Identification of risk factors for postoperative delirium in patients following intraoral reconstruction with microvascular free flaps: a matched-pair analysis.

Postoperative delirium (POD) following microvascular head and neck reconstruction negatively impacts patient outcomes, and only a few risk factors have been identified. The aim of this study was to identify additional risk factors for POD after intraoral reconstruction with microvascular free flaps. Data from 377 patients who underwent intraoral microvascular free flap reconstruction between 2011 and 2019 were analysed retrospectively. Preoperative, intraoperative, and postoperative variables were compared between 40 patients with POD and 40 patients without POD who were matched for previously identified risk factors (i.e., sex, age, American Society of Anesthesiologists class, preoperative arterial hypertension, tracheotomy, operation time, and blood transfusion). A multivariable regression analysis was then performed to identify risk factors associated with POD. POD occurred in 50 (13.3%) of the 377 cases studied; the median time of onset was postoperative day 2. Excessive preoperative alcohol consumption (odds ratio 9.22, 95% confidence interval 1.09-77.97; P = 0.041) and postoperative transplant revision (odds ratio 25.72, 95% confidence interval 1.26-525.43; P = 0.035) were identified as risk factors for POD. The identification of patients at high risk of POD based on these two risk factors may allow early adjustment of diagnostic and therapeutic modalities to improve outcomes and reduce healthcare costs.

Evaluation of anterolateral thigh flap dimensions with virtual flap models.

Free flaps are commonly used for head and neck reconstruction. However, flap dimensions are still evaluated by visual and tactile assessment. The aim of this study was to enable preoperative planning of flap dimensions for soft tissue reconstruction based on clinical parameters. Computed tomography records from 230 patients dated from 2009 to 2019 were analysed retrospectively. A virtual, three-dimensional anterolateral thigh flap model was standardized, aligned to segmented leg models in two positions, and flap thicknesses and volumes were determined. Associations of flap thickness and volume with clinical parameters were evaluated, and an approximative calculation method was derived. The laterally positioned anterolateral thigh flap showed an average (interquartile range) thickness of 15.6 mm (8.7 mm) and volume of 1.5 cm3 (0.9 cm3) per cm2. The medially positioned anterolateral thigh flap showed an average (interquartile range) thickness of 16.3 mm (8.7 mm) and volume of 1.6 cm3 (0.9 cm3) per cm2. For both flap positions, leg circumference was the strongest predictor of flap thickness (ß = 0.545, P < 0.001 and ß = 0.529, P < 0.001) and flap volume (ß = 0.523, P < 0.001 and ß = 0.480, P < 0.001). Flap dimensions can be calculated based on leg circumference, and this preoperative planning of flap dimensions can help the surgeon to select the appropriate flap.

Perfusion of microvascular free flaps in head and neck reconstruction after prior neck dissection and irradiation.

Microvascular free flaps are frequently used for head and neck reconstruction after prior neck dissection (ND) and neck irradiation (RTX). The aim of this study was to investigate the influence of ND and RTX on flap perfusion as a critical factor for flap success. Overall, 392 patients reconstructed with a microvascular fasciocutaneous flap (FF) or perforator flap (PF) in the head and neck region between 2011 and 2020 were analysed retrospectively. Flap perfusion measured intraoperatively and postoperatively with the O2C tissue oxygen analysis system was compared between patients who had received neither ND nor RTX (controls), patients who had received ND but no RTX (ND group), and patients who had received both ND and RTX (ND+RTX group). Intraoperative and postoperative flap blood flow was decreased in FFs in ND group patients compared to controls (median 66.3 AU vs 86.0 AU, P = 0.023; median 73.5 AU vs 93.8 AU, P = 0.045, respectively). In the multivariable analysis, these differences showed a tendency to persist (P = 0.052 and P = 0.056). Flap success rates were similar in control patients, ND patients, and ND+RTX patients (98.7%, 94.0%, and 97.6%, respectively). Flap perfusion is not reduced in FFs and PFs in patients who have undergone ND or ND and RTX. This indicates that neck dissection and neck irradiation should not be contraindications for microvascular free flap reconstruction.

