The validity of ultrasound-derived equation models to predict whole-body muscle mass:A systematic review

Background & aims: Sarcopenia is defined as the age-related loss in muscle quantity and quality which is associated with physical disability. The assessment of muscle quantity plays a role in the diagnosis of sarcopenia. However, the methods used for this assessment have many disadvantages in daily practice and research, like high costs, exposure to radiation, not being portable, or doubtful reliability. Ultrasound has been suggested for the estimation of muscle quantity by estimating muscle mass, using a prediction equation based on muscle thickness. In this systematic review, we aimed to summarize the available evidence on existing prediction equations to estimate muscle mass and to assess whether these are applicable in various adult populations. Methods: The databases PubMed, PsycINFO, and Web of Science were used to search for studies predicting total or appendicular muscle mass using ultrasound. The methodological quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS-2) and the quality assessment checklist (QA) designed by Pretorius and Keating (2008). Results: Twelve studies were included in this systematic review. The participants were between 18 and 79 years old. Magnetic Resonance Imaging and dual-energy X-ray absorptiometry were used as reference methods. The studies generally had low risk of bias and there were low concerns regarding the applicability (QUADAS-2). Nine out of eleven studies reached high quality on the QA. All equations were developed in healthy adults. Conclusions: The ultrasound-derived equations in the included articles are valid and applicable in a healthy population. For a Caucasian population we recommend to use the equation of Abe et al., 2015. While for an Asian population, we recommend to use the equation of Abe et al., 2018, for the South American population, the use of the equation of Barbosa-Silva et al., 2021 is the most appropriate

Teaching geriatric medicine through gamification: a tool for enhancing postgraduate education in geriatric medicine

Background Polypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently. Aims The aim of this project is to evaluate the feasibility and use of a novel gamification-based teaching intervention on polypharmacy among doctors undergoing advanced geriatric training. Among others, one of the learning goals for the students was to be able to describe the adherence to medication. Methods Electronic questionnaire sent to students of the third session “evidence-based medicine in geriatrics” of advanced postgraduate course in geriatrics of the European Academy for Medicine of Ageing. Results Most students reported issues with forgetting doses and remembering sufficiently to establish a medication routine due to busy schedules as well as social influences around medication taking. Reflecting on the challenges of the game, most students reported that their own prescribing practice was likely to change. Discussion and conclusion The current model of learning appears to be a feasible approach for postgraduate medical education or in other areas of healthcare such as nursing or physiotherapy. Learning through action and reflection promotes deeper thinking and can lead to behavioral change, in this case thus enhancing the attitudes and understanding regarding pharmacological issues associated with ageing. Recommendations for future research in medical education about medication adherence are outlined.publishedVersio

Comprehensive Quantitative Spatiotemporal Gait Analysis Identifies Gait Characteristics for Early Dementia Subtyping in Community Dwelling Older Adults

Background: Recent studies associated gait patterns with cognitive impairment stages. The current study examined the relation between dementia type and spatiotemporal gait characteristics under different walking conditions in pre and mild neurocognitive disorder stage.Methods: Community-dwelling older adults (age 50+) with memory complaints consulting a memory clinic underwent, at baseline and during follow-up (every 4 months), a standard dementia assessment and a comprehensive spatiotemporal gait analysis [walking on an electronic walkway at usual pace (UP) with and without a counting-backwards (CW) or animal-reciting dual-task (AW), at fast (FP) and at slow (SP) pace]. At baseline the participants were categorized according to the Clinical Dementia Rating (CDR) scale. At the end of the study, the dementia diagnosis was used to stratify the categories in three outcome groups: developed “No-dementia,” “AD+FTD” (grouping Alzheimer's or Fronto-temporal dementia) or “VascD+LBD” dementia (grouping Vascular dementia or Lewy body dementia). The gait characteristics were compared per category in paired groups. Sub-analyzing in the ≥70-years-old participants evaluated the age effect.Results: Five hundred and thirty-six participants, age 50-to-95-years old were followed for 31-to-41 months. In the CDR 0, no differences were seen between eventual dementia and no-dementia individuals. In the CDR 0.5, CW dual task cost (DTC) step width was larger in the imminent “AD+FTD” and AW (normalized) gait speed was slower in the future “VascD+LBD” group compared to the no-dementia participants. Slower UP (normalized) gait speed differed the future “VascD+LBD” from the “AD+FTD” individuals. In the CDR 1: Wider steps in UP, SP and CW differed the “VascD+LBD” from the “AD+FTD” group. In the ≥70-years old CDR 0 category, higher AW cycle time variability in the imminent “AD+FTD” dementia group, wider UP step width and higher AW cycle time variability in the “VascD+LBD” group differed them from the no-dementia group up to 3 years before dementia diagnosis. The distinctive gait characteristics between the no-dementia and the imminent dementia groups in CDR 0.5 and CDR 1 remained the same as in the overall group. However, no gait differences were found between “VascD+LBD” and “AD+FTD” groups in the pre-dementia stages.Conclusion: Distinctive spatiotemporal gait characteristics were associated with specific dementia types up to 3 years before diagnosis. The association is influenced by the cognitive stage and age

