Effects of rivastigmine on common symptomatology of Alzheimer’s disease (EXPLORE)

Abstract

Objective:

To evaluate, in a real-world clinical setting, the efficacy of rivastigmine in the management of six symptoms commonly associated with Alzheimer's disease (AD).     

右美托咪啶对小儿七氟醚麻醉苏醒期躁动的Meta分析

目的 系统评价右美托咪啶是否可以降低七氟醚麻醉引起的小儿苏醒期躁动的发生率.方法 计算机检索Cochrane Library、PubMed、EBSCO、Springer、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、维普（VIP）、万方数据库,手工检索纳入文献的相关参考文献,检索时限均为建库至2013年4月.由两名评价者按照纳入与排除标准选取临床随机对照试验、提取资料和评价文献质量后,采用RevMan 5.2软件进行Meta分析.结果 共纳入26个随机对照试验,1842例患儿.Meta分析结果显示,与安慰剂相比,右美托味啶可显著降低患儿苏醒期躁动的发生率[RR=0.31,95％CI（0.26,0.38）]及躁动评分[MD=-0.89,95％CI（-1.04,-0.74）],对小儿呛咳的发生率[RR=0.39,95％CI（0.23,0.68）]有一定的预防作用;所有纳入的文献均未见呼吸、循环系统方面的严重不良反应.结论 右美托咪啶可安全用于小儿,显著降低小儿苏醒期躁动的发生率,并降低躁动评分,对呛咳的发生可能也有一定的预防作用.     

七氟醚和丙泊酚全身麻醉对小儿术后躁动影响的系统评价

目的系统评价七氟醚和丙泊酚全身麻醉对小儿术后躁动发生率的影响。方法计算机检索PubMed、SCI、EMbase、The Cochrane Library（2012年第4期）、CNKI、CBM、WanFangData和VIP等数据库,全面收集七氟醚和丙泊酚麻醉对A,JL术后躁动影响的随机对照试验（RCT）,检索时限均为建库至2012年12月,并追溯纳入研究的参考文献。南两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质砒后。采用RevMan5．1软件进行Meta分析。结果共纳入9个RCT,但仅6个可进行定撮分析,共692例患儿。Meta分析结果显示：①经七氟醚诱导后,丙泊酚维持组的躁动发生牢低于七氟醚维持组[RR=0．57,95％CI（0．39,0．84）,P=0．004];②全程丙泊酚静脉麻醉组的躁动发生牢低于全程七氟醚吸人麻醉组[RR=0．16,95％CI（0．06,0．39）．P〈0．0001]。结论t氟醚麻醉小儿术后躁动发生率高于丙泊酚麻醉、受纳入研究数最与质最限制,临床上在选择是否使用七氟醚麻醉之前,应该对患儿各方面情况进行综合考虑。     

Factors associated with quality of life of people with dementia in long-term care facilities: A systematic review

Background

Quality of life has become an important outcome measure in dementia research. Currently there is no convincing evidence about which factors are associated with quality of life of people with dementia living in long-term care facilities.

Objective

This study aims to investigate which factors are associated with quality of life, including factors associated with change over time, of people with dementia living in long-term care facilities.

Design

A systematic literature review was performed.

Data sources

Cochrane, Pubmed, CINAHL, Web of Science, and PsycINFO were searched.

Review methods

Three researchers independently assessed studies for eligibility. The inclusion criteria were: (1) the primary focus was on factors related to quality of life; (2) the study was performed in long-term care facilities; (3) the study regarded quality of life as multidimensional construct. Methodological quality of studies included in the review was assessed with a quality criteria checklist.

Results

Ten cross-sectional and three longitudinal articles were included in the review. In cross-sectional studies, depressive symptoms were negatively related to self-rated quality of life of people with dementia. The association between depressive symptoms and proxy-rated quality of life was less clear. Behavioural disturbances, especially agitation, appeared to be negatively related to proxy-rated quality of life. There appeared to be a negative relation between quality of life, activities of daily living and cognition, although this could not be confirmed in all studies. In longitudinal studies, depressive symptoms were negatively related and cognition was positively related to self-rated quality of life, whereas dependency and depressive symptoms were negatively related to proxy-rated quality of life.

Conclusions

There are only few high quality studies that investigate associations of (change in) quality of life of people with dementia living in long-term care facilities. Our results suggest that depressive symptoms and agitation are related to lower quality of life. Perspective of quality of life measurement, i.e. self- or proxy rating, may influence its associations. Longitudinal studies are needed to determine which factors are related to change in quality of life over time. This information is essential for the development of interventions that aim to improve quality of life.     

Gentamicin production by Micromonospora echinospora (Me- 22) in stirred tank reactor: effect of various parameters

Effect of production medium components, initial starch and soyabean meal concentrations, for the enhanced production of gentamicin by Micromonospora echinospora (Me- 22) was studied in a lab scale stirred tank reactor. Also effect of different aeration (0.5, 1, 2, and 4 vvm) and agitation rates (100, 200, 300 and 400 rpm) in a stirred tank reactor was examined. A maximum gentamicin concentration of 2.68 g l(-1) was achieved in the medium having low concentrations of initial starch (7.5 g l(-1)) and high concentrations of initial soyabean meal (4 g l(-1)). Both aeration and agitation significantly affected gentamicin concentration, productivity and biomass formation. The maximum gentamicin concentration of 4.12 g l(-1) and the highest yield of gentamicin on substrate 0.967 g g(-1) were obtained at impeller speed of 200 rpm and aeration rate of 2 vvm. Under optimal culture conditions in STR the production of gentamicin could be increased 3 fold when compared with shake flask.     

