Transcranial direct current stimulation as an adjunct to cognitive training for older adults with mild cognitive impairment: A randomized controlled trial

BackgroundCognitive training (CT) for individuals with mild cognitive impairment (MCI) may not be optimal for enhancing cognitive functioning. Coupling CT with transcranial direct current stimulation (tDCS) may maximize the strength of transmission across synaptic circuits in pathways that are stimulated by CT. The synergistic effects arising from this combination could be superior to those with administration of CT alone.ObjectivesTo investigate whether the receiving tDCS combined with CT is superior to CT alone on domain-specific and task-specific cognitive outcomes in older adults with MCI.MethodsThis double-blind, sham-controlled randomized trial included 67 older adults with MCI assigned to 3 groups: 1) tDCS combined with CT (tDCS + CT), 2) sham tDCS combined with CT (sham tDCS + CT) and 3) CT alone. Nine sessions of computerized CT were administered to the 3 groups for 3 weeks. In addition, tDCS and sham tDCS was delivered to the left dorsolateral prefrontal cortex to the tDCS + CT and sham tDCS + CT groups, respectively, simultaneously with CT. Standardized cognitive assessments were performed at baseline, post-intervention, and at 6-week follow-up. Participants’ performance in the CT tasks was rated every session.ResultsThe 3 groups showed improvements in global cognition and everyday memory (P < 0.017) after the intervention and at follow-up, with larger effect sizes in the tDCS + CT than other groups (d > 0.94) but with no significant differences between groups. Regarding CT outcomes, the groups showed significant differences in favour of the tDCS + CT group in decreasing the completion and reaction times of working memory and attention activities (P < 0.017).ConclusionstDCS combined with CT was not superior to sham tDCS with CT and CT alone in its effects on domain-specific cognitive outcomes, but it did provide comparatively larger effect sizes and improve the processing speed of task-specific outcomes.ClinicalTrials.govNCT03441152.     

Complexity of knee extensor torque in patients with frailty syndrome: a cross-sectional study

BackgroundFrailty syndrome is characterized by a marked reduction in physiological reserves and a clinical state of vulnerability to stress. Torque complexity analysis could reveal changes in the musculoskeletal systems that are the result of having the syndrome.ObjectiveThe aim of this study was to evaluate the complexity of submaximal isometric knee extensor torque in frail, pre-frail, and non-frail older adults. A secondary aim was to analyze the torque complexity behavior in different force levels in each group.MethodsA cross-sectional study was conducted. Forty-two older adults were divided into three groups: non-frail (n = 15), pre-frail (n = 15), and frail (n = 12). The data collected included body composition, five times sit-to-stand test, walking speed, and isometric knee extensor torque at 15, 30, and 40% of maximal voluntary contraction. The knee extensor torque variability was evaluated by coefficient of variation, and the torque complexity was evaluated by approximate entropy and sample entropy.ResultsThe frail group presented a reduction in body mass and peak torque value compared to the non-frail group. Also, the frail group showed worse physical performance (on the five times sit-to-stand test and walking speed) compared to the pre-frail and non-frail groups. In addition, the frail older adults showed reduced torque complexity compared to the non-frail group. Finally, the association between torque complexity and force levels remained similar in all groups.ConclusionTorque complexity is reduced in the presence of frailty syndrome.     

Outcomes for older adults in inpatient specialist neurorehabilitation

BackgroundInpatient specialist neurorehabilitation in the United Kingdom is based on providing a service to “working-age” adults (<65 years), with little evidence for outcomes for older adults involved with these services.ObjectiveThe aim of this study is to determine any difference in outcome after inpatient neurorehabilitation between younger and older adults assessed as having rehabilitation potential.MethodsA two-centre retrospective review was performed comparing patients aged < 65 and ≥ 65 years by diagnostic group in terms of length of stay, changes in UK Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) scores and discharge destination.ResultsSix hundred and sixteen patients (32% ≥ 65 years) were included. The 2 age groups did not differ in length of stay (median difference 7 days, 95% confidence interval [CI] −2 to 15, P = 0.112), but both UK FIM + FAM change and efficiency were higher for the older than younger group (median difference 7, 95% CI 2–13, P = 0.006 and 0.10, 0.01–0.19, P = 0.031 respectively). Older age was associated with discharge to long-term care (6% < 65 years; 11% ≥ 65 years, x² = 4.10, P = 0.043). Results and trends were similar in patients with acquired brain injury (n = 429), spinal cord injury (n = 59) and peripheral neuropathy (n = 34) but not progressive neurological disorders (n = 70).ConclusionOlder adults considered to have rehabilitation potential may have greater functional gains from inpatient specialist inpatient rehabilitation than younger adults. Age alone should not exclude admission to inpatient specialist neurorehabilitation.     

