Acceptability, feasibility, and effectiveness of WE-SURF™: a virtual supervised group-based fall prevention exercise program among older adults.

Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this study, we aimed to assess the acceptability, feasibility, and effectiveness of a virtual supervised group-based falls prevention exercise program (WE-SURF™) for community-dwelling older adults at risk of falls. METHOD: A preliminary study utilizing virtual discussions was conducted to assess the acceptability of the program among six older adults. Effectiveness was evaluated in a randomized controlled feasibility study design, comprising 52 participants (mean age: 66.54; SD: 5.16), divided into experimental (n = 26) and control (n = 26) groups. The experimental group engaged in a 6-month WE-SURF™ program, while the control group received standard care along with a fall's prevention education session. Feasibility of the intervention was measured using attendance records, engagement rates from recorded videos, dropouts, attrition reasons, and adverse events. RESULTS: Preliminary findings suggested that WE-SURF™ was acceptable, with further refinements. The study revealed significant intervention effects on timed up and go (TUG) (η2p:0.08; p < 0.05), single leg stance (SLS) (η2p:0.10; p < 0.05), and lower limb muscle strength (η2p:0.09; p < 0.05) tests. No adverse events occurred during the program sessions, and both attendance and engagement rates were high (> 80% and 8/10, respectively) with minimal dropouts (4%). The WE-SURF™ program demonstrated effectiveness in reducing the risk of falls while enhancing muscle strength and balance. CONCLUSION: In conclusion, WE-SURF™ was demonstrated to be an acceptable, feasible, and effective virtual supervised group-based exercise program for fall prevention in community-dwelling older adults at risk of falls. With positive outcomes and favourable participant engagement, WE-SURF™ holds the potential for wider implementation. Further research and scaling-up efforts are recommended to explore its broader applicability. (Registration number: ACTRN 12621001620819).

Estimation of Ultrasonic Velocity, Density, Internal Pressure, and Thermophysical Parameters of Ionic Liquid Mixtures: Application of Flory's Statistical Theory.

Flory's statistical theory (FST) has been employed to estimate the ultrasonic velocity, density, internal pressure, and several important thermophysical parameters such as the energy of vaporization, the heat of vaporization, cohesive energy density, polarity index, and solubility for eight binary mixtures of ionic liquids and water within the temperature range of 288.15 to 308.15 K. The ionic liquids chosen for this investigation are [BMim][dca], [BMim][TfO], [BMpy][TfO], [BMpyr][dca], [BMpyr][TfO], [EEPy][ESO4], [HMim][dca], and [MPy][MSO4]. The predicted values of ultrasonic velocity and density show good agreement with the data reported in the literature. It endorses the applicability of FST to these binary mixtures. A comparative analysis of the internal pressure values (Pi) determined by using FST and the standard thermodynamic approach is also presented. The results obtained for Pi using both approaches show good agreement. Besides, for the mixtures under study, the correlation between ultrasonic velocity, density, and surface tension has also been examined. The variation of thermophysical parameters with concentration and temperature changes has been utilized to explore the nature and strength of the solute-solvent interactions prevalent in these mixtures. It is pointed out that A-A-type interactions dominate over A-B-type interactions in water-rich regions of the mixtures.

Predictors, Protective Factors, and Adverse Outcomes of Joint Pain among Malaysian Community-Dwelling Older Adults: Findings from the LRGS-TUA Longitudinal Study.

Background: Joint pain has been recognized as one of the major causes of limitations in mobility, functional decline, and consequently declined quality of life in older adults. Hence, this study aimed to identify the predictors, protective factors, and adverse outcomes of joint pain in community-dwelling older adults. Methods: In this Long-term Research Grant Scheme-Towards Useful Ageing (LRGS-TUA) longitudinal study, a total of 1005 older participants aged 60 years and above who were successfully followed up after five years were included in the analysis. The participants self-reported their joint pain status at baseline and during the fifth year. Subsequently, the baseline characteristics were used to predict changes in joint pain status. Adverse outcomes related to joint pain were evaluated based on the participants' joint pain statuses. Results: Results showed that being female, having diabetes mellitus, and higher body mass index were associated with the incidence of joint pain. Meanwhile, increased intake of pantothenic acid and higher levels of blood albumin levels were associated with recovery from joint pain. Participants with persistent joint pain at baseline and follow-up showed higher levels of depression and disability compared to individuals who never experience any joint pain. However, participants who had recovered from joint pain did not differ significantly from those without joint pain at baseline and follow-up in these measures. Conclusions: By identifying the modifiable risk factors, factors associated with recovery, and adverse outcomes related to joint pain, this study adds to current evidence that may contribute to further management strategies for joint pain in older adults.

