Incorporating the Clinical Frailty Scale into routine outpatient nephrology practice: an observational study of feasibility and associations.

BACKGROUND: There is an unmet need for routine and accurate prognostication of older adults with end-stage kidney disease (ESKD) and subsequently inadequate advance care planning. Frailty, a clinical syndrome of increased vulnerability, is predictive of adverse health outcomes in the renal population. We propose the Clinical Frailty Scale (CFS) as a feasible tool for routine use in the nephrology outpatient setting to address this unmet need. AIMS: To assess feasibility and associations of incorporating CFS assessment into routine outpatient nephrology practice in the pre-dialysis setting. METHODS: CFS was integrated into the outpatient nephrology clinic proforma. A convenience sample of 138 patients aged >50 years, with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 , attending the outpatient service between September 2018 and April 2019 was included. RESULTS: Eighty-one CFS assessments were completed by nephrologists, nephrology advanced trainees and clinical nurse specialists. CFS completion rates were 79% from the multidisciplinary Low Clearance Clinic and 41% from nurse-led Pre-dialysis Education Clinic. Planned modality of ESKD management varied with degree of frailty (P < 0.001). 21% of patients who had CFS completed were planned for Conservative Management of ESKD, in contrast to only 5% of those who did not have CFS assessment completed (P < 0.001). CONCLUSION: Frailty assessment via CFS was feasible in outpatient practice when integrated into routine clinical assessment in a dedicated clinic. Planned ESKD management varied with the degree of frailty. Completion of frailty assessment, when compared with non-completion, appears to be associated with increased planned conservative management of ESKD.

Nursing and Allied Health Staff Perceptions and Experiences of a Volunteer Stroke Peer Support Program: A Qualitative Study.

PURPOSE: Stroke brings about physical, cognitive, and psychosocial changes and, consequently, many stroke survivors feel underprepared for the transition from hospital to home. Nursing and allied health staff have a key role in stroke rehabilitation. Peer support programs have been found effective in supporting stroke survivors, alongside hospital staff caring for stroke patients, by providing experiential knowledge that staff are not able to provide. AIM: This study explored the perceptions and experiences of nursing and allied health staff of a volunteer peer support program for stroke inpatients. METHODS: This study utilised a qualitative, evaluative case study design. This study was conducted at a public metropolitan hospital in Western Australia that had developed a stroke peer support program (SPSP) on a rehabilitation ward. A purposeful sample of nurses (n = 5) and multidisciplinary allied health staff (n = 5) were recruited from the ward where the SPSP was provided for stroke inpatients. Semi-structured, face-to-face interviews were conducted with staff participants. Verbatim transcripts from audio-recorded interviews were analysed using inductive thematic analysis. RESULTS: Nursing and allied health staff perceived the SPSP as valuable to stroke patients' rehabilitation and beneficial to families, volunteer peers and staff. Four themes encapsulated the findings: awareness of and involvement in the program; recognising the benefits of the program; perceived enablers and barriers of the program and suggestions for the future of the program. CONCLUSION: Nursing and allied health staff within multidisciplinary teams are cognisant of the psycho-emotional needs of stroke patients which staff are not fully able to meet. The study findings confirm volunteer peer support can provide valuable and fundamental adjunct support to address stroke patients' unmet needs, as well as supporting staff to enhance stroke patient care.

Survey of Dengue Knowledge and Prevention Practices Associated with Sociodemographic Status: A Cross-Sectional Study Among the Community Living in an Urban Area of Selangor, Malaysia.

The present study aimed to explore the current status of knowledge and practices of dengue prevention associated with sociodemographic status among the community living in an urban area of Selangor, Malaysia. A total of 441 participants were interviewed regarding sociodemographic status, knowledge of dengue, and self-reported prevention practices. Participants over 40 years old were more likely (odds ratio [OR] = 4.210, 95% CI = 1.652-10.733, P = 0.003) to have better dengue knowledge. Participants whose average monthly household income was more than MYR3,000 (US$715) were more likely (OR = 1.607, 95% CI = 1.059-2.438, P = 0.026) to have better practices of dengue prevention measures. The finding suggests that both government and community efforts are essential in order to continue to educate about dengue and reduce the frequency of dengue cases nationwide.

Post-stroke sleep disturbances and rehabilitation outcomes: a prospective cohort study.

