Benefit analysis of the auto-verification system of intelligent inspection for microorganisms.

In recent years, the automatic machine for microbial identification and antibiotic susceptibility tests has been introduced into the microbiology laboratory of our hospital, but there are still many steps that need manual operation. The purpose of this study was to establish an auto-verification system for bacterial naming to improve the turnaround time (TAT) and reduce the burden on clinical laboratory technologists. After the basic interpretation of the gram staining results of microorganisms, the appearance of strain growth, etc., the 9 rules were formulated by the laboratory technologists specialized in microbiology for auto-verification of bacterial naming. The results showed that among 70,044 reports, the average pass rate of auto-verification was 68.2%, and the reason for the failure of auto-verification was further evaluated. It was found that the main causes reason the inconsistency between identification results and strain appearance rationality, the normal flora in the respiratory tract and urine that was identified, the identification limitation of the mass spectrometer, and so on. The average TAT for the preliminary report of bacterial naming was 35.2 h before, which was reduced to 31.9 h after auto-verification. In summary, after auto-verification, the laboratory could replace nearly 2/3 of manual verification and issuance of reports, reducing the daily workload of medical laboratory technologists by about 2 h. Moreover, the TAT on the preliminary identification report was reduced by 3.3 h on average, which could provide treatment evidence for clinicians in advance.

Frailty is Associated With Frontal Cortex-Related Cognitive Function in Patients With Alzheimer Disease.

OBJECTIVE: We compared the cognitive functions of Alzheimer disease (AD) patients who were robust, frail or pre-frail and hypothesized that declines in frontal cortex-related neuropsychological function would be associated with frailty. METHOD: One hundred and sixty outpatients aged 65 years or older with mild AD were enrolled. Cognitive function was assessed using the Cognitive Ability Screening Instrument and further classified into 4 clusters (recent memory, frontal cortex cluster, posterior cortex cluster, and orientation). Other variables included depressive mood, daily activities, body mass index, handgrip strength (HGS), and normal gait speed (NGS). RESULTS: Performance in daily activities, and slower NGS than robust group. Both the frail and pre-frail groups had lower HGS and more depressive symptoms than robust group. Generalized linear with ordinal logistic analysis showed that increment in age, slowing in NGS, and worse frontal cortex cluster function associated with being in a higher level of frailty. The patients with depression symptoms were the odds of being in a higher level of frailty compared to those without depression symptoms. CONCLUSIONS: In addition to physical and psychological symptoms, frailty is associated with specific cognitive domains in patients with AD. A multidimensional approach should be used to assess the impact of intervention programs focusing on frail patients with AD.

Sarcopenia in female patients with Alzheimer's disease are more likely to have lower levels of haemoglobin and 25-hydroxyvitamin D.

AIM: Few studies have investigated sarcopenia in patients with cognitive impairment. However, identifying the characteristics and factors associated with sarcopenia in these patients may help to decrease the risk of falls, prevent disabilities, and maintain an independent life, all of which can affect the quality of life of both patient and caregiver. Therefore, the aim of this study was to investigate associated factors of sarcopenia in patients with mild to moderate Alzheimer's disease. METHODS: This cross-sectional study enrolled 125 outpatients aged 65 to 89 years (mean age 79.5 ± 7.9 years) from January 2018 to December 2018. In addition to demographic characteristics, cognitive status, depressive mood, activities of daily living, body mass index (BMI), handgrip strength, gait speed, muscle mass, and serum levels of 25-hydroxyvitamin D (Vit D), haemoglobin (Hb), albumin and creatinine were assessed. Sarcopenia was defined based on the presence of low muscle mass and either low muscle strength or low physical performance. RESULTS: Overall, 29.6% of the patients had sarcopenia. The patients with sarcopenia were mostly male, significantly older, and had a lower BMI and lower levels of Vit D. The female patients with sarcopenia were more likely to have lower levels of Hb. Multiple logistic regression showed that sarcopenia was associated with BMI in both genders. The level of Vit D was associated with sarcopenia in the female patients, whereas age was associated with sarcopenia in the male patients. CONCLUSIONS: A low BMI may be a dementia-related risk factor for sarcopenia. The female patients with sarcopenia were more likely to have lower levels of Hb and Vit D. There may be different risk profiles for sarcopenia in men and women with Alzheimer's disease. Further studies are needed to devise different nutritional support for muscle weakness in patients with cognitive decline by gender.

Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with Alzheimer's disease.

OBJECTIVES: This study aimed to investigate factors associated with frailty in patients with mild to moderate Alzheimer's disease (AD). METHODS: One hundred fifty-seven outpatients aged 65 years or older with mild to moderate AD were enrolled from January 2018 to December 2018. Cognitive status, depressive mood, activities of daily livings (ADLs), body mass index, handgrip strength (HGS), usual gait speed (UGS), and serum levels of 25-hydroxyvitamin D, hemoglobin (Hb), albumin, and creatinine were assessed. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: fatigue, resistance, ambulation, illness, and unintentional weight loss. RESULTS: The prevalence of frailty was 15.9%. Those classified as being frail were significantly older, had worse cognitive function, worse ADLs, slower UGS, and lower level of Hb compared to those classified as being pre-frail and those robust, respectively. The pre-frail group was significantly older, had worse ADLs, and slower UGS compared to the robust group. Both the frail and pre-frail groups had more depressive symptoms and weaker HGS than the robust group. Multiple logistic regression analysis showed that cognitive function, UGS, level of Hb, and depressive symptoms were associated with frailty, and that only depressive symptoms were associated with pre-frailty. CONCLUSIONS: Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with AD. Hb levels and UGS were associated with being frail. Preventing frailty in patients with AD should be approached from both physiological and psychological aspects.

Advance Care Planning and Advance Directives: A Multimedia Education Program in Community-Dwelling Older Adults.

This community-based cluster randomized trial evaluated the efficacy of a 4-week multimedia educational intervention followed by telephone consultations at Weeks 12 and 24 on the selection of a hospice program for end-of-life care and completion of an advance directive (AD) in case of future advanced dementia. One hundred twenty-three cognitively intact older adults from five community centers in Taiwan were randomly assigned to two groups. The study showed that 100% of participants in the intervention group (two community centers, n = 52) selected hospice program care for end-of-life care and signed ADs, whereas those in the control group were less likely to do both (p < .001). Participants in the intervention group also had a positive change in knowledge, subjective norms, perceived behavioral control, and behavioral intention of advance care planning (ACP) for advanced dementia. The theoretically based multimedia educational program was effective in assisting ACP implementation and completing ADs among community-dwelling older adults.