Assessment of innovative living and care arrangements for persons with dementia: a systematic review.

BACKGROUND: Alternative forms of housing for persons with dementia have been developed in recent decades. These concepts offer small groups of residents familiar settings combined with efforts to provide normal daily life. The aim of this systematic review is to collate and analyze these more innovative forms of housing regarding residents' quality of life, behavioral aspects, as well as functional, cognitive and emotional aspects. METHODS: Searches were conducted in PubMed, EMBASE and PsycInfo in November 2020. Studies comparing traditional and more innovative living environments for persons with dementia were eligible. Concepts are described based on the results of additional searches. Risk of bias of included studies was assessed using checklists from the Joanna Briggs Institute. RESULTS: A total of 21 studies corresponding to 11 different concepts were included, namely Green Houses (USA), Group Living (Sweden), Cantou (France), Group Homes (Japan), Small-scale Group Living (Austria), Special Care Facilities (Canada), Shared-housing Arrangements (Germany), Residential Groups (Germany), Residential Care Centers / Woodside Places (USA/Canada), Small-scale Living (Netherlands/ Belgium), and Green Care Farms (Netherlands). The concepts are broadly similar in terms of care concepts, but partly differ in group sizes, staff qualifications and responsibilities. Several studies indicate that innovative forms of housing may encourage social behavior, preserve activity performance and/or positively influence emotional status compared to more traditional settings, while other studies fail to demonstrate these effects. Some studies also show increased behavioral and psychological symptoms of dementia (BPSD) in residents who live in more innovative housing concepts. The effect on cognition remains indistinct. DISCUSSION: The positive effects may be attributable to the inherent characteristics, including small group sizes, a stimulating design, and altered staff roles and responsibilities. Arguably, some of these characteristics might also be the reason for increased BPSD. Studies had variable methodological quality and results have to be considered with caution. Future research should examine these effects more closely and should investigate populations' preferences with regards to housing in the event of dementia.

Improving and Comparing Probiotic Plate Count Methods by Analytical Procedure Lifecycle Management.

Probiotics are live microorganisms that confer a health benefit to the host when administered in adequate amounts. This definition links probiotic efficacy to microbial viability. The current gold standard assay for probiotic potency is enumeration using classical microbiology plating-based procedures, yielding results in colony-forming units (CFU). One drawback to plating-based procedures is high variability due to intrinsic and extrinsic uncertainties. These uncertainties make comparison between analytical procedures challenging. In this article, we provide tools to reduce measurement uncertainty and strengthen the reliability of probiotic enumerations by using analytical procedure lifecycle management (APLM). APLM is a tool that uses a step-by-step process to define procedure performance based on the concept that the reportable value (final CFU result) must be fit for its intended use. Once the procedure performance is defined, the information gathered through APLM can be used to evaluate and compare procedures. Here, we discuss the theory behind applying APLM and give practical information about its application to CFU enumeration procedures for probiotics using a simulated example and data set. Data collected in a manufacturer's development laboratory is included to support application of the concept. Implementation of APLM can lead to reduced variability by identifying specific factors (e.g., the dilution step) with significant impact on the variability and providing insights to procedural modifications that lead to process improvement. Understanding and control of the analytical procedure is improved by using these tools. The probiotics industry can confidently apply the information and analytical results generated to make decisions about processes and formulation, including overage requirements. One benefit of this approach is that companies can reduce overage costs. More reliable procedures for viable cell count determinations will improve the quality evaluation of probiotic products, and hence manufacturing procedures, while ensuring that products deliver clinically demonstrated beneficial doses.

[Hemodynamic effects of cafedrine/theodrenaline on anesthesia-induced hypotension]. / Hämodynamisches Wirkungsspektrum von Cafedrin/Theodrenalin bei Anästhesie-assoziierter Hypotension.

