A systematic review of the provision and efficacy of patient and carer information and support (PCIS) interventions for patients with dementia and their informal carers.

BACKGROUND: The NHS dementia strategy identifies patient and carer information and support (PCIS) as a core component of gold-standard dementia care. This is the first systematic review of PCIS, performed to analyse the literature and evidence for these interventions. AIMS: To systematically review literature evaluating the effectiveness of the provision of PCIS for people with dementia and their informal carers, in inpatient and outpatient settings. METHODS: Searches of four online biomedical databases, accessed in September 2018. Studies were selected if they were: relating to people with dementia or their informal carers, based in inpatient or outpatient settings, published in English-language peer-reviewed journals no earlier than the year 2000 and assessed dementia-related information or social support interventions, by measuring qualitative or quantitative carer or patient-reported outcomes. Standardised data extraction and quality appraisal forms were used. RESULTS: 7 of 43 full-text papers analysed were eligible for analysis. 3 papers were different arms of one original study. Trends were present in the quantitative results towards reduced patient and carer depression and anxiety and the themes in the qualitative analysis were in favour of the intervention. CONCLUSIONS: The studies analysed were too heterogeneous in design, population and outcomes measured to make a conclusive opinion about the efficacy of these interventions. It is surprising that for such a common condition, a gold-standard evidence-based intervention and standardised delivery for provision of PCIS for people living with dementia in the UK does not exist. Further research is therefore vital.

A systematic review of specialist inpatient dementia care services versus standard inpatient dementia care in acute hospitals.

BACKGROUND: Specialist inpatient dementia units (SIDU) have been developed to address adverse outcomes often experienced by people living with dementia admitted to acute hospitals. However, the evidence base of their effectiveness remains limited. AIM: To review the current literature to establish the comparative effectiveness of acute hospital SIDU vs. standard ward care (SWC). METHODS: We did an online search of 12 biomedical databases from inception to 31st October 2017. Studies of inpatients with any form of dementia in acute hospitals, published in English language peer-reviewed journals, using experimental, observational or qualitative study designs, comparing SIDU with SWC and which measured any qualitative or quantitative outcome of the patient or carer experience were included in the search criteria. We used a standardised data extraction and appraisal form. RESULTS: Three of 46 full-text studies evaluated were suitable for analysis. Due to study heterogeneity, pooled odds ratios were only possible for mortality [OR 1.06 (CI 1.0-1.4)]. Otherwise, a narrative synthesis was performed. Although quantitative measures of length of stay, mortality and behavioural and psychiatric symptoms of dementia are not significantly lower, SIDU are associated with greater patient and carer satisfaction, reduced readmission rates, more accurate and comprehensive assessment processes, documentation of resuscitation decisions, and increased rates of discharge to the patient's own home. CONCLUSIONS: Although SIDU may be associated with improved care outcomes, the current evidence of their effectiveness is markedly limited. Further research and service evaluation of SIDU as a method for providing high-quality dementia care in acute NHS Trusts is needed. PROSPERO: CRD42017078364.

Discovery of Streptococcus pneumoniae serogroup 35 variants in Australian patients.

OBJECTIVES: Streptococcus pneumoniae isolates from Australian invasive pneumococcal disease cases displaying an atypical 35B phenotype. Whole genome sequencing was used to analyse these strains and identify changes to the capsule gene regions. METHODS: Four atypical serogroup 35 isolates from Australian reference laboratories were unable to be assigned to one of the four known group 35 serotypes by the Quellung serotyping method. Genetic characterization of the capsule locus was performed by bioinformatic analysis of whole genome sequencing data for all isolates. RESULTS: Genetic analysis identified four independent disruptions to the wciG gene, which encodes an O-acetyltransferase responsible for the O-acetylation of the 6Galß1 residue in the capsular polysaccharide repeat unit of serotype 35B. CONCLUSIONS: This is the first published report on the incidence and capsular gene characteristics of a S. pneumoniae 35B variant.

Molecular characterization of an Australian serotype 1 Streptococcus pneumoniae outbreak.

Serotype 1 Streptococcus pneumoniae is a cause of invasive pneumococcal disease (IPD) worldwide and has been associated with IPD outbreaks, while carriage is rarely detected in healthy adults or children. This study details an Australian multi-state and territory outbreak of serotype 1 S. pneumoniae IPD between 2010 and 2012. Molecular characterization demonstrated the outbreak was largely due to the clonal expansion of sequence type 306, MLVA type 261 S. pneumoniae serotype 1.

Growing older and wiser. Part 1--What is life all about?

