The feasibility of volunteers facilitating personalized activities for nursing home residents with dementia and agitation

Background

Nursing home residents' behavioral and psychological symptoms of dementia are often exacerbated by a lack of social contact and meaningful activity. Volunteers might assist in addressing this deficiency but they are often discouraged by staff from engaging with residents with challenging behaviors. As a result, some of the neediest residents receive the least social and psychological support.

Aim

This project explored the implementation of personalized, one-to-one activities by nursing home volunteers to determine if volunteers were able and willing to complete a training program and undertake activities with residents with dementia and challenging behaviors.

Methods

19 nursing home volunteers in Melbourne, Australia, were trained to apply Montessori-type personalized activities with a selected resident whose dementia was complicated by a frequent, non-aggressive agitated behavior. The volunteers were asked to attend a workshop and pay six 30-min visits to the resident over a three week period. They completed knowledge and attitude rating scales before and after the intervention and were interviewed afterward regarding their experiences and perceptions.

Results

16 volunteers completed the program and eight met or exceeded every study requirement. Most of them derived satisfaction from engaging residents' interest and were pleased to learn new skills. The scores on the dementia knowledge and attitude rating scale of those who completed the visits were higher at the study's outset than the scores of those who failed to make any visits.

Conclusions

It is certainly feasible to train volunteers to work with residents who might otherwise be isolated. It is important to demonstrate activities to volunteers at the outset and to provide them with careful, ongoing supervision and support. Notwithstanding some difficulties and challenges, volunteers represent a growing and hitherto untapped pool of support for people with dementia and complex needs.     

Acute antidepressant response to fluoxetine and sertraline in psychiatric outpatients with psychomotor agitation

INTRODUCTION: Sertraline and fluoxetine have different pharmacologic and pharmacokinetic profiles, which may be of clinical relevance in the determination of treatment response in different subtypes of depression. OBJECTIVE: To analyse the efficacy of sertraline and fluoxetine in a subgroup of 78 patients with evidence of significant psychomotor agitation (HAM-D item 8 &#104 1 and HAM-D item 9 &#83 2 at study entry) in a 6-week study comparing sertraline (50 - 100 mg/day) and fluoxetine (20 - 40 mg/day) for the treatment of major depression in 286 psychiatric outpatients. RESULTS: The proportion of patients with psychomotor agitation responding ( &#83 50% reduction HAM-D score) at last visit was significantly ( P < 0.05) higher in the sertraline group than in the fluoxetine group (62% vs 39%, respectively). Most of the secondary efficacy parameters showed significantly ( P &#104 0.05) greater improvement in the sertraline treatment group at last visit: HAM-D &#104 8, HAM-D total score, HAM-D anxiety/somatization factor, HAM-D weight factor, HAM-A total score, CGI-S, Raskin Depression score, and Covi Anxiety score. CONCLUSION: The findings of this retrospective data analysis suggest that fluoxetine may be a less efficacious antidepressant than sertraline in patients with psychomotor agitation.     

利培酮口崩片合并地西泮对精神分裂症急性期激越行为的疗效观察

目的探讨利培酮口崩片合并地西泮对精神分裂症急性期激越行为的疗效。方法将2017年7月～2018年5月我院接诊的60例精神分裂症急性激越症状患者纳入本研究。按照随机数字表法均分为观察组和对照组,各30例。对照组:氟哌啶醇治疗。观察组:利培酮口崩片合并地西泮注射液治疗。观察两组疗效、PANSS评分、CGISI评分、不良反应发生情况。结果观察组治疗总有效率与对照组比较差异无统计学意义,TESS总发生率低于对照组(P0.05);观察组干预后PANSS评分、CGI-SI评分均低于对照组(P0.05)。结论对精神分裂症急性期激越行为患者,采用利培酮口崩片合并地西泮效果较好,能够改善患者PANSS评分、CGI-SI评分,而且TESS较少,临床安全性较高。     

Incidência de delírio ao despertar e fatores de risco após o uso de sevoflurano em pacientes pediátricos para cirurgia ambulatorial,Kingston, Jamaica

Background and objectivesEmergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica.MethodsThis was a cross‐sectional, observational study including pediatric patients aged 3–10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day‐case procedures. Data collected included patients’ level of anxiety pre‐operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non‐purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post‐operative complications related to emergence delirium episodes were also noted.Results145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9 ± 7.8 min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4 ± 11.9 versus 29.7 ± 10.8 min for non‐agitated children; p < 0.001). Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2–8.6) and moderate and severe anxiety prior to induction (p < 0.001, OR 5.6, 95% CI 2.3–13.0). Complications of emergence delirium included intravenous line removal (n = 1), and surgical site bleeding (n = 3).ConclusionChildren of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.     

