Effects of social activation and physical mobilization on sleep in nursing home residents

Age-related changes in sleep physiology, frequent occurrence of health impairments, and a sedentary lifestyle make nursing home residents particularly vulnerable to sleep disturbances. Despite the high prevalence of sleep disturbances in nursing homes, there is a lack of research concerning the use of non-pharmacological approaches for improving residents' sleep. This study aimed to promote residents' sleep by improving their social activation and physical mobilization. An experimental group of residents attending an activation program four times a week during an eight-week study course was compared to a non-treated control group in a cluster-randomized intervention trial among 85 residents of 20 nursing homes. Sleep was assessed by the Insomnia Severity Index (ISI), nurses' ratings of residents' sleep disturbances and actigraphy-based sleep parameters. Although no changes in actigraphy-based sleep parameters were observed, the subjective sleep quality ratings of the intervention participants significantly improved compared to the control group members (p = 0.004). This study suggests that physical mobilization and social activation may improve residents' subjective sleep quality. Further efforts to improve residents' sleep by increasing their physical and social activity should consider existing obstacles to encourage participation and adherence to the program.     

Anxiety and depression and their influence on the quality of life after total hip replacement: preliminary report

Objective. The study investigated health-related quality of life in relation to mental status (anxiety and depression) and demographic factors in patients before and after total hip replacement due to osteoarthrosis. Methods. The SF-36, HADS, socio-demographic data questionnaire was delivered to a group of 184 subjects (108 females, 76 males) at the mean age at the time of surgery of 59 years. Questionnaires were delivered to the subjects 2 weeks before the surgery and 6 months after the operation (by mail). Results. Patients after hip replacement showed significant improvement in health-related quality of life in most domains of SF-36 score and summary scale of PCS (Physical Component Summary Scale) and MCS (Mental Component Summary Scale). They also showed improvement in mental status. Elderly patients were more likely to show worse score in MCS and PCS before and after surgery. BMI (body mass index) was correlated only with preoperative PCS. Mental status was associated with postoperative PCS and MCS. Patients who were satisfied with the results of the surgery showed higher PCS and MCS score. Conclusion. Hip replacement surgery brings significant improvement to the quality of life. Age and mental status of those patients influence markedly their postoperative performance.     

病案首页信息质量控制及应用

新时期的医院管理,无论从宏观角度还是微观角度对病案首页的依赖已经越来越强。病案首页信息质量对医院来讲举足轻重。医院制定了一套比较完善的病案首页质控体系,加大宣传培训力度,完善质量控制措施,在应用中取得了明显的效果。     

麻醉风险与质量评估学的创立和研究

目的建立一整套完善具体的麻醉风险与质量评估学理论体系，从回避麻醉风险及事故的角度分析总结经验教训以提高麻醉质量减少并发症及事故的发生并为麻醉学建立一门能客观预估麻醉风险和提高麻醉质量的二级学科。方法收集本医院近二十年各种不同类型麻醉病例，尤其对急、危、重、罕见、抢救病例进行评估、反思、总结其麻醉质量、麻醉经验和风险；收集本省市及本医院近二十年各种不同类型麻醉事故／并发症／麻醉赔偿官司并进行评估、反思、总结其经验教训。结果106例麻醉导致脑死亡（植物人）其主要原因是手术中低血压、低血氧或心跳骤停时间过长、抢救不及时或麻醉复苏清醒评分不足导致，75例麻醉截瘫和马尾综合征其主要原因是病人过胖过矮致摸不清椎体间隙且穿刺粗暴或穿刺点过高，也有3例因用药错误或不慎导致麻醉死亡病例，有4例因术前谈话不充分导致赔偿个案，有56例因术中大出血抢救无效死亡及困难插管导致死亡。结论发现容易出事故和风险的情形很容易再次出现，即重复相同原因出现相同的差错和事故．有必要建立一整套麻醉风险与质量评估的理论指导体系，有必要为麻醉学建立一门能客观预估麻醉风险和提高麻醉质量远离麻醉事故的二级学科一麻醉风险与质量评估学。     

