Cognitive impairment and its relationship to gait rehabilitation in the elderly

In a prospective study of 116 elderly people admitted to a geriatric rehabilitation ward, mini-mental state score on admission was used to classify nonaphasic subjects into three groups: cognitively normal (24-30), mildly impaired (17-23) and severely impaired (less than 17). Forty-three percent of the subjects were normal, 34% had mild and 23% had severe cognitive impairment. Using walking speed as the index of gait rehabilitation, subjects with normal cognition had significantly greater gait improvement than those with cognitive impairment. Age and urinary incontinence did not contribute to predicting gait improvement in regression modelling. Cognitive impairment also predicted discharge placement to long term hospital care and to a higher level of care than the subject received prior to admission. Thus cognitive impairment on admission to a geriatric rehabilitation ward predicts poor rehabilitation outcome with respect to gait and discharge residence.     

社区综合性居家干预对产后抑郁的影响

目的 观察社区综合性居家干预对产后抑郁的影响.方法 随机对照将60例符合产后抑郁诊断标准的产妇分为观察组(n=30)和对照组(n=30),对照组给予常规家庭产后照护,观察组在家庭常规产后照护基础上进行社区综合性居家干预.采用社会支持量表(SSRS)、爱丁堡产后抑郁量表(EPDS)对比干预后2、4、8周产妇SSRS、EPDS的评分情况.结果 干预2、4、8周后观察组SSRS得分(32.83±7.35分,40.63±3.38分,46.87±5.62分)高于对照组(26.06±7.50分,31.93±5.42分,35.03±6.18分),观察组EPDS评分(9.83±0.35分,7.03±0.38分,5.27±0.32分)显著低于对照组(11.26±0.55分,10.23±0.42分,9.23±0.38分),差异有统计学意义(P<0.05).结论 社区综合性居家干预对提高产妇社会支持水平,改善产后抑郁症状效果显著,且全面、便捷、产妇和家属依从性高,群众乐于接受.     

Use of anxiolytic or hypnotic drugs and total mortality in a general middle-aged population

PURPOSE: The aim of the study was to evaluate the effect of the consumption of anxiolytic or hypnotic drugs on total mortality in a general population. METHODS: We followed a cohort of 7225 men and 7726 women aged 40-42 years who underwent health surveys in 1985-1989 in two Norwegian counties, with respect to deaths. Mean follow-up period was 18 years. The subjects were categorised according to frequency of anxiolytic or hypnotic drug use during the last month: daily, every week, less than every week and not used during the last month. RESULTS: The proportion of anxiolytic or hypnotic drug users was 6.6% among men and 16.2% among women. Altogether 402 men and 290 women died. There was an increase in risk of death with an increase in frequency of use. Crude hazard ratios for men and women daily using anxiolytics or hypnotics were 3.1 (95%CI 2.0, 4.8) and 2.7 (1.9, 4.0), respectively, as compared with non-users last month. After adjusting painkiller use and smoking the hazard ratios were lowered, being 2.4 (1.5-4.0) (men) and 2.1 (1.4-3.2) (women). After additional adjustments for other possible confounders the hazard ratios were further attenuated to 1.5 (0.9-2.7) for men and 1.7 (1.1-2.6) for women. CONCLUSIONS: Daily users of anxiolytic or hypnotic drugs in our study showed higher crude mortality than non-users. However, after adjusting lifestyle and socio-economic variables the difference was markedly reduced suggesting that the remaining excess mortality is due to residual confounding.     

Elderly people referred for institutional care--is prior assessment necessary?

AIMS: To determine whether requests for placement of an elderly person into rest home or hospital care accurately predicted the final outcome and to identify factors influencing a move to institutional care. METHODS: Three month audit of all referrals to an assessment and rehabilitation unit for the elderly requesting rest home or hospital placement. Requests for medical advice or rehabilitation were excluded. RESULTS: Two hundred patients were studied (24.6% of all referrals). Placement was requested in a rest home in 132 and hospital in 68. Seventy-one (54%) patients referred for rest home placement were able to return to their own home and 64 remained there at six month follow-up. Hospital level care was assessed as appropriate in 62% of requests for this initially and at six month follow up. Age and diagnosis were not significant predictors of patients requiring placement. Overall, of 158 patients living at home referred for rest home or hospital care, 67 (42%) were managing at home six months later. CONCLUSION: Accurate assessment and treatment/management of elderly patients is necessary before recommending higher levels of care. Patients can be maintained in their current environment for longer than perceived by the referring doctor. This has important social and financial benefits.     

