The Computerized Cognitive Composite (C3) in an Alzheimer's Disease Secondary Prevention Trial.

BACKGROUND: Computerized cognitive assessments may improve Alzheimer's disease (AD) secondary prevention trial efficiency and accuracy. However, they require validation against standard outcomes and relevant biomarkers. OBJECTIVE: To assess the feasibility and validity of the tablet-based Computerized Cognitive Composite (C3). DESIGN: Cross-sectional analysis of cognitive screening data from the A4 study (Anti-Amyloid in Asymptomatic AD). SETTING: Multi-center international study. PARTICIPANTS: Clinically normal (CN) older adults (65-85; n=4486). MEASUREMENTS: Participants underwent florbetapir-Positron Emission Tomography for Aß+/- classification. They completed the C3 and standard paper and pencil measures included in the Preclinical Alzheimer's Cognitive Composite (PACC). The C3 combines memory measures sensitive to change over time (Cogstate Brief Battery-One Card Learning) and measures shown to be declining early in AD including pattern separation (Behavioral Pattern Separation Test- Object- Lure Discrimination Index) and associative memory (Face Name Associative Memory Exam- Face-Name Matching). C3 acceptability and completion rates were assessed using qualitative and quantitative methods. C3 performance was explored in relation to Aß+/- groups (n=1323/3163) and PACC. RESULTS: C3 was feasible for CN older adults to complete. Rates of incomplete or invalid administrations were extremely low, even in the bottom quartile of cognitive performers (PACC). C3 was moderately correlated with PACC (r=0.39). Aß+ performed worse on C3 compared with Aß- [unadjusted Cohen's d=-0.22 (95%CI: -0.31,-0.13) p<0.001] and at a magnitude comparable to the PACC [d=-0.32 (95%CI: -0.41,-0.23) p<0.001]. Better C3 performance was observed in younger, more educated, and female participants. CONCLUSIONS: These findings provide support for both the feasibility and validity of C3 and computerized cognitive outcomes more generally in AD secondary prevention trials.

Health-related quality of life, emotional burden, and neurocognitive function in the first generation of metastatic melanoma survivors treated with pembrolizumab: a longitudinal pilot study.

PURPOSE: The aim of this study was to assess the evolution of health-related quality of Life (HRQoL), emotional burden, and neurocognitive function in the first-generation metastatic melanoma survivors treated with pembrolizumab. METHODS: Survivors were defined as patients who achieved a durable remission for at least 6 months after initiating pembrolizumab in a single-center observational study (N = 141). A semi-structured interview was performed at baseline. Neurocognitive computerized testing and patient-reported outcomes were collected at 4 time points to assess HRQoL using the EORTC QLQ-C30 and the HADS to assess anxiety and depression. RESULTS: Out of 35 eligible patients, 25 were recruited and completed baseline assessment (18 female; median age 58 years [range 28-86]; 24 completed the 1-year follow-up phase. Median time since diagnosis was 30 months (range 12-84); median time since initiation of pembrolizumab was 19 months (range 6-42). At all visits, survivors reported a significantly lower global HRQoL, lower physical, emotional, cognitive, role, and social functioning compared with the European Mean of the healthy population. Fifteen patients (64%) had clinical levels of anxiety/depression at one time point during follow-up. The clinical interview revealed that 12 patients (48%) suffered from Cancer-Related-Post-Traumatic-Stress disorder, of whom 7 (28%) developed transient suicidal ideation, 1 patient made a suicide attempt. Neurocognitive testing revealed cognitive impairment in 8 patients (32%). CONCLUSIONS: Metastatic melanoma survivors, treated successfully with pembrolizumab, are at risk for suffering from emotional distress and neurocognitive impairment with a persistent impact on their HRQOL. Timely detection in order to offer tailored care is indicated.

Undergraduate students' evaluation and reflections on a gerodontology programme.

INTRODUCTION: Many societies have observed a steady increase of many older adults living longer due to advancements in health and standard of living. The dental team requires specialised training in gerodontology to better prepare for the future needs of the elderly patients. It is the aim of this study to report the undergraduate students' activities and perspectives on their work experience in a geriatric residence. MATERIALS AND METHODS: An anonymous online questionnaire on the theoretical and practical aspects of training was sent to students in dentistry and dental hygiene (DH) undergraduate courses. Students were also invited to discuss their experiences. Data of clinical treatment performed by the students were collected. The number of clinical hours of student exposure to patients was measured. RESULTS: Completion of the questionnaire was high (90%). Both DH and dentistry students have in excess of 100 hours/y of clinical practice. Overall students rate their experience as a positive one that enriches patients' well-being. However they identify barriers to oral health and experience challenges related to their clinical work and level of competence (Kruskal-Wallis Test P < .05). CONCLUSIONS: study participants were strongly motivated towards the management of frail older adults and cognisant of the barriers and constraints of achieving a reasonable level of oral health. Gerodontology programmes should be adaptable in order to create the appropriate environment and address socio-emotional challenges experienced by students.