BACKGROUND: There is insufficient knowledge about the hemodynamic effects of cafedrine/theodrenaline (caf/theo), a commercially available drug combination, to treat hypotension. METHODS: This prospective observational study investigated the hemodynamic effects of caf/theo on anesthesia-induced hypotension in 20 patients scheduled for elective major abdominal surgery. After induction of total intravenous anesthesia (TIVA) with propofol and remifentanil, a decrease in mean arterial blood pressure (MAP) below 60 mm Hg (n = 12) was treated with 60 mg/3 mg caf/theo. The systemic vascular resistance index (SVRI), cardiac index (CI), global end-diastolic index (GEDI), maximum pressure increase in the aorta (dPmx) and global ejection fraction (GEF) were assessed by transpulmonary thermodilution (PiCCO2-Monitor). RESULTS: The MAP increased by approximately 60% 10 min after administration of caf/theo. The increase in MAP was a result of the simultaneous effects on various cardiovascular determinants. An increase in peripheral resistance (SVRI +42%) and CI (+17%) could be determined. Data further indicated that the increase in CI was a consequence of an increase in both dPmx (+31%) and GEDI (+9%) but the GEF remained constant. CONCLUSION: In anesthesia-induced hypotension caf/theo effectively increased the mean arterial blood pressure by combined effects on preload, contractility, and afterload without altering cardiovascular efficiency.

Visual exploration of isotope labeling networks in 3D.

Isotope labeling networks (ILNs) are graphs explaining the flow of isotope labeled molecules in a metabolic network. Moreover, they are the structural backbone of metabolic flux analysis (MFA) by isotopic tracers which has been established as a standard experimental tool in fluxomics. To configure an isotope labeling experiment (ILE) for MFA, the structure of the corresponding ILN must be understood to a certain extent even by a practitioner. Graph algorithms help to analyze the network structure but produce rather abstract results. Here, the major obstruction is the high dimension of these networks and the large number of network components which, consequently, are hard to figure out manually. At the interface between theory and experiment, the three-dimensional interactive visualization tool CumoVis has been developed for exploring the network structure in a step by step manner. Navigation and orientation within ILNs are supported by exploiting the natural 3D structure of an underlying metabolite network with stacked labeled particles on top of each metabolite node. Network exploration is facilitated by rotating, zooming, forward and backward path tracing and, most important, network component reduction. All features of CumoVis are explained with an educational example and a realistic network describing carbon flow in the citric acid cycle.

Potential risk of vasovagal syncope for motor vehicle driving.

Vasovagal syncope is the most common cause of syncope, but its risk for driving remains uncertain. We analyzed the clinical characteristics of patients who had syncope during driving and subsequently underwent the head-up tilt test (HUTT). Of the 245 consecutive patients undergoing HUTT, 23 (9%) had > or =1 episode of syncope during driving. HUTT was positive in 19 (group A) and negative in 4 (group B) patients. No patient had structural heart disease. In group A, the driving incident occurred on the first syncope in 3 patients, and the other 16 patients had 1 to 4 episodes of prior syncope not associated with driving. In group B, the driving incident occurred on the first syncope in 1 patient, and the other 3 patients had prior syncope (3 episodes in each) not associated with driving. Seven group A and 1 group B patients had 2 syncope-related driving incidents, and the remaining patients had only 1 syncope-related driving incident. The syncope-related driving incidents caused personal injury in 7 group A and 2 group B patients. One incident in 1 group A patient caused the death of another driver. After HUTT, all but 1 patient in group A received medical treatment and only 1 patient in group B received empirical beta-blocker therapy. During the follow-up of 51+/-26 months, 1 patient died and another was lost to follow-up. Of the remaining patients, 4 patients had recurrence of syncope and 2 patients had presyncope in group A. One of these patients had another syncope-related driving incident. No group B patient had syncope recurrence. A second etiology of syncope was never found in any patient. We conclude that vasovagal syncope during driving is not uncommon in patients referred for syncope evaluation. Early medical attention to patients with vasovagal syncope may help reduce syncope-related driving incidents.

Integration into professional nursing by graduates of an innovative entry-level MSN program.