The Mental Activity and eXercise (MAX) trial: Effects on physical function and quality of life among older adults with cognitive complaints

BackgroundOlder adults with cognitive complaints are vulnerable to dementia, physical impairments, and poor quality of life. Exercise and mental activity may improve physical function and health-related quality of life (HRQOL) but combinations have not been investigated systematically. The Mental Activity and eXercise (MAX) trial found that mental activity plus exercise over 12 weeks improved cognitive function (primary outcome) in sedentary older adults with cognitive complaints.ObjectiveTo investigate the effects of combinations of two mental activity and exercise programs on physical function and HRQOL (secondary outcomes).MethodsParticipants (n = 126, age 73 ± 6 years, 65% women) were randomized to 12 weeks of exercise (aerobic exercise or stretching/toning, 3 × 60 min/week) plus mental activity (computer-based cognitive training or educational DVDs, 3 × 60 min/week) using a factorial design. Assessments included the Senior Fitness Test (physical function), Short Form-12 physical and mental sub-scales (HRQOL), and CHAMPS questionnaire (physical activity).ResultsThere were no differences between groups at baseline (p > 0.05). We observed improvements over time in most physical function measures [chair stands (p-for-time = 0.001), arm curls (p-for-time < 0.001), step test (p-for-time = 0.003), sit & reach (p-for-time = 0.01), and back scratch (p-for-time = 0.04)] and in physical HRQOL (p-for-time = 0.04). There were no differences in change between groups (group 1 time p > 0.05). Changes in most physical function measures and physical HRQOL correlated with physical activity changes.ConclusionCombined mental activity and exercise interventions of various types can improve both physical function and physical HRQOL among sedentary older adults with cognitive complaints. Exercise control group design should be carefully considered as even light exercise may induce benefits in vulnerable older adults.     

Efficacy of a progressive resistance exercise program to increase toe flexor strength in older people

BackgroundReduced toe flexor strength is an independent predictor of falls in older people. However it is unknown whether strengthening programs can restore toe flexor strength in older individuals. The aim of this study was to investigate whether a progressive resistance training program, focused specifically on the foot muscles, could improve toe flexor strength in community-dwelling older people.MethodsAfter baseline testing, 85 men and women (age range 60–90 years) were randomized to either a supervised, progressive resistance training (n = 43) or a home-based exercise (n = 42) group for 12 weeks. A further 32 participants were recruited for a control group. The primary outcome measures were hallux and lesser toe flexor strength pre- and post-intervention. Secondary outcome measures were exercise compliance, components of the Foot Health Status Questionnaire and single-leg balance time.FindingsAverage class attendance was 89% with 68 participants from the two intervention groups (80%) completing the follow-up assessments. Participants in the supervised, progressive resistance training group significantly increased their toe strength (up to 36%; P < 0.02), whereas there was no change in toe strength in either the home-based or control groups. This increased toe strength was accompanied by a significant improvement in perceived general foot health and single-leg balance time compared to the other groups (P < 0.05).InterpretationProgressive resistance exercises are a viable intervention to increase toe flexor strength in older adults. A clinical trial is now required to determine whether this intervention can reduce the number of falls suffered by older adults.     

