Introduction Advancements in HIV treatment has resulted in an ageing population in people living with HIV (PLWH). Increasing prevalence of frailty in older PLWH has been demonstrated, giving rise to multi-morbidities, polypharmacy and consequently, complex medical and social needs. Approximately 5650 people are living with HIV across Greater Manchester. With increasing patient complexity, a pathway was developed to help provide holistic care and improve quality of life for older adults living with HIV. Methods A pilot involving multi-disciplinary professionals from the hospital frailty, HIV and community teams was established. Patients were screened using the Clinical Frailty Scale and patients with a CFS ≥ 4 were referred for completion of a comprehensive geriatric assessment (CGA). Patients would then be discussed at the Frailty MDT meeting, where action plans were devised. Results 47 patients were assessed between October 2020 to December 2021, with 30 eligible for review in the frailty clinic. Commonly reported issues were mobility n=26 (86.6%), pain n=23 (76.6%), low mood n= 14 (46.6%), memory issues n=3 (43.3%) and falls n=12 (40%). Following MDT recommendations, 8 (26.6%) referrals were completed for social care, 1 (3%) referral for safeguarding and 9 (30%) referrals for active case management community teams for co-ordination of care in the community. Deprescribing recommendations were suggested for 16 (53.3%) patients and new medicine recommendations made for 24 (80%) patients. Conclusion A collaborative MDT approach to managing older PLWH can facilitate formulation of action plans to address patients physical, psychological and social needs.
This article aims to support healthcare professionals from all care sectors when making prescribing decisions in patients with kidney disease. The authors discuss which renal dosing equation to use on a case-by-case basis and provide some background to common medicines prescribed for kidney patients. When discussing patients with chronic kidney disease, acute kidney injury and kidney transplants, commonplace prescribing issues that can be avoided are highlighted. It is hoped that raising awareness of prescribing in kidney patients can ensure these patients have a better experience and outcome from their treatment.
There are limited data on how the lifestyle behaviours of school-aged children in Singapore fare against the Singapore Integrated 24-hr Activity Guidelines. One hundred and thirty-eight children ages 9 to 13 years self-reported their recreational screen time, moderate-to-vigorous physical activity (MVPA), night-time sleep duration, and health-related Quality of Life (HRQoL) in a survey package. Their lifestyle behaviours were then benchmarked against the Singapore Integrated 24-hr Activity Guidelines recommendations, specifically, (i) at least 1 hr/day of MVPA, (ii) no more than 2 hr/day of recreational screen time, and 7-9 hr/day of sleep. Association between the number of guideline recommendations met and HRQoL z-scores were explored. Of the 138 children, 6.5% met all three guideline recommendations while 29.0% did not meet any guideline recommendations. MVPA guideline recommendation was least adhered to followed by recreational screen time and sleep. The number of guideline recommendations met was significantly associated with children’s HRQoL, with an increase of 0.289 in HRQoL z-score (5.9%) for every additional guideline met. The 24-hr activity behaviours of Singapore children was sub-optimal in which the proportion of children who did not meet any guideline recommendations is higher than those who met all guideline recommendations. Nonetheless, larger cohort studies are needed to establish its prevalence. Greater dissemination of the guidelines and ameliorative programs targeted at different groups of children should be made to help support children in adopting healthy lifestyle habits.
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