居家认知行为疗法在多发性骨髓瘤化疗病人癌因性疲乏中的应用

目的 探讨居家认知行为疗法在多发性骨髓瘤(MM)化疗病人癌因性疲乏中的影响效果。 方法 选取2015年4月至2017年5月无锡市人民医院收治行常规护理的MM化疗病人124例,采用随机数字表法分为观察组和对照组。护理8周后,对比两组癌因性疲乏、生活质量及护理满意度。 结果 观察组护理8周后无疲乏率高于对照组,中度疲乏率低于对照组,差异有统计学意义(P＜0.05)。观察组护理8周后视觉模拟(VAS)评分相比于对照组更高,差异有统计学意义(P＜0.05)。观察组护理8周后社会功能(SF)、认知功能(CF)、情绪功能(EF)、角色功能(RF)、躯体功能(PF)评分均高于对照组,差异有统计学意义(P＜0.05)。观察组护理总满意率95.16%高于对照组77.42%,差异有统计学意义(P＜0.05)。 结论 居家认知行为疗法应用于MM化疗病人效果显著,可有效减轻癌因性疲乏,提高生活质量与护理满意度,值得推广。     

Health services utilization and cost for at-risk drinkers: rural and urban comparisons

OBJECTIVE: The purpose of this study was to examine differences between healthcare use and associated costs in rural and urban at-risk drinkers. METHOD: Primary healthcare utilization and cost data were collected from 1995 to 1998 on rural (n = 215) and urban (n = 228) cohorts of drinkers residing in six southeastern states who met criteria for at-risk drinking. Data were obtained through subject interview and from abstracts of medical and pharmacy records. RESULTS: Overall healthcare costs were not significantly different between the rural and urban cohorts. For subjects who incurred any hospital costs (including emergency room [ER] visits), however, costs were significantly greater (p < .01) for rural patients (median = dollars 2,561) than for urban patients (median = dollars 865). Hospital costs associated with patients' ER visits and any subsequent admissions were also greater (p < .01) for rural patients (median = dollars 1,004) than for urban patients (median = dollars 512). Use of healthcare services was significantly more likely to occur among women (p < .0001), individuals with lower overall self-reported physical health (p < .01) and individuals with health insurance (p < .0001). Among subjects who used healthcare services, greater costs were significantly associated with older age (p < .05), being female (p <.0001), having lower overall physical health (p < .0001) and having health insurance (p < .01). CONCLUSIONS: While overall healthcare costs are not significantly different between rural and urban residents in this sample of at-risk drinkers, there are some notable differences in the costs associated with inpatient and ER services.     

Estazolam treatment of insomnia in generalized anxiety disorder: a placebo-controlled study

Estazolam, a triazolobenzodiazepine with an intermediate elimination half-life, has been shown previously to be an effective and safe hypnotic in insomniacs without concomitant psychiatric illness. Our study of the efficacy of estazolam in patients with insomnia associated with generalized anxiety disorder began when 108 patients meeting criteria for generalized anxiety disorder (mean total score of Hamilton Rating Scale for Anxiety [HAM-A] = 22.0 +/- 3.1 [SD]) and insomnia were given single-blind placebo for 7 nights. Nine patients whose anxiety and/or insomnia improved were dropped as placebo responders. The remaining 99 patients were randomly allocated (1:1) to double-blind treatment with either estazolam 2.0 mg or matching placebo for 7 nights. Hypnotic efficacy, as determined by patient-completed sleep questionnaires, was statistically significant for estazolam 2.0 mg versus placebo for all sleep indices (p less than 0.01). Patients treated with estazolam 2.0 mg showed significantly greater improvement in anxiety than those receiving placebo on the mean total score of HAM-A ([placebo, -3.4; estazolam, -7.1; p less than 0.001] and without the insomnia item [placebo, -2.7; estazolam, -5.5; p less than 0.001]). Anxiety scores on the State-Trait Anxiety Inventory showed greater improvement in the estazolam group, but without statistical significance (p = 0.237). Estazolam 2.0 mg is an effective hypnotic in patients with generalized anxiety disorder and appears to have a favorable anxiolytic action.     

风险管理在老年精神科干预不良事件管理中的应用

目的:在老年精神科护理中应用风险管理,分析其在不良事件管理的应用效果。方法:选择2020年1月~2020年4月期间某院老年精神科护理出现的不良事件,作为研究组,2019年1月~2019年4月老年精神科护理出现的不良事件作为对照组,共180例患者。比较两组患者出现的不良事件以及干预后心理弹性评分(CD-RISC)。结果:研究组采用风险管理后跌倒、压疮、自残、暴力、出走不良事件的发生情况低于对照组(P<0.05);研究组的CD-RISC评分高于对照组(P<0.05)。结论:在老年精神科护理中应用风险管理,结果显示在不良事件管理中效果良好,能够明显降低不良事件的发生情况,以便能够为患者提供更好的服务,有利于提高患者的满意程度,改善患者心理调适,值得推广应用。     

Hypnosis and behavioral treatment in a worksite smoking cessation program

In the initial study, 48 subjects of the total (N = 63) ultimately used, were assigned to one of three treatments: four hypnotic sessions with a booster, two hypnotic sessions, or two hypnotic and two behavioral sessions with a booster. A follow-up group was later recruited composed of 15 subjects who received four hypnotic sessions and a booster session with less time between sessions. The results indicated no difference in smoking cessation 6 months after treatment regardless of the frequency, length between sessions, or addition of behavioral methods. Successful subjects were more educated, less able to utilize their imagination, and had fewer smokers at home.     