Oxidative stress and DNA damage in older adults that do exercises regularly

ObjectivesFree radicals may damage lipids, proteins and DNA, which may lead to critical diseases in the aging. This work evaluated levels of malondialdehyde (MDA), glutathione peroxidase (GPx) and DNA damage by comet assay (SCGE) in older adults that do exercises regularly.Design and Methods110 females, aged 66.3 ± 8 years were divided into sedentary (n = 54), walking (n = 36) and muscle building (n = 20) groups. Levels of MDA, GPx and SCGE were measured in venous blood before and after exercise.ResultsMDA levels were higher (P < 0.005) and GPx levels were lower (P < 0.005) in active groups than in sedentary group. SCGE index after physical activity was greater than at baseline (muscle building: P = 0.004; walking: P = 0.002).ConclusionsExercise reduces the diseases risk, but may promote the production of free radicals. It remains unclear whether cell adaptations responsible for health benefits are associated with such events. However we may suggest the existence of a different biochemical pattern for older adults that do exercise regularly.     

Prediction equation of hip external rotators maximum torque in healthy adults and older adults using the measure of hip extensors maximum torque

BackgroundThe use of predictive equation of muscular torque can reduce physical effort and time spent during evaluation.ObjectivesTo establish, validate, and test the accuracy of a prediction equation to estimate the hip external rotators (HER) torque in adults and older adults by means of hip extensors (HEX) torque measurement.MethodsEighty-three healthy adults (development set) were assessed to test the association of HEX and HER torques and to establish the prediction equation. A separate 36 adults and 15 older adults (validation sets) were assessed to test the ability of the equation to estimate HER torque. Hip isometric strength was assessed by a handheld dynamometer.ResultsSimple linear regression analysis revealed that HEX torque was associated with HER torque (r = 0.80; p < 0.0001), resulting in the following prediction equation: HER_torque= −0.02 + (0.58 * HEX_torque). Paired t-test revealed no difference between directly measured and predicted values of HER torque in adults (mean difference = 0.02; 95% CI = −0.115, 0.072) and older adults (mean difference = 0.05; 95% CI = −0.02, 0.12).ConclusionThe HEX and HER torques were strongly correlated. The prediction equation was valid, accurate, and can be used to estimate HER muscle strength in healthy adults and older adults, requiring only the direct measurement of HEX torque.     

Patient transfer from a rehabilitation hospital to an emergency department : A retrospective study of an American trauma center

ObjectiveTo analyze medical indications and conditions for patients transferred from a rehabilitation hospital to an emergency department (ED). Are there differences in terms of which patients go to the ED during their stay and which do not? Specifically, what type of patient is most likely to be transferred?MethodologyA retrospective study was conducted at an American adult and pediatric urban trauma center that serves 40,000 patients per year. This study compared randomly selected samples of 534 patients having been transferred to the ED from a rehabilitation hospital and 500 patients who were directly admitted to the ED from the community. Variables examined were: demographics, ED diagnosis and level of care, length of hospital stay, costs, discharge condition and return within 60 days to the ED.ResultsThe patients transferred from the rehabilitation hospital were older (P < 0.01), differed with regard to ethnicity (83% African American; P < 0.01), the reason for hospitalization (P < 0.01; the majority presented with cardiovascular disease, respiratory disease or altered mental status), had longer and more expensive stays (average: 4–8 days, P < 0.01), required a higher level of care (P < 0.01), were more often admitted to surgery or telemetry, and, lastly, were more likely to be discharged in a frail or poor condition (P < 0.01).ConclusionsThe patients transferred from a rehabilitation hospital had complex, intense medical (and often psychological) issues. These patients’ medical needs required a high level of resources in the ED. They frequently left the hospital in sub-optimal conditions, making it likely that they would return to the hospital via the ED prior to completing their treatment within the rehabilitation hospital.     