Het gebruik van antidepressiva bij ouderen : prevalentie van gebruik op de afdeling geriatrie van een universitair ziekenhuis en toepassing van de herziene STOPP-criteria

Ouderen gebruiken frequent antidepressiva. Deze patiëntenpopulatie is echter gevoeliger voor bijwerkingen en geneesmiddeleninteracties. Deze beschrijvende studie wil het antidepressivagebruik bij 75-plussers op de geriatrieafdeling in kaart brengen en nagaan of het voorschrijven ervan op een wetenschappelijk onderbouwde manier gebeurt. Hiervoor werden patiënten ≥ 75 jaar opgenomen tussen februari en juli 2017 op de afdeling geriatrie van ZNA Middelheim geïncludeerd. Er werd nagegaan of ze antidepressiva innamen, om welk type het ging en in welke dosis, wie het voorschreef en of het voorschrijven ervan voldeed aan de herziene STOPP-criteria („Screening Tool of Older People’s Prescriptions”). Van de 239 geïncludeerde patiënten bleken er 61 antidepressiva te gebruiken, met depressie als belangrijkste indicatie. Huisartsen bleken de meest frequente voorschrijvers. Trazodon was het meest voorgeschreven product, dat in 50% van de gevallen gebruikt werd voor slaapstoornissen. Antidepressiva werden in bijna één op vijf gevallen langer ingenomen dan aanbevolen. Patiënten met diabetes mellitus (DM) en nierinsufficiëntie kregen minder vaak antidepressiva voorgeschreven. Slechts 2,8% van de studiedeelnemers kreeg deze medicatie voorgeschreven voor angststoornissen. Het voorschrijven van antidepressiva bij ouderen gebeurt dus vaak niet op een wetenschappelijk onderbouwde manier. Duidelijkere richtlijnen kunnen een oplossing bieden, maar hiervoor zijn meer studies nodig rond het gebruik ervan bij ouderen

Three-dimensional CT reconstructions illustrating the ontogenetic development of the ears in cetaceans.

<p>The tympanoperiotic complex is highlighted in yellow and the right lateral view is shown. Some parts of the skull were digitally removed to expose the ears. The scale bar represents 1 cm for <i>S</i>. <i>attenuata</i> (a-d) and 2 cm for <i>B</i>. <i>physalus</i> (e-h) except for the enlarged inserts in (a) and (e), which are twice the size of the corresponding image. The insert in (a) is a flipped image of the left side, in which the goniale is more distinct compared to the right side. Specimens featured in each panel are as follows: a) USNM 504373; b) USNM 504022; c) USNM 504052; d) USNM 504008; e) USNM 301532; f) USNM 267672; g) USNM 268884; h) USNM 260585. Abbreviations: a, accessory ossicle; g, goniale; m, malleus; p, periotic; s, sigmoid process; t, tympanic. The V-shaped malleus-goniale complex is illustrated by the pink dashed line.</p