Hyponatremia : Special Considerations in Older Patients

Acknowledgments Roy L. Soiza is funded by an NRS Career Research Fellowship.Peer reviewedPublisher PD

Digitising diabetes education for a safer Ramadan:Design, delivery, and evaluation of massive open online courses in Ramadan-focused diabetes education

Aims: Ramadan-focused diabetes education is critical to facilitate safer Ramadan fasting amongst Muslim people living with diabetes. We present the design, delivery, and evaluation of two parallel massive open online courses (MOOCs) in Ramadan-focused diabetes education for people with diabetes and HCPs. Methods: Two Ramadan-focused diabetes education MOOCs were developed and delivered for Ramadan 2023: one for HCPs in English, and another for people with diabetes in English, Arabic and Malay. A user-centred iterative design process was adopted, informed by user feedback from a 2022 pilot MOOC. Evaluation comprised a mixed-methods evaluation of pre- and post-course user surveys. Results: The platform was utilised by people with diabetes and their family, friends and healthcare professionals. Overall, a total of 1531 users registered for the platform from 50 countries, 809 started a course with a 48% subsequent completion rate among course starters. Qualitative analysis showed users found the course a user-friendly and authoritative information source. In the HCP MOOC, users reported improved post-MOOC Ramadan awareness, associated diabetes knowledge and ability to assess and advise patients in relation to their diabetes during Ramadan (p&lt;0.01). Conclusions: We demonstrate the potential of MOOCs to deliver culturally tailored, high-quality, scalable, multilingual Ramadan-focused diabetes education to HCPs and people with diabetes.</p

Digitising diabetes education for a safer Ramadan:Design, delivery, and evaluation of massive open online courses in Ramadan-focused diabetes education

AIMS: Ramadan-focused diabetes education is critical to facilitate safer Ramadan fasting amongst Muslim people living with diabetes. We present the design, delivery, and evaluation of two parallel massive open online courses (MOOCs) in Ramadan-focused diabetes education for people with diabetes and HCPs.METHODS: Two Ramadan-focused diabetes education MOOCs were developed and delivered for Ramadan 2023: one for HCPs in English, and another for people with diabetes in English, Arabic and Malay. A user-centred iterative design process was adopted, informed by user feedback from a 2022 pilot MOOC. Evaluation comprised a mixed-methods evaluation of pre- and post-course user surveys.RESULTS: The platform was utilised by people with diabetes and their family, friends and healthcare professionals. Overall, a total of 1531 users registered for the platform from 50 countries, 809 started a course with a 48% subsequent completion rate among course starters. Qualitative analysis showed users found the course a user-friendly and authoritative information source. In the HCP MOOC, users reported improved post-MOOC Ramadan awareness, associated diabetes knowledge and ability to assess and advise patients in relation to their diabetes during Ramadan (p&lt;0.01).CONCLUSIONS: We demonstrate the potential of MOOCs to deliver culturally tailored, high-quality, scalable, multilingual Ramadan-focused diabetes education to HCPs and people with diabetes.</p

Minimising disability and falls in older people through a post-hospital exercise program: a protocol for a randomised controlled trial and economic evaluation

Background: Disability and falls are particularly common among older people who have recently been hospitalised. There is evidence that disability severity and fall rates can be reduced by well-designed exercise interventions. However, the potential for exercise to have these benefits in older people who have spent time in hospital has not been established. This randomised controlled trial will investigate the effects of a home-based exercise program on disability and falls among people who have had recent hospital stays. The cost-effectiveness of the exercise program from the health and community service provider's perspective will be established. In addition, predictors for adherence with the exercise program will be determined. Methods and design: Three hundred and fifty older people who have recently had hospital stays will participate in the study. Participants will have no medical contraindications to exercise and will be cognitively and physically able to complete the assessments and exercise program. The primary outcome measures will be mobility-related disability (measured with 12 monthly questionnaires and the Short Physical Performance Battery) and falls (measured with 12 monthly calendars). Secondary measures will be tests of risk of falling, additional measures of mobility, strength and flexibility, quality of life, fall-related self efficacy, health-system and community-service contact, assistance from others, difficulty with daily tasks, physical activity levels and adverse events. After discharge from hospital and completion of all hospital-related treatments, participants will be randomly allocated to an intervention group or usual-care control group. For the intervention group, an individualised home exercise program will be established and progressed during ten home visits from a physiotherapist. Participants will be asked to exercise at home up to 6 times per week for the 12-month study period. Discussion: The study will determine the impact of this exercise intervention on mobility-related disability and falls in older people who have been in hospital as well as cost-effectiveness and predictors of adherence to the program. Thus, the results will have direct implications for the design and implementation of interventions for this high-risk group of older people.7 page(s