BACKGROUND: Poor sleep is common after stroke, and data regarding its effect on rehabilitation outcomes are limited. Controversial evidence was found concerning the effect of sedatives on improving sleep quality in poor sleepers after stroke. AIM: To assess the prevalence of poor sleep in post-stroke patients and its effect on rehabilitation outcomes. METHOD: A total of 104 stroke patients from two major stroke rehabilitation units in Western Australia was enrolled. Sleep quality was assessed using the Pittsburgh Sleep Quality Indexes at baseline and after stroke. The main outcome measures were Functional Independence Measure (FIM) change and length of stay (LOS). Sedative use during this period was also recorded. RESULTS: A total of 29.8% post-stroke patients suffered from poor sleep. There was no relationship between poor sleep and the stroke characteristics, such as severity, side and type, or demographics, such as age and gender. Poor sleep quality was inversely associated with rehabilitation outcomes measured by FIM (Rs. -0.317, P = 0.005). However, there was no significant association between sleep quality and LOS (P = 0.763). Sedatives were used in 18.2% of patients but had no impact on sleep quality or rehabilitation outcomes. CONCLUSION: This research supported that poor sleep was frequent after stroke and had negative effects on rehabilitation outcomes. Use of sedatives was of limited benefit to improve sleep quality, and further studies are required to search for strategies to improve sleep problems after stroke.

Prognostication accuracy of final destination in poststroke patients requiring transitional care.

OBJECTIVES: Transitional care program in Australia targets older patients in hospitals requiring ongoing slow-stream restorative care prior to discharge. Poststroke patients often require extended care and are transferred to these facilities. Transitional care providers require a predicted discharge destination. The aim of this study was to assess the accuracy of this prediction. METHODOLOGY: This study included all patients transferred to transitional care from a stroke rehabilitation unit over eight years. Information regarding the predicted final discharge destination was collected from medical records, and the actual discharge destination was obtained from the transitional care registry. RESULTS: Final destination prediction was equivalent between medical and multidisciplinary teams (κ = 0.87). However, only 60% of the predictions were accurate. Subgroup analysis, as measured by the Modified Barthel Index, suggested that functional gain was a better predictor of final destination. Other characteristics, such as age, sex and type of stroke, did not demonstrate good correlation with the final destination. CONCLUSION: Functional improvement, that is the Modified Barthel Index, is the best predictor of final destination after transitional care.

Rehabilitation Indices associated with sustaining a minimal trauma fracture within 12 months of a stroke in Western Australia.

OBJECTIVE: To identify Rehabilitation Indices associated with a minimal trauma fracture (MTF) within 12 months poststroke. METHODS: Retrospective case-control study. Stroke survivors with MTF were matched 5:1 with stroke survivors without MTF. Logistic regression determined whether Rehabilitation Indices, such as Physiotherapy Ambulation score (PhysioAmb), were associated with a MTF within 12 months poststroke. RESULTS: Forty-three stroke survivors (mean age: 79.8; 55.81% female) experienced a MTF (median time to MTF of 1.79 years [IQR 0.70, 4.48]). Those with a MTF within 12 months had lower PhysioAmb (4.53 vs 8.29) and Berg Balance Scale (BBS; 12.25 vs 40.57) scores on admission, lower BBS score on discharge (30.33 vs 49.29) and a greater change in PhysioAmb (+5.67 vs +3.24) and BBS scores (+21.50 vs +8.71) after rehabilitation, all P < 0.05. Greater changes in PhysioAmb score increased the odds of a MTF within 12 months by 18%. CONCLUSION: Rehabilitation Indices are associated with a MTF within 12 months poststroke.

Time to onset of efficacy in fracture reduction with current anti-osteoporosis treatments.

Early prevention of future fracture is an important goal in those at risk. A similar 3-year fracture efficacy is reported for most osteoporosis agents. Onset of fracture efficacy may be useful to help tailor treatment based on risk. We reviewed the peer-reviewed literature for onset of fracture efficacy data on the commonly prescribed osteoporosis treatments. All papers were reviewed independently by at least two reviewers for onset of efficacy for morphometric vertebral fracture (MVF), clinical vertebral fracture (CVF), nonvertebral fracture (NVF), hip fracture, and any clinical fracture (ACF). Alendronate is reported to reduce multiple CVF by 6 months; all CVF, NVF, and multiple ACF by 12 months; and all ACF and hip fracture by 18 months. Ibandronate is reported to reduce MVF by 12 months and NVF by 36 months. Raloxifene is reported to reduce CVF by 3-6 months and NVF by 36 months. Risedronate is reported to reduce CVF and NVF by 6 months, and hip fracture by 12 months. Strontium ranelate is reported to reduce MVF, CVF, NVF, and ACF by 12 months, and hip fracture by 36 months. Zoledronic acid is reported to reduce MVF, CVF, and ACF by 12 months, NVF by 24 months, and hip fracture by 36 months. Although direct comparisons are limited, based on the available literature, risedronate, followed by alendronate, have the earliest onset of benefit across the range of fracture types. Onset of efficacy may be an important consideration in the selection of treatment for some patients.