Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

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Sarcopenia: Revised European consensus on definition and diagnosis

Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia.

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Transactions of the Institute of British Geographers

羟氨苄青霉素引起大疱性类天疱疮样疹

Objective To evaluate the current status of pain severity and quality of life (QoL) in patients with complex regional pain syndrome (CRPS), and to assess both their perceived needs and any unmet needs of current rehabilitation services. Methods A single-center questionnaire-based survey was conducted on 47 patients with CRPS who were diagnosed based on Budapest's criteria. It collected demographic and clinical data, and the structured questionnaire included the Brief Pain Inventory (BPI), the Korean version of the World Health Organization Disability Assessment Schedule II (WHODAS-K II), as well as the 5-Level EuroQol-5D (EQ-5D-5L) for measuring the QoL. Results The average value of BPI and WHODAS-K II were 7.69%±2.26% and 70.49%±19.22%, respectively. In the evaluation of their perceived needs and unmet needs for rehabilitation, patients had the highest rehabilitation needs in terms of pain (95.74%), followed by bodyaches (80.85%). Regarding their unmet needs, patients had the highest unmet needs in terms of memory impairment (83.33%), followed by weight management (72.00%). According to the regression analysis, only the overall BPI was significantly associated with QoL (p=0.01), and a higher BPI value led to poorer results for QoL. Conclusion In Korea, patients with CRPS do not receive adequate rehabilitation, and they are not satisfied with current received treatments. A more structured and individualized rehabilitation treatment plan is required to manage every aspect related to chronic pain, and provision should be made for improved care guidelines for future CRPS management.

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Understanding the Rehabilitation Needs of Korean Patients With Complex Regional Pain Syndrome

Impacts of Whole-body Vibration on Denervated Skeletal-muscle Atrophy in Rats.

Osteoporosis is a major threat to musculoskeletal health in older adults. Osteoporotic fractures or fragility fractures have been recognized as geriatric conditions associated with various and complex problems that significantly compromise whole-body conditions and functions in addition to the musculoskeletal problems due to fracture per se. Of all fragility fractures, the care and rehabilitation of patients with hip fractures pose critical challenges in terms of functional outcomes and medical costs in a superaged society. Vertebral fracture is the most common fragility fracture, reducing health-related quality of life by causing pain and decreasing physical capabilities. More attention must be paid to mortality and morbidity profiles, loss of independence, and their resulting clinical and socioeconomic impacts. Comprehensive and systematic rehabilitation can minimize complications and increase the success of medical and surgical treatments, thereby lowering the extent of impairment. The most common cause of osteoporotic fracture is a fall-related injury. Epidemiologic data and the healthcare systems regarding the occurrence of falls, risk factors for falls, and postfall outcomes in older adults show that such problems are already of major international concern. We will review the recent trends in the management of osteoporosis and fragility fractures. Comprehensive and integrated rehabilitation for fragility fractures including exercise management and fall prevention will be discussed. This chapter focuses on the rehabilitative management of hip and vertebral fractures, which are the most common fragility fractures causing severe dysfunction in the very elderly.

Osteoporosis and Fragility Fracture

This paper discusses an efficient image segmentation using morphological watershed algorithm that is robust to noise. Morphological image segmentation consists of four steps: image simplification, computation of gradient image and watershed algorithm and region merging. Conventional watershed segmentation exhibits a serious weakness for over-segmentation of images. In this paper we present a morphological edge detection methods for detecting edges under noisy condition and apply our watershed algorithm to the resulting gradient images and merge regions using Kolmogorov-Smirnov test for eliminating irrelevant regions in the resulting segmented images. Experimental results are analyzed in both qualitative analysis through visual inspection and quantitative analysis with percentage error as well as computational time needed to segment images. The proposed algorithm can efficiently improve segmentation accuracy and significantly reduce the speed of computational time.

Efficient Image Segmentation Using Morphological Watershed Algorithm

Background/Aims Drugs with anticholinergic properties (DAPs) are associated with adverse health outcomes in older patients. The objective of this study was to evaluate the factors that determine the prescribing of more DAPs in long-term care hospitals (LTCHs) in Korea. In addition, the current patterns of DAP prescription were explored using a novel platform, which can collect data from LTCHs. Methods This was a Health-RESPECT (integrated caRE Systems for elderly PatiEnts using iCT) sub-study, which is a pragmatic, cluster-randomized, controlled trial. The Health-RESPECT platform was used to collect prescribed medication data of 466 patients (aged ≥ 65 years) from seven LTCHs. DAPs were identified using the Korean Anticholinergic Burden Scale (KABS). Physical frailty, cognitive function, functional status, and quality of life were evaluated. Results Among 466 LTCH patients, 88.8% (n = 414) were prescribed DAPs, and the prevalence of high KABS (≥ 3) was 70.4% (n = 328). The drugs that contributed most to the total KABS were quetiapine (20.7%), chlorpheniramine (19.5%), tramadol (9.8%), cimetidine (5.8%), and furosemide (3.6%). Polypharmacy, higher body mass index, less dependence, better communication and cognitive functions, and poorer quality of life were associated with high KABS. Conclusions Although the patients with a high burden of DAPs were less dependent and had better cognitive and communication functions, they had poorer quality of life. DAP use in LTCH patients should be monitored carefully, and the risk/benefit relationship for their use should be considered.

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Jae Young Lim

Papers

Understanding the Rehabilitation Needs of Korean Patients With Complex Regional Pain Syndrome

Impacts of Whole-body Vibration on Denervated Skeletal-muscle Atrophy in Rats.

Osteoporosis and Fragility Fracture

Efficient Image Segmentation Using Morphological Watershed Algorithm

Factors associated with anticholinergic burden among older patients in long-term care hospitals in Korea