工娱疗法对阿尔茨海默病患者认知功能、激越行为及社会功能的影响

目的 探讨工娱疗法对阿尔茨海默病患者认知功能、激越行为及社会功能的影响。方法 选取从2016年10月-2018年10月我院收治的130例阿尔茨海默病患者为研究对象,采用随机抽签法将其分成对照组和观察组,各65例。对照组予以常规护理干预,观察组在对照组基础上增加工娱疗法干预。比较2组干预前后认知功能、激越行为以及社会功能的差异。结果 干预后,观察组简易智能状态检查量表评分高于对照组(t=9.517,P＜0.001);激越行为量表总评分均低于对照组(t=3.307,P=0.001);社会功能评定量表总分高于对照组(t=23.091,P＜0.001)。结论 工娱疗法在阿尔茨海默病患者中的应用效果明显,有利于改善患者的认知功能、激越行为以及社会行为,值得临床推广应用。     

右美托咪定在撤机躁动患儿中的应用

目的探讨右美托咪定在机械通气撤机躁动患儿应用的有效性及安全性。方法采取前瞻性开放性观察性研究，纳入2017年3月至2018年8月入住重症监护室接受机械通气由于躁动导致自主呼吸试验（SBT）失败而应用右美托咪定的病例。将镇静-躁动评分≥5分定义为躁动。观察入组患儿使用右美托咪定0.5、1、2、6、12 h后的镇静情况，拔管前及拔管后1、24、48 h血气分析结果，SBT前、拔管前、拔管后10 min、拔管后60 min、拔管后120 min、拔管后24 h的重要生命体征（心率、呼吸频率、平均动脉压）及使用右美托咪定过程中不良反应发生情况。结果 19例患儿纳入研究。患儿入组时均为躁动状态，使用右美托咪定0.5、1、2、6、12 h后分别有12、17、17、18、18例患儿达到目标镇静状态。拔管前后各时间点的氧合指数、PaCO₂及心率、呼吸频率、平均动脉压差异均无统计学意义（P > 0.05）。所有患儿均未发生严重低血压、呼吸抑制等不良反应，仅1例患儿发生可逆性心动过缓。结论右美托咪定在机械通气撤机躁动患儿中的应用是安全有效的，但尚需前瞻性随机对照试验加以验证。     

右美托咪定预防小儿全身麻醉苏醒期躁动的效果分析

目的探讨右美托咪定预防小儿全身麻醉苏醒期躁动的作用。方法收集2017年12月～2018年10月我院收治的需要在全身麻醉下行手术治疗的患儿86例作为研究对象,按麻醉方法将86例患儿进行分组,研究组43例,麻醉诱导后应用右美托咪定,对照组43例,麻醉诱导后给予生理盐水。比较两组手术时间、不同时间的心率、平均动脉压(MAP)、全身麻醉苏醒期躁动评分及呕吐、躁动发生率。结果研究组手术时间与对照组比较,差异无统计学意义(P0.05)。研究组T2、T3心率明显低于对照组,两组比较,差异有统计学意义(P0.05);研究组T2、T3、T4 MAP明显低于对照组,两组比较,差异有统计学意义(P0.05);研究组苏醒期呕吐发生率与对照组比较更高,而躁动发生率与对照组比较更低,拔管时、苏醒时躁动评分与对照组比较更低,两组比较,差异有统计学意义(P0.05)。结论应用右美托咪定可使患儿的心率、MAP更平稳,安全性更高,降低小儿全身麻醉苏醒期躁动发生率,减轻苏醒期躁动程度,建议在临床推广应用。     

手术室护理干预对食管癌根治术患者麻醉苏醒期躁动及留置尿管耐受度的影响

目的：探讨手术室护理干预对食管癌根治术患者麻醉苏醒期躁动及留置尿管耐受度的影响,为提高全身麻醉患者护理水平提供临床依据。方法：选取2013年8月至2015年8月在我院进行全身麻醉下行食管癌根治术患者80例,根据入院先后的顺序分为观察组和对照组各40例,对照组采取传统护理,观察组实施手术室护理干预,比较二者清醒时间、拔管时间、躁动发生情况及尿道刺激反应程度等。结果：两组患者麻醉时间、手术时间、术中输液量及术中出血量相似,差异无统计学意义（P＞0．05）。观察组患者清醒时间（10．16±1．78）min、拔管时间（14．51±1．17）min,对照组患者清醒时间（12．24±1．82） min、拔管时间（16．70±1．23）min,差异有统计学意义（P＜0．05）。观察组患者苏醒期躁动发生率及躁动程度均低于对照组,麻醉苏醒后观察组患者尿路刺激反应轻于对照组,差异有统计学意义（P ＜0．05）。结论：对食管癌根治术患者实施手术室护理干预,能促进麻醉后清醒、缩短拔管时间、减少苏醒期躁动发生率和程度,提高留置尿管耐受度。