scholarly journals Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Ashley Polhemus ◽  
Laura Delgado Ortiz ◽  
Gavin Brittain ◽  
Nikolaos Chynkiamis ◽  
Francesca Salis ◽  
...  
Keyword(s):  
Scoping Review ◽  
Gait Speed ◽  
Clinical Utility ◽  
Common Ground ◽  
Ecological Validity ◽  
Step Length ◽  
Step Count ◽  
Chronic Obstructive ◽  
Medical Conditions ◽  
Clinical Measures

AbstractPhysical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.

scholarly journals Validation of Clinical Characteristics and Effectiveness of Pulmonary Rehabilitation in a COPD Population with Discrepancy between Exercise Tolerance and FEV1

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 53
Author(s):  
Jun Horie ◽  
Koichiro Takahashi ◽  
Shuuichi Shiranita ◽  
Kunihiko Anami ◽  
Shinichiro Hayashi
Keyword(s):  
Gait Speed ◽  
Pulmonary Rehabilitation ◽  
Exercise Tolerance ◽  
Respiratory Illness ◽  
Forced Expiratory Volume ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
St George's Respiratory Questionnaire ◽  
History Of

This study’s objective was to examine the characteristics of patients with chronic obstructive pulmonary disease (COPD) presenting with various exercise tolerance levels. A total of 235 patients with stable COPD were classified into 4 groups: (1) LoFlo + HiEx—patients with a six-minute walking distance (6MWD) ≥350 m and percentage of predicted forced expiratory volume in 1 s (%FEV1.0) <50%; (2) HiFlo + HiEx—patients with a 6MWD ≥350 m and a %FEV1.0 ≥50%; (3) LoFlo + LoEx—patients with a 6MWD < 350 m and %FEV1.0 < 50%; and (4) HiFlo + LoEx—patients with a 6MWD <350 m and %FEV1.0 ≥ 50%. Aspects of physical ability in the HiFlo + LoEx group were significantly lower than those in the HiFlo + HiEx group. The HiFlo + LoEx group was characterized by a history of hospitalization for respiratory illness within the past year, treatment with at-home oxygen therapy, and lacking daily exercise habits. Following three months of pulmonary rehabilitation, the LoFlo + HiEx group significantly improved in the modified Medical Research Council dyspnea score, maximum gait speed, and 6MWD, while the HiFlo + LoEx group significantly improved in the percentage of maximal expiratory pressure, maximum gait speed, 6MWD, incremental shuttle walking distance, and St. George’s Respiratory Questionnaire score. The HiFlo + LoEx group had the greatest effect of three-month pulmonary rehabilitation compared to other groups.

scholarly journals Preventable adverse drug events causing hospitalisation: identifying root causes and developing a surveillance and learning system at an urban community hospital, a cross-sectional observational study

2021 ◽  
Vol 10 (1) ◽  
pp. e001161
Author(s):  
Jane de Lemos ◽  
Peter Loewen ◽  
Cheryl Nagle ◽  
Robert McKenzie ◽  
Yong Dong You ◽  
...  
Keyword(s):  
Observational Study ◽  
Adverse Drug Events ◽  
Healthcare Providers ◽  
Medication Use ◽  
Learning System ◽  
Chronic Obstructive ◽  
Action Plans ◽  
Medical Conditions ◽  
Cross Sectional ◽  
Medication Changes

ObjectivesTo identify root causes of preventable adverse drug events (pADEs) contributing to hospital admission; to develop key messages which identify actions patients/families and healthcare providers can take to prevent common pADEs found; to develop a surveillance learning system for the community.MethodsCross-sectional observational study; 120 patients and families, 61 associated healthcare providers were interviewed then root cause analysis was performed to develop key learning messages and an electronic reporting tool was designed. Most common pADE-related medical conditions and their root causes and most common pADE root causes of entire cohort are reported.ResultsMost common pADE-related medical conditions: chronic obstructive pulmonary disease/asthma (13.3%), bleeding (12.5%), hypotension (12%), heart failure (10%), acute kidney injury (5%) and pneumonia (5%). Most common root causes were: providers not confirming that the patient/family understands information given (29.2%), can identify how a medication helps them/have their concerns addressed (16.7%), can identify if a medication is working (14.1%) or causing a side effect (23.3%); can enact medication changes (7.5%); absence of a sick day management plan (12.5%), and other action plans to help patients respond to changes in their clinical status (10.8%); providers not assessing medication use and monitoring competency (19.2%). Ten key learning messages were developed and a pADE surveillance learning system was implemented.ConclusionsTo prevent pADEs, providers need to confirm that patients/families understand information given, how a medication helps them, how to recognise and respond to side effects, how to enact medication changes and follow action plans; providers should assess patient’s/families’ medication use and monitoring competency.

