Severe Spastic Contractures and Diabetes Mellitus Independently Predict Subsequent Minimal Trauma Fractures Among Long-Term Care Residents

Design This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. Setting A 300-bed long-term care hospital in Hong Kong. Participants All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. Measurements Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. Results Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8–56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3–12.7). Conclusions Severe spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings.published_or_final_versio

Residents with Alzheimer’s Disease in Long-Term Care Facilities in Hong Kong: Patterns of Hospitalization and Emergency Room Use

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Semaphorin3A, associated with perineuronal nets, regulates the development of the maturation of the central vestibular circuitry

Poster Presentation - Theme 5: NeuroscienceDuring the formative period of neural circuits, perineuronal nets (PN) are established to restrict plasticity of the circuit. The role of PN in vestibular plasticity can be tested by studying the emergence of negative geotaxis with postnatal maturation of the vestibular circuitry for gravity detection. Using rats as model, we observed that negative geotaxis was mature by postnatal day (P) 9, in correlation with consolidation of PN around GABAergic neurons …postprin

Perineuronal chondroitin sulfates and semaphorin 3A regulate postnatal maturation of the vestibular circuit for gravity detection

Conference Theme: The Extracellular Matrix NichePoster Presentation: abstract no. P30Perineuronal chondroitin sulfate proteoglycan networks are implicated in restricting plasticity of the mature CNS. Less is known of the impact of ligands associated with the perineuronal network (PN) in the formative period of neural circuits. The emergence of negative geotaxis with postnatal maturation of the vestibular circuitry for gravity detection offers a behavioral readout in tests for roles of the PN and associated ligands in vestibular plasticity. Using postnatal rats as model, we found that negative geotaxis was mature by postnatal day (P) 9, in correlation with ...postprin

Severe spastic contractures and diabetes mellitus independently predict subsequent minimal trauma fractures among long-term care residents

Objective The study aimed to examine the epidemiology of hypertonic contractures and its relationship with minimal trauma fracture (MTF), and to determine the incidence and predictors of (MTF) in long-term care residents. Design This was a longitudinal cohort study of prospectively collected data. Participants were followed from March 2007 to March 2016 or until death. Setting A 300-bed long-term care hospital in Hong Kong. Participants All long-term care residents who were in need of continuous medical and nursing care for their activities of daily living. Measurements Information on patients' demographic data, severe contracture defined as a decrease of 50% or more of the normal passive range of joint movement of the joint, and severe limb spasticity defined by the Modified Ashworth Scale higher than grade 3, medical comorbidities, functional status, cognitive status, nutritional status including body mass index and serum albumin, past history of fractures, were evaluated as potential risk factors for subsequent MTF. Results Three hundred ninety-six residents [148 males, mean ± standard deviation (SD), age = 79 ± 16 years] were included for analysis. The presence of severe contracture was highly prevalent among the study population: 91% of residents had at least 1 severe contracture, and 41% of residents had severe contractures involving all 4 limbs. Moreover, there were a significant proportion of residents who had severe limb spasticity with the elbow flexors (32.4%) and knee flexors (33.9%) being the most commonly involved muscles. Twelve residents (3%) suffered from subsequent MTF over a median follow-up of 33 (SD = 30) months. Seven out of these 12 residents died during the follow-up period, with a mean survival of 17.8 months (SD = 12.6) after the fracture event. The following 2 factors were found to independently predict subsequent MTF in a multivariate Cox regression: bilateral severe spastic knee contractures (hazard ratio = 16.5, P < .0001, confidence interval 4.8–56.4) and diabetes mellitus (hazard ratio = 4.0. P = .018, confidence interval 1.3–12.7). Conclusions Severe spasticity and contractures are common morbidities in long-term care residents, and bilateral severe spastic knee contractures and diabetes mellitus are 2 independent predictors of subsequent MTF. Spasticity management and prevention of contractures, combined with educational programs for caregivers to identify the high-risk residents and apply proper handling techniques during routine care, may be helpful in reducing the risk of MTF in long-term care residents. Further large-scale longitudinal studies are needed to confirm these findings

Concordance between side-stream end-tidal carbon dioxide and arterial carbon dioxide partial pressure in respiratory service setting

