Validation of the Chinese Version of Dementia Quality of Life Measure - Proxy in Care Home Residents with Dementia.

OBJECTIVE: To evaluate psychometric properties of the Chinese version of Dementia Quality of Life Measure - Proxy (C-DEMQoL-Proxy). METHODS: Care home residents aged ≥60 years who were diagnosed with dementia or demonstrated impairment in cognition were recruited from four care facilities in Hong Kong. Caregivers of these participants were also invited to participate. The original DEMQoL-Proxy was translated into Chinese (Cantonese) by a trained translator. The forward-translated version was reviewed by an expert panel of six experienced healthcare professionals. Revisions were made based on comments. The instrument was back-translated to English to check whether further changes were necessary. Demographic data (age, sex, type and severity of dementia, and Mini-Mental State Examination [MMSE] score) were collected from medical records of participants with dementia. Caregivers were interviewed by an occupational therapist or personnel supervised by the occupational therapist using the C-DEMQoL-Proxy and the Chinese version of Quality of Life-Alzheimer's Disease-Proxy (C-QoL-AD-Proxy). Acceptability, reliability, and validity of the C-DEMQoL-Proxy were evaluated using standard psychometric methods. RESULTS: 90 individuals (82.2% women) with dementia aged 72 to 102 years were included. Their diagnosis included Alzheimer's disease (23.3%), vascular dementia (15.6%), mixed and other types of dementias (51.1%), and missing (10%). Severity was mild in 12.2%, moderate in 62.2%, and severe in 25.6%. The mean MMSE score was 12.0 ± 4.9. 20% of the caregivers were family members and the rest were professional carers. The C-DEMQoL-Proxy had good acceptability, with no floor or ceiling effects or missing data. It had good internal consistency (Cronbach alpha = 0.91) and test-retest reliability (intraclass correlation coefficients = 0.83). It was mildly correlated with C-QoL-AD-Proxy (r = 0.29, p < 0.01). Age and sex were not correlated with C-DEMQoL-Proxy scores. C-DEMQoL-Proxy scores were not significantly different between dementia types, severity levels, or between those with higher or lower MMSE scores. CONCLUSION: The C-DEMQoL-Proxy is a valid and reliable instrument to assess health-related quality of life in individuals with dementia.

Systematic review: effect of psychiatric symptoms on return to work after occupational injury.

BACKGROUND: Although post-traumatic stress disorder (PTSD) and depression are commonly observed following injury, few studies have focused on the effect of psychiatric symptoms on return to work (RTW) following occupational injury. AIMS: To determine the impact of psychiatric symptoms on RTW after occupational injury. METHODS: PubMed (1980-2014), MEDLINE (1980-2014) and PsycINFO (1980-2014) databases were examined with linked fields of research in February 2015. Reference lists of eligible articles were also searched. Cohort, case-control, cross-sectional studies and intervention studies were selected according to predefined criteria. Evidence was synthesized qualitatively according to the Downs and Black and Crombie checklist. The standard checklist was used to assess the methodological quality of each study by two reviewers. RESULTS: Five of the 56 records met the inclusion and exclusion criteria. After occupational injury, the rates of RTW after the injuries varied widely, ranging from 31 to 63%. PTSD symptoms and depressive symptoms appeared to be negatively associated with RTW. CONCLUSIONS: Currently, the evidence is insufficient to draw conclusions about the effects of psychiatric symptoms on RTW after occupational injury and more studies are needed. Future studies with large sample sizes are warranted to determine the prevalence of RTW and to detect the psychiatric factors.

Effects of Tai Chi training on postural control and cognitive performance while dual tasking - a randomized clinical trial.

BACKGROUND: This single-blinded, randomized controlled study investigated the effects of practicing Tai Chi on the postural control and cognitive performance of older women while dual tasking. METHODS: Community-dwelling older women (n=31) were recruited from community centers. They were randomized to Tai Chi group (n=15, 12-form Yang style Tai Chi training) or a control group (n=16, general interest classes) for 16 weeks. Balance was tested in single leg stance after stepping down from a step, with and without a concurrent auditory response task (auditory Stroop test). Balance was measured by total sway path and sway area of subject's center of pressure (COP). The reaction time and the correctness of the auditory Stroop test were also measured. RESULTS: Tai Chi subjects made fewer errors in auditory Stroop test under dual-task condition after Tai Chi training (p=0.01). They also showed significant decreases in the COP path (p<0.05) and the COP area (p<0.05) in their postural control after training in both single- and dual-task conditions. The subjects in the control group did not show any significant improvement in dual-task condition after the intervention. CONCLUSIONS: Tai Chi training improves the cognitive and postural control performance of older women when dual tasking.

The Effect of Walking Speed on Gait Variability in Healthy Young, Middle-aged and Elderly Individuals.

Previous research with healthy young adults has suggested that the temporal structure of gait variability is not random but shows self-similarity that is dependent on speed. Specifically, the strength of the long-range correlation of stride intervals follows a quadratic relationship with the minimum values at the respective preferred walking speed (PWS). The purpose of this study was to investigate if this relationship is affected by increasing age. Ten healthy young, seven healthy, middle-aged and seven healthy, elderly adults completed five-minute walking trials at 80%, 90%, 100%, 110% and 120% of their PWS on a treadmill. We investigated the temporal structure of gait variability by using detrended fluctuation analysis. In addition, we computed the Coefficient of Variation (CV) to identify effects on amount of gait variability. Our results revealed a significant quadratic relationship between the temporal structure of gait variability and speed for all groups extending the previously reported existence of such a relationship in healthy young adults to older individuals. However, only significant negative linear relationships were found between amount of variability and speed providing support that this relationship is not quadratic but linear across individuals of different ages. In addition, we found that the examination of the temporal structure of gait variability is more sensitive in differentiating middle-age and younger individuals. If middle-age is where the aging process starts, then measures of the temporal structure of gait variability are essential as prognostic and diagnostic tools of aging.