Synergistic effects of cognitive frailty and comorbidities on disability: a community-based longitudinal study.

OBJECTIVE: In this study, we aimed to assess the synergistic effects of cognitive frailty (CF) and comorbidity on disability among older adults. METHODS: Out of the 1318 participants from the Malaysian Towards Useful Aging (TUA) study, only 400 were included in the five-year follow-up analysis. A comprehensive interview-based questionnaire covering socio-demographic information, health status, biochemical indices, cognitive and physical function, and psychosocial factors was administered. Binary logistic regression analysis was employed to estimate the independent and combined odd ratios (ORs). Measures such as the relative excess risk due to interaction (RERI), the attributable proportion of risk due to the interaction, and the synergy index were used to assess the interaction between CF and comorbidity. RESULTS: Participants with CF (24.1%) were more likely to report disability compared to those without CF (10.3%). Synergistic effects impacting disability were observed between CF and osteoarthritis (OA) (OR: 6.675, 95% CI: 1.057-42.158; RERI: 1.501, 95% CI: 1.400-1.570), CF and heart diseases (HD) (OR: 3.480, 95% CI: 1.378-8.786; RERI: 0.875, 95% CI: 0.831-0.919), CF and depressive symptoms (OR: 3.443, 95% CI: 1.065-11.126; RERI: 0.806, 95% CI: 0.753-0.859), and between CF and diabetes mellitus (DM) (OR: 2.904, 95% Confidence Interval (CI): 1.487-5.671; RERI: 0.607, 95% CI: 0.577-0.637). CONCLUSION: These findings highlight the synergism between the co-existence of CF and comorbidity, including OA, HD, DM, and depressive symptoms, on disability in older adults. Screening, assessing, and managing comorbidities, especially OA, HD, DM and depressive symptoms, when managing older adults with CF are crucial for reducing the risk of or preventing the development of disability.

Exploring physiotherapists' perceptions of telerehabilitation for musculoskeletal disorders: Insights from focus groups.

Objective: This study explored the perceived benefits, barriers, and recommendations of telerehabilitation for musculoskeletal disorders among physiotherapists in Malaysia. Methods: This study employed an exploratory qualitative methodology to gather the perceptions of government-employed physiotherapists in Malaysia regarding the benefits, barriers, and recommendations for telerehabilitation in treating musculoskeletal disorders. The researchers conducted semistructured focus group discussions (FGDs) via Google Meet, which were recorded, transcribed, and analyzed using thematic analysis. Results: Five FGDs were conducted with 24 participants, 37.5% of whom had prior experience with telerehabilitation. The data analysis returned three main themes: (1) perceived benefits, (2) barriers, and (3) recommendations. Four subthemes were derived from perceived benefits: (1a) saving time and money, (1b) convenience, (1c) clients responsible for their treatment, and (1d) alternatives for infectious diseases. Perceived barriers revealed three subthemes: (2a) technology, (2b) organization, and (2c) personal barriers. Finally, participants provided recommendations for improving telerehabilitation services, including training programs to facilitate greater acceptance of this modality. Conclusion: The findings of this study offer crucial insights into the evolving landscape of telerehabilitation in Malaysia. These findings revealed a greater prevalence of barriers to enablers among Malaysian physiotherapists, potentially influenced by varying experience levels. Despite the prevailing lack of experience among participants, this research underscores the significance of identifying barriers and enablers in implementing telerehabilitation with participants offering recommendations for integrating telerehabilitation into their practices. This study provides clear insights and a roadmap for stakeholders aiming to shape the future of telerehabilitation among physiotherapists in Malaysia.

Lifestyle and incident dementia: A COSMIC individual participant data meta­analysis.

INTRODUCTION: The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS: We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. RESULTS: A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION: Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. HIGHLIGHTS: A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.

Impact of diabetes mellitus on osteoarthritis: a scoping review on biomarkers.

