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Objective
To examine changes in personality in individuals with mild cognitive impairment (MCI) or dementia as observed by family members using both new data and a meta-analysis with the published literature.Design
Current and retrospective personality assessments of individuals with dementia by family informants. PubMed was searched for studies with a similar design and a forward citation tracking was conducted using Google Scholar in June 2018. Results from a new sample and from published studies were combined in a random effect meta-analysis.Setting and participants
Family members of older adults with MCI or dementia.Measures
The 5 major dimensions (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and facets of personality were assessed with NEO Personality Inventory questionnaires.Results
The new sample (n = 50) and meta-analysis (18 samples; n = 542) found consistent shifts in personality from the premorbid to current state in patients with cognitive impairment. The largest changes (>1 standard deviation) were declines in conscientiousness (particularly for the facets of self-discipline and competence) and extraversion (decreased energy and assertiveness), as well as increases in neuroticism (increased vulnerability to stress). The new sample suggested that personality changes were larger in individuals taking cognition-enhancing medications (cholinesterase inhibitors or memantine). More recent studies and those that examined individuals with MCI found smaller effects.Conclusions and implications
Consistent with the clinical criteria for the diagnosis of dementia, the new study and meta-analysis found replicable evidence for large changes in personality among individuals with dementia. Future research should examine whether there are different patterns of personality changes across etiologies of dementia to inform differential diagnosis and treatments. Prospective, repeated assessments of personality using both self- and informant-reports are essential to clarify the temporal evolution of personality change across the preclinical, prodromal, and clinical phases of dementia. 相似文献Background
There is a movement to ensure that pediatric patients are treated in appropriately resourced hospitals through the ACS Children’s Surgery Verification (CSV) program. The objective of this study was to assess the potential difference in care provision, health outcomes and healthcare and societal costs after implementation of the CSV program.Methods
All 2011 inpatient admissions for selected complex pediatric patients warranting treatment at a hospital with Level I resources were evaluated across 6 states. Multivariate regressions were used to analyze differences in healthcare outcomes (postoperative complications including death, length of stay, readmissions and ED visits within 30 days) and costs by CSV level. Recycled predictions were used to estimate differences between the base case scenario, where children actually received care, and the optimized scenario, where all children were theoretically treated at Level I centers.Results
8,006 children (mean age 3.06 years, SD 4.49) met inclusion criteria, with 45% treated at Level I hospitals, 30% at Level II and 25% at Level III. No statistically significant differences were observed in healthcare outcomes. Readmissions within 30 days were higher at Level II compared to Level I centers (adjusted IRR 1.61; 95% CI 1.11, 2.34), with an estimated 24 avoidable readmissions per 1000 children if treatment were shifted from Level II to Level I centers. Overall, costs per child were not significantly different between the base case and the optimized scenario.Conclusion
Many complex surgical procedures are being performed at Level II/III centers. This study found no statistically significant increase in healthcare or societal costs if these were performed instead at Level I centers under the optimized scenario. Ongoing evaluation of efforts to match institutional resources with individual patient needs is needed to optimize children’s surgical care in the United States.Level of evidence
II. 相似文献Materials and Methods: The first tier of testing utilized the Organization for Economic Co-operation and Development (OECD) QSAR Toolbox to perform an in silico evaluation of the skin irritation potential of the product ingredients, and the second tier of testing utilized an OECD in vitro guideline test to evaluate the skin irritation potential of each product.
Results: Thirty-two ingredients were evaluated using the OECD QSAR Toolbox profiler for the tier one analysis; nine ingredients received a structural alert for skin irritation/corrosion. In the tier two in vitro analysis, the evaluated cleansing conditioner products were all classified as non-irritants.
Conclusions: These results provide evidence that use of the evaluated commercially available cleansing conditioners would not be expected to cause skin irritation among consumers. Additionally, this study demonstrates that the presence of structural alerts does not always accurately predict the safety of a product, as focused tier-based testing is necessary to comprehensively evaluate a product. This study illustrates a tier-based safety assessment approach, applicable to a wide variety of health endpoints, which efficiently and adequately evaluates the safety of personal care and cosmetic products and their ingredients. 相似文献