中重度阻塞性睡眠呼吸暂停低通气综合征患者听觉功能检查特征及其与阻塞性睡眠呼吸暂停低通气综合征、三酰甘油的相关性分析

背景　阻塞性睡眠呼吸暂停低通气综合征（OSAHS）病理改变可引起内耳和听觉系统的功能障碍，而关于OSAHS合并高脂血症对这一发生过程的影响暂无定论。目的　研究中重度OSAHS患者听觉功能检查特征及其与OSAHS、三酰甘油（TG）的相关性，并探究其可能原因。方法　选取2017年1月-2019年5月在上海交通大学医学院附属瑞金医院耳鼻咽喉科住院的中重度OSAHS患者50例，根据患者清晨空腹TG水平分为TG升高OSAHS组（25例）、TG正常OSAHS组（25例），同期选择20例健康体检者为对照组。对研究对象进行纯音听阈测定（PTA）、畸变产物耳声发射（DPOAE）检查，并记录不同频率的听阈值及信噪比（SNR），分析OSAHS患者听觉功能检查特征，探究TG是否加重听力损伤。采用Pearson相关分析探究不同频率的听阈值、SNR与OSAHS患者特征的相关性。结果　TG正常OSAHS组PTA的 2.00 、4.00 、8.00 kHz的听阈值及平均听阈值高于对照组（P<0.05），DPOAE的 4.00 kHz的SNR低于对照组（P<0.05）。TG升高OSAHS组DPOAE的1.00、2.00 、8.00 kHz的SNR低于TG正常OSAHS组（P<0.05）。PTA的0.50 kHz（r=0.227）、1.00 kHz（r=0.362）、2.00 kHz（r=0.328）、4.00 kHz（r=0.403）、8.00 kHz（r=0.463）听阈值及平均听阈值（r=0.500）与年龄呈正相关，1.00 kHz（r=0.333）、2.00 kHz（r=0.372）、4.00 kHz（r=0.464）、8.00 kHz（r=0.330）听阈值及平均听阈值（r=0.399）与呼吸暂停低通气指数（AHI）呈正相关，2 kHz（r=-0.314）听阈值与最低动脉血氧饱和度（SaO2）呈负相关，1.00 kHz（r=0.378）、2.00 kHz（r=0.444）听阈值与TG呈正相关；DPOAE的2.00 kHz（r=-0.221）、4.00 kHz（r=-0.432）、8.00 kHz（r=-0.441）的SNR与年龄呈负相关，4.00 kHz（r=-0.545）、8.00 kHz（r=-0.241）的SNR与AHI呈负相关，1.00 kHz（r=-0.507）、2.00 kHz（r=-0.385）的SNR与TG呈负相关（P<0.05）。结论　中重度OSAHS患者有不同程度的听力损伤，中重度OSAHS伴血脂升高则可加重听力损伤。OSAHS越严重，听力损伤越明显。年龄、AHI、TG水平越高，中重度OSAHS 患者的听力损伤越严重。     

Improvement of intensive care unit sound environment and analyses of consequences on sleep: an experimental study

ObjectiveUninterrupted sleep is of vital importance for restoration and regaining health. In intensive care units (ICUs) where recovering and healing is crucial, patients’ sleep often is fragmented and disturbed due to noise from activities from oneself, other patients, and alarms. The aim of our study was to explore if sleep could be improved by modifying the sound environment in a way that is practically feasible in ICUs.MethodsWe studied the effects of originally recorded ICU noise and peak reduced ICU noise on sleep in healthy male participants. Sleep was registered with polysomnography (PSG) during four nights: one adaptation night, one reference (REF) night, and the two exposed nights with similar equivalent sound levels (47 dB L_Aeq) but different maximum sound levels (56- vs 64-dB L_AFmax). The participants answered questionnaires and saliva cortisol was sampled in the morning.ResultsDuring ICU exposure nights, sleep was more fragmented with less slow-wave sleep (SWS), more arousals, and more time awake. The effects of reduced maximum sound level were minor. The subjective data supported the polysomnographic findings, though cortisol levels were not significantly affected by the exposure conditions.ConclusionsNoise in ICUs impairs sleep and the reduction of maximal A-weighted levels from 64 to 56 dB is not enough to have a clear improved effect on sleep quality.     