Osteoarthritis (OA) commonly affects the knee and hip joints and accounts for 19.3% of disability-adjusted life years and years lived with disability worldwide (Refs , ). Early management is important in order to avoid disability uphold quality of life (Ref. ). However, a lack of awareness of subclinical and early symptomatic stages of OA often hampers early management (Ref. ). Moreover, late diagnosis of OA among those with severe disease, at a stage when OA management becomes more complicated is common (Refs , , , ). Established risk factors for the development and progression of OA include increasing age, female, history of trauma and obesity (Ref. ). Recent studies have also drawn a link between OA and metabolic syndrome, which is characterized by insulin resistance, dyslipidaemia and hypertension (Refs , ).

Initial Experience with Unidirectional Barbed Suture for Abdominal Donor Site Closure in Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

Background: The deep inferior epigastric perforator (DIEP) flap is a predominant technique for autologous breast reconstruction. However, the best method of abdominal fascial closure in this technique is not well defined. This study details our initial experience with unidirectional barbed suture-only repair of abdominal donor site fascia. Methods: Patients who underwent DIEP flap breast reconstruction and abdominal fascial closure with Stratafix Symmetric Polydioxanone PDS Plus were retrospectively reviewed. Information regarding pertinent patient history, medical comorbidities, risk factors, and surgical technique was extracted, along with the incidence of eight separate postoperative abdominal surgical site occurrences. Results: Retrospective review identified 43 patients who underwent 19 unilateral and 24 bilateral DIEP flap breast reconstruction procedures (n = 67). Average patient follow-up was 791 days (range 153-1769). Six patients (14%) had a complication of the donor site. Seroma was most frequent (n = 3, 7%), followed by surgical site infection (n = 2, 5%). One patient had incisional dehiscence (2%) and another patient developed bulging (2%). No patients had chronic pain, weakness, hematoma, or hernia postoperatively. Patients with donor site complications had a history of abdominal/pelvic surgery significantly more often than the patients without donor site complications (100% versus 49%; P = 0.032). Conclusions: Abdominal fascial repair with Stratafix Symmetric suture alone led to low rates of abdominal donor site morbidity, including no hernia and rare bulging, following DIEP flap breast reconstruction. Additional advantages of this technique may be reduced operative times and lower operative costs compared with alternative methods of fascial repair, although prospective and randomized studies are warranted.

Mapping the landscape: A bibliometric analysis of information and communication technology adoption by older adults with cognitive frailty or impairment.

The adoption of information and communication technology (ICT) by older adults with cognitive frailty and impairment is beneficial to support aging in place and promote healthy aging. However, data are scarce regarding the use of ICT by this demographic in comparison with other age groups. This bibliometric analysis was aimed at systematically mapping the literature on ICT-related research on older adults with cognitive frailty and cognitive impairment to provide insights into research trends, patterns and knowledge gaps. Data were extracted from the Web of Science database, which identified 324 publications between 1980 and 2023. Performance analysis and science mapping were carried out using Microsoft® Excel, VOSViewer and Harzing's Publish or Perish. The analysis showed an upsurge in the research output trend over time. Notable journals, authors, citations, nations and research areas have been documented. Four key clusters were identified, including: (i) caregiver concern, support and involvement; (ii) technology as a tool for cognitive training and cognitive rehabilitation; (iii) cognitive improvement; and (iv) the use of technology for prevention and self-management. The findings derived from this analysis provide an appropriate reference for future researchers to bridge the gap in ICT-related studies among this population, and distinguish the relevant articles that are required for further investigation. These include the need for further long-term research, the incorporation of ICT-based approaches to counter cognitive frailty and the importance of multidomain telehealth interventions. Geriatr Gerontol Int 2024; 24: 251-262.

Remote intensive management to improve antiplatelet adherence in acute myocardial infarction: a secondary analysis of the randomized controlled IMMACULATE trial.

