Validation of the Greek version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+, version 3)

Objectives: There is a growing need for evaluation of the results of mental health services and clinical treatment in older people, but evidence for effectiveness is limited in Greece. The Health of the Nations Outcome Scales for Elderly People (HoNOS65+) are promising instruments for the assessment of mental, physical and social health in older persons. They have been translated into the Greek language but have not been validated. The aim was to assess the inter-rater reliability, intraclass correlation, concurrent validity, internal consistency and sensitivity to change of HoNOS65+ in a Greek sample of older people with mental health problems.

Method: Two samples, one of inpatients in a psychiatric hospital and the other of older people living in the community were used. In order to test the extent to which the HoNOS65+ were sensitive to change the first sample was reassessed after two months and the second after three months. For each participant HoNOS65+ were completed by two independent raters, and the clinician rated blindly each participant on the Stockton Geriatric Rating Scale and a scale which measured behavioural, physical, cognitive and emotional status.

Results: In both groups (inpatients n?=?50, community n?=?65), the inter-rater reliability, intraclass correlation and concurrent validity were high while internal consistency of the scales taken together was low. At reassessment in 98 participants, HoNOS65+ showed changes comparable to clinician ratings.

Conclusion: The Greek version of HoNOS65+ can achieve high levels of reliability, validity and sensitivity to change for measuring outcomes in older people with mental health problems.     

A prospective assessment of renal oxygenation in children undergoing laparoscopy using near-infrared spectroscopy

Background

This study was designed to determine whether a decrease in renal oxygenation occurs during CO₂ pneumoperitoneum in children with normal renal function undergoing laparoscopy.

Methods

Near infrared spectroscopy (NIRS) probes were applied to both the lateral flank (T10-L2) and lateral cerebral area of all patients with normal renal function undergoing a laparoscopic procedure. Information was recorded in 5-s intervals for 15-min before, during, and for 15-min after pneumoperitoneum insufflation and desufflation. Simultaneously, additional hemodynamic parameters (arterial saturation, mean arterial pressure, end tidal CO₂, and urine output) were recorded every 5-min. Pneumoperitoneum pressures used were: 0–1 month old, <6 mmHg; 2–12 months old, <8 mmHg; 1–2 years old, <10 mmHg, and 2–8 years old, <12 mmHg. The lowest possible pressure was used to obtain adequate vision.

Results

Twenty-nine patients were enrolled in the study. Renal regional oxygen saturation (rSO₂) did not decrease significantly between baseline (preinsufflation), insufflation, and desufflation of the pneumoperitoneum (p = 0.343). Meta-analysis of this data demonstrated a pooled weighted difference of ?1.4 (?3.5 to 0.54), confirming no significant change. A significant increase in cerebral rSO₂ occurred during the insufflation period of the CO₂ pneumoperitoneum (p = 0.001). Heart rate (F = 11.05; p < 0.001) and mean arterial pressure (MAP) (F = 19.2; p < 0.001) also increased significantly during the laparoscopy. No significant correlation was identified between fluid input and urine output during the laparoscopy (r = 0.012; p = 0.953).

Conclusions

Renal hypoxia does not occur during laparoscopic surgery in children if the minimum age-appropriate intra-abdominal pressures are used. Alternative causes must account for the oliguria and anuria demonstrated in children undergoing laparoscopy.     

Dental pulp stem cells and their potential roles in central nervous system regeneration and repair

Functional recovery from injuries to the brain or spinal cord represents a major clinical challenge. The transplantation of stem cells, traditionally isolated from embryonic tissue, may help to reduce damage following such events and promote regeneration and repair through both direct cell replacement and neurotrophic mechanisms. However, the therapeutic potential of using embryonic stem/progenitor cells is significantly restricted by the availability of embryonic tissues and associated ethical issues. Populations of stem cells reside within the dental pulp, representing an alternative source of cells that can be isolated with minimal invasiveness, and thus should illicit fewer moral objections, as a replacement for embryonic/fetal‐derived stem cells. Here we discuss the similarities between dental pulp stem cells (DPSCs) and the endogenous stem cells of the central nervous system (CNS) and their ability to differentiate into neuronal cell types. We also consider in vitro and in vivo studies demonstrating the ability of DPSCs to help protect against and repair neuronal damage, suggesting that dental pulp may provide a viable alternative source of stem cells for replacement therapy following CNS damage. © 2013 Wiley Periodicals, Inc.     