Interaction between eggshell temperature and carbon dioxide concentration after day 8 of incubation on broiler chicken embryo development.

Carbon dioxide (CO2) is considered to be an important factor during incubation of eggs. Effects attributed to higher CO2 concentrations during experiment might be due to confounding effects of other environmental conditions, such as incubation temperature. To disentangle effects of eggshell temperature (EST) and CO2 concentration, an experiment was conducted. A total of 630 Cobb 500 hatching eggs from 37 to 45 wk commercial breeder flocks were collected and incubated according to treatments. The experiment was setup as a complete randomized 2 × 3 factorial design, resulting in 6 treatments. From day 8 of incubation onward, broiler eggs were exposed to one of two EST (37.8 or 38.9 °C) and one of three CO2 concentrations (0.1, 0.4 or 0.8%). Eggs were incubated in climate-respiration chambers and metabolic heat production was determined continuously. At day 18 of incubation and at 6 h after hatching, embryo and chicken quality were determined by evaluation of organ weights, navel condition, blood metabolites and hepatic glycogen. Hatching time and chicken length at 6 h after hatching showed an interaction between EST and CO2 concentration (both P = 0.001). Furthermore, no effect of CO2 concentration was found on embryo development or chicken quality. Metabolic heat production between day 8 and 18 of incubation was not affected by either EST or CO2. At day 18 of incubation, an EST of 38.9 °C resulted in a higher egg weight loss, longer embryos, higher yolk free body mass (YFBM) and lower heart weight than an EST of 37.8 °C (all P < 0.008). At 6 h after hatching, an EST of 38.9 °C resulted in a higher residual yolk weight and lower YFBM, liver weight and heart weight than an EST of 37.8 °C (all P < 0.003). Lactate, uric acid and hepatic glycogen were not affected by EST at either day 18 of incubation or at hatch. Glucose was not affected by EST at day 18 of incubation, but at hatch, it was higher at an EST of 37.8 °C than at an EST of 38.9 °C (P = 0.02). It can be concluded that effects of CO2 concentration (at concentrations ≤0.8%) on embryonic development and chicken quality appear to be limited when EST is maintained at a constant level. Moreover, a higher EST from day 8 of incubation onward appears to negatively affect chicken quality at hatch.

Changes in the temporomandibular joint position depending on the sagittal osteotomy technique and extent of mandibular movement.

The bilateral sagittal split osteotomy (BSSO) and high oblique sagittal split osteotomy (HSSO) are common techniques for mandibular movement in orthognathic surgery. The aim of this study was to evaluate the influence of both techniques, as well as movement distances and directions, on the position of the temporomandibular joint (TMJ). A total of 80 mandibular movements were performed on 20 fresh human cadaver heads, four on each head. Pre- and postoperative cone beam computed tomography was used to plan the surgical procedure and analyse the TMJ. Reference measurements included the anterior, superior, and posterior joint spaces, intercondylar distances and angles in the axial and coronal planes, and the sagittal, coronal, and axial angulations of the proximal segment. Only minor differences were found between the BSSO and HSSO techniques, particularly in terms of the intercondylar angle in the axial plane (P < 0.03) and the condylar angle of the proximal segment in the sagittal plane (P < 0.011). Observed changes in the TMJ were mostly opposite when moving the mandible forwards and backwards and increased with increasing movement distance. BSSO and HSSO result in similar changes in TMJ position. The extent of the movement distance influences the position of the condyle more than the osteotomy technique.

Both the rooster line and incubation temperature affect embryonic metabolism and hatchling quality in laying hen crossbreds.