Managing agitation during early recovery in adults with traumatic brain injury: An international survey

BackgroundManaging agitation is a significant challenge in the early stages of recovery after traumatic brain injury (TBI), and research investigating current practice during this period is lacking.ObjectivesThis study examined how clinicians worldwide conceptualise, measure and manage agitation during early TBI recovery.MethodsA cross-sectional anonymous online survey was distributed via email, newsletters, conferences and social media to clinicians involved in early TBI care worldwide. Respondents were 331 clinicians (66% female) from 34 countries worldwide who worked in inpatient and outpatient settings in disciplines including medicine, nursing and allied health. Participants had an average of 13 years’ clinical experience working specifically with an adult TBI population.ResultsAgitated behaviour was commonly defined as aggression and restlessness. Three quarters of clinicians reported that their services measure agitation, and clinicians in North America more frequently use standardised assessment tools. Common non-pharmacological approaches used across all regions surveyed included providing familiarising information (85%) and environmental cues (82%), managing patients in single rooms (81%) and reducing noise levels (80%). Most clinicians (90%) reported pharmacology use, particularly atypical antipsychotic agents. Clinicians’ mean rating of confidence in managing agitation was 7 out of 10 (10 being excellent) and was higher for services that provided staff with written guidelines for agitation management. Only half of clinicians reported sufficient training for managing agitation and 52% were satisfied with current agitation management practices.ConclusionsDespite high rates of agitation measurement and management, many clinicians reported dissatisfaction with current agitation management and insufficient training. This study supports the development of international guidelines and training to ensure consistent and effective agitation management in early TBI care.     

小剂量氯胺酮对儿童七氟醚麻醉后苏醒期躁动作用的临床研究

目的使用不同剂量氯胺酮应用于儿童七氟醚麻醉后苏醒期,探讨其对小儿麻醉后疼痛和躁动的应用价值。方法以七氟醚全麻下行浅表手术的儿童为研究对象,随机将分为实验组、观察组和对照组,麻醉后分别静注0.50 mg/kg、0.25 mg/kg的氯胺酮静脉推射和生理盐水,对患儿苏醒后疼痛评分及躁动情况等情况进行记录和统计分析。结果实验组、观察组和对照组3组患儿术后疼痛评分结果呈现显著差异性（P〈0.05）,3组患儿苏醒时间、并发症发生以及拔管时间等差异无统计学意义（P〉0.05）。结论氯胺酮的小剂量使用有助于减少小儿七氟醚麻醉后苏醒期的躁动症状,临床观察显示0.50 mg/kg的剂量能达到较好的效果。     

静注曲马多用于预防全麻患者拔管期躁动的临床观察

目的：研究手术结束前静注曲马多对预防全麻病人报管期躁动的临床作用。方法：40例普胸手术全麻病人，采用随机、双盲、对照试验的方法于手术结束前静脉给予生理盐水(对照组)、曲马多2mg／kg(观察组)观察术后病人的镇静效果。结果：观察组与对照组比较，术后清醒时间、拔管时间和血氧饱合度均无显著差异。观察组镇静效果Remesay评分：其烦躁率(1分)、镇静满意率(2—4分)分别为1(5％)，15(75％)，对照组分别为6(30％)，7(35％)。两者比较有显著差异(P＜0．05)。结论：全麻病人手术结束前使用2mg／kg曲马多可明显减少全麻病人拔管期躁动。     

痴呆患者激越行为的调查研究

目的 研究痴呆患者激越行为的发生情况。方法 用问卷法调查72例居家和65例老人院痴呆患者。结果 两组痴呆患者激越行为发生率分别为86．1％和90．8％，主要表现为反复问问题、骂人、不恰当地处理物品、藏东西、徘徊等；其中不恰当地处理物品、身体攻击及徘徊的发生率老人院痴呆患者与居家痴呆患者间差异有显著性意义，而居家痴呆患者藏东西的发生率与老人院痴呆患者问差异有显著性意义；某些激越行为在中重度痴呆患者更多见，还与日常生活能力受损明显相关。结论 激越行为在痴呆患者中普遍存在，表现多样，可结合不同场所、不同程度痴呆患者激越行为的特点进行相应的护理干预，从而有针对性地降低其发生率。