Factors associated with the prognosis of elderly patients with advanced dementia who receive palliative care from geriatric health services facilities.

AIM: The aim of the present study is to identify the factors associated with the prognosis of advanced dementia patients who are newly admitted to a geriatric health services facility. METHODS: This retrospective cohort study used data that were obtained on admission in the care-assessment of long-term care facility patients. The 177 participants with advanced dementia were admitted to our facility between 2006 and 2013. The association between the factors in the care-assessment and the three-month-mortality rates were examined throughout the year. RESULTS: At each of the 3-month time points, the mortarity rates of the patients who had total dependence on oral eating or hypoalbuminemia (<3.5 g/dl by BCG method) were significantly higher in comparison to the patients who had neither of these factors. The mortality rates in the patients with a past history of pneumonia (within 3 months) were significantly associated with both factors. At each time point, the three-month-mortality rates showed a significant decrease in the following patients groups (in order): patients with both total dependence on oral eating and hypoalbuminemia, patients with dependence on oral eating or hypoalbuminemia, patients without these two factors. CONCLUSION: Our results indicate that the factors in the care-assessment. That were associated with the prognosis of patients with advanced dementia on admission may be total dependence on oral eating and hypoalbuminemia. Evaluating the combination of these two factors can be a simple and useful measure to identify advanced dementia patients with a high risk of death who receive palliative care in a geriatric health services facility.

Impact of injected dose and acquisition time on a normal database by use of 3D-SSP in SPECT images: quantitative simulation studies.

The present study aimed to validate the accuracy of normal databases (NDBs) with respect to variable injected doses and acquisition times by use of three-dimensional stereotactic surface projections (3D-SSP) in N-isopropyl-p-[123I]-iodoamphetamine (I-123-IMP) brain perfusion images. We constructed NDBs based on brain SPECT images obtained from 29 healthy volunteers. Each NDB was rebuilt under simulated unique conditions by use of dynamic acquisition datasets and comprised injected doses (222, 167, and 111 MBq) and acquisition times (30, 20, and 15 min). We selected seven of 29 datasets derived from the volunteers to simulate patients' data (PD). The simulated PD were designed to include regions of hypoperfusion. The study comprised protocol A (same conditions for PD and NDB) and protocol B (mismatched conditions for PD and NDB). We used 3D-SSP to compare with the Z score and detection error. The average Z scores were decreased significantly in protocol A [PD (High)-NDB (High) vs. PD (Low)-NDB (Low); PD (30 m)-NDB (30 m) vs. PD (15 m)-NDB (15 m) and PD (20 m)-NDB (20 m)].The average Z scores of PD (High) and PD (Medium) with NDB (High) did not differ significantly in protocol B, whereas all others were decreased significantly. The error of detection increased 6.65 % (protocol A) and 32.05 % (protocol B). The Z scores were specific to the injected dose and acquisition time used in 3D-SSP studies, and the calculated Z scores were affected by mismatched injected doses and acquisition times between PD and selected NDBs.

[Availability of normal database by single photon emission computed tomography system with use of 3 dimensional-stereotactic surface projections].

PURPOSE: The present study aims to quantitatively investigate a normal database (NDB) created under the same acquisition and reconstruction conditions for three gamma camera systems (four types of collimator systems) with use of three-dimensional stereotactic surface projections (3D-SSP). We rebuilt a NDB with use of the N-isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) SPECT data derived from 30 healthy individuals at 20 institutions nationwide. We standardized the acquisition and reconstruction conditions, evaluated Z scores using patient data (PD) and examined each compensation effect. RESULTS: Z scores determined using the advanced NDB were the same value. Artifacts were often generated in Z score maps derived from the conventional NDB (CONDB). The Z score of the own site NDB (OWNDB) was 70% of that calculated based on the CONDB. The combinatorial difference in compensation (scatter and attenuation) resulted in many artifacts being generated in Z score map images. DISCUSSIONS: More artifacts were generated in Z score map images using the novel NDB compared with the CONDB. The novel NDB was comparable to the performance of OWNB. The accuracy of brain function image analysis can be improved the reconstruction conditions and correcting for scatter and attenuation on both the novel NDB and PD.

[Basic investigation of software named "Heart Risk View" to estimate the probability of cardiac events, for the purpose of evaluating the availability in clinical practice].

We validated Heart Risk View (HRV) software for estimating cardiac event probability in patients with suspected ischemic heart disease. This software is based on the results of the J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT). The HRV software can calculate stress summed scores (SSS), summed rest scores (SRS), and summed difference scores automatically using the 5 point, 20 or 17 segment model of myocardial SPECT images. It can also calculate the probability of cardiac events occurring in patients within 3 years using SSS and parameters obtained from the results of gated SPECT. Changing the threshold of % uptake for determining SPECT scores elevated the agreement of SSS (kappa = 0.269 to 0.657). Cardiac event probability calculated from Perfusion and Function Assessment for Myocardial SPECT (p-FAST) using end systolic volume (ESV), tended to be higher than that calculated from Quantitative Gated SPECT software (QGS). In contrast, cardiac event probability calculated from QGS and p-FAST using left ventricle ejection fraction (LVEF) closely agreed.