Validation of a simple screening test for elementary visuo-spatial perception deficit

ObjectiveThe reliability and validity of a screening test for a deficit in elementary visuo-spatial perception (EVSP) were evaluated.MethodThis prospective study collected performance from 210 typically developing individuals and evaluated the internal consistency of the EVSP screening test. Test–retest reliability was examined with 25 individuals. Validity also involved retrospective clinical data collected from 223 non-typically developing children coming to the hospital for outpatient consultation. Since EVSP matures through childhood, we standardized the EVSP screening test scores by age category and performed Pearson correlations with standardized clinical tests scores.ResultsTest–retest reliability (intraclass correlation coefficient = 0.76) and internal consistency (Cronbach's alpha = 0.76) were satisfactory. Construct validity included correlation with the subtests of the Wechsler Intelligence Scale IV (WISC-IV) involving visuo-spatial analysis (Matrix Reasoning and Block Design, P < 0.01; Symbol Search and Coding, P < 0.05) and was reinforced by the expected non-correlation between the Verbal Comprehension Index and EVSP scoring class. The EVSP scoring class was correlated with Manual dexterity of the M-ABC (P < 0.05) and the Working Memory Index (P < 0.05) of the WISC-IV including the subtest Arithmetic (P < 0.01).ConclusionThis screening test is reliable and valid to evaluate EVSP before more complex cognitive or motor assessment.     

Metabolomic analysis of serum by (1) H NMR spectroscopy in amyotrophic lateral sclerosis

BackgroundAmyotrophic lateral sclerosis (ALS), an invariably fatal neurological disorder shows complicated pathogenesis that poses challenges with respect to diagnosis as well as monitoring of disease progression.MethodsWe investigated metabolite profiles in the serum of 30 patients with ALS, 10 patients of Hirayama disease, which served as a neurological disease control and 25 healthy controls by using (1) H NMR spectroscopy.ResultsCompared to healthy controls, the ALS patients had higher quantities of glutamate (P < 0.001), beta-hydroxybutyrate (P < 0.001), acetate (P < 0.01), acetone (P < 0.05), and formate (P < 0.001), and lower concentrations of glutamine (P < 0.02), histidine (P < 0.001) and N-acetyl derivatives. On the other hand, Hirayama disease patients had significantly higher median concentrations of pyruvate (P < 0.05), glutamate (P < 0.001), formate (P < 0.05) and lower median concentrations of N-acetyl derivatives. Furthermore, we also found that serum glutamate showed a positive correlation (P < 0.001, r = 0.6487) whereas, histidine showed a negative correlation (P < 0.001, r = ? 0.5641) with the duration of the disease in ALS.ConclusionsSuch (1) H NMR study of serum may reveal abnormal metabolite patterns, which could have the potential to serve as surrogate markers for monitoring ALS disease progression.     

Day-to-day variation of urinary NGAL and rational for creatinine correction

ObjectivesThe number of clinical studies evaluating the new tubular biomarker urinary neutrophil gelatinase-associated lipocalin (U-NGAL) in urine are increasing. There is no consensus whether absolute U-NGAL concentrations or urinary NGAL/creatinine (U-NGAL/Cr) ratios should be used when chronic tubular dysfunction is studied. The aim was to study the biological variation of U-NGAL in healthy subjects and the rational for urinary creatinine (U-Cr) correction in two different study samples.Design and methodsTo study biological variation of U-NGAL and U-NGAL/Cr ratio and the association between U-NGAL and U-Cr in healthy subjects 13 young males and females (median age 29 years) collected morning urine in 10 consecutive days. Additionally, a random subsample of 400 males from a population-based cohort (aged 78 years) collecting 24-hour urine during 1 day was studied.ResultsThe calculated biological variation for absolute U-NGAL was 27% and for U-NGAL/Cr ratio, 101%. Absolute U-NGAL increased linearly with U-Cr concentration (the theoretical basis for creatinine adjustment) in the older males (R = 0.19, P < 0.001) and with borderline significance in the young adults (R = 0.16, P = 0.08). The U-NGAL/Cr ratio was, however, negatively associated with creatinine in the older males (R = ? 0.14, P < 0.01) and in the young adults (R = ? 0.16, P = 0.07) indicating a slight “overadjustment.”ConclusionsThe study provides some support for the use of U-NGAL/Cr ratio but the rather large biological variation and risk of possible overadjustment need to be considered. Both absolute U-NGAL and U-NGAL/Cr ratios should be reported for the estimation of chronic tubular dysfunction.     

Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years

ObjectivesThe usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.MethodsThis was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.ResultsWe reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%–10%; P < 0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P < 0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P < 0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P < 0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P < 0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P < 0.05).ConclusionsDisabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.     