Effects of 3 eggshell temperatures (EST; 36.7. 37.8, and 38.9°C) in 2 genetic laying hen crossbreds (AB and BB; same hen line, different rooster line) on embryonic metabolism and hatchling quality were investigated. EST were applied from day 14.5 of incubation (E14.5) until hatching. The experiment consisted of 6 consecutive batches with eggs weighing between 59 and 61 g. Heat production was determined continuously from E14.5 onward. In fresh eggs, yolk weight tended to be higher (Δ = 0.28 g; P = 0.08) in the AB crossbred than in the BB crossbred. At E14.5 and E18.5, yolk-free body mass (YFBM) and residual yolk (RY) weight did not differ between genetic crossbred and EST. Hatching time after the start of incubation was not affected by genetic crossbred, but was longer in the 36.7°C (517 h) than in the 38.9°C (505 h), with 37.8°C in between (506 h). At 6 h after hatching, no differences between crossbreds were found for chicken quality parameters, such as chicken weight, chicken length, RY, YFBM, and organ weights, but heart weight was higher in the 36.7°C EST than in the other 2 EST (Δ = 0.24 to 0.30% of YFBM, P = 0.005). Intestinal weight was higher at 36.7°C EST than at 38.9°C EST (Δ = 0.79% of YFBM; P = 0.02), with 37.8°C EST in between. Heat production between E14.5 and E18.5 was higher in the AB crossbred than in the BB crossbred (Δ = 2.61%, P < 0.001) and regardless of crossbred higher at an EST of 38.9°C than at other 2 EST (Δ = 3.59% on average; P < 0.001). Hatchling quality determined at pulling (E21.5) was not affected by EST, but AB chickens were lighter (Δ = 0.46 g; P = 0.03), had less red hocks (Δ = 0.03; P = 0.02), more red beaks (Δ = 0.10; P < 0.001), and a higher (worse) navel score (Δ = 0.11; P < 0.001) than BB chickens. It can be concluded that not only incubation temperature, but also the rooster line appears to play a role in layer crossbred embryo metabolism and hatchling quality.

[Vitamin D supplementation in the elderly: guidelines and practice]. / Vitamine D-suppletie bij ouderen: advies en praktijk.

OBJECTIVE: In 2008, the Health Council of the Netherlands published an advice on vitamin D supplementation for the elderly. Nevertheless, suspicion arose at the Ministry of Health, Welfare and Sport and the Netherlands Nutrition Centre that vitamin D supplementation in the elderly is still insufficient. We aimed to determine the extent to which general practitioners and elderly care physicians actually followed the advice of the Health Council. DESIGN: Questionnaire study. METHOD: Brief questionnaires were sent to all elderly care physicians in the Netherlands. Some questions were also posed to general practitioners at a network meeting of the Academic Network of GP Practices of the VU University Medical Center in Amsterdam. RESULTS: More than two-thirds of the respondents, both elderly care physicians and general practitioners, are familiar with the guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly, but about half do not prescribe vitamin D when the guideline advises to do so. When supplementation is prescribed, about half of the elderly care physicians and a fifth of the general practitioners uses an insufficient dose. CONCLUSION: The guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly are not sufficiently followed by elderly care physicians and general practitioners. Awareness of and support for the vitamin D supplementation guidelines among health care providers is still limited.

Preclinical evaluation of [(18)F]JNJ42259152 as a PET tracer for PDE10A.