Recently, nursing programs that admit nonnurse college graduates to graduate study in nursing have emerged around the country. The University of Texas at Austin has such a program called the Alternate Entry Master of Science in Nursing (AEMSN) program. Using a grounded theory approach, 13 telephone interviews were conducted with alumni of the AEMSN program to examine the socialization of these nontraditional graduates into the profession of nursing. Participants reported some anxiety as they approached graduation. They were particularly aware of a disconnection between their academic credentials and their limited professional nursing experience. To manage others' and their own expectations of them, the participants chose various strategies, such as using positive self-talk and seeking a manager who understood and favored the AEMSN program. Eventually the graduates found places where they felt comfortable and where they could hone their skills. As they began to function in roles that they believed were consistent with master's level nursing, the AEMSN graduates began to embrace the identity of master's-prepared nurses.

Acute volume expansion enhances baroreceptor discharge in dogs.

By recording single-unit discharge from the carotid sinus nerve of normal dogs in the control and in the volume-expanded state, both with the sinus open to the circulation and with it isolated, the effects of acute volume expansion on baroreceptor discharge sensitivity were investigated. The carotid sinus was vascularly isolated except for the common carotid and external carotid arteries. Inflation of hydraulic occluders on these vessels completely isolated the sinus from the systemic circulation. Flow and diameter changes of the carotid sinus were measured. Plasma volume was expanded with isotonic, isoncotic dextran in normal saline until the left ventricular end-diastolic pressure reached a value of 20-25 mmHg. In the group with the sinus open to the circulation, volume expansion did not depress baroreceptor discharge sensitivity; in fact, it augmented baroreceptor activity (peak discharge = 39.2 +/- 1.6 vs. 49.9 +/- 3.3 spikes/s, P less than 0.05). There was no such effect in the group with the sinus isolated from the circulation during volume expansion. In the group with the sinus open to the circulation, volume expansion significantly increased flow through the common carotid artery and shifted the carotid sinus pressure-diameter curves upward without a change in compliance. These data suggest that acute volume expansion augments baroreceptor discharge, and this phenomenon may be mediated either by some circulating substance(s) or by an increase in flow through the carotid sinus during volume expansion.

Cutting the costs of survey research: third-class bulk and business reply mail.

This article considers third-class bulk mail and business reply mail as alternatives for investigators doing survey research. Both have advantages and disadvantages. The wise researcher considers the pertinent trade-offs when making the choice that is most appropriate for a particular research project.

False-negative magnetic resonance imaging in early stage of Legg-Calvé-Perthes disease.

We report a 7-year 6-month-old boy with Legg-Calvé-Perthes (LCP) disease in whom a magnetic resonance imaging (MRI) was normal during the early symptomatic phase when the 99mTc bone scintigraphy showed segmental hypoperfusion of the femoral head suggestive of bone infarction. Only later in the disease did the MRI also show the typical changes of LCP. The follow-up on this patient with bilateral disease leaves no doubt about the diagnosis of LCP. This sequence of a positive scintigram before positive MRI findings may be the exception, but it is important to realize that MRI is not always the most sensitive way to diagnose or exclude LCP as suggested hitherto by the literature.

A test of the health promotion model with blue collar workers.

The health promotion model (Pender, 1987b) was tested with a volunteer sample of 179 blue-collar workers. Four psychological variables (importance of health, perceived health locus of control, health status, and self-efficacy), one modifying variable (selected demographics), and certain health-promoting behaviors were examined. Pearson product moment correlations and stepwise and hierarchical multiple regression techniques were used to analyze the data. Each of the psychological variables examined was predictive of health-promotive behaviors. Health status and self-efficacy were the most powerful predictors. The modifer role of demographics was also supported. The results suggest the health promotion model is potentially useful for explaining the occurrence of health-promotive behaviors among blue-collar workers.

[IE and IgG antibodies against flavonoids following therapy with flavonoid-containing drugs]. / IgE- und IgG-Antikörper gegen Flavonoide nach Therapie mit flavonoidhaltigen Medikamenten.