A placebo-controlled add-on trial of the Ampakine, CX516, for cognitive deficits in schizophrenia.

AMPA-receptor-positive modulators (Ampakines) facilitate learning and memory in animal models and in preliminary trials in human subjects. CX516 is the first Ampakine to be studied for cognitive enhancement in schizophrenia. Stable schizophrenia patients treated with clozapine (n=52), olanzapine (n=40), or risperidone (n=13) were randomly assigned to add-on treatment with CX516 900 mg three times daily or placebo for 4 weeks. Subjects were assessed with a cognitive battery at baseline, week 4, and at 4-week follow-up. Clinical scales and safety monitoring were also performed. The primary endpoint was the change from baseline in a composite cognitive score at week 4 for the intent-to-treat sample. Additional analyses examined change in symptom rating scores and examined drug effects on patients treated with clozapine separately from patients treated with either olanzapine or risperidone. A total of 105 patients were randomized and 95 (90%) completed the 4-week trial. Patients treated with CX516 did not differ from placebo in change from baseline on the composite cognitive score, or on any cognitive test at weeks 4 or 8. The between groups effect size at week 4 for the cognitive composite score was -0.19 for clozapine-treated patients and 0.24 for patients treated with olanzapine or risperidone. The placebo group improved more on the PANSS total score than the CX516 group; no other clinical rating differed between treatment groups. CX516 was associated with fatigue, insomnia and epigastric discomfort compared to placebo, but was generally well tolerated. CX516 was not effective for cognition or for symptoms of schizophrenia when added to clozapine, olanzapine, or risperidone.     

The correlation of the serotonin-positive and anxiolytic activities of nonbenzodiazepine substances

The anxiolytic activity of serotonin agonists (buspirone, ipsapirone, campirone, caplapirone, 1-pyrimidinyl-piperazine) determined in rats on 3 experimental models of anxiety closely correlates with the degree of inhibition of impulse release of 3H-serotonin by electrically stimulated slices of the midbrain raphe dorsal nucleus (r = +0.85) but not the slices of the cerebral hemispheric cortex (r = +0.60) of the rats. The anxiolytic activity of neuroleptics (chlorpromazine, trifluorperazine), antidepressant (amitriptyline, imipramine) and beta-carbolines (harmane, 3.4-tetramethyleneharmane) corresponds well (r = +0.94) to the ability of the drugs to potentiate the hyperpolarizing effects of serotonin in the rat sensory ganglion.     

乌司他丁对腹腔镜下直肠癌根治术患者POCD的影响及机制探讨

目的探讨乌司他丁对腹腔镜辅助下行直肠癌根治术的患者术后认知功能障碍(POCD)的影响及其机制。方法收集2011年7月至2014年5月我院行腹腔镜下直肠癌根治术的130例患者的资料,分为观察组(65例,加乌司他丁)和对照组(65例,不加乌司他丁)。比较两组患者的术后认知功能、炎性指标、S100β及血液T淋巴细胞。结果术后观察组患者的POCD发生率低于对照组(P=0.01)。术后3 d,观察组患者的MMSE评分、联想学习及视觉再生评分均高于对照组(P<0.01);观察组患者的CRP、ESR、TNF-α、IL-6、S100β均低于对照组(P<0.01);观察组患者的CD3~+%、CD4~+%、CD4~+/CD8~+均高于对照组(P<0.01),而CD8~+%低于对照组(P<0.01)。结论乌司他丁能够通过抑制炎症反应、改善T细胞免疫功能,降低直肠癌患者POCD发生率。     

多奈哌齐联合康复训练治疗脑卒中后血管性认知障碍的效果

目的：探讨多奈哌齐联合康复训练治疗脑卒中后血管认知障碍的效果。方法选取本院康复科收治的脑卒中后血管性认知障碍患者共90例,将其分为观察组（n=47）和对照组（n=43）。对照组给予康复训练和基本药物治疗,观察组在对照组上给予多奈哌齐治疗,对比两组的疗效。结果治疗后,观察组的MMSE评分明显高于对照组（t=2.459,P=0.016）,ADL评分明显高于对照组（t=2.459,P=0.016）,疗效明显优于对照组（χ2=5.067,P=0.024）。结论早期多奈哌齐联合康复训练治疗脑卒中后血管性认知障碍可在一定程度上延缓血管性认知障碍的进程,提高患者的MMSE、ADL评分,改善患者的预后,提高临床效果。