This is an edited version of a presentation given at the 1999 RACGP Annual Scientific Meeting, held in Adelaide. Lady Valerie Hicks is the widow of Sir Stanton Hicks a renowned South Australian physiologist. As 1999 was the Year of the Older Person, Lady Valerie was asked for her reflections on what getting older means, the place of the older person in today's society and for her thoughts on life in general. Her erudite and thought provoking response to this task will be published over the next three issues.

Validation of near-infrared interactance and skinfold methods for estimating body composition of American Indian women.

PURPOSE: This study tested the predictive accuracy of the Jackson et al. skinfold (SKF) equations (sigma7SKF and sigma3SKF), a multi-site near-infrared interactance (NIR) prediction equation, and the Futrex-5000 NMR equation in estimating body composition of American Indian women (N = 151, aged 18-60 yr). METHODS: Criterion body density (Db) was obtained from hydrodensitometry at residual lung volume. RESULTS: Sigma7SKF significantly underestimated Db (P < 0.05). Sigma3SKF and Heyward's NIR equations significantly overestimated Db (P < 0.05). The Futrex-5000 NIR equation significantly underestimated percent of body fat (%BF) (P < 0.05). Prediction errors for SKF and multi-site NIR exceeded 0.0080 g x cc(-1). The SEE for Futrex-5000 was 5.5%BF. Thus, ethnic-specific SKF and NIR equations were developed. For the SKF model, the sigma3SKF (triceps, axilla, and suprailium) and age explained 67.3% of the variance in Db:Db = 1.06198316 -0.00038496(sigma3SKF) -0.00020362(age). Cross-validation analysis yielded r = 0.88, SEE = 0.0068 g x cc(-1), E = 0.0070 g x cc(-1), and no significant difference between predicted and criterion Db. For the NIR model, the hip circumference, sigma2AdeltaOD2 (biceps and chest), FIT index, age, and height explained 73.9% of the variance in Db:Db = 1.0707606 -0.0009865(hip circumference) -0.0369861(sigma2deltaOD2) + 0.0004167(height) + 0.0000866(FIT index) -0.0001894(age). Cross-validation yielded r = 0.85, SEE = 0.0076 g x cc(-1), E = 0.0079 g x cc(-1), and a small, but significant, difference between predicted and criterion Db. CONCLUSIONS: We recommend using the ethnic-specific SKF and NIR equations developed in this study to estimate Db of American Indian women.

The fatness-specific bioelectrical impedance analysis equations of Segal et al: are they generalizable and practical?

The fatness-specific bioelectrical impedance analysis (BIA) equations of Segal et al (Am J Clin Ntr 1988;47: 7-14; Segal equations) have been shown to be generalizable across sex, ethnicity, age, and degrees of adiposity. However, these fatness-specific equations require an a priori determination of percentage body fat (%BF) by using a skinfold equation or densitometry to categorize subjects into obese or nonobese groups. These procedures negate the use of BIA as a fast and simple method. It was hypothesized that the average of the Segal nonobese and obese fatness-specific equations (BIA average method) could be used in lieu of the skinfold method for categorizing subjects who are not obviously lean or obese. In phase 1 these three methods were compared for a subsample of 59 women who were not obviously lean or obese. The %BF of 75% of these subjects was accurately estimated within 3.5%BF by using the BIA average method whereas only 71% and 46% were accurately estimated by fusing the densitometric and skinfold methods, respectively. In phase 2, the predictive accuracy of the Segal fatness-specific equations, used in combination with the BIA average method, was compared with other BIA equations published previously for 602 American Indian, Hispanic, and white women and men. The Segal fatness-specific equations yielded the smallest prediction error (SEE = 2.22 kg for women and 3.59 kg for men) and the %BF of 70% of the subjects was accurately estimated within 3.5%BF compared with 24-59% for other BIA equations. Therefore, we recommend using the Segal fatness-specific and average equations to assess body composition in heterogeneous populations.

Prescribing patterns of antilipemic drugs and prevalence of hypercholesterolemia in the Nova Scotia population more than 65 years old.