Neuronal apoptosis may not contribute to the long-term cognitive dysfunction induced by a brief exposure to 2% sevoflurane in developing rats

BackgroundSevoflurane is an inhaled anesthetic commonly used in the pediatric. Recent animal studies suggest that early exposure to high concentration of sevoflurane for a long duration can induce neuroapoptosis and later cognitive dysfunction. However, the neurodevelopmental impact induced by lower concentration and shorter exposure duration of sevoflurane is unclear. To investigate whether early exposure to 2% concentration of sevoflurane for a short duration (clinically relevant usage of sevoflurane) can also induce neuroapoptosis and later cognitive dysfunction.MethodsRat pups were subjected to control group, 2% sevoflurane for 3 h and 3% sevoflurane for 6 h. TUNEL assay and apoptotic enzyme cleaved caspase-3 measured by western blot were used for detection of neuronal apoptosis in frontal cortex and CA1 region of hippocampus 24 after sevoflurane treatment. Long-term cognitive function was evaluated by Morris water maze and passive avoidance test as the rats grew up.ResultsThe apoptotic levels in frontal cortex and CA1 region were significantly increased after rats exposed to 3% sevoflurane for 6 h (P < 0.05), but not 2% sevoflurane for 3 h (P > 0.05). Exposure to both 2% sevoflurane for 3 h and 3% sevoflurane for 6 h could cause long-term cognitive dysfunction and animals exposed to 3% sevoflurane for 6 h exhibited worse neurodevelopmental outcomes (P < 0.05).ConclusionIt was suggested that neuronal apoptosis might not contribute to long-term cognitive dysfunction induced by 2% concentration and short exposure time of sevoflurane. Our findings also suggested that the mechanisms of sevoflurane-induced neurodevelopmental impact might be various, depending on the concentration and exposure duration.     

Dancer perceptions of the cognitive,social, emotional,and physical benefits of modern styles of partnered dancing

ObjectiveTo study dancers’ perceptions of the physical, cognitive, affective, and social benefits of partnered dancing.Method225 dancers (71% female) were recruited through a community ballroom dance center and completed an online survey designed to measure their perceptions of the physical, cognitive, affective, and social benefits of modern, partnered dance styles (swing, Lindy Hop, and ballroom dancing). Subgroups were formed for analyses. For one set of analyses, groups based on length of dance participation were formed: experienced (dancing for more than 2 years) or novice (dancing for less than a year) dancers. For another set of analyses, groups based on frequency of dance practice were formed: committed (dancing at least one or more times per week) or occasional (dancing two or fewer times per month).ResultsThe majority of participants reported perceived benefits in physical fitness, cognition, affect, and social functioning. Experienced dancers reported significantly greater self-perceived physical, social, and cognitive benefits than novice dancers. Committed dancers were more likely than occasional dancers to report improvements in physical fitness, U = 6942, z = 2.38, r = 0.16, p < 0.05. A Mann-Whitney test indicated that self-reported improvements in mood (i.e., feeling less depressed and more happy) were greater for women than for men, U = 3945, z = −3.07, r = 0.20, p < 0.001. Length and frequency of dance participation significantly predicted perceived physical benefits [Χ² (1,6) = 35.463, p <0.001, R² = 0.16] and social benefits [Χ² (1,6) = 15.776, p < 0.05, R² = 0.07], but not cognitive benefits.ConclusionsResults suggest that participation in partnered dance styles is associated with perceived improvements in physical fitness, cognitive functioning, social functioning, mood, and self-confidence, and that perceived benefits may increase as individuals dance more frequently and over longer periods of time.     

Effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in pigs

AimStomach inflation during mask ventilation is frequent, but the effects on haemodynamic and pulmonary function are unclear. We evaluated the effects of stomach inflation on haemodynamic and pulmonary function during spontaneous circulation in a porcine model.MethodsRandomised prospective animal study. After randomisation, in 23 domestic pigs the stomach was inflated every 90 s with 0 L (control; n = 8), 0.5 L (n = 7) or 1 L (n = 8) ambient air.ResultsAfter 22.5 min, i.e. 8.5 L in the 0.5 L and 17 L in the 1 L stomach inflation group, stomach inflation increased central venous pressure (median) (control: 10 mmHg vs. 1 L: 23 mmHg, P < 0.05) and mean pulmonary artery pressure (control: 24 mmHg vs. 1 L: 45 mmHg, P < 0.05). As a result stroke volume index decreased (control: 135 mL/kg vs. 0.5 L: 90 mL/kg, P < 0.05; vs. 1 L: 72 mL/kg, P < 0.05). Stomach inflation also decreased static pulmonary compliance (control: 24 mL/cmH₂O vs. 0.5 L: 8 mL/cmH₂O, P < 0.05; vs. 1 L: 3 mL/cmH₂O, P < 0.05), which increased peak airway pressure (control: 28 cmH₂O vs. 0.5 L: 69 cmH₂O, P < 0.05; vs. 1 L: 73 cmH₂O, P < 0.05). Additionally, arterial oxygen partial pressure (control: 305 mmHg vs. 0.5 L: 140 mmHg, P < 0.05; vs. 1 L: 21 mmHg, P < 0.05) and systemic oxygen delivery (control: 53 mL O₂/min vs. 1 L: 19 mL O₂/min, P < 0.05) decreased. Stomach inflation increased mortality (control: 0/8 vs. 1 L: 5/8, P < 0.05).ConclusionsStomach inflation with 1 L when compared to 0.5 L increments resulted in faster haemodynamic and pulmonary failure and increased mortality. Stomach inflation may cause a hyper-acute abdominal compartment syndrome.     

The effects of gait retraining in runners with patellofemoral pain: A randomized trial

BackgroundRunning popularity has increased resulting in a concomitant increase in running-related injuries with patellofemoral pain most commonly reported. The purpose of this study was to determine whether gait retraining by modifying footstrike patterns from rearfoot strike to forefoot strike reduces patellofemoral pain and improves associated biomechanical measures, and whether the modification influences risk of ankle injuries.MethodsSixteen subjects (n = 16) were randomly placed in the control (n = 8) or experimental (n = 8) group. The experimental group performed eight gait retraining running sessions over two weeks where footstrike pattern was switched from rearfoot strike to forefoot strike, while the control group performed running sessions with no intervention. Variables were recorded pre-, post-, and one-month post-running trials.FindingsKnee pain was significantly reduced post-retraining (P < 0.05; effect size = 0.294) and one-month follow-up (P < 0.05; effect size = 0.294). Knee abduction was significantly improved post-retraining (P < 0.05; effect size = 0.291) and one-month follow-up (P < 0.05; effect size = 0.291). Ankle flexion was significantly different post-retraining (P < 0.05; effect size = 0.547), as well as ankle range of motion post-retraining (P < 0.05; effect size = 0.425) and one-month follow-up (P < 0.05; effect size = 0.425).InterpretationFindings suggest running with a forefoot strike pattern leads to reduced knee pain, and should be considered a possible strategy for management of patellofemoral pain in recreational runners.This trial is registered at the US National Institutes of Health (clinicaltrials.gov) #NCT02567123.     

Determining the effectiveness of an Elder Abuse Nurse Examiner Curriculum: A pilot study

ObjectivesTo pilot and evaluate a novel Elder Abuse Nurse Examiner Curriculum and its associated training materials for their efficacy in improving Sexual Assault Nurse Examiner (SANE)s' knowledge of elder abuse and competence in delivering care to abused older adults.MethodsPilot training was held with 18 SANEs from across Ontario, Canada. A 52-item pre- and post-training questionnaire was administered that assessed participants' self-reported knowledge and perceived skills-based competence related to elder abuse care. A curriculum training evaluation survey was also delivered following the training. Qualitative non-participant observational data were collected throughout the training.ResultsThere were statistically significant improvements in self-reported knowledge and perceived skills-based competence from pre-training to post-training for all content domains of the curriculum: older adults and abuse (p < 0.0001), documentation, legislative, and legal issues (p < 0.0001); interview with the older adult, caregiver, and other relevant contacts (p < 0.0001); assessment (p = 0.0018); medical and forensic examination (p < 0.0001); case summary, discharge plan, and follow-up care (p < 0.0001). The post-training evaluation survey demonstrated satisfaction among participants across all components of the curriculum and its delivery, particularly with reference to the comprehensiveness of the curriculum, and the clarity and appropriateness of the training materials.ConclusionsThe Elder Abuse Nurse Examiner Curriculum and associated training materials were efficacious in improving SANEs' self-reported knowledge of and perceived competence in delivering elder abuse care. Future steps will further evaluate these materials as a component of a pilot of a larger comprehensive Elder Abuse Intervention at multiple sites across Ontario.     

