肠外营养预混配方与全合一配液配方的临床应用调查

目的 了解国内住院患者全合一肠外营养液与预混肠外营养液的配方特点。方法 收集国内6家不同地区医院的配制中心因不同疾病住院患者的肠外营养处方,统计营养素供给量、总液体量、非蛋白质热卡、总氮量、热氮比、糖脂比等指标,并与预混营养液相比较。结果 全合一营养液处方中营养素的供给量能够满足患者基本营养需要,不同能最级别的预混营养液基本能够满足大多数住院患者的营养需要。全合一营养液处方中总氮量基本能够满足患者营养需要,但热氮比[(180～250):1]、糖脂比(0.56 ～1.26)与推荐值[(100 ～ 150):1,1.0]差距较大,而3种不同能量级别的预混营养液中的热氮比(167)、糖脂比(0.8)更为理想。结论 全合一营养液和预混营养液各有优缺点,能满足多数住院患者疾病治疗的需要。全合一营养液处方应多考虑营养素分配比例的问题。     

Wound dressings: principles and practice

Wound dressings have increased in efficacy and number as the scientific understanding of wound healing has improved. However current practice is governed by expert opinion as high-quality studies comparing the effectiveness of different dressings are lacking. Surgeons are regularly involved in wound management, therefore require a good understanding of the properties and uses of different wound dressings. By having a firm grasp of the pathophysiology that underlies the wound-healing process a surgeon can make informed decisions about how best to manage a patient. An overview of optimal conditions for healing and the assessment of wounds is provided here. Dressings and their modes of action are discussed to provide guidance for their use in different wounds.     

Engaging life in two Irish nursing home units for people with dementia: Quantitative comparisons before and after implementing household environments

Objectives: This study compares the Social Engagement and Interactive Occupation of residents with dementia in two Irish nursing homes, before and after conversion to a household model environment. The changes were an open plan design and a functioning unit kitchen, supported by a homemaker role and operational policies which reduced task-based work in favour of person-centred care offering choice.

Method: A snapshot observation method was used to obtain quantitative data of resident activity using the Assessment Tool for Occupation and Social Engagement (ATOSE). Residents were assessed for four hours, on seven different weekdays, over a six-week period both pre- and post-renovation. The exception to this was the assessment of the traditional model unit (TMU) for Nursing Home 1 which was reduced to four days due to the early start of the building work.

Results: The results were consistent for both nursing homes and data were aggregated. Residents spent more time in the communal living spaces and were more likely to be active and engaged in the household model units (HMUs) compared to the TMUs. Using the independent t-test, these changes were found to be highly significant (p? Conclusion: Creating an HMU increased the Interactive Occupation and Social Engagement of residents in the communal areas of the two nursing homes. The physical environment change, in conjunction with supportive staff procedures and organizational initiatives, improved the well-being of residents with dementia. The outcomes must be viewed in context with financial implications.     

Persian version of the geriatric anxiety scale: Translation and preliminary psychometric properties among Iranian older adults

Objective: The Geriatric Anxiety Scale (GAS) is a new self-report screening measure designed for older adults. Due to the burgeoning Iranian population of older adults and the need for validated, culturally-appropriate screening measures for anxiety in Iran, the purposes of the present study were to translate the GAS into Persian and to explore its preliminary psychometric properties.

Method: Iranian older adults (N = 295; M age = 67.0 years) completed the GAS and the Iranian version of the Geriatric Depression Scale (GDS-15).

Results: Cronbach's alpha for the GAS total score and the GAS subscales were excellent (Total score α = .92; Cognitive α = .81; Somatic α = .84; Affective α = .80). As expected, each subscale was significantly positively correlated (all p's < .01) with the other subscales. The subscales share common variance ranging from 42% to 56%. The GAS total score and GAS subscale scores were significantly positively correlated with the GDS-15, with medium effect sizes (GAS Total r = .55; Cognitive r = .51; Somatic r = .50; Affective r = .48). Finally, exploratory and confirmatory factor analyses were conducted to investigate the factor structure of the Persian version of the GAS. Results support a one factor solution (general anxiety) for this Iranian sample.

Conclusion: This study provides preliminary psychometric support for the Persian version of the GAS as a screening measure for anxiety in Iranian older adults, with a one-dimensional factor structure.     

The character of behavioural symptoms on admission to three Canadian long-term care homes

Objectives: We determined the prevalence and nature of behavioural symptoms at the time of admission to a long-term care home (LTCH) and occurrence of resident-to-resident aggressive behaviour associated with behavioural symptoms within three months following admission.

Method: The Cohen-Mansfield Agitation Inventory and Aggressive Behaviour Scale were completed at the time residents were admitted into the LTCH. A chart review, conducted three months after admission into the LTCH, abstracted documented resident-to-resident aggression. Three LTCHs located in Ontario, Canada participated in the study.

Results: During a 16-month period, 339 individuals admitted to the LTCHs comprised the study sample. A comparison was made between residents with and without dementia. At admission, residents with dementia had a greater number of behavioural symptoms than those without dementia (mean = 3.79, SD = 3.32 versus mean = 2.56, SD = 2.24, respectively; t(200) = 1.91; p = 0.059). Residents with and without dementia exhibited similar behaviours but differed on the prevalence of these behaviours. The most frequently reported behavioural symptoms for residents in both groups were verbal agitation and non-aggressive physical behaviours. The most frequently recorded aggressive behaviour for all residents was ‘resisting care’. In the three months post admission, 79 (23%) residents were involved in a documented incident that involved aggressive behaviour to another resident.