OBJECTIVE: To examine the prevalence of antilipemic drug use, demographic characteristics of patients using these drugs, and the prevalence of hypercholesterolemia in the Nova Scotia population over 65 years of age. DESIGN: Information was collected on the prescribing of antilipemic drugs using Nova Scotia Medical Services Insurance Pharmacare program data from October 1991 through March 1992. Pharmacare data were compared with prevalence data on increased low-density lipoprotein (LDL) cholesterol concentrations obtained from the Nova Scotia Heart Health Survey (NSHHS). SETTING: Pharmacare is a centrally administered drug insurance system maintained in computerized claims files since 1974. It provides prescription drugs to all residents of Nova Scotia who are at least 65 years old and who are insured under the provincial Medicare program. PARTICIPANTS: In the 1991-1992 fiscal year, 47,000 men and 65,700 women were eligible for Pharmacare. The NSHHS was administered to a probability sample of 2,108 individuals, representative of the 1986 population aged 18-74 years. MAIN OUTCOME MEASURES: Prescriptions for antilipemic agents. RESULTS: The NSHHS data indicated that 3.7% of women and 2.3% of men at least 65 years old and 4.8% of women and 2.8% of men 65-74 years old received a prescription for antilipemic drugs.

The cholesterol-lowering properties of a psyllium-based breakfast cereal in hamsters.

Hamsters were fed high fiber diets containing cellulose, wheat bran or psyllium. The psyllium was incorporated into high fiber, ready-to-eat (RTE) flakes that were used to formulate the test diet. All the diets contained 0.125% cholesterol. The study was terminated after three weeks. Food intake, weight gain and feed efficiency were not significantly different in the three groups. Serum total and HDL cholesterol levels were reduced significantly by the psyllium diet. Serum triglycerides were 26% lower in the hamsters fed psyllium but because of the large variation the difference did not reach statistical significance. Liver total cholesterol and cholesteryl ester levels were significantly lower in the hamsters fed psyllium. Liver triglycerides were highest in the psyllium-fed hamsters and liver phospholipid levels were similar in the three groups. Liver cholesterol and triglyceride levels were higher in hamsters fed cellulose than in those fed wheat bran. Psyllium formulated into an RTE cereal was effective in reducing serum and liver cholesterol levels in hamsters.

Predictive accuracy of bioelectrical impedance in estimating body composition of Native American women.

The predictive accuracy of race-specific and fatness-specific bioelectrical impedance analysis (BIA) equations for estimating criterion fat-free mass (FFM) derived from two-component (2C) and multicomponent (MC) models was examined. Body density (Db) of Native American women (n = 151) aged 18-60 y was measured by hydrostatic weighing at residual volume. Total body bone ash was obtained by dual-energy, x-ray absorptiometry. Cross-validation of the Rising (5), Segal (3), and Gray (4) equations against FFM2C yielded high correlation coefficients (0.86-0.95) and acceptable SEEs (1.47-2.72 kg). Cross-validation of these equations against criterion FFMMC, with Db adjusted for total body mineral, yielded similar correlation coefficients (0.82-0.94) and SEEs (1.69-2.80 kg). However, each BIA equation significantly overestimated FFMMC. A new race-specific BIA equation based on an MC model was developed: FFMMC = 0.001254(HT2)-0.04904(R) + 0.1555(WT) + 0.1417(Xc) - 0.0833(AGE) + 20.05 (R = 0.864, and SEE = 2.63 kg).

Use of ophthalmologic services by diabetic patients in Nova Scotia.

To evaluate the possible public health consequences of diabetic retinopathy in Nova Scotia, we investigated the number and frequency of ophthalmologic examinations in patients with diabetes mellitus. A total of 36,683 people (4.2%) were identified from the administrative database of the provincial health department as having a diagnostic code of diabetes during the period March 1987 to February 1990. All billings by ophthalmologists for these patients during the same period were then identified. Of the 36,129 patients aged 10 years or more, 17,518 (48.5%) had seen an ophthalmologist at least once during the study period, and 5218 (14.4%) had seen an ophthalmologist approximately annually. Increased age and being female were associated in univariate logistic regression analysis with higher use of ophthalmologic services. The medical insurance system is free of direct costs to patients, and there are enough ophthalmologists to meet patient needs (4.35 per 100,000 population). The findings indicate that most diabetic patients in Nova Scotia are not seen at least once a year, as recommended by the Expert Committee of the Canadian Diabetes Advisory Board, despite ready availability of ophthalmologic care.

Body composition of Native-American women estimated by dual-energy X-ray absorptiometry and hydrodensitometry.

In the present sample, the Native-American women varied in age (18-60 y) and fatness (23.0-57.4% BF). The cross-validation analysis for %BF estimated by DXA for this sample yielded a high validity coefficient (r = 0.89), and the average %BFDXA (37.3%) and %BFHW (37.6%) did not differ significantly. The prediction error (3.28% BF) was less than the theoretical expected value, given the wide range in age and fatness in this sample. Thus, it appears that DXA may be a viable alternative method for estimating the %BF of a diverse group of Native-American women. The DXA method is more practical than hydrostatic weighing, especially for subjects who are uncomfortable in the water. Also, DXA estimates of bone mineral may lead to improved estimates of FFB density for different ethnic populations.