Phosphodiesterase-10A (PDE10A) is implicated in several neuropsychiatric disorders involving basal ganglia neurotransmission, such as schizophrenia, obsessive-compulsive disorder and Huntington's disease. To confirm target engagement and exposure-occupancy relationships of clinical candidates for treatment, and to further explore the in vivo biology of PDE10A, non-invasive imaging using a specific PET ligand is warranted. Recently we have reported the in vivo evaluation of [(18)F]JNJ41510417 which showed specific binding to PDE10A in rat striatum, but with relatively slow kinetics. A chemically related derivative JNJ42259152 was found to have a similar in vivo occupancy, but lower lipophilicity and lower PDE10A in vitro inhibitory activity compared to JNJ41510417. (18)F-labeled JNJ42259152 was therefore evaluated as a potential PDE10A PET radiotracer. Baseline PET in rats and monkey showed specific retention in the PDE10A-rich striatum, and fast wash-out, with a good contrast to non-specific binding, in other brain regions. Pretreatment and chase experiments in rats with the selective PDE10A inhibitor MP-10 showed that tracer binding was specific and reversible. Absence of specific binding in PDE10A knock-out (KO) mice further confirmed PDE10A specificity. In vivo radiometabolite analysis using high performance liquid chromatography (HPLC) showed presence of polar radiometabolites in rat plasma and brain. In vivo imaging in rat and monkey further showed faster brain kinetics, and higher striatum-to-cerebellum ratios for [(18)F]JNJ42259152 compared to [(18)F]JNJ41510417. The arterial input function corrected for radiometabolites was determined in rats and basic kinetic modeling was established. For a 60-min acquisition time interval, striatal binding potential of the intact tracer referenced to the cerebellum showed good correlation with corresponding binding potential values of a Simplified Reference Tissue Model and referenced Logan Plot, the latter using a population averaged reference tissue-to-plasma clearance rate and offering the possibility to generate representative parametric binding potential images. In conclusion we can state that in vivo imaging in PDE10A KO mice, rats and monkey demonstrates that [(18)F]JNJ42259152 provides a PDE10A-specific signal in the striatum with good pharmacokinetic properties. Although presence of a polar radiometabolite in rat brain yielded a systematic but reproducible underestimation of the striatal BPND, a Logan reference tissue model approach using 60 min acquisition data is appropriate for quantification.

Prevention and treatment of vitamin D deficiency in Dutch psychogeriatric nursing home residents by weekly half-body UVB exposure after showering: a pilot study.

BACKGROUND: in older people, induction of cutaneous vitamin D production by ultraviolet B (UVB) exposure may be preferable to oral supplementation: it cannot cause toxic levels, it helps to prevent polypharmacy and, moreover, there are indications that UVB exposure has beneficial effects on health and well being by mechanisms other than the vitamin D pathway alone. OBJECTIVE: the aim of this pilot study is to investigate whether weekly, half-body, UVB irradiation after showering can increase serum 25-hydroxyvitamin D (25(OH)D) to sufficient levels, in a Dutch psychogeriatric nursing home population. METHOD: subjects were eight psychogeriatric nursing home patients, mean age: 79 ± 8. Exclusion criteria were going outdoors into the sun more than once a week, the presence of actinic or cancer skin lesions and known resistance to body contact. The intervention consisted of weekly half-body UVB irradiation, after showering, over 8 weeks, with 0.5 minimal erythemal dose (MED). Main outcome measures were change in fasting serum levels of 25(OH)D and parathyroid hormone (PTH) at 0, 2, 4 and 8 weeks. RESULTS: at baseline, mean serum 25(OH)D was 28.5 nmol/l. Mean serum 25(OH)D levels increased to 46.5 nmol/l. Median serum PTH levels decreased by 20% after 8 weeks of treatment. CONCLUSION: an 8 week course of weekly, frontal half-body irradiation with UVB, at 0.5 MED, leads to an significant increase in 25(OH)D serum levels, but this period is too short to reach vitamin D sufficiency.

Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents.

UNLABELLED: The effect of equivalent oral doses of vitamin D3 600 IU/day, 4200 IU/week and 18,000 IU/month on vitamin D status was compared in a randomized clinical trial in nursing home residents. A daily dose was more effective than a weekly dose, and a monthly dose was the least effective. INTRODUCTION: It is assumed that equivalent daily, weekly or monthly doses of vitamin D3 equally influence vitamin D status. This was investigated in a randomized clinical trial in nursing home residents. METHODS: The study was performed in ten nursing homes including 338 subjects (76 male and 262 female), with a mean age of 84 (+/- SD 6.3 years). They received oral vitamin D3 either 600 IU/day, or 4200 IU/week, or 18,000 IU/month or placebo. After 4 months, calcium was added during 2 weeks, 320 mg/day or 640 mg/day or placebo. OUTCOME: serum levels of 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH) and bone turnover markers. Statistical approach: linear multilevel analysis. RESULTS: At baseline, mean serum 25(OH)D was 25.0 nmol/L (SD 10.9), and in 98%, it was lower than 50 nmol/L. After 4 months, mean serum 25(OH)D levels increased to 62.5 nmol/L (after daily vitamin D3 69.9 nmol/L, weekly 67.2 nmol/L and monthly 53.1 nmol/L, P < 0.001 between groups). Median serum PTH levels decreased by 23% (p < 0.001). Bone turnover markers did not decrease. Calcium supplementation had no effect on serum PTH and bone turnover. CONCLUSION: Daily vitamin D was more effective than weekly, and monthly administration was the least effective.

