The experience of Malaysian occupational therapists in conducting home assessments and home visits with older clients

Introduction: Home visits are complex processes for clients and occupational therapists. Despite the benefits of home visits, the numbers of home visits being conducted are decreasing in international settings due to service constraints or client reluctance. Published international studies may not be applicable to Malaysia due to cultural and geo-demographic differences relating to the home context. This study aimed to explore the experience of occupational therapists in Malaysia in conducting home visits. Materials and Methods: A focus group discussion was conducted with seven occupational therapists in one teaching hospital in Kuala Lumpur. The group session was audio-recorded, transcribed, summarised and analysed using thematic analysis. Results: Themes developed were: i) client factors inhibiting effective service provision, ii) uninformed policies and guidelines, and iii) professional identity and growth. Conclusions: Our study has revealed major challenges for Malaysian occupational therapists with regards to conducting home visits. Future studies should now evaluate factors underlying reluctance to participate in home visits and effective strategies to overcome these difficulties

SCAMP:standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care

<p>Abstract</p> <p>Background</p> <p>Infants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake.</p> <p>Methods</p> <p>We propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational age</p> <p>Trial registration</p> <p>Current controlled trials: <a href="http://www.controlled-trials.com/ISRCTN76597892">ISRCTN76597892</a>; EudraCT Number: 2008-008899-14</p

Author Reply : The relationship between alcohol intake and falls

Peer reviewedPostprin

Could obesity be linked to falls in older adults?

Peer reviewedPublisher PD

Ethnic-specific Sociodemographic Factors as Determinants of Cognitive Performance : Cross-sectional Analysis of the Malaysian Elders Longitudinal Research (MELoR) Study Article

Acknowledgement We are grateful to Prof Dr Chin Ai Vyrn and Prof Dr Shahrul Bahyah Kamaruzzaman from Faculty of Medicine, University of Malaya for their help in MELoR study. We also thank members of the Ageing and Age-Associated Disorders Research Group for helping with patient recruitment and data collectionPeer reviewedPostprin

Blood pressure variability and cognitive function : A scoping review

Acknowledgements The Malaysian Elders Longitudinal Research (MELoR) study is now part of the Transforming Cognitive Frailty into Later Life Self-Sufficiency (AGELESS) longitudinal cohort study, currently funded by the Ministry of Higher Education Long Term Research Grant Scheme (LRGS/1/2019/UM/01/1). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.Peer reviewedPostprin

The Relationship between Alcohol Intake and Falls Hospitalization : Results from the EPIC-Norfolk

Acknowledgements The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) hasreceived funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK(C864/A14136). We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this researchPeer reviewedPostprin

Increased beat-to-beat blood pressure variability is associated with impaired cognitive function

ACKNOWLEDGEMENTS We are grateful to Prof Dr Chin Ai Vyrn and Prof Dr Shahrul Bahyah Kamaruzzaman from Faculty of Medicine, University of Malaya for their help in MELoR study. Ageing and Age Associated Disorders Research Group for helping with patient recruitment and data collection. SOURCE OF FUNDING The Malaysian Elders Longitudinal Research (MELoR) study is now part of the Transforming Cognitive Frailty into Later Life Self-Sufficiency (AGELESS) longitudinal cohort study, currently funded by the Ministry of Higher Education Long Term Research Grant Scheme (LRGS/1/2019/UM/01/1).Peer reviewedPostprin

Informing policy makers in developing countries: practices and limitations of geriatric home medication review in Malaysia-a qualitative inquiry

Objective: To explore existing practices and challenges in the delivery of geriatric home medication review (HMR). The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR. Methods: This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals. The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR. Results: Based on the emerging themes from the qualitative data, the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits, encompassing a diverse patient population with various healthcare needs. However, it faces challenges such as the lack of outcome monitoring, formal training, and workforce constraints. Despite these hurdles, there is a pressing need for the expansion of this service to better serve the community, and collaboration with community pharmacists holds potential to broaden its scope. Ultimately, the findings suggest that pharmacistled HMR is both warranted and feasible within the Malaysian healthcare context. In order to optimize medicine-use among older people living in the community, approaches for expanding geriatric HMR services in Malaysia must be developed. Conclusions: This study holds profound implications as it attempts to illuminate policy makers in developing countries, enabling them to formulate effective HMR plans. By considering the challenges highlighted within this research, policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population

The Dementia Health Literacy Intervention For Informal Caregivers: A Systematic Review Protocol

This&nbsp;review&nbsp;will&nbsp;systematically&nbsp;examine&nbsp;the&nbsp;effectiveness&nbsp;of&nbsp;educational&nbsp;interventions&nbsp;on&nbsp;dementia&nbsp;health&nbsp;literacy&nbsp;(DHL)&nbsp;among&nbsp;informal&nbsp;caregivers&nbsp;(ICs)&nbsp;in&nbsp;42&nbsp;Asia&nbsp;Pacific&nbsp;countries/territories.&nbsp;Methods:&nbsp;A&nbsp;systematic&nbsp;literature&nbsp;search&nbsp;will&nbsp;be&nbsp;performed&nbsp;in&nbsp;nine&nbsp;databases.&nbsp;No&nbsp;date&nbsp;nor&nbsp;language restriction will be applied. The quality of studies will be assessed using&nbsp;existing appraisal tools&nbsp;(i.e. Joanna Briggs Institute’s Checklists) and an inductive&nbsp;narrative&nbsp;synthesis&nbsp;technique&nbsp;will&nbsp;be&nbsp;used&nbsp;to&nbsp;analyse&nbsp;the&nbsp;extracted&nbsp;data.&nbsp;Randomized&nbsp;Controlled Trial (RCT) and non-RCT interventions will be full-reviewed but only&nbsp;RCT studies will be pooled in a meta-analysis. Heterogeneity, publication bias, and&nbsp;sensitivity will also be assessed. Results: The results will be reported following the&nbsp;Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)&nbsp;2020 statement. The standardized procedure and reporting will ensure the review’s&nbsp;quality&nbsp;and&nbsp;could&nbsp;be&nbsp;used&nbsp;by&nbsp;the&nbsp;stakeholders&nbsp;in&nbsp;the&nbsp;region&nbsp;for&nbsp;planning&nbsp;DHL-related&nbsp;programs&nbsp;and&nbsp;significantly&nbsp;contribute&nbsp;to&nbsp;dementia&nbsp;caregiving&nbsp;and&nbsp;caregiver&nbsp;literature and programs. Conclusion: This protocol of the planned systematic&nbsp;review and meta-analysis of the effectiveness of educational interventions on DHL&nbsp;for ICs in the Asia Pacific countries/territories will set the foundation for its further&nbsp;progress. &nbsp; Keywords:&nbsp;Aging,&nbsp;Alzheimer’s,&nbsp;Caregiving,&nbsp;Gerontology,&nbsp;Global&nbsp;Sout