Association between Circulating Osteoprogenitor Cells and Sarcopenia

Gerontology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Ahmed Al Saedi ◽  
Steven Phu ◽  
Sara Vogrin ◽  
Piumali Gunawardene ◽  
Gustavo Duque
Keyword(s):  
Gait Speed ◽  
Muscle Function ◽  
Older Persons ◽  
Clinical Utility ◽  
Handgrip Strength ◽  
Community Dwelling ◽  
Gait Velocity ◽  
Cut Points ◽  
Potential Biomarker ◽  
Marrow Mesenchymal Stem Cells

<b><i>Background:</i></b> Circulating osteoprogenitor (COP) cells are a surrogate of the bone marrow mesenchymal stem cells with high levels observed in osteoporosis and the initial stages of fracture healing. Conversely, a low percentage of COP cells (%COP) is strongly associated with frailty and disability. However, it is unknown whether %COP is associated with sarcopenia, a musculoskeletal disease closely related to frailty. <b><i>Objectives:</i></b> This study sought to determine the associations between %COP and sarcopenia defined using the Sarcopenia Definitions and Outcomes Consortium (SDOC) criteria. <b><i>Methods:</i></b> Data from a random sample of 73 community-dwelling older persons enrolled in the Nepean Osteoporosis and Frailty study (median age 74 years; 60% female) were analyzed. %COP was quantified by flow cytometry using selective gating of CD45/osteocalcin (OCN) + cells. Sarcopenia was defined using handgrip strength and gait speed with cut points as per the SDOC criteria. Linear regression was used for analysis. <b><i>Results:</i></b> Sarcopenia was identified in 19% of participants, all of whom were frail. After adjusting for age, sex, and interleukin 6, sarcopenic participants had 36% lower %COP (95% confidence interval [CI] −56%, −6%, <i>p =</i> 0.024). Both grip strength and gait speed showed associations with %COP (<i>p =</i> 0.065 and 0.002, respectively); however, after adjusting for age and frailty, only gait speed remained associated with %COP (0.1 m/s increase in gait velocity was associated with a 5% increase in %COP cells (95% CI 0%, 10%, <i>p =</i> 0.052). <b><i>Conclusions:</i></b> High levels of %COP are associated with better muscle function. Future longitudinal studies are required to elucidate the clinical utility of %COP as a potential biomarker or disease stratifier for sarcopenia.

Mild Cognitive Impairment Affects Obstacle Negotiation in Older Adults: Results from “Gait and Brain Study”

Gerontology ◽  
2018 ◽  
Vol 65 (2) ◽  
pp. 164-173 ◽  
Author(s):  
Frederico Pieruccini-Faria ◽  
Yanina Sarquis-Adamson ◽  
Manuel Montero-Odasso
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Dual Task ◽  
Gait Speed ◽  
Step Length ◽  
Gait Control ◽  
Dual Tasking ◽  
Brain Study

Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

Executive Function Measures for Children: A Scoping Review of Ecological Validity

2017 ◽  
Vol 38 (1) ◽  
pp. 6-14 ◽  
Author(s):  
Anna Wallisch ◽  
Lauren M. Little ◽  
Evan Dean ◽  
Winnie Dunn
Keyword(s):  
Executive Function ◽  
Scoping Review ◽  
Ecological Validity

scholarly journals Mobility improvement in the first 6 postoperative weeks in orthogeriatric fracture patients

2021 ◽  
Author(s):  
Alexander M. Keppler ◽  
Jenny Holzschuh ◽  
Daniel Pfeufer ◽  
Johannes Gleich ◽  
Carl Neuerburg ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Gait Speed ◽  
Daily Living ◽  
Step Length ◽  
Care Hospital ◽  
Self Assessment ◽  
Postoperative Rehabilitation ◽  
Femur Fractures ◽  
Prospective Study Design

