Ipsilateral Axillary Adenopathy from mRNA COVID-19 Vaccines

Shyh Poh Teo 대한노인병학회 2021 Annals of geriatric medicine and research Vol.25 No.3

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Consent for Research in Dementia: A Narrative Review

Shyh Poh Teo 대한임상노인의학회 2021 대한임상노인의학회지 Vol.22 No.1

Dementia is the leading chronic disease contributing to disability and dependence among older people. There is a need for quality research to ensure an evidence-based approach to manage this global crisis. Research is also required to explore the psychosocial context and perspectives of people with dementia. Obtaining consent from people with dementia presents challenges to researchers, and may limit the participation of people with dementia in research. In this review, consent issues are discussed with an overview of approaches for those unable to give informed consent. It is hoped that applying the concepts of process consent, surrogate or proxy decision makers and advance research directives will enable and improve the participation of people with dementia in research.

Review of COVID-19 Vaccines and Their Evidence in Older Adults

Shyh Poh Teo 대한노인병학회 2021 Annals of geriatric medicine and research Vol.25 No.1

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a global pandemic and significant loss of life. Older people are vulnerable to SARS-CoV-2 infections and complications; thus, they are a priority group to receive COVID-19 vaccines. This review discusses considerations for COVID-19 vaccines for older adults. The general concepts of vaccine effectiveness in older adults are described, particularly immune senescence and vaccine development approaches to improve immunogenicity. The types of COVID-19 vaccine platforms are also described before reviewing the available, although limited, evidence from phase 3 COVID-19 vaccine trials relevant to older adults. The BNT162b2 vaccine by Pfizer-BioNTech and mRNA-1273 vaccine from Moderna demonstrated high efficacy and immunogenicity, which were also observed in older people. While the ChAdOx1 nCoV-19 vaccine (AZD1222) by AstraZeneca demonstrated some efficacy in older people, the vaccine dose requires clarification through further studies. Finally, the Ad26.COV2.S vaccine by Janssen Pharmaceuticals shows promise as a single-dose vaccine with a potential durability of response.

Barriers and Solutions for Improving Pain Management Practices in Acute Hospital Settings: Perspectives of Healthcare Practitioners for a Pain-Free Hospital Initiative

Nuraqilah Akbar,Shyh Poh Teo,Hjh Noor Artini Hj-Abdul-Rahman,Hjh Asmah Hj-Husaini,Munikumar Ramasamy Venkatasalu 대한노인병학회 2019 Annals of geriatric medicine and research Vol.23 No.4

Background: Effective pain management is a fundamental human right. However, global disparities in pain management practices exist across health settings. This study explored healthcare practitioners’ views on pain management in the acute care hospital setting. Methods: The focus groups included clinical specialties most likely to encounter patients with ‘difficult to manage pain’, namely those in the Geriatrics and Palliative Care Unit (2 doctors and 3 nurses), Critical Care Unit (7 doctors), and the Pain Management Team (3 doctors and 2 nurses). The transcripts were analyzed using a qualitative thematic analysis. Results: The data analysis revealed four themes. Theme 1, ‘Being too safe’ described the presence of apprehensive attitudes among patients and healthcare practitioners that limits the appropriate use of diverse and tailored pain medications in acute care hospital settings. Theme 2, ‘Working as a team’ described the need for collaborative approaches to achieve hospital-wide evidence-based pain management. Theme 3, ‘Adaptation for local and cultural preferences’ explored how pain was perceived through cultural lenses and suggested strategies to tailor pain management to local and cultural preferences. Finally, Theme 4, ‘Driving acute pain management forward’ listed clinician solutions for improving pain management in acute care hospital settings toward a pain-free hospital initiative. Conclusion: Despite advances in pain medicine and pain teaching strategies, effective pain management is proportionate to both clinical and cultural preferences. Future studies should investigate the standardization of global pain management tools and guidelines to fit the local culture and context.