Minimising disability and falls in older people through a post-hospital exercise program: a protocol for a randomised controlled trial and economic evaluation

Abstract Background Disability and falls are particularly common among older people who have recently been hospitalised. There is evidence that disability severity and fall rates can be reduced by well-designed exercise interventions. However, the potential for exercise to have these benefits in older people who have spent time in hospital has not been established. This randomised controlled trial will investigate the effects of a home-based exercise program on disability and falls among people who have had recent hospital stays. The cost-effectiveness of the exercise program from the health and community service provider's perspective will be established. In addition, predictors for adherence with the exercise program will be determined. Methods and design Three hundred and fifty older people who have recently had hospital stays will participate in the study. Participants will have no medical contraindications to exercise and will be cognitively and physically able to complete the assessments and exercise program. The primary outcome measures will be mobility-related disability (measured with 12 monthly questionnaires and the Short Physical Performance Battery) and falls (measured with 12 monthly calendars). Secondary measures will be tests of risk of falling, additional measures of mobility, strength and flexibility, quality of life, fall-related self efficacy, health-system and community-service contact, assistance from others, difficulty with daily tasks, physical activity levels and adverse events. After discharge from hospital and completion of all hospital-related treatments, participants will be randomly allocated to an intervention group or usual-care control group. For the intervention group, an individualised home exercise program will be established and progressed during ten home visits from a physiotherapist. Participants will be asked to exercise at home up to 6 times per week for the 12-month study period. Discussion The study will determine the impact of this exercise intervention on mobility-related disability and falls in older people who have been in hospital as well as cost-effectiveness and predictors of adherence to the program. Thus, the results will have direct implications for the design and implementation of interventions for this high-risk group of older people. Trial Registration The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12607000563460.</p

Cost-effectiveness of a home-exercise program among older people after hospitalization

Background: Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. Objective: To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. Method: An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. Results: The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was$A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and$A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and$A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. Conclusion: The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup.7 page(s

Hyponatremia predicts mortality after stroke

Background: Hyponatremia, the commonest electrolyte imbalance encountered in clinical practice, is associated with adverse outcomes. Despite this, understanding of the association between hyponatremia and stroke mortality outcome is limited. Aims: To investigate the association between admission serum sodium and mortality at various time-points after stroke. Methods: Cases of acute stroke admitted to Norfolk and Norwich University Hospital consecutively from January 2003 until June 2013 were included, with mortality outcomes ascertained until the end of December 2013. Odds ratios (OR) or Hazards ratio (HR) for death were constructed for various time points (within 7 days, 8-30 days, within 1 year and over full follow-up). Results: 8540 participants were included (47.4% male, mean age 77.3 (± 12.0) years). Point prevalence of hypernatremia and hyponatremia were 3.3% and 13.8%, respectively. In fully adjusted models controlling for age, sex, pre-stroke modified Rankin score, stroke type, Oxford community stroke project class and laboratory biochemical and hematological results, the ORs (up to one year)/HRs (for full follow up) for the above time points were 1.00, 1.11, 1.03, 1.05 for mild hyponatremia, 1.97, 0.78, 1.11, 1.2 for moderate hyponatremia, 3.31, 1.57, 2.45, 1.67 for severe hyponatremia and 0.47, 1.23, 1.30, 1.10 for hypernatremia. When stratified by age-groups, outcomes were poorer in younger hyponatremic patients (aged <75 years). Conclusions: Hyponatremia is prevalent in acute stroke admissions and is independently associated with higher mortality in patients <75 years