Assessing compressibility and compactibility of powder formulations with Near-Infrared Spectroscopy

Context: The compressibility and compatibility of a powder formulation is usually determined by compaction and following destructive tensile strength and relative density measurement of the final compact.

Objective: In this study, a non-destructive method with Near-Infrared Spectroscopy (NIRS) was designed and evaluated for the measurement of powder compressibility and compactibility.

Materials and Methods: 12 different formulations with a wide range of difference in properties were investigated by compaction and analysis of the resulting tablets. Two similar tablet batches were produced with every formulation. Relative density and tensile strength were measured with the traditional, destructive method on one tablet batch while a newly developed non-destructive chemometric NIRS method was applied for the second batch. The outcomes of the two approaches were compared to validate the developed method. All data sets were applied to three established mathematical equations to calculate equation factors, which are claimed to represent the formulation compressibility and compactibility. The study focus was set on the equation factor value comparison between the traditional and the newly designed method.

Results & Discussion: The results showed a high similarity between the outcomes of the two methods. An essential difference was noticed for the outcomes of the equation factors after application to the Leuenberger equation.

Conclusion: The approach with the NIRS is suggested as a promising tool for a reliable inline quality monitoring in the tablet manufacturing process.     

On Functions,Abilities and Quality of Life After Subarachnoid Haemorrhage: Occupational Therapy Aspects

This investigation addresses functions/impairments, abilities/disabilities and quality of life (QoL) in a consequtive series of non-hospitalized long-term survivors [2, 5–12 years] of subarachnoid haemorrhage (SAH). The investigated parameters of functions/impairments were: motor, language, perceptual and memory functions. Abilities/disabilities studied were: activities of daily living (ADL) including both personal- and instrumental ADL, working and leisure capacities. Quality of life was assessed using a double visual analogue scale. Occurrence of depression was registered using a self-rating scale.

A questionnaire focusing motor and language impairments, personal ADL, work and leisure activities was initially mailed to 324 subjects. Most of them answered the questionnaire. Ten hospitalized subjects could not validly report their functions and abilities and for that reason were excluded.

In a follow-up investigation up to 247 long-term non-hospitalized subjects were investigated by a physician and an occupational therapist. A total of 82% had at least one impairment. The majority (73%) had memory impairment and among these subjects equal proportions (about 50%) had impairments of long-and short-term memory. Forty-five percent were perceptually impaired, while motor impairment occurred for 25% and aphasia in 10%. Only a small minority (9%) were, according to self-reports, regarded as being to some extent disabled in personal ADL. The corresponding numbers of disabled in instrumental ADL, leisure and working-capacity were 52%, 48% and 40% respectively. Depression was found in 22%—among whom the majority had minimal or mild depression. Overall QoL was judged to be unchanged or increased in 62% of cases and, therefore, decreased in 38%.

As expected, impairments to a significant degree caused disabilities. None of the five different categories of impairment were associated with mood (depressed/not depressed) and QoL (decreased/not decreased). Occurrence of depression was significantly associated with the different aspects of disabilities. In contrast, among a series of instrumental ADL-variables, leisure and working capacity, QoL was influenced negatively only by decreased ability to act sociably and, to a minor extent, by depressed mood.

Judging from the extent of decreased quality of life, it appears that nearly 40% of all non-hospitalized former victims of SAH have not coped successfully with the impact of the SAH. A follow-up programme aiming at optimizing the coping process of SAH victims is, therefore, outlined