Utility of Frailty Screening Tools in Older Surgical Patients

Alicia Wan Yan Poh,Shyh Poh Teo 대한노인병학회 2020 Annals of geriatric medicine and research Vol.24 No.2

Frailty is a loss of functional reserve that compromises a person’s ability to cope with stressors such as surgery. Identifying and quantifying frailty may enable intensive rehabilitation interventions, caregiver support, or consideration of palliative care before surgery. This study describes the characteristics of five frailty screening tools, namely the Geriatric 8, Vulnerable Elders Survey-13, the Groningen Frailty Indicator, Edmonton Frailty Scale (EFS), and Clinical Frailty Scale. We further propose an approach incorporating a frailty scale into preoperative assessment, wherein older patients undergoing elective general surgery are screened using EFS, and frail patients are offered comprehensive geriatric assessment. The expected outcome is an individualized patient-centered care plan that will reduce frailty and optimize the patient’s condition before surgery.

Post-intensive Care Syndrome

Muhammad Hanif Ahmad,Shyh Poh Teo 대한노인병학회 2021 Annals of geriatric medicine and research Vol.25 No.2

The increasing survival rate after discharge from the intensive care unit (ICU) has revealed long-term impairments in the cognitive, psychiatric, and physical domains among survivors. However, clinicians often fail to recognize this post-ICU syndrome (PICS) and its debilitating effects on family members (PICS-F). This study describes two cases of PICS to illustrate the different impairments that may occur in ICU survivors. The PICS risk factors for each domain and the interactions among risk factors are also described. In terms of diagnostic evaluation, limited evidence-based or validated tools are available to assist with screening for PICS. Clinicians should be aware to monitor for its symptoms on the basis of cognitive, psychiatric, and physical domains. The Montreal Cognitive Assessment is recommended to screen for cognition, as it has a high sensitivity and can evaluate executive function. Mood disorders should also be screened. For mobile patients, a 6-minute walk test should be performed. PICS can be prevented by applying the ABCDEF bundle ABCDEF bundle in ICU described in this paper. Finally, the family members of patients in the ICU should be involved in patient care and a tactful communication approach is required to reduce the risk of PICS-F.

Impact of Hypertension on Cognitive Decline and Dementia

Han Lin Naing,Shyh Poh Teo 대한노인병학회 2020 Annals of geriatric medicine and research Vol.24 No.1

Dementia reduces a person’s ability to perform their activities of daily living and is the leading cause of morbidity worldwide. While most preventive measures are ineffective in reducing dementia risk, active treatment of hypertension in middle-aged and older adults without dementia may reduce the incidence of dementia. Hypertension is associated with vascular dementia but may also affect the manifestations of Alzheimer disease. Observational studies support the association between hypertension and white matter lesions, hippocampal atrophy, and cognitive decline. Both increased and decreased blood pressure were related to the development of white matter lesions. Cohort studies showed that hypertension treatment and treatment duration were associated with lower cognitive decline. This study describes findings from randomized controlled studies on the effects of antihypertensives on cognitive decline. Only the Systolic Hypertension in Europe (Syst-Eur) trial using calcium-channel blockers demonstrated a significant reduction in dementia incidence. Further studies are required to evaluate the long-term benefits of antihypertensive treatment in dementia.

Pharmacovigilance and Its Importance for Primary Health Care Professionals

Asma A’tiyah Abdul Hamid,Rashidah Rahim,Shyh Poh Teo 대한가정의학회 2022 Korean Journal of Family Medicine Vol.43 No.5

Pharmacovigilance is used to detect, assess, understand, and prevent the adverse effects of medications. The need for safety monitoring has evolved around unfortunate incidents in history, with deaths caused by anesthesia and congenital malformations from thalidomide use. Reports from adverse drug reactions (ADRs) are stored in a global database and can be used to evaluate the associations between various medications and associated ADRs. Clini-cians play an important role in the recognition and reporting of ADRs to national pharmacovigilance centers (NPCs). The purpose of NPCs is to make the clinicians understand their functions, including the monitoring, inves-tigation, and assessment of ADR reports, along with periodical benefit-risk assessments of medications via multiple sources. A case study on NPCs and the types of safety issues evaluated by them are provided to illustrate their role in medicine safety surveillance. ADR monitoring was also combined with vaccine safety surveillance approaches. Overall, this study will provide insights to clinicians on the importance of pharmacovigilance in maintaining pa-tient safety with the proper use of medications.