Increased mucosal matrix metalloproteinase-1, -2, -3 and -9 activity in patients with inflammatory bowel disease and the relation with Crohn's disease phenotype.

BACKGROUND AND OBJECTIVE: Matrix metalloproteinases are associated with matrix turnover in both physiological and pathological conditions. We postulate an association between aberrant matrix metalloproteinases proteolytic activity and the intestinal tissue destruction, seen in patients with Crohn's disease and/or ulcerative colitis. MATERIALS AND METHODS: Surgically resected inflamed and non-inflamed ileum and colon with/without extensive fibrosis from 122 Crohn's disease, 20 ulcerative colitis and 62 control patients were homogenized. Protein levels of matrix metalloproteinases and tissue inhibitor of metalloproteinases were measured by enzyme-linked immunosorbent assays (ELISA), while matrix metalloproteinases and myeloperoxidase activity were measured by specific activity assays. RESULTS: Expression of total levels of matrix metalloproteinases-1, -2, -3 and -9 relative to tissue inhibitor of metalloproteinases-1 and -2 was increased in inflamed inflammatory bowel disease compared to non-inflamed inflammatory bowel disease and control intestinal mucosa. Also, net matrix metalloproteinases-1, -2, -3 and -9 activity in inflamed inflammatory bowel disease was increased, with similar expression profiles in Crohn's disease and ulcerative colitis. Within inflamed inflammatory bowel disease, a close correlation of matrix metalloproteinases with myeloperoxidase was observed. The expression of matrix metalloproteinases and tissue inhibitor of metalloproteinases was similar in inflamed Crohn's disease tissue with or without extensive fibrosis and not related to fistulizing disease. CONCLUSIONS: We have shown increased net matrix metalloproteinases activity in intestinal inflammatory bowel disease tissue, likely to contribute to the tissue damage and remodelling seen in inflammatory bowel disease.

[Degree of discomfort following the decision to discontinue artificial nutrition and hydration in institutionalised psychogeriatric patients with severe dementia who no longer or scarcely eat or drink]. / Mate van onwelbevinden bij psychogeriatrische patiënten met vergevorderde dementie, die zelf niet of nauwelijks meer eten of drinken, bij wie in het verpleeghuis is besloten afte zien van kunstmatige toediening van voedsel en vocht.

OBJECTIVE: To determine the level and course of discomfort after the decision was made to forgo artificial nutrition and hydration (ANH) in nursing home patients with severe dementia who scarcely or no longer eat and drink. DESIGN: Longitudinal questionnaire investigation. METHOD: In a prospective, longitudinal, observational study conducted in 32 Dutch nursing homes, discomfort was measured in 178 patients using the observational 'Discomfort scale for patients with dementia of the Alzheimer type' (DS-DAT) at various time points: on the day of the decision to discontinue ANH and 2, 5, 9, 14 and 42 days thereafter. Data on factors that may have influenced the degree of discomfort were also collected at all time points. RESULTS: The decision to forgo ANH occurred most often in severely demented female patients with an acute illness. Overall, 134 patients (75%) died within 1-2 weeks after the decision. The mean level ofdiscomfort was highest on the day of the decision and decreased thereafter. However, the degree of discomfort differed substantially among patients. The presence of dyspnoea, restlessness, and physician-observed pain and dehydration were associated with higher levels of discomfort. Patients who were awake had higher levels of observed discomfort than patients who were asleep. CONCLUSION: Discontinuing ANH in patients with severe dementia who scarcely or no longer eat or drink was not generally associated with high levels of discomfort and therefore appears to be an acceptable decision. The individual differences emphasise the need for constant attention to distressful symptoms.