This study aim to investigate if remote intensive coaching for the first 6 months post-AMI will improve adherence to the twice-a-day antiplatelet medication, ticagrelor. Between July 8, 2015, to March 29, 2019, AMI patients were randomly assigned to remote intensive management (RIM) or standard care (SC). RIM participants underwent 6 months of weekly then two-weekly consultations to review medication side effects and medication adherence coaching by a centralized nurse practitioner team, whereas SC participants received usual cardiologist face-to-face consultations. Adherence to ticagrelor were determined using pill counting and serial platelet reactivity measurements for 12 months. A total of 149 (49.5%) of participants were randomized to RIM and 152 (50.5%) to SC. Adherence to ticagrelor was similar between RIM and SC group at 1 month (94.4 ± 0.7% vs. 93.6±14.7%, p = 0.537), 6 months (91.0±14.6% vs. 90.6±14.8%, p = 0.832) and 12 months (87.4±17.0% vs. 89.8±12.5%, p = 0.688). There was also no significant difference in platelet reactivity between the RIM and SC groups at 1 month (251AU*min [212-328] vs. 267AU*min [208-351], p = 0.399), 6 months (239AU*min [165-308] vs. 235AU*min [171-346], p = 0.610) and 12 months (249AU*min [177-432] vs. 259AU*min [182-360], p = 0.678). Sensitivity analysis did not demonstrate any association of ticagrelor adherence with bleeding events and major adverse cardiovascular events. RIM, comprising 6 months of intensive coaching by nurse practitioners, did not improve adherence to the twice-a-day medication ticagrelor compared with SC among patients with AMI. A gradual decline in ticagrelor adherence over 12 months was observed despite 6 months of intensive coaching.

Outcomes of Immediate versus Delayed Autologous Reconstruction in the Setting of Post-Mastectomy Radiation Therapy: A Meta-analysis.

INTRODUCTION: Post-mastectomy autologous breast reconstruction can be immediate (IBR) or delayed (DBR). The safety of performing IBR and the impact of radiation on the newly reconstructed breast is not yet validated. METHODS: A Pubmed, EMBASE, and Google scholar search was conducted from inception to September 17th 2023. We included comparative studies that assessed complications or aesthetic outcomes of IBR versus DBR in the setting of post-mastectomy radiotherapy (PMRT). RESULTS: The search identified 2693 articles. Thirteen were eligible for inclusion. A total of 565 patients underwent IBR followed by radiotherapy while 699 had DBR. Mean follow-up time and age for both groups were comparable (p > 0.1). None of revision surgery, infection, total flap failure, seroma, hematoma, dehiscence, or delayed wound healing was significantly different across groups (p > 0.1). IBR was found to have a higher risk of flap fibrosis (OR 28.18 [5.15 - 154.12]; p = 0.0001, I 2 of 44%) and skin flap necrosis (OR 6.12 [2.71 - 13.82]; p < 0.0001, I 2 of 27%) but a lower risk of partial flap failure (OR 0.18 [0.06 - 0.58]; p 0.004, I 2 of 0%) when compared to DBR. Results of fat necrosis should be interpreted with caution. Patient-reported as well as objective aesthetic outcomes were mostly comparable between groups. CONCLUSION: IBR in the setting of PMRT is increasingly being performed and poses a specific set of challenges that surgeons usually consider. The choice between IBR or DBR in the setting of PMRT should be an individualized decision based on patient risk factors and desires. LEVEL OF EVIDENCE: III.

Prevalence, clinical characteristics, and management of silicone lymphadenopathy: A systematic review of the literature.

INTRODUCTION: Implant-based breast augmentations and reconstructions are one of the most common surgical procedures performed by plastic surgeons in the United States, which has rapidly increased in popularity since the 2000s. Silicone lymphadenopathy (SL) is a complication of breast implants that involves migration of silicone to nearby soft tissue/lymph nodes. Data on its clinical features and management is scarce. METHODS: SL-related search terms were used to find articles in 3 databases. Of 598 articles, 101 studies met the inclusion criteria. Demographics, clinical presentation, workup, and management data were analyzed. RESULTS: Of 279 cases of SL and 107 with information on initial diagnosis, 35 (33%) were incidental. The most common symptom was painless lymphadenopathy, followed by painful lymphadenopathy. 251 (95%) and 13 (5%) patients had silicone and saline implants, respectively. 149 (68%) patients had implant rupture. Axillary lymphadenopathy was the most affected region (136 cases, 72%), followed by internal mammary (40 cases, 21%), cervical/supraclavicular (36 cases, 19%), and mediastinal (24 cases, 13%) regions. 25% of patients underwent fine-needle aspiration, 12% core needle biopsy, and 59% excisional biopsy. 32% of cases underwent explantation and/or implant exchange. The most common indication for surgery was implant rupture. Histology showed multinucleated giant cells, large histiocytes, and silicone accumulation. CONCLUSIONS: SL is a complication associated with breast implants. The majority of patients are asymptomatic, and most cases are managed conservatively. Minority need a biopsy and surgical interventions due to abnormal imaging, persistent symptoms, and/or implant rupture. Workup and management should be tailored to the patient.