Nurse provision of support to help inpatients quit smoking.

Issue addressed Identification of the factors that facilitate nurses to provide smoking cessation advice to hospitalised patients. Method Six semistructured focus groups with 26 nurses were conducted in June 2015. Participants completed a structured survey to collect patient demographic data and assess attitudes towards their role in addressing smoking cessation among inpatients. Results Important themes that emerged from the qualitative data were: nurses' negative perceptions of smokers, nurses' confidence in their knowledge of smoking cessation care and nurses' uncertainty around whose role it is to provide smoking cessation care. Conclusion Nurses require training in order to confidently and competently address smoking among inpatients as part of routine care. Formal ways to document the smoking status of inpatients and the offer of smoking cessation support from a nurse to an inpatient would enhance the communication between nurses around which inpatients had been asked about their smoking status and which had not. For patients who are resistant to conventional cessation strategies, innovative ways are needed to reduce the harm caused to them by tobacco use. So what? Nurses need to be provided with education and training around smoking cessation to increase their confidence and skills to provide smoking cessation care to inpatients.

Cardiac changes in subclinical and overt hyperthyroid women: retrospective study.

BACKGROUND: This retrospective and descriptive 4-year study was undertaken to describe cardiac changes in subclinical and overt hyperthyroidism. METHODS: We revised the charts of 386 consecutive cardiopathic women whose blood samples were referred to the Radioimmunoassay Laboratory to evaluate thyroid function from 1 January 1997 through 31 December 2000. RESULTS: After excluding women because euthyroid or hypothyroid, or taking amiodarone and women with hypertension, rheumatic disease, myocardial infarction, a total of 31 hyperthyroid women were thus selected for the study: 19 with subclinical hyperthyroidism and 12 with overt hyperthyroidism. The prevalence of atrial fibrillation did not differ between subclinical (48%) and overt (67%) hyperthyroid women, as well as left atrial dimension; the latter was larger in hyperthyroid (27.8+/-7.8 cm(2)/m(2)) than in control women (18.9+/-2.8 cm(2)/m(2)) (P<0.001). In the subclinical and overt hyperthyroidism, the heart rate (HR) was increased and left ventricular end diastolic (LVED) volume was reduced; in addition, only in overt hyperthyroidism, left ventricular (LV) mass was increased. A significant correlation between LV mass and free triiodothyronine was found. CONCLUSION: HR increase and LVED decrease, both in subclinical and overt hyperthyroidism, indicate a global impairment of diastolic heart performance, complicated in overt hyperthyroidism by LV concentric hypertrophy. So, in our opinion, subclinical hyperthyroidism, far from being considered a simple laboratory finding, in clinical practice should be taken into serious consideration.

The implications of visual impairment in an elderly population in recognizing oral disease and maintaining oral health.

The incidence of impairment and disability increases in the elderly population. Disability can affect elderly people's ability to maintain oral health, maintain access to dental care, and accept dental treatment. The oral health of visually impaired people can be disadvantaged, since they are not in a position to detect and recognize early oral disease and may be unable to take immediate action unless informed of the situation. The aim of this pilot study was to identify the problems experienced by a visually impaired elderly population regarding the maintenance of oral health and the need to seek treatment. Sixty-two legally blind people underwent a structured interview and a clinical dental examination. Data are presented descriptively. All the participants would be potentially able to maintain their own adequate oral health level if given the appropriate stimulus. At the time of the study, 53% brushed their own teeth, 39% of whom brushed daily. Of the denture wearers, 58% cleaned them at least once a week. Most of the participants were independent. Eighty-two percent believed that they did not need help to brush their teeth or dentures, even though 85% had never been shown how to brush their teeth. Eighty percent of people did not realize that regular oral reviews were necessary. Other barriers to regular care included poor health, mobility problems, cost, and fear. Twenty-one percent of the sample had toothache or a denture problem. The professionally assessed treatment need was high in the dentate group, and 32% of denture wearers had denture-related pathology. The professionally assessed treatment need was greater than the visually impaired people's perceived need for care. The majority of visually impaired elderly were capable of maintaining a reasonable level of oral hygiene by themselves and were aware of their own dental needs but either had no reason to seek care or were unable to access oral health care services. It is important for visually impaired persons to realize that they need supervision to maintain good oral hygiene standards and to ensure the early identification of oral pathology. Also, the barriers to access to oral health services need to be reduced.