[Chronic pain in dementia and in disorders with a high risk for congnitive impairment]. / Chronische pijn bij dementie en bij aandoeningen met een verhoogd risico op cognitieve achteruitgang.

Ageing increases the risk for the etiology of chronic pain and dementia. hence, the increase in the number of elderly people implies that the number of elderly with dementia suffering from chronic pain will increase as well. A key question relates to if and how patients with dementia perceive pain. the inadequateness of pain assessment, particularly in a more advanced stage, is also reflected in a decreased use of analgesics by elderly people with dementia. Insight into possible changes in pain experience as have been observed in the few available clinical studies, could be enhanced by knowledge about the neuropathology which may differ per subtype of dementia. It is striking that pain has not been examined in degenerative diseases of the central nervous system with a high risk for cognitive impairment such as Parkinson's disease and multiple sclerosis. In these disorders, pain is a prominent clinical symptom and to date it is not known whether the experience of pain will change in a stage in which patients become cognitively impaired. Finally, a number of instruments which are most appropriate to assess pain in communicative and non-communicative patients are discussed.

Down and drowsy? Do apathetic nursing home residents experience low quality of life?

This cross-sectional study investigated the relationship between apathy and quality of life (QOL) in nursing home residents (n = 227). In all, 92 residents could be assessed with the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Philadelphia Geriatric Centre Morale Scale (PGCMS), and were able to answer a question about overall subjective QOL. Apathetic behaviour and consciousness disorders were measured with the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). Linear regression analysis was first applied to study the association of cognition, depression and consciousness with apathy. It was then used to study the relationship between apathy and QOL, controlling for the constructs that were associated with apathy. The relationship between apathy and QOL appeared to vary with the cognitive functioning of the residents: In residents with a low level of cognitive functioning, apathetic behaviour was associated with high QOL; in residents with a higher level of cognitive functioning, apathetic behaviour was associated with low QOL. The necessity and nature of interventions aimed at stimulating apathetic residents may depend on the level of cognitive functioning of the residents. Further research is needed to determine if and when apathy interventions are appropriate.

Chronische pijn bij dementie en bij aandoeningen met een verhoogd risico op cognitieve achteruitgang.

Chronic pain in dementia and in disorders with a high risk for cognitive impairment. Ageing increases the risk for the etiology of chronic pain ánd dementia. Hence, the increase in the number of elderly people implies that the number of elderly with dementia suffering from chronic pain will increase as well. A key question relates to if and how patients with dementia perceive pain. The inadequateness of pain assessment, particularly in a more advanced stage, is also reflected in a decreased use of analgesics by elderly people with dementia. Insight into possible changes in pain experience as have been observed in the few available clinical studies, could be enhanced by knowledge about the neuropathology which may differ per subtype of dementia. It is striking that pain has not been examined in degenerative diseases of the central nervous system with a high risk for cognitive impairment such as Parkinson's disease and multiple sclerosis. In these disorders, pain is a prominent clinical symptom and to date it is not known whether the experience of pain will change in a stage in which patients become cognitively impaired. Finally, a number of instruments which are most appropriate to assess pain in communicative and non-communicative patients are discussed.

Finding a useful conceptual basis for enhancing the quality of life of nursing home residents.

In this article it is depicted that before nursing home staff can effectively contribute to optimising the quality of life (QOL) of nursing home residents, it has to be clear what exactly QOL is and how it can be enhanced. The aim is to identify a QOL framework that provides tools for optimising QOL and can form the basis for the development of guidelines for QOL enhancement. For that purpose, a framework should meet three basic criteria: (1) it should be based on assumptions about comprehensive QOL of human beings in general; (2) it should clearly describe the contribution of each dimension to QOL and identify relationships between the dimensions; (3) it should take individual preferences into account. After the criteria are defined, frameworks identified from a literature search are discussed and evaluated according to these criteria. The most suitable framework appears to be the QOL framework of the theory of Social Production Functions. The implications of this framework in understanding the QOL of nursing home residents are described and recommendations for further research are discussed.