The Aesthetic Surgery Education and Research Foundation (ASERF): A 30-Year Retrospective Analysis.

Federal government research grants provide limited funding to plastic surgeon-scientists, with reconstructive research taking precedence over aesthetic research. The Aesthetic Surgery Education and Research Foundation (ASERF) is a nonprofit, 501(c)(3) organization that seeks to support innovative, diverse research endeavors within aesthetic surgery. A total of 130 ASERF-funded studies and 32 non-funded applications from 1992 to 2022 were reviewed. Kruskal Wallis, Fisher's exact, and chi-squared tests were utilized to assess the potential relationship between self-identified gender, practice setting, geographical location, and study type with individual grant amounts and grant funding decision. Although significant differences were observed between male and female grant recipient h-indices (P < .05), there were no differences in the amount of funding they received (P > .05). Grant amounts were also consistent between study types as well as principal investigator practice settings and geographical locations (P > .05). The subanalysis revealed that the practice setting of the primary investigator (PI) was the only variable to exhibit a significant association with the decision to award funding (P < .05). Further, of the 61 applicants between 2017 and 2022, only 2 PIs self-identified as female. ASERF serves as an excellent funding source for global aesthetic surgery. To promote further research diversification, increased emphasis should be placed on recruiting applicants from outside academia and those who identify as female or gender nonbinary.

Prevalence of depression and clinical depressive symptoms in community-dwelling older adults with cognitive frailty.

AIM: The present study determines the prevalence of depression and the extent of clinical depression symptoms among community-dwelling older adults with cognitive frailty and its associated factors. METHODS: A total of 755 older adults aged ≥60 years were recruited. Their cognitive performance was determined using the Clinical Dementia Rating. Fried's criteria was applied to identify physical frailty, and the Beck Depression Inventory assessed their mental states. RESULTS: A total of 39.2% (n = 304) of the participants were classified as cognitive frail. In this cognitive frail subpopulation, 8.6% (n = 26) had clinical depressive symptoms, which were mostly somatic such as disturbance in sleep pattern, work difficulty, fatigue, and lack of appetite. Older adults with cognitive frailty also showed significantly higher depression levels as compared with the noncognitive frail participants (t (622.06) = -3.38; P = 0.001). There are significant associations between depression among older adults with cognitive frailty and multimorbidity (P = 0.009), polypharmacy (P = 0.009), vision problems (P = 0.046), and hearing problems (P = 0.047). The likelihood of older adults with cognitive frailty who experience impairments to their vision and hearing, polypharmacy, and multimorbidity to be depressed also increased by 2, 3, 5, and 7-fold. CONCLUSIONS: The majority of the Malaysian community-dwelling older adults were in a good mental state. However, older adults with cognitive frailty are more susceptible to depression due to impairments to their hearing and vision, multimorbidity, and polypharmacy. As common clinical depressive symptoms among older adults with cognitive frailty are mostly somatic, it is crucial for health professionals to recognize these and not to disregard them as only physical illness. Geriatr Gerontol Int 2024; 24: 225-233.

Toxicity and bioremediation of the lead: a critical review.

Lead is a naturally occurring, bluish-gray metal that is found in small quantities in the earth's crust. The existing literature demonstrates that non-biodegradable character and continuous use results in accumulation of lead concentration in the environment and causes various ill effects such as neurotoxicity, change in psychological and behavioral development of different organisms. Nowadays the most effective technique in the revival of the environment is bioremediation and it is environmentally friendly and cost-effective. Bacterial strains such as Oceanobacillus profundus and Lactobacillus acidophilus ATCC4356 have the ability to reduce lead 97% and 73.9%, respectively. Similarly some species of algae and fungal strains also showed lead removal efficiency as 74% (spirulina), 97.1% (Chlorella kessleri), 95.5% (Penicillium janthinillum) and 86% (Aspergillus flavus). Biodegradation of lead by various microbes would be the most efficient and sustainable approach. This review focuses on toxicity, fate of lead in the environment and its microbial degradation.

