INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of adjunct systemic corticosteroid therapy in patients admitted to the intensive care unit (ICU) with bacterial community-acquired pneumonia (CAP). METHOD: We searched MEDLINE, Embase and the Cochrane Library to identify randomised controlled trials (RCTs) published from the databases' inception to February 2024. All RCTs evaluating the effect of systemic corticosteroids on mortality, compared to standard of care among adult bacterial CAP patients admitted to ICU were included. Bayesian meta-analysis was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Independent authors reviewed each study for eligibility, extracted data and assessed risk of bias in duplicate, with discrepancies referred to senior reviewers. RESULTS: A total of 6 RCTs comprising 1585 patients were included for analysis. In ICU patients with severe CAP who were treated with corticosteroids, there was no significant reduction in hospital mortality (risk ratio [RR] 0.70, 95% confidence interval [CI] 0.39-1.14, certainty of evidence: ⊕⊕⊝⊝ low) or all-cause mortality (RR 0.68, 95% CI 0.34-1.22, ⊕⊕⊝⊝ low) compared with placebo. The use of corticosteroids showed a significant reduction in mechanical ventilation post-intervention (RR 0.58, 95% CI 0.37-0.86, ⊕⊕⊕⊕ high) compared with placebo. In a subgroup analysis of patients treated with hydrocortisone, hospital mortality was significantly reduced (RR 0.45, 95% CI 0.20-0.88, ⊕⊕⊝⊝ low) compared with placebo. There was no significant increase in gastrointestinal bleeding, secondary infections or hyperglycaemia in patients treated with corticosteroids. CONCLUSION Corticosteroids significantly reduced mechanical ventilation requirements, and hydrocor-tisone significantly reduced hospital mortality. Further work is required to determine whether other corticosteroids reduce mortality among ICU patients with CAP.
Humans ; Adrenal Cortex Hormones/therapeutic use* ; Bayes Theorem ; Community-Acquired Infections/mortality* ; Critical Illness ; Hospital Mortality ; Intensive Care Units ; Pneumonia, Bacterial/mortality* ; Randomized Controlled Trials as Topic ; Respiration, Artificial

INTRODUCTION: A voluntary cerebral palsy (CP) registry was established in 2017 to describe the clinical characteristics and functional outcomes of CP in Singapore. METHODS: People with CP born after 1994 were recruited through KK Women's and Children's Hospital, National University Hospital and Cerebral Palsy Alliance Singapore. Patient-reported basic demographics, service utilisation and quality of life measures were collected with standardised questionnaires. Clinical information was obtained through hospital medical records. RESULTS: Between 1 September 2017 and 31 March 2020, 151 participants were recruited. A majority (n=135, 89%) acquired CP in the pre/perinatal period, where prematurity (n=102, 76%) and the need for emergency caesarean section (n=68, 50%) were leading risk factors. Sixteen (11%) of the total participants had post-neonatally acquired CP. For predominant CP motor types, 109 (72%) had a spastic motor type; 32% with spastic mono/hemiplegia, 41% diplegia, 6% triplegia and 21% quadriplegia. The remaining (42, 27.8%) had dyskinetic CP. Sixty-eight (45.0%) participants suffered significant functional impairment (Gross Motor Functional Classification System levels IV-V). Most participants (n=102, 67.5%) required frequent medical follow-up (≥4 times a year). CONCLUSION Optimisation of pre- and perinatal care to prevent and manage prematurity could reduce the burden of CP and their overall healthcare utilisation.

The populations in Singapore and worldwide are ageing rapidly and poses many challenges to patients, medical professionals and the healthcare system. Recent population-based research in community-dwelling older adults in Singapore suggest that after the age of 80, impaired physical ability and cognition are two major contributors to loss of independent living. Hence, there is an urgent need to raise awareness of the importance of muscle health in older adults as one of the modifiable factors to reduce and prevent disability in later life. Good muscle health is essential to facilitate independent living for as long as possible. The SARC-F questionnaire is an ideal screening tool in the community setting for sarcopenia in older adults. For screening of low muscle mass, calf-circumference can be used in the community as a surrogate measure. Bio-electrical Impedance Analysis (BIA) and Dual-Energy X-ray Absorptiometry (DEXA) can be used to assess appendicular skeletal muscle mass index (ASMI) in the community and hospital setting respectively. Low ASMI with low muscle strength leads to the diagnosis of sarcopenia. Severe sarcopenia is diagnosed when all three of low muscle mass, low muscle strength and low physical performance are present. Muscle health is intimately linked with nutritional health and physical activity. Risk of malnutrition in older adults can be rapidly screened using Malnutrition Universal Screening Tool (MUST) in both inpatient and outpatient settings. For best outcomes, a combined multidisciplinary approach using targeted progressive resistance exercise training (RET) and provision of adequate protein, energy and replacement of any underlying Vitamin D deficiency is required. Efforts are urgently required to raise awareness and knowledge on the importance of muscle health, and its impact on function and clinical outcomes in older people.

The phenomenon of age-related loss of muscle mass and strength was named sarcopenia in 1988 by Rosenberg. Since then, sarcopenia has evolved to include the loss of muscle function in the definition. Sarcopenia has a high prevalence in specific clinical conditions and in the older population and can lead to significant morbidity, poor recovery from adverse events and ultimately, institutionalisation. In spite of the severe health care burden posed, the diagnosis and treatment of sarcopenia have yet to become standard care. Emerging consensus on definition and diagnosis by the international work groups on sarcopenia with tailored population-based cut-offs and growing evidence-based management options will facilitate the meeting of these needs.

Rehabilitation medicine is the medical specialty that integrates rehabilitation as its core therapeutic modality in disability management. More than a billion people worldwide are disabled, and the World Health Organization has developed the International Classification of Functioning, Disability and Health as a framework through which disability is addressed. Herein, we explore paradigm shifts in neurorehabilitation, with a focus on restoration, and provide overviews on developments in neuropharmacology, rehabilitation robotics, virtual reality, constraint-induced therapy and brain stimulation. We also discuss important issues in rehabilitation systems of care, including integrated care pathways, very early rehabilitation, early supported discharge and telerehabilitation. Finally, we highlight major new fields of rehabilitation such as spasticity management, frailty and geriatric rehabilitation, intensive care and cancer rehabilitation.
Disability Evaluation ; Disabled Persons ; classification ; rehabilitation ; Humans ; Practice Guidelines as Topic ; Rehabilitation ; methods ; standards ; trends ; World Health Organization