Relationship of optical density and skinfold measurements: effects of age and level of body fatness.

We examined relationships between skinfold (SKF) and optical density (delta OD) measurements across age and levels of body fatness (%BF) for 151 women, 20 to 72 years. There were significant (p < .05) relationships between delta ODs and SKFs at all sites, except the thigh. The interaction (SKF x Age) was significant (p < .05) for pectoral and biceps delta ODs. Slope comparisons indicated the relationships for younger (29 years) and older (59 years) women differed significantly from zero and each other (p < .05). Analysis of SKF x %BF interactions revealed that relationships between SKFs and delta ODs at the pectoral and biceps sites for leaner (22% BF) women differed significantly from zero (p < .05) and were larger than those for obese (39% BF) women (p < or = .05). Thus, the relationship between SKFs and delta ODs is stronger for younger and leaner women compared to older and fatter women. These findings may reflect differences in fat layering due to age or body fatness and provide insight as to why the manufacturer's near-infrared (NIR) equation significantly underestimates the %BF of obese women.

Predictive accuracy of three field methods for estimating relative body fatness of nonobese and obese women.

Three methods of body composition assessment were used to estimate percent body fat (%BF) in nonobese (n = 77) and obese (n = 71) women, 20-72 yrs of age. Skinfolds (SKF), bioelectrical impedance (BIA), and near-infrared interactance (NIR) methods were compared to criterion-derived %BF from hydrostatic weighing (%BFHW). Nonobese subjects had < 30% BFHW and obese subjects had > or = 30% BFHW. The Jackson, Pollock, and Ward SKF equation and the manufacturer's equations for BIA (Valhalla) and NIR (Futrex-5000) were used. For nonobese women there were no significant differences between mean %BFHW and %BFSKF, %BFBIA, and %BFNIR. The rs and SEEs were 0.65 and 3.4% BF for SKF, 0.61 and 3.6% BF for BIA, and 0.58 and 3.7% BF for NIR for nonobese subjects. For obese women, mean %BFHW was significantly underestimated by the SKF, BIA, and NIR methods. The rs and SEEs for the obese group were 0.59 and 3.4% BF for SKF, 0.56 and 3.5% BF for BIA, and 0.36 and 3.9% BF for NIR. The total errors of the equations ranged from 5.6 to 8.0% BF in the obese group. It is concluded that all three field methods accurately estimate %BF for nonobese women; however, none of the methods is suitable for estimating %BF for obese women.

Coronary heart disease knowledge test: developing a valid and reliable tool.

This study tested the validity and reliability of a written test designed to assess knowledge of coronary heart disease (CHD) and its risk factors. The subjects were 93 males diagnosed with CHD. Subjects were classified into a treatment group (n = 48) or a control group (n = 45) based on whether or not they participated in a cardiac rehabilitation program (CRP). An additional 38 subjects were used to pilot test the original form of the knowledge test, which consisted of 80 multiple-choice questions. Content validity was established by a five-member jury of cardiac rehabilitation experts. Each question was rated using a Likert-type scale. Questions that did not receive an average rating of at least four were eliminated. The revised form was pilot tested for validity and internal consistency with the discrimination index (point biserial correlation coefficient) and the Kuder-Richardson formula 20 (KR-20). Questions with a discrimination index of less than 0.14 were eliminated; thus, the final form of the test consisted of 40 questions. Validation of this test yielded difficulty ratings (DRs) between 0 percent and 98 percent, with an average DR of 63 percent. Construct validation indicated that the average test score of subjects participating in a CRP was significantly higher than that of non-participants (t = 3.51, df = 91, p less than or equal to 0.01). The internal-consistency reliability of the test was 0.84. The results indicate that this test is a valid and reliable tool for assessing patients' knowledge of CHD and its risk factors.

Modifications of the AOAC total dietary fiber method.

1. The TDF values measured by the modification showed excellent agreement with those determined by the AOAC method. 2. The estimated assay variabilities of the modification were significantly less than those of the AOAC TDF method. 3. The TDF method can be simplified with the simultaneous incubation of a sample with alpha-amylase and amyloglucosidase, followed by subsequent protease incubation without changing pH and temperature. The precision of this shortened method is comparable to that of the AOAC method.