Abstract Background Physical activity is a relevant outcome parameter in orthopedic surgery, that can be objectively assessed. Until now, there is little information regarding objective gait parameters in the orthogeriatric population. This study focuses on the first 6 weeks of postoperative rehabilitation, and delivers objective data about gait speed and step length in typical orthogeriatric fracture patterns. Methods Thirty-one orthogeriatric fracture patients [pertrochanteric femur fractures (PFF), femoral neck (FN), and proximal humerus fractures (PHF)] were consecutively enrolled in a maximum care hospital in a prospective study design. All patients wore an accelerometer placed at the waist during the postoperative stay (24 h/d) and at 6-week follow-up, to measure real gait speed and step length. In addition, self-assessment of mobility (Parker mobility score) and activities of daily living (Barthel index) were collected at baseline, during the inpatient stay, and at 6-week follow-up. Results During postoperative hospitalization, significantly higher gait speed (m/s) was observed in the PHF group (0.52 ± 0.27) compared with the FN group (0.36 ± 0.28) and PFF group (0.19 ± 0.28) (p < 0.05). Six weeks postoperatively, gait speed improved significantly in all groups (PHF 0.90 ± 0.41; FN 0.72 ± 0.13; PFF 0.60 ± 0.23). Similarly, step length (m) differed between groups postoperatively [FN 0.16 ± 0.13; PFF 0.12 ± 0.15; PHF 0.31 ± 0.05 (p < 0.005)] and improved over time significantly (FN 0.47 ± 0.01; 0.39 ± 0.19; 0.50 ± 0.18). Self-assessment scores indicate that the majority of the patients had minor restrictions in mobility before the fracture. These values decreased immediately postoperatively and improved in the first 6 weeks, but did not reach the initial level. Conclusions Gait speed, step length, and self-assessment in terms of mobility and activities of daily living improve significantly in the first 6 postoperative weeks in orthogeriatric fracture patients. As very low postoperative mobility during hospitalization was observed, this collective shows great potential in postoperative rehabilitation regardless of their fracture pattern. For this reason, specific aftercare concepts similar to the “fast track” concepts in primary arthroplasty are crucial for orthogeriatric patients in clinical practice. Level of evidence Prospective cohort study, 2.

scholarly journals Scoping Review: Pengaruh Paparan Asap Rokok Terhadap Kadar Kotinin Dalam Tubuh Perokok Pasif

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Madina Tul Munawaroh ◽  
Annisa Rahmah Furqaani ◽  
Lelly Resna Nugrahawati
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Clinical Trial ◽  
Coronary Heart Disease ◽  
Scoping Review ◽  
The Body ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Cytochrome P450 Family

Perokok pasif adalah orang tidak merokok, namun ikut menghirup asap rokok dari orang-orang merokok di sekitarnya. Produk yang dihirup dihasilkan dari asap utama yang dihembuskan dan asap dari ujung rokok yang masih membara. Perokok pasif memiliki kandungan nikotin yang akan dimetabolisme menjadi kotinin menggunakan enzim CYP2A6 Cytochrome P450, Family 2, Subfamily A, Polypeptide dan didistribusikan dalam tubuh perokok pasif seperti darah, saliva, dan urine. Hasil metabolisme mengakibatkan peningkatan kadar kotinin dalam tubuh perokok pasif. Dampak peningkatan kadar kotinin menyebabkan gangguan kesehatan seperti lung cancer, oral cancer, asthma, chronic obstructive pulmonary disease (COPD), dan coronary heart disease. Tujuan penelitian menganalisis pengaruh paparan asap rokok terhadap kadar kotinin dalam tubuh perokok pasif. Penelitian dilakukan dengan metode scoping review dengan subjek artikel ilmiah nasional dan internasional yang memenuhi kriteria kelayakan (eligible). Hasil pada penelitian ini diambil dari artikel yang akan dinilai secara PICOS, yaitu Population: anak-anak perokok pasif yang terdapat pada jurnal artikel, Intervention/Exposure: asap rokok sekunder, Comparison: anak-anak yang tidak tinggal dengan perokok, Outcome: kadar kotinin dalam tubuh perokok pasif, Studi: RCT, clinical trial, dan cross sectional. Artikel yang memenuhi kelayakan (eligible) ada 6 artikel. Simpulan penelitian ini menunjukkan bahwa pada perokok pasif menunjukan kadar kotinin yang meningkat.  Scope Review: The Effect of Cigarette Exposure to Cotinine Levels in The Body of Passive SmokersSecondhand smoke is a product produced from the main smoke that is exhaled and the smoke from the tip of the cigarette that is still burning. Passive smokers who contain nicotine which will be metabolized into cotinine use the enzymes CYP2A6 Cytochrome P450, Family 2, Subfamily A, Polypeptides and distros in the body of passive smokers such as blood, saliva and urine. From the measurement results the increase in cotinine levels in the body of passive smokers. The impact of increasing levels of cotinins causes health problems such as lung cancer, oral cancer, asthma, chronic obstructive pulmonary disease (COPD), and coronary heart disease. The research objective was to analyze the effect of cigarette smoke on cotinine levels in the body of passive smokers. The research was taken using the scoping review method with the subject of national and international scientific articles that meet the eligibility criteria (elegible). The results in this study were taken from articles to be taken using PICOS, namely Population: children of passive smoking found in journal articles, Intervention/Exposure:secondary cigarette smoke, Comparison: children who do not live with smokers, Results: body cotinine levels in passive smokers, Studies (RCT, clinical trial, and cross sectional). There are 6 articles that fulfill the eligibility (elegible). The conclusion of this study shows that exposure to passive smoking using cotinine concentrations taken in the body of passive smokers shows an increase in cotinine levels.

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