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis

BackgroundThe association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis.MethodsSixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n = 18), mild pain (n = 27), or moderate/severe pain (n = 22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified.FindingsThe moderate/severe pain group demonstrated worse global pain (P < 0.01) and physical function scores (P < 0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P = 0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P = 0.009), which was associated with higher weight acceptance peak knee adduction moments (P = 0.003) and worse global pain (P = 0.003) and physical function scores (P = 0.006).InterpretationGreater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait.     

Acid-base disturbances in acute poisoning and their association with survival

PurposeThe purpose was to investigate the association between acid-base disturbances and mortality in acute poisoning.Materials and methodsWe performed a retrospective cross-sectional exploratory study on all acutely poisoned patients older than 12 years who had been admitted to the main tertiary toxicology hospital in Tehran between March and August 2010.ResultsOf a total of 1167 patients (median age = 25 years, 50.9% male), 98 died (74.5% male). Psychotropic medications were the most common cause of poisoning (36.5%), whereas narcotics and psychodysleptics were the most common cause of death (23.5%). Mixed respiratory alkalosis and metabolic acidosis with normal pH were the most common acid-base status (333, 28.5%). However, patients with primary metabolic acidosis and respiratory compensation had significantly higher mortality (31 cases, 18.8%). Logistic regression analysis identified age (odds ratio [OR], 1.051; 95% confidence interval [CI], 1.031-1.070; P < .001), intensive care unit admission (OR, 12.405; 95% CI, 7.178-21.440; P < .001), consciousness level (OR, 1.752; 95% CI, 1.301-2.359; P < .001), hospitalization period (OR, 1.1361; 95% CI, 1.079-1.195; P < .001), severe metabolic acidosis (OR, 6.016; 95% CI, 1.647-21.968; P = .007), and primary respiratory alkalosis (OR, 5.579; 95% CI, 1.353-23.001; P = .017) as death predictors during hospitalization (P < .001).ConclusionOn-arrival acid-base status predicts survival and can be used in prognostication of the poisoned patients.     

Impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults: A Quasi-experimental study

BackgroundWith an aging population, it is critical that nurses are educated and prepared to offer quality healthcare to this client group. Incorporating gerontology content into nursing curricula and addressing students' perceptions and career choices in relation to working with older adults are important faculty concerns.ObjectivesTo examine the impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults and career intentions.DesignQuasi-experimental, pre- and post-test design.SettingMedium-sized state university in the Mid Western United StatesParticipantsData were collected from three student cohorts during the spring semesters of 2012 (n = 98), 2013 (n = 80) and 2014 (n = 88) for a total of N = 266 with an average response rate of 85%.MethodsA survey instrument was administered via Qualtrics and completed by students prior to, and following completion of the course.ResultsThere was an overall significant increase (p = 0.000) in positive perceptions of working with older adults among nursing students following completion of the course. The majority of participants (83.5%) reported having previous experience with older adults. Those with previous experience had higher perception scores at pre-test than those without (p = 0.000). Post-test scores showed no significant difference between these two groups, with both groups having increased perception scores (p = 0.120). Student preferences for working with different age groups suggested an overall increase in preference for working with older adults following the course.ConclusionsA course in gerontological nursing, incorporating learning partnerships with community dwelling older adults, promotes positive perceptions of working with older adults, independently of the quality of prior experience. There was some evidence that students changed their preferences of working with different age groups in favor of working with older adults. Further research should be conducted to determine the mechanisms through which this takes place.