Strategies to improve continuity maintenance for people with dementia: a rapid realist review.

OBJECTIVES: People with life-limiting diseases such as dementia are living longer. How to improve the quality of life of those living with dementia is an important challenge for society. Continuity maintenance in older adulthood is a psychosocial adaptation strategy by searching for preference and familiarity, making a sense of connection, and creating coherence. Continuity maintenance is a useful concept for effective dementia care, which could bring psychosocial benefits. This review investigates effective ways of continuity maintenance for people with dementia (PWD). STUDY DESIGN: A rapid realist review (RRR) of a comprehensive range of databases was conducted. METHODS: Realist review methodology provides an explanatory analysis of what works for whom, in what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms, and outcomes. A literature search was conducted using four databases, and articles discussing potential interventions to maintain continuity in PWD were included. Data were extracted on key variables related to contextual factors, mechanisms, and outcomes. RESULTS: Four key themes emerged: (1) maintaining personal identity, (2) maintaining social identity, (3) keeping a familiar environment, and (4) sustaining daily activities. It is hypothesized that these four factors combine and interact to maintain continuity and ultimately lead to psychosocial benefits. CONCLUSIONS: Maintenance of identity, environment, and activities is central to continuity for PWD. The resulting model and program theories respond to the need for a coherent approach to continuity maintenance. Using the foundations created by this RRR, nursing homes may psychosocially improve PWD through maintaining continuity.

Outcomes of transoral laser microsurgical management of T1b stage glottic cancer.

OBJECTIVE: This study aimed to evaluate the oncological and voice outcomes of transoral laser microsurgery for tumour stage T1b stage glottic cancer patients. METHODS: A prospective cohort study in a tertiary care head and neck cancer centre included tumour-node-metastasis stage T1bN0M0 glottic cancer patients scheduled to undergo transoral laser microsurgery from January 2002 until June 2014. Kaplan-Meier five-year analyses of local control, overall survival, disease-specific survival and laryngeal preservation were performed. Voice Handicap Index-10 scores and maximum phonation times were also recorded. RESULTS: Twenty-one participants with a mean age of 66.8 years were enrolled. The mean follow up was 56.5 months. Kaplan-Meier 5-year survival analysis illustrated a local control rate of 82 per cent, overall survival of 88 per cent, disease-specific survival of 100 per cent, and laryngeal preservation of 100 per cent. The pre-operative Voice Handicap Index-10 score was 19.1 ± 9.47 (mean ± standard deviation (SD)) and the post-operative scores were 13.5 ± 9.29 at three months, 10.44 ± 9.70 at one year and 5.83 ± 4.91 at two years. The pre-operative maximum phonation time was 16.23 ± 5.46 seconds (mean ± SD) and the post-operative values were 14.44 ± 6.73 seconds at three months, 15.27 ± 5.71 seconds at one year and 14.33 ± 6.44 seconds at two years. CONCLUSION: Transoral laser microsurgery yields relatively high rates of oncological control and acceptable voice outcomes, and thus shows utility as a primary treatment modality for T1b glottic cancer.

Dysregulation of miR-106a and miR-591 confers paclitaxel resistance to ovarian cancer.

BACKGROUND: MicroRNAs are noncoding regulatory RNAs strongly implicated in carcinogenesis, cell survival, and chemosensitivity. Here, microRNAs associated with chemoresistance in ovarian carcinoma, the most lethal of gynaecological malignancies, were identified and their functional effects in chemoresistant ovarian cancer cells were assessed. METHODS: MicroRNA expression in paclitaxel (PTX)-resistant SKpac sublines was compared with that of the PTX-sensitive, parental SKOV3 ovarian cancer cell line using microarray and qRT-PCR. The function of differentially expressed microRNAs in chemoresistant ovarian cancer was further evaluated by apoptosis, cell proliferation, and migration assays. RESULTS: Upregulation of miR-106a and downregulation of miR-591 were associated with PTX resistance in ovarian cancer cells and human tumour samples. Transfection with anti-miR-106a or pre-miR-591 resensitized PTX-resistant SKpac cells to PTX by enhancing apoptosis (23 and 42% increase), and inhibited their cell migration (43 and 56% decrease) and proliferation (64 and 65% decrease). Furthermore, ZEB1 was identified as a novel target gene of miR-591, and BCL10 and caspase-7 were target genes of miR-106a, as identified by immunoblotting and luciferase assay. CONCLUSION: MiR-106a and miR-591 have important roles in conferring PTX resistance to ovarian cancer cells. Modulation of these microRNAs resensitizes PTX-resistant cancer cells by targeting BCL10, caspase-7, and ZEB1.

Involvement of the ser-glu-pro motif in ligand species-dependent desensitisation of the rat gonadotrophin-releasing hormone receptor.

There are two forms of gonadotrophin-releasing hormone (GnRH), GnRH-I and GnRH-II, in the vertebrate brain. Both GnRH-I and GnRH-II are thought to interact with the type-I GnRH receptor (GnRHR). The present study attempted to demonstrate whether GnRH-I and GnRH-II induce differential desensitisation of GnRHR and to identify the motif involved. Time course inositol phosphate (IP) accumulation assay reveals that, in cells expressing the wild-type rat GnRHR, GnRH-I induced continuous increase in IP production, whereas GnRH-II-induced IP production rate at later time points (30-120 min after ligand treatment) became attenuated. However, in cells expressing the mutant receptor in which the Ser-Glu-Pro (SEP) motif in extracellular loop 3 was replaced by Pro-Glu-Val (PEV), IP accumulation rates at later time points were more decreased by GnRH-I than GnRH-II. Ca2+ responses to repetitive GnRH applications reveal that GnRH-II desensitised the wild-type receptor faster than GnRH-I, whereas the opposite situation was observed in the PEV mutant. In addition, cell surface loss of GFP-tagged wild-type receptor was more facilitated by GnRH-II than GnRH-I, whereas that of the GFP-tagged PEV mutant receptor was more enhanced by GnRH-I than GnRH-II. The present study indicates that the SEP motif is potentially responsible for ligand species-dependent receptor desensitisation. Together, these results suggest that GnRH-I and GnRH-II may have different effects on mammalian type-I GnRHR via modulation of desensitisation rates.

Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample.

This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.

Sexual satisfaction among Korean-American couples in the Midwestern United States.

One hundred couples composed of American husbands and Korean wives from the midwestern United States were surveyed with respect to sexual satisfaction. Though the responses of spouses were correlated highly, husbands were more satisfied with the quality of the sexual relationship than were wives. As found previously with more general populations, self-esteem and higher levels of positive regard, communication, and cohesion were related to higher sexual satisfaction for both husbands and wives. For wives, higher socioeconomic status and younger age were related to higher sexual satisfaction, as was the husband's being a current or retired member of the US military. Cultural factors were also important; conflicts over sexual practices related to cultural differences, though limited to about 10% of the subjects, were related to sexual satisfaction for both husbands and wives. Wives' English proficiency was related slightly to sexual satisfaction, but not husbands' proficiency in Korean. For husbands only, marital conflict over cultural differences and rejection by relatives and friends were related negatively to sexual satisfaction. Clinical implications of the results are discussed.