Action Observation of Motor Skills Followed by Immediate Sleep Enhances the Motor Rehabilitation of Older Adults With Stroke.

BACKGROUND AND PURPOSE: Motor rehabilitation following stroke is a demanding challenge in search for new strategies to improve outcome. Rehabilitation through action observation has been reported beneficial for older adults recovering from stroke. Early sleep session following motor learning enhanced the performance of the acquired motor skills. The purpose of this study was to examine whether an early sleep session following action observation has benefit over action observation alone in the rehabilitation of older adults after stroke. METHODS: Twenty patients with paresis of dominant upper limb in first ischemic stroke were assigned to 2 study groups (10 subjects each). The participants were presented a 5-minute video film of phone operation. Participants of the intervention group had a sleep session of 90 to 120 minutes immediately following the film while control participants did not sleep. Identical procedure was repeated for 4 consecutive sessions (4 weeks). A single item of the Chedoke Arm and Hand Activity Inventory was used as rehabilitation's outcome measure. RESULTS: During the 4 weeks of the study, the performances of both groups improved but the intervention group had higher Chedoke Arm and Hand Activity Inventory scores, as indicated by a significant session by group interaction (P < .001). CONCLUSIONS: An early sleep session added to action observation therapy may significantly improve motor performances of patients with stroke. Further studies are required to support this method for inclusion in rehabilitation arsenal.

Clostridium difficile-associated disease: A primary clinical evaluation of elderly patients in a geriatric hospital.

The purpose of this study was to screen all cases of Clostridium difficile-associated disease during a 2-year period in a geriatric hospital to determine the incidence and clinical characteristics related to this risk. Twenty percent of suspected cases were diagnosed as positive and analyzed. The C difficile disease-associated clinical factors were ischemic heart disease and chronic obstructive pulmonary disease. Use of acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs, and steroids were more frequently found in the non-C difficile group. There were fewer cases in men than in women and more in patients residing in skilled nursing wards.

QT Interval Length in Elderly Prostatic Cancer Patients on Anti-Testosterone Treatment.

UNLABELLED: Background: QT segment prolongation is a high risk factor for fatal arrhythmias. Several studies have indicated a possible relation between low testosterone levels and QT interval prolongation. OBJECTIVES: To compare the QT interval length in elderly patients with prostate carcinoma who were on anti-testosterone treatment and those who were not. METHODS: We screened the electrocardiograms (ECGs) of 100 prostate cancer patients divided into two groups: 50 patients on anti-testosterone drug treatment and 50 patients not. QT interval length was measured according to the accepted methods. RESULTS: The mean QTc 12 leads in the entire group was 0.45 ± 0.04 sec, which is close to the upper limit. Mean QTc was actually longer in the control group and there was no QTc difference between the groups after adjustment for possible confounders. Prolonged QTc 12-lead ECG (48% in treated and 54% in non-treated) and lead L2 QT interval (50% in treated and 56% in non-treated) did not differ significantly between the groups. The analysis of QTc 12-lead ECG indicated no significant effects of anti-testosterone drug treatment. Only the use of furosemide was associated with QT prolongation. CONCLUSIONS: The results of this preliminary study do not support our initial concern of an alarmingly prolonged QT interval in the anti-testosterone treated group. However, further prospectively designed studies are needed. In the meanwhile we call for a close follow-up of the QT interval length in patients receiving anti-testosterone treatment.

Evaluation of an intra-institutional diabetes disease management program for the glycemic control of elderly long-term care diabetic patients.

AIM: Increasing numbers of nursing home elderly patients suffer from diabetes requiring individually optimized glycemic control. This is a complicated challenge because of their high comorbidity level, and heterogeneous and changing eating status varying from independent to dysphagia and enteral feeding. In order to cope with these complex needs, we developed and implemented a diabetes disease management program. The purpose of the present study was to evaluate this program. METHODS: We used the point prevalence approach by checking for fasting blood glucose, glycated hemoglobin and other routine biochemical tests. Eating status was evaluated by the Functional Outcome Swallowing Scale. Details about the diabetes disease management program are given in the text. RESULTS: A total of 86 (36%) of the 234 patients on the study day were diabetics. Of these, 80 were eligible for the study. Their mean fasting blood glucose was 143.1 ± 60.6 mg/dL. The mean glycated hemoglobin level was 7.23 ± 1.39%. CONCLUSION: No case of hypoglycemia was detected on the examination day, or during the preceding 3 weeks. No significant difference was found among the different Functional Outcome Swallowing Scale categories. These results are within satisfactory range for this category of patients suggesting that our diabetes disease management program contributes to a better glycemic control.

QT interval disturbances in elderly residents of long-term care facilities.

BACKGROUND: The QT interval reflects the total duration of ventricular myocardial repolarization. Disturbed QT--either prolonged or shortened--is associated with arrhythmia and is life-threatening. OBJECTIVES: To investigate an elderly population for disturbed QT interval. METHODS: We conducted a cross-sectional study on residents of long-term care wards in a geriatric hospital. Excluded were those with pacemaker, atrial fibrillation or bundle branch block. The standard 12 lead and lead 2 electrocardiograms in the patients' files were used for the evaluation of QT interval. RESULTS: We screened the ECGs of 178 residents. QTc prolongation based on the mean 12 ECG leads was detected in 48 (28%), while 45 (25%) had prolonged QTc based on lead L2. Factors associated with QT prolongation were male gender, chronic renal failure and diabetes mellitus. Short QT was found in 7 residents (4%) and was not related to any parameter. CONCLUSIONS: About one-third of the elderly long-term care residents in our study had QT disturbances. Such a considerable number warrants close QT interval follow-up in predisposed patients.