abstract	Background Angiotensin II (AII), has been suggested to promote muscle loss. Reducing AII synthesis, by inhibiting angiotensin converting enzyme (ACE) activity has been proposed as a method to inhibit muscle loss. The LACE clinical trial was designed to determine whether ACE inhibition would reduce further muscle loss in individuals with sarcopenia but suffered from low recruitment and returned a negative result. Polymorphic variation in the ACE promoter (I/D alleles) has been associated with differences in ACE activity and muscle physiology in a range of clinical conditions. This aim of this analysis was to determine whether I/D polymorphic variation is associated with muscle mass, strength, in sarcopenia or contributed to the lack of response to treatment in the LACE study. Methods Sarcopenic individuals were recruited into a 2x2 factorial multicentre double-blind study of the effects of perindopril and/or leucine versus placebo on physical performance and muscle mass. DNA extracted from blood samples (n = 130 72 women and 58 men) was genotyped by PCR for the ACE I/D polymorphism. Genotypes were then compared with body composition measured by DXA, hand grip and quadriceps strength before and after 12 months' treatment with leucine and/or perindopril in a cross-sectional analysis of the influence of genotype on these variables. Results Allele frequencies for the normal UK population were extracted from 13 previous studies (I = 0.473, D = 0.527). In the LACE cohort the D allele was over-represented (I = 0.412, D = 0.588, p = 0.046). This over-representation was present in men (I = 0.353, D = 0.647, p = 0.010) but not women (I = 0.458, D = 0.532, p = 0.708). In men but not women, individuals with the I allele had greater leg strength (II/ID = 18.00 kg (14.50, 21.60) vs DD = 13.20 kg (10.50, 15.90), p = 0.028). Over the 12 months individuals with the DD genotype increased in quadriceps strength but those with the II or ID genotype did not. Perindopril did not increase muscle strength or mass in any polymorphism ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Activin type I receptor polymorphisms and body composition in older individuals with sarcopenia—Analyses from the LACE randomised controlled trial

Tufail Bashir / Marcus Achison / Simon Adamson / Asangaedem Akpan / Terry Aspray / Alison Avenell / Margaret M. Band / Louise A. Burton / Vera Cvoro / Peter T. Donnan / Gordon W. Duncan / Jacob George / Adam L. Gordon / Celia L. Gregson / Adrian Hapca / Cheryl Hume / Thomas A. Jackson / Simon Kerr / Alixe Kilgour /

Tahir Masud / Andrew McKenzie / Emma McKenzie / Harnish Patel / Kristina Pilvinyte / Helen C. Roberts / Christos Rossios / Avan A. Sayer / Karen T. Smith / Roy L. Soiza / Claire J. Steves / Allan D. Struthers / Divya Tiwari / Julie Whitney / Miles D. Witham / Paul R. Kemp

PLoS ONE, Vol 18, Iss

2023 Volume 11

Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Activin type I receptor polymorphisms and body composition in older individuals with sarcopenia-Analyses from the LACE randomised controlled trial.

Tufail Bashir / Marcus Achison / Simon Adamson / Asangaedem Akpan / Terry Aspray / Alison Avenell / Margaret M Band / Louise A Burton / Vera Cvoro / Peter T Donnan / Gordon W Duncan / Jacob George / Adam L Gordon / Celia L Gregson / Adrian Hapca / Cheryl Hume / Thomas A Jackson / Simon Kerr / Alixe Kilgour /

Tahir Masud / Andrew McKenzie / Emma McKenzie / Harnish Patel / Kristina Pilvinyte / Helen C Roberts / Christos Rossios / Avan A Sayer / Karen T Smith / Roy L Soiza / Claire J Steves / Allan D Struthers / Divya Tiwari / Julie Whitney / Miles D Witham / Paul R Kemp

PLoS ONE, Vol 18, Iss 11, p e

2023 Volume 0294330

Abstract: Background Ageing is associated with changes in body composition including an overall reduction in muscle mass and a proportionate increase in fat mass. Sarcopenia is characterised by losses in both muscle mass and strength. Body composition and muscle ... ...

Abstract	Background Ageing is associated with changes in body composition including an overall reduction in muscle mass and a proportionate increase in fat mass. Sarcopenia is characterised by losses in both muscle mass and strength. Body composition and muscle strength are at least in part genetically determined, consequently polymorphisms in pathways important in muscle biology (e.g., the activin/myostatin signalling pathway) are hypothesised to contribute to the development of sarcopenia. Methods We compared regional body composition measured by DXA with genotypes for two polymorphisms (rs10783486, minor allele frequency (MAF) = 0.26 and rs2854464, MAF = 0.26) in the activin 1B receptor (ACVR1B) determined by PCR in a cross-sectional analysis of DNA from 110 older individuals with sarcopenia from the LACE trial. Results Neither muscle mass nor strength showed any significant associations with either genotype in this cohort. Initial analysis of rs10783486 showed that males with the AA/AG genotype were taller than GG males (174±7cm vs 170±5cm, p = 0.023) and had higher arm fat mass, (median higher by 15%, p = 0.008), and leg fat mass (median higher by 14%, p = 0.042). After correcting for height, arm fat mass remained significantly higher (median higher by 4% padj = 0.024). No associations (adjusted or unadjusted) were seen in females. Similar analysis of the rs2854464 allele showed a similar pattern with the presence of the minor allele (GG/AG) being associated with greater height (GG/AG = 174±7 cm vs AA = 170 ±5cm, p = 0.017) and greater arm fat mass (median higher by 16%, p = 0.023). Again, the difference in arm fat remained after correction for height. No similar associations were seen in females analysed alone. Conclusion These data suggest that polymorphic variation in the ACVR1B locus could be associated with body composition in older males. The activin/myostatin pathway might offer a novel potential target to prevent fat accumulation in older individuals.
Keywords	Medicine ; R ; Science ; Q
Subject code	796
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients

Iosief Abraha / Fabiana Trotta / Joseph M Rimland / Alfonso Cruz-Jentoft / Isabel Lozano-Montoya / Roy L Soiza / Valentina Pierini / Paolo Dessì Fulgheri / Fabrizia Lattanzio / Denis O'Mahony / Antonio Cherubini

PLoS ONE, Vol 10, Iss 6, p e

A Systematic Overview. The SENATOR project ONTOP Series.

2015 Volume 0123090

Abstract: Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological ...

Abstract	Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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