The genetics of deliria

Delirium not induced by alcohol or other psychoactive substance and alcohol withdrawal delirium (or delirium tremens) are both cerebral syndromes with similar presentations and are associated with various adverse outcomes. Recently, interest in identifying genetic predisposing factors that influence the occurrence or the outcome of delirium has become a prominent point of delirium research. We systematically searched published articles concerning genetic associations and the occurrence and outcome of delirium. Of 33 identified articles, six investigated non-alcohol withdrawal delirium, and from those six, five evaluated an association with apolipoprotein E (APOE). One association of APOE genotype with the emergence of delirium and two associations of APOE genotype with the duration of delirium were reported. The remaining 27 identified articles investigated genetic associations with alcohol withdrawal delirium and were mainly related to dopamine. Two studies reported a significant association of alcohol withdrawal delirium with the dopamine transporter gene (SLC6A3) and the dopamine receptor 3 (DRD3). Results are inconclusive, and no hard evidence exists due primarily to insufficiently powered studies and other methodological issues. Prospective studies incorporating systematic and rigorous diagnostic criteria and involving long term follow up are needed to advance understanding of this field.     

In vivo monitoring of the bone healing process around different titanium alloy implant surfaces placed into fresh extraction sockets

Objectives

Increasing surface roughness and coating with tricalcium phosphate of titanium and titanium alloy implants has been proposed to provide better rates of osseointegration. However, how these changes in surface topography and chemistry influence the osseointegration process of immediate implants placed in fresh extraction sockets is unclear. This study investigated the influence of three clinically employed implant surfaces on the early bone healing events in vivo.

Methods

Machined smooth implants were milled from grade 5 Ti6Al4V titanium. Surfaces were moderately roughened by grit blasting, which were then coated with tricalcium phosphate. Implants were placed into freshly extracted incisor sockets of mandibles of normal Wistar rats and left for 1, 3 and 9 weeks. Healing bone tissue around the implants was examined by histochemistry and immunocytochemistry to localise PCNA proliferative cells, and osteoblast differentiation markers osteopontin and osteocalcin. Positive synthesising cells were counted using image analysis.

Results

Histology indicated no differences in the amount or pattern of bone formation within the healing tissue surrounding the different implant surfaces. Bone healing occurred predominantly on exposed bone surfaces (distance osteogenesis) and not on the implant surface (contact osteogenesis). No differences were observed in the number or timing of PCNA, osteopontin and osteocalcin positive cells within the bone healing tissue around each of the implant analysed.

Conclusion

For immediately placed implants, the surface modifications investigated appeared to have little influence on the activity of bone forming cells surrounding the implant, probably due to the high level of distance osteogenesis seen within this scenario.

Clinical significance

For immediate placement of implants into fresh extraction sockets, titanium implants with roughened surfaces and coating with tricalcium phosphate have negligible influence in accelerating the early bone healing events of osseointegration.     

Can we identify older people most vulnerable to living in cold homes during winter?

Purpose

Living in a cold home increases the risk of dying in winter, especially in older people. However, it is unclear which individual factors predict whether older people are living in cold homes.

Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group

OBJECTIVE: To provide a uniform platform from which to study acute liver failure, the U.S. Acute Liver Failure Study Group has sought to standardize the management of patients with acute liver failure within participating centers. METHODS: In areas where consensus could not be reached because of divergent practices and a paucity of studies in acute liver failure patients, additional information was gleaned from the intensive care literature and literature on the management of intracranial hypertension in non-acute liver failure patients. Experts in diverse fields were included in the development of a standard study-wide management protocol. MEASUREMENTS AND MAIN RESULTS: Intracranial pressure monitoring is recommended in patients with advanced hepatic encephalopathy who are awaiting orthotopic liver transplantation. At an intracranial pressure of > or =25 mm Hg, osmotic therapy should be instituted with intravenous mannitol boluses. Patients with acute liver failure should be maintained in a mildly hyperosmotic state to minimize cerebral edema. Accordingly, serum sodium should be maintained at least within high normal limits, but hypertonic saline administered to 145-155 mmol/L may be considered in patients with intracranial hypertension refractory to mannitol. Data are insufficient to recommend further therapy in patients who fail osmotherapy, although the induction of moderate hypothermia appears to be promising as a bridge to orthotopic liver transplantation. Empirical broad-spectrum antibiotics should be administered to any patient with acute liver failure who develops signs of the systemic inflammatory response syndrome, or unexplained progression to higher grades of encephalopathy. Other recommendations encompassing specific hematologic, renal, pulmonary, and endocrine complications of acute liver failure patients are provided, including their management during and after orthotopic liver transplantation. CONCLUSIONS: The present consensus details the intensive care management of patients with acute liver failure. Such guidelines may be useful not only for the management of individual patients with acute liver failure, but also to improve the uniformity of practices across academic centers for the purpose of collaborative studies.