During treatment with flavonoid drugs a number of patients developed adverse reactions such as fever, various skin eruptions and intravascular hemolysis. The appearance of flavonoid-specific IgE and IgG antibodies and its possible relation to the observed side effects was studied on a total of 168 individuals treated with flavonoid drugs: 71 patients received troxerutin (Venoruton) parenterally to improve tolerance of radiation therapy, 12 patients were treated intravenously with silymarin (Legalon) for amanita intoxication and 77 patients received various flavonoid drugs for other indications. Flavonoid treatment often induced specific IgG antibodies and less frequently IgE antibodies. After short treatment IgE antibodies were more frequently detected than after treatment of longer duration which nearly always induced IgG antibodies. Patients with hemolysis had the highest IgG titers. In cases with fever and skin eruptions no correlation with antibody titers became evident. Antibody production in patients undergoing radiation therapy appeared to be lower than in non-irradiated patients. Both the IgE and IgG antibody test show a remarkable cross-reactivity between four different flavonoids. Prospective studies will be necessary to decide whether or not this method for the detection of anti-flavonoid antibodies will be suitable for recognizing increased risk of side reactions upon reexposure to flavonoid drugs.

Diabetic gastroparesis: treatment with domperidone--a double-blind, placebo-controlled trial.

6 patients with severe symptomatic diabetic gastroparesis were studied in a placebo-controlled randomized manner to establish if intravenous domperidone accelerates the delayed gastric emptying of a semisolid homogenized meal. Domperidone, 10 mg intravenously, shortened the gastric emptying half-time in all of the 6 patients significantly, but not in the healthy control subjects. These results suggest that intravenous domperidone may be potentially beneficial to diabetic gastroparesis patients by improving delayed gastric emptying.

Regression of liver cell adenoma. A follow-up study of three consecutive patients after discontinuation of oral contraceptive use.

Three consecutive young female patients with unresected liver cell adenoma and a history of contraceptive use of several years' duration were followed up over a period of 2-4.5 yr after withdrawal of hormonal medication. One patient presented multiple adenomas and in another, the adenoma was associated with a Budd-Chiari syndrome due to bilateral thrombotic hepatic vein occlusion. Complete regression of the adenomas was documented in all 3 patients by ultrasonography, liver radionuclide scan, laparoscopy, or computerized tomography. It is concluded that, in selected cases, conservative management after withdrawal of hormonal contraception may be a valid alternative to surgical therapy.

[Hormone-producing thyroid carcinoma with hyperthyroidism. Analysis of 6 cases and review of the literature]. / Hormonproduzierendes Schilddrüsenkarzinom mit Hyperthyreose. Analyse von 6 Fällen und Ubersicht über die Literatur.

Report on 6 female patients with follicular thyroid carcinoma producing hyperthyroidism. Two of them had large metastases with hormone production, while 4 mimicked an autonomously functioning thyroid adenoma. Hormone synthesis was investigated in the tumor tissue of one patient and was found to be similar to that of normal thyroid tissue.

[The diagnosis of liver metastases and primary hepatomas by means of scintigraphy, laparoscopy and laparotomy]. / Diagnose von Lebermetastasen und primärem Hepatom mit Szintigraphie, Laparoskopie und Laparotomie

To evaluate the presence or absence of hepatic metastases or primary hepatoma 106 patients were examined by liver scintigram as well as laparoscopy or laparotomy. A definite diagnosis was established in all patients by histology, autopsy or observation of clinical course for at least one year. Only scintigrams resulted in false positive diagnosis (in 5%). False negative diagnoses were obtained in 29% of laparoscopies and in 36% of scintigrams when evaluated routinely with knowledge of the clinical findings and laboratory examinations. Analysis of the same scintigrams by an experienced examiner without knowledge of the clinical findings lowered the proportion of false negative scintigrams to 12%. In 5 patients with liver metastases or hepatoma coexisting in liver cirrhosis or advanced chronic liver congestion, both methods of examination gave false negative results.