A fast and accurate method to measure both oxidative stress and vitality in a single organ slice.

Increased oxidative stress does not necessarily cause an organ to suffer from oxidative damage, since antioxidant systems to protect organs are present. However, when a decrease in the vitality of an organ coincides with an increase in oxidative stress, increased oxidative damage is likely. A sequential method for the measurement of both energy status and oxidative stress in the same sample has been developed. The novelty of this method lies in the combination of efficiency and accuracy. Nucleotides and malondialdehyde (MDA) of 80 different samples can be released in a perchloric environment with ultrasonic treatment instead of homogenization. Malondialdehyde concentration can be measured after complexing with 2,4-dinitrophenylhydrazine without any homogenization, solvent phase extraction, and centrifugation steps. Yields of both malondialdehyde and nucleotides were similar to those of the homogenization procedure. Detection limit was 141 fmol for MDA and 22.5 pmol for the nucleotides. Furthermore, the stability of the malondialdehyde-2,4-dinitrophenylhydrazine complex after 3 weeks at -20 degrees C is excellent 99.7% (+/-5.6). Nucleotides are stable for the same time period. Spiking of samples with MDA and nucleotides showed good recoveries (102.5% (+/-5.0) and 99.8% (+/-7.9), respectively). The present data show an accurate method to measure both the energy status and the oxidative stress in a single organ slice with a minimum of effort and time.

Repeated pain assessment in Alzheimer's disease.

In previous studies, patients with probable Alzheimer's disease (AD) have indicated that they experienced less pain intensity and affect from their painful conditions than nondemented elderly persons. However, in those studies, pain assessment occurred only once. Therefore, it may be possible that pain which had occurred, for example, a day earlier, could have been forgotten. Therefore, in the present study, AD patients' pain was assessed daily, i.e. once a day and even three times a day, during a longer period. The results parallel those of earlier studies, i.e. compared to elderly persons without dementia, AD patients appear to perceive less pain intensity and pain affect. These findings support the hypothesis that AD is characterized by an alteration in pain experience.

Effects of the implementation of the Resident Assessment Instrument on gaps between perceived needs and nursing care supply for nursing home residents in the Netherlands.

This study evaluated the effects of the implementation of the Resident Assessment Instrument (RAI) on gaps perceived between residents' needs and nursing care received in Dutch nursing homes. In a controlled group design residents were interviewed before and after the implementation. Most gaps were perceived in the psycho-social area rather than physical or needs with aids and facilities. In general, perceived gaps decreased more strongly in the experimental group. The results give an indication that assessment using RAI leads to a better meeting of the residents' perceived needs. More research is needed to investigate the quality of the assessment using RAI in more detail.

Decisions to treat or not to treat pneumonia in demented psychogeriatric nursing home patients: evaluation of a guideline.

We evaluated a new guideline, in the form of a "checklist of considerations," to support end-of-life decision making in the treatment of demented patients with pneumonia. Questionnaires were sent to nursing home physicians (NHPs) in The Netherlands at three times: before implementation of the checklist (concerning 91 individual patients), during use of the checklist (concerning another 107 individual patients), and after data collection (concerning the targeted patient category of demented nursing home patients with pneumonia as a whole). In the last questionnaire, one NHP from each nursing home (n = 55 NHPs) gave his or her general opinion about the checklist. We measured the usefulness of the checklist in supporting decision making and its frequency of actual use. The NHPs accepted the contents of the checklist for use in the targeted patient category. It was used in 46% of the incident cases of pneumonia. The checklist was considered more useful in supporting decision making for the targeted patient category (85% of the NHPs) than for the individual patient (47%). Possible explanations for this discrepancy in "usefulness" include the difference in the nature of the outcome measures and the fact that the checklist was used more frequently for the "easier cases." Information on individual patient level, patient category level, and nursing home and NHP characteristics is used to suggest checklist improvements.