OBJECTIVE: To explore the correlation and concordance between end-tidal carbon dioxide and arterial carbon dioxide partial pressure, and confirm the experience of the general consensus among service environments. DESIGN: A prospective cross-sectional analysis. SETTING: Two respiratory service units in Hong Kong. PARTICIPANTS: Two hundred respiratory patients were recruited, in whom 219 sets of observations were recorded. Patients deemed to require arterial blood gas determination also had their end-tidal carbon dioxide partial pressure measured at that time, using two LifeSense LS1-9R Capnometers. MAIN OUTCOME MEASURES: The agreement of end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was studied by correlation coefficients, mean and standard deviation of their difference, and the Bland-Altman plot. RESULTS: Overall, the correlation was low and insignificant (r=0.1185, P=0.0801). The mean of the difference was 7.2 torr (95% confidence interval, 5.5-8.9) and significant (P<0.001). The limits of agreement by Bland-Altman analysis were -18.1 to 32.5 torr, which were too large to be acceptable. In the sub-group on room air, the mean difference was reduced to 2.26 torr, the correlation between end-tidal carbon dioxide partial pressure and arterial carbon dioxide partial pressure was 0.2194 (P=0.0068), though statistically significant, the extent of correlation was still low. CONCLUSION: End-tidal carbon dioxide partial pressure did not show significant correlation or concordance with arterial carbon dioxide partial pressure, especially when supplemental oxygen was used. End-tidal carbon dioxide partial pressure currently cannot replace arterial blood gas measurement as a tool for monitoring arterial carbon dioxide partial pressure. Possible reasons for the discrepancy with previous studies include small sample size in previous studies, lack of research facilities in service settings, and publication bias against negative studies.published_or_final_versio

Service learning in medical and nursing training: A randomized controlled trial

The purpose of this study was to explore the long term effect of a service learning project on medical and nursing students' knowledge in aging and their attitudes toward older adults. A total of 124 students were recruited and then randomized to intervention group (IG) and control group (CG). A pre-and-post-intervention design measured students' knowledge in aging (using modified Palmore's Fact on Aging Quiz) and attitudes toward older adults (using Kogan's Old People Scale). A total of 103 students completed all the activities and questionnaires. After the intervention, there were significant differences between the IG and CG on Palmore's mental health (MH) (P =.04), Palmore's total score (P =.02) and Kogan's negative attitudes toward older adults (P =.001). All students increased their positive attitude toward older adults after the intervention. However, both the IG and CG showed a decrease in positive attitudes 1 month after the interventon, and such decrease varied, depending on the programme which students attended. The current study showed that the 10-week service learning activities significantly increased medical and nursing students' overall knowledge of aging and their understanding of mental health needs in old age, and reduced their negative attitudes toward older adults. However, the effect is not long-lasting. On the other hand, its effect on positive attitudes toward older adults cannot be concluded. Periodic contacts with older adults via service learning activities may be needed to sustain attitude change toward older adults. © 2011 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Factors affecting long-term care use in Hong Kong

Key Messages: 1. Psychological factors play the most significant role in contributing to long-term care choices. Older people’s positive attitude towards community care services (CCS) and strong structural solidarity of the family are two key factors. 2. Stronger family structural solidarity is associated with the use of CCS, whereas family structural solidarity tends to be confined to nuclear families rather than intergenerational families, which implies that spouse and children caregivers have different needs. Caregiver support services targeting the elderly couple’s families and children as caregivers should be differentiated and more specifically targeted. 3. In general, CCS serve frail elders with acute rehabilitation needs, who are more likely to be cared for by family members and/or domestic helpers, whereas residential care services serve frail elders with a higher level of cognitive impairment.published_or_final_versio

Residential Assessment Instrument 2.0 in care planning for residents in nursing homes

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Interim estimates of the effectiveness of influenza vaccination against influenza-associated hospitalization in children in Hong Kong, 2015-16

From 1 September 2015 through 31 January 2016, we enrolled 2068 children 6 months to 17 years of age admitted to hospital with a febrile acute respiratory infection in our test-negative study. Information on receipt of 2015-16 northern hemisphere inactivated influenza vaccination was elicited from parents or legal guardians. Using conditional logistic regression adjusting for age and matching on calendar time, we estimated influenza vaccine effectiveness against hospitalization with influenza A or B to be 79.2% (95% confidence interval: 42.0%-92.4%). Annual influenza vaccination should be more widely used in children in Hong Kong. This article is protected by copyright. All rights reserved.published_or_final_versio