Multi-degree of freedom joystick for virtual reality simulation.

A modular control interface and simulated virtual reality environment were designed and created in order to determine how the kinematic architecture of a control interface affects minimally invasive surgery training. A user is able to selectively determine the kinematic configuration of an input device (number, type and location of degrees of freedom) for a specific surgical simulation through the use of modular joints and constraint components. Furthermore, passive locking was designed and implemented through the use of inflated latex tubing around rotational joints in order to allow a user to step away from a simulation without unwanted tool motion. It is believed that these features will facilitate improved simulation of a variety of surgical procedures and, thus, improve surgical skills training.

A virtual reality training program for improvement of robotic surgical skills.

The purpose of this study was to use a simulated virtual reality environment for training of surgical skills and then to identify if the learning that occurred was transferable to a real world surgical task. The virtual surgical tasks consisted of bimanual carrying, needle passing and mesh alignment. In this ongoing study, the experimental group (n = 5) was trained by performing four blocks of the virtual surgical tasks using the da Vinci surgical robot. Pre and post training, all subjects were tested by performing a suturing task on a "life-like" suture pad. The control group (n = 5) performed only the suturing task. Significantly larger pre and post differences were revealed in time to task completion (p < 0.05) and total distance travelled by the dominant side instrument tip (p < 0.01) in the experimental group as compared to the control group. These differences were specific to the suture running aspect of the surgical task. In conclusion, virtual reality surgical skills training may produce a significant learning effect that can transfer to actual robot-assisted laparoscopic procedures.

Consistency of performance of robot-assisted surgical tasks in virtual reality.

The purpose of this study was to investigate consistency of performance of robot-assisted surgical tasks in a virtual reality environment. Eight subjects performed two surgical tasks, bimanual carrying and needle passing, with both the da Vinci surgical robot and a virtual reality equivalent environment. Nonlinear analysis was utilized to evaluate consistency of performance by calculating the regularity and the amount of divergence in the movement trajectories of the surgical instrument tips. Our results revealed that movement patterns for both training tasks were statistically similar between the two environments. Consistency of performance as measured by nonlinear analysis could be an appropriate methodology to evaluate the complexity of the training tasks between actual and virtual environments and assist in developing better surgical training programs.

Improved survival in young women with colorectal cancer.

BACKGROUND: Studies have reported the effect of gender in the context of assessing predictors of survival from colorectal cancer (CRC); however, few have specifically addressed the impact of gender on the clinical and pathological outcomes of CRC. Appreciation of gender disparities may assist in the implementation of measures to address these differences, and improve the overall outcomes of patients with CRC. METHODS: The South Western Sydney Colorectal Tumour Group registry, which encompasses a population in excess of 800,000, prospectively collects data on new patients with CRC. Data from 1997 to 2004 were collected, including demography, site, grade, histopathology, stage, treatment, and survival. RESULTS: In total, 2,050 consecutive patients (44% women) with CRC were analyzed. Compared to men, women were older (median 69 yr, range 27-95 yr vs 67, range 22-92 yr, P= 0.001), had more emergency surgery for CRC-related complications (18.8%vs 15.1%, P= 0.03), had more proximal cancers (42.2%vs 31.5%, P < 0.001), had more poorly differentiated cancers (16.9%vs 12.9%, P= 0.01), and had fewer radiotherapy treatments for Dukes B and C rectal cancers (36.4%vs 48.1%, P= 0.02). Young women (aged 50 yr and below) had significantly better overall survival compared to young men; in this group, female gender predicted improved overall survival independent of age, emergency surgery, site, grade, and stage (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25-0.86, P= 0.01). Similarly, young women had significantly better cancer-specific survival (HR 0.46, 95% CI 0.25-0.85, P= 0.01). However, older women (aged over 50 yr) had worse survival independent of age, emergency surgery, site, grade, and stage (HR 1.38, 95% CI 1.14-1.68, P= 0.001). There were no gender differences in screening, histopathology, stage, or utilization of chemotherapy. CONCLUSIONS: This study demonstrated an opposing effect of gender on overall and cancer-specific survival at either side of the age of 50 yr. The protective effect of estrogen on CRC may be an important factor. Women had a greater proportion of emergency surgery, which was related to the predominance of proximal cancers in this gender. Women also had more proximal cancers, thereby limiting flexible sigmoidoscopy as a screening test.

Validating advanced robot-assisted laparoscopic training task in virtual reality.

The purpose of this study was to validate a complex robotic surgical task, mesh alignment, in virtual reality. Nine subjects unrolled and aligned a mesh onto an inanimate template for the mesh alignment task in both an actual (the da Vinci Robotic Surgical System) and a virtual environment. Data analysis included time to task completion, distance traveled, and speed, of the surgical instrument, as well as electromyography of the extensors and flexors of the dominant arm of the subject. Paired t-tests were used to compare the dependent variables between the actual and virtual environments. The virtual mesh alignment task was statistically similar for all variables except the flexor activity as compared to the actual task. In conclusion, virtual reality could be used as an effective environment to train the next generation of robot-assisted laparoscopic surgeons.