Conclusion: A standardized comprehensive assessment for admission to a LTCH is an important strategy that can be used to identify behavioural symptoms and plan appropriate care management.     

Driving and off‐road impairments underlying failure on road testing in Parkinson's disease

Parkinson's disease (PD) affects driving ability. We aimed to determine the most critical impairments in specific road skills and in clinical characteristics leading to failure on a road test in PD. In this cross‐sectional study, certified driving assessment experts evaluated specific driving skills in 104 active, licensed drivers with PD using a standardized, on‐road checklist and issued a global decision of pass/fail. Participants also completed an off‐road evaluation assessing demographic features, disease characteristics, motor function, vision, and cognition. The most important driving skills and off‐road predictors of the pass/fail outcome were identified using multivariate stepwise regression analyses. Eighty‐six (65%) passed and 36 (35%) failed the on‐road driving evaluation. Persons who failed performed worse on all on‐road items. When adjusted for age and gender, poor performances on lateral positioning at low speed, speed adaptations at high speed, and left turning maneuvers yielded the best model that determined the pass/fail decision (R² = 0.56). The fail group performed poorer on all motor, visual, and cognitive tests. Measures of visual scanning, motor severity, PD subtype, visual acuity, executive functions, and divided attention were independent predictors of pass/fail decisions in the multivariate model (R² = 0.60). Our study demonstrated that failure on a road test in PD is determined by impairments in specific driving skills and associated with deficits in motor, visual, executive, and visuospatial functions. These findings point to specific driving and off‐road impairments that can be targeted in multimodal rehabilitation programs for drivers with PD. © 2013 International Parkinson and Movement Disorder Society     

The structure of the Montgomery–Åsberg depression rating scale over the course of treatment for depression

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a widely used clinician‐rated measure of depressive severity. Empirical support for the factor structure of the MADRS is mixed; further, the comparison of MADRS scores within and between patients requires the demonstration of consistent instrument properties. The objective of the current investigation was to evaluate MADRS factor structure as well as MADRS factorial invariance across time and gender. The MADRS was administered to 821 depressed outpatients participating in a large‐scale effectiveness study of combined pharmacotherapy and psychotherapy for depression. Treatment outcome did not differ across treatment groups. Factor structure and invariance was evaluated via confirmatory factor analysis. A four‐factor model consisting of Sadness, Negative Thoughts, Detachment and Neurovegetative symptoms demonstrated a good fit to the data. This four‐factor structure was invariant across time and gender. A hierarchical model, in which these four factors served as indicators of a general depression factor, was also supported. A limitation of the current study is the lack of comprehensive characterization of patient clinical features; results need to be replicated in more severely depressed or treatment refractory patients. Overall, evidence supported the use of the MADRS total score as well as subscales focused on affective, cognitive, social and somatic aspects of depression in male and female outpatients. Copyright © 2013 John Wiley & Sons, Ltd.     

Cerebral perfusion assessment by bolus tracking using hyperpolarized 13C.

Cerebral perfusion was assessed with 13C MRI in a rat model after intravenous injections of the 13C-labeled compound bis-1,1-(hydroxymethyl)-1-13C-cyclopropane-D8 in aqueous solutions hyperpolarized by dynamic nuclear polarization (DNP). Since the tracer acted as a direct signal source, several of the problems associated with techniques based on traditional dynamic susceptibility contrast (DSC) MRI contrast agents were avoided. Maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were calculated. The MTT was determined to be 2.8 +/- 0.8 sec. However, arterial partial-volume effects in the animal model prevented accurate absolute quantification of CBF and CBV. It was demonstrated that depolarization of the hyperpolarized 13C tracer via relaxation and the imaging sequence had little influence on CBF assessment when the time resolution of the imaging sequence was short compared to the MTT. However, CBV and MTT were increasingly underestimated as MTT or the depolarization rate increased if depolarization was not taken into account. With a modified bolus-tracking theory depolarization could be compensated for, assuming that the depolarization rate was known. Three separate compensation methods were investigated experimentally and by numerical simulations.     

Embedded Effort Indicators on the California Verbal Learning Test – Second Edition (CVLT–II): An Attempted Cross-Validation

This study determined whether the logistic regression method that was recently developed by Wolfe and colleagues (2010) for the detection of invalid effort on the California Verbal Learning Test – Second Edition (CVLT–II) could be cross-validated in an independent sample of 100 consecutively referred patients with traumatic brain injury. Although the CVLT–II logistic regression formula demonstrated a statistically significant level of agreement with results from the Word Memory Test, it was associated with an unacceptably high proportion of false positives. The component variables of the logistic regression were sensitive to length of coma but did not covary with psychosocial complicating factors (e.g., unresolved prior psychiatric history) that were associated with a higher relative risk of failure of WMT validity criteria. It is concluded that the Wolfe et al. logistic regression should be used only with great caution in the context of clinical neuropsychological evaluations.     

Assessing executive performance during cognitive rehabilitation

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002 Stuss, D. and Levine, B. 2002. Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53: 401–433. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Impairment in executive functioning disrupts a person's ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a person's executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005 Peterson, D. 2005. International Classification of Functioning, Disability and Health: An introduction for rehabilitation psychologists. Rehabilitation Psychology, 50: 105–112. [Crossref], [Web of Science ®] , [Google Scholar]), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.