Association between maximal oxygen consumption and physical performance tests among older adults with cognitive frailty.

INTRODUCTION: Cardiorespiratory fitness has an inverse relationship with cognitive impairment and frailty in older adults. Direct assessment of maximal oxygen consumption (VO2 max) is the gold standard to assess cardiorespiratory fitness. However, it is costly and requires a laboratory setting. Therefore, VO2 max estimation among older adults with cognitive frailty (CF) will allow the assessment of aerobic capacity, which is commonly overlooked due to the complexity of the test. AIM: This study aims to determine the use of one of three physical performance tests (2-minute step, 2-minute walk, and 1-minute sit to stand) to effectively estimate cardiorespiratory fitness among older adults with CF. METHODS: In this cross-sectional study, community-dwelling individuals aged 60 years old and above in Klang Valley were screened for CF. The participants performed three physical performance tests (2-minute walk, 2-minute step, and 1-minute sit to stand) followed by treadmill-based maximal exercise testing on another day. RESULTS: A total of 32 older adults with cognitive frailty (mean age; SD: 67.1;4.7 years) participated in this study. Nearly half of them had hypertension (43.5 %), hypercholesterolemia (43.5 %), and multimorbidity (47.8 %). Among the endurance tests performed, only the 2-minute walk test independently predicted VO2 max by sex-specific with men (R2 = 0.58, p = 0.03) and women (R2 = 0.34, p = 0.01). The 2-minute walk test had good agreement with VO2 max (ICC = 0.77, 95 % CI: -3.1-2.4). CONCLUSION: The 2-minute walk test is a valid tool for estimating cardiorespiratory fitness among older adults with CF. However, it should be further tested across a larger population.

Digital technology usage among older adults with cognitive frailty: A survey during COVID-19 pandemic.

Objective: The research aimed to study digital divide by determining the usage of digital technology among older adults with cognitive frailty (CF) in Malaysia. Methods: The dataset was obtained from the AGELESS trial screening phase conducted from October 2021 to March 2022, involving 476 community-dwelling Malaysian older adults (67.7 years old ± 6.1). Digital technology usage was assessed and CF was determined using Fried's criteria and Clinical Dementia Rating. A binary logistic regression was used to determine the sociodemographic factors associated with digital technology use among older adults with CF. Results: The findings suggest a digital divide between older adults with CF and robust in Malaysia. CF individuals (72.1%) were less likely to utilise digital technology, mainly smartphone than robust older adults (89.6%). More than 70% of older people owned social media on their smartphones, namely, WhatsApp. The most frequent online activities in both groups were family interaction and obtaining current news. CF older adults were less likely to play games on their smart devices. Usage of digital technology was more common among male, younger age, attained formal education more than 6 years, had a higher monthly household income, and robust participants. Conclusions: The usage of digital technology was inversely related to CF status. CF older adults were less likely to integrate digital technology into their daily living compared to robust even though they were familiar with it. The use of digital technology should be reinforced among female, advanced age, widowers/divorcees without formal education and those from lower- or middle-income statuses, and cognitively frail older people.

Prospective sarcopenia outcomes associated with physical performance in individuals aged 55 years and over in Malaysia.

Background: While the potential of physical performance tests as screening tools for sarcopenia is evident, limited information on relevant reference values for sarcopenia detection. In this study, we aimed to establish the prospective relationship between physical performance tests, including time up and go (TUG), functional reach (FR), gait speed (GS), and hand grip strength (HGS) with five-year sarcopenia risk and to determine suitable cut-off values for screening activities. Method: This was a prospective study utilizing data from the Malaysian Elders Longitudinal Research (MELoR) study, which involved community-dwelling older adults aged 55 years and above at recruitment. Baseline (2013-2015) and wave 3 (2019) data were analyzed. Sarcopenia risk was determined using the strength, assistance walking, rising from a chair, climbing stairs, and falls (SARC-F) tool, with SARC-F ≥ 4 indicating sarcopenia. Baseline physical performance test scores were dichotomized using ROC-determined cut-offs. Result: Data were available from 774 participants with mean age of 68.13 (SD = 7.13) years, 56.7% women. Cut-offs values for reduced GS, TUG, FR, and HGS were: <0.7 m/s (72.9% sensitivity and 53% specificity), >11.5 s (74.2%; 57.2%), <22.5 cm (73%; 54.2%) and HGS male <22 kg (70.0%; 26.7%) and female <17 kg (70.0%; 20.3%) respectively. Except for FR = 1.76 (1.01-3.06), GS = 2.29 (1.29-4.06), and TUG = 1.77 (1.00-3.13) were associated with increased sarcopenia risk after adjustments for baseline demographics and sarcopenia. Conclusion: The defined cut-off values may be useful for the early detection of five-year sarcopenia risk in clinical and community settings. Despite HGS being a commonly used test to assess strength capacity in older adults, we advocate alternative strength measures, such as the sit-to-stand test, to be included in the assessment. Future studies should incorporate imaging modalities in the classification of sarcopenia to corroborate current study findings.

Lymphedema Surgical Education and Faculty Demographics in United States Plastic Surgery Residency Programs.

BACKGROUND: Recent advancements in supermicrosurgery and promising preliminary outcomes have led to a surge in physiologic lymphedema surgery. This study is the first to evaluate lymphedema surgical education among U.S. plastic surgery residency programs, along with the background and experience of plastic surgeons subspecializing in the field. METHODS: Cross-sectional evaluation of 103 accredited U.S. plastic surgery residency programs was performed in January 2023. Web-based searches of program curricula, faculty profiles, and main institutional pages indicated whether a program provided nonclinical or clinical exposure to lymphedema surgery. Review of online faculty profiles, surname searches, Doximity, and Scopus determined the perceived demographics, academic productivity, and procedures performed by lymphedema surgeons. RESULTS: Compared with the 11 programs that incorporated lymphedema surgery into their online curriculum, 67 programs had a rotation site with a surgeon performing lymphedema procedures. Of the 33 programs without evidence of clinical exposure, 76% (n = 25) did not provide or specify providing elective time. Faculty perceived to be female or a race underrepresented in plastic surgery had significantly more assistant professor titles (p < 0.0214) and significantly fewer years of experience (p < 0.0293) than their counterparts. CONCLUSION: Great variation in lymphedema surgical education exists among U.S. plastic surgery residency programs. While few programs incorporate lymphedema surgery into their advertised curriculum, programs without clinical exposure frequently did not provide elective time to obtain it. Faculty that were female or a race underrepresented in plastic surgery were most often early in their career, suggesting lymphedema surgeons may grow increasingly diverse in years to come.

A framework for design and usability testing of telerehabilitation system for adults with chronic diseases: A panoramic scoping review.

Objective: This scoping review aimed to identify the design and usability testing of a telerehabilitation (TR) system, and its characteristics and functionalities that are best-suited for rehabilitating adults with chronic diseases. Methods: Searches were conducted in PubMed, EBSCO, Web of Science, and Cochrane library for studies published between January 2017 and December 2022. We followed the Joanna Briggs Institute guidelines and the framework by Arksey and O'Malley. Screening was undertaken by two reviewers, and data extraction was undertaken by the first author. Then, the data were further reviewed and discussed thoroughly with the team members. Results: A total of 31 results were identified, with the core criteria of developing and testing a telerehabilitation system, including a mobile app for cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. All developed systems resulted from multidisciplinary teams and employed mixed-methods research. We proposed the "input-process-output" framework that identified phases of both system design and usability testing. Through system design, we reported the use of user-centered design, iterative design, users' needs and characteristics, theory underpinning development, and the expert panel in 64%, 75%, 86%, 82%, and 71% of the studies, respectively. We recorded the application of moderated usability testing, unmoderated testing (1), and unmoderated testing (2) in 74%, 63%, and 15% of the studies, respectively. The identified design and testing activities produced a matured system, a high-fidelity prototype, and a released system in 81.5%, 15%, and 3.5%, respectively. Conclusion: This review provides a framework for TR system design and testing for a wide range of chronic diseases that require prolonged management through remote monitoring using a mobile app. The identified "input-process-output" framework highlights the inputs, design, development, and improvement as components of the system design. It also identifies the "moderated-unmoderated" model for conducting usability testing. This review illustrates characteristics and functionalities of the TR systems and healthcare professional roles.