Comparison of Four Cognitive Screening Tools: Clinical Utility in a Skilled Nursing Setting and Relationship to Discharge Location

A systematic review of 34 articles was conducted to answer the following clinical questions posed by Joette Jindra, the Director of Rehabilitation, at ManorCare of Tacoma: “Which cognitive screen, out of the four we are currently using, most accurately measures a patient\u27s functional cognitive performance?” and “How well do cognitive tools and measures predict a client’s discharge setting from a skilled nursing facility (SNF)?”. Results indicate the Montreal Cognitive Assessment (MoCA) to be the most clinically useful tool for detecting mild cognitive impairment (MCI) as it demonstrated the greatest sensitivity across studies and diagnoses. The evidence did not support the use of the Mini Mental State Examination (MMSE) as it has low sensitivity to detect MCI across diagnoses. There is limited psychometric data available regarding the St. Louis University Mental Status Exam (SLUMS) and Allen Cognitive Level Screen (ACLS). Additionally, the research suggests a relationship between clients’ cognitive functioning and their discharge location. It is recommended that ManorCare change their cognitive screening protocols, requiring all patients to be screened using the MoCA as opposed to the MMSE, SLUMS, or ACLS based on the available evidence. This will ensure client safety and detection of mild to severe cognitive impairment when present. New research pertaining to the SLUMS and ACLS should be monitored as this may affect the current recommendation. To translate knowledge and support the implementation of evidence-based practice, a 30 minute in-service was delivered during which the research process and findings were presented to a team of 15 rehabilitation professionals. Additionally, an informational MoCA resource packet was provided and discussed. Pre- and post- in-service surveys were conducted to determine the impact of the in-service presentation. Analysis of survey responses indicated the in-service and informational resource packet to be effective knowledge translation activities. It is recommended that a follow-up implementation study be conducted by graduate students at the University of Puget Sound to determine the extent that policy changes are adopted by ManorCare and to develop a chart review research project to examine the connection between patient MoCA scores and discharge settings

Dementia care in the Danube Region. A multi-national expert survey

Background: Dementia is a particularly severe societal challenge in several countries of the Danube Region due to higher-than-average increment in population longevity, disproportionate increase of the old-age dependency ratio, and selective outward migration of health care professionals. A survey was conducted among dementia experts to obtain a deeper understanding of the dementia care structures and services in this geographical area, and to identify the educational needs of health care professionals, and the availability of assistive technology. ------ Subjects and methods: A standardized questionnaire was sent out to 15 leading dementia experts/clinicians in 10 Danube Region countries inquiring about professional groups involved in dementia care, availability and reimbursement of services, inclusion of dementia in professional education and training, acceptability of Internet-based education, and availability of assistive technology. The authors are the survey respondents. ----- Results: The majority of individuals with dementia receive care in the community rather than in institutions. The roles of medical specialties are disparate. General practitioners usually identify dementia symptoms while specialists contribute most to clinical diagnosis and treatment. Health care professionals, particularly those who work closely with patients and carers, have limited access to dementia-specific education and training. The greatest need for dementia-specific education is seen for general practitioners and nurses. An Internetbased education and skill-building program is considered to be equivalent to traditional faceto- face but offer advantages in terms of convenience of access. Assistive technology is available in countries of the Danube Region but is significantly underused. ----- Conclusion: Dementia care in the Danube Region can be improved by an educational and skill-building program for health care professionals who work in the frontline of dementia care. Such a program should also attempt to enhance interdisciplinary and intersectorial collaboration, to intensify the interaction between primary care and specialists, and to promote the implementation of assistive technology

The effect of a complex fortified preparation on the quality indicators of broiler chicken meat

The article presents the results of the conducted studies on the effect of the complex fortified preparation "Nitamin" on the quality indicators of meat of broiler chickens of the Cobb-500 cross. The preparation was administered with drinking water at a dose of 1 ml per 1 liter of drinking water, according to the scheme from 2 day to 5 day of keeping and from 15 to 18 day, poultry slaughter was carried out on 42 day of keeping. The composition of the preparation includes vitamins A; D3; E; trace elements organic iodine and selenium. The research material was the muscle tissue of broiler chickens of the studied groups, according to generally accepted methods, the content of amino acid composition and trace elements of selenium and iron was determined according to GOST R 55569-2013 Feed, compound feed, compound feed raw materials. Determination of proteinogenic amino acids by capillary electrophoresis, GOST 31707-2012 (EN 14627:2005) Trace element food products. Determination of total arsenic and selenium by atomic absorption spectrometry with generation of hydrides with preliminary mineralization of the sample under pressure and GOST 30178-96 Raw materials and food products. Atomic absorption method for the determination of toxic elements. According to the results obtained, the meat of broiler chickens treated with Nitamin was superior in amino acid composition to the meat of broiler chickens of the control group (essential amino acids by 14.38%, nonessential amino acids by 10.9%). When studying the content of trace elements in the muscle tissue of broiler chickens treated with Nitamin, an increase in the iron content of 10 mg/kg was noted, no iron was found in the muscle tissue of broiler chickens of the control group

Features of account and planning of training process of sportsmen pair-group acrobats taking into account sexual dimorphism (analysis of questionnaire these trainers of Ukraine)

Purpose: expose the features of planning of training process of different age acrobats and line of business on the stage of the direct training to the competitions from position of sexual dimorphism. Research tasks was to define methods and criteria of account and control of the training loading in pair-group to acrobatics. Material: in a questionnaire took part 38 trainers of Ukraine on sporting acrobatics aged from 28 to 68 years. Results: it is set that in an incomplete measure registered trainers loading executed sportsmen. The insufficient disinformation of trainers is exposed about knowledge and necessity of account of gender distinctions. Also about the methods of realization of account of the specific loading. There is absence of model of account, planning and control of the trainings loadings taking into account the functional, age, sexual features of sportsmen depending on their line of business. Conclusions: findings testify to the necessity of perfection of existent method of planning of training process. It is necessary to probe the morphofunctional features of organism of sportsmen and sportswomen. Also - to take into account the features of sexual dimorphism depending on the specific of type of sport. It is necessary to develop the trainings programs from position of morphofunctional and adaptation distinctions of masculine and womanish organism

Control of general and special physical preparedness of sportsmen is 12-13 years in taekwondo

The features of control of general and special physical preparedness of young sportsmen are examined. Considerable part of researches in area of control and training process control in taekwondo is devoted practice of sport of higher achievements. Timely realization of control of physical preparedness for sportsmen will allow expediently to develop physical qualities. It will allow in the future to apply sportsmen on achievement of high and stable sporting results

Assessment of cognitive functions in patients with metabolic syndrome after ischemic stroke

Post-stroke cognitive impairment (PSCI) occupies a prominent position among cognitive impairment associated with vascular brain pathology. The purpose – to assess cognitive functions in patients with the history of ischemic stroke, depending on the metabolic syndrome (MS) presence and to determine the peculiarities of cognitive functions dynamics in the early recovery period after ischemic stroke in the anterior circulation area in patients with and without metabolic syndrome depending on ischemic lesion localization. Materials and methods. There were 122 patients in the early recovery period after ischemic stroke enrolled into the study. Depending on the MS presence, patients with the history of ischemic stroke were divided into 2 groups: with MS (n = 72) and without MS (n = 50). All the patients were divided into 3 age subgroups: 45 – 59 years – middle age, 60 – 74 years – elderly, 75 – 89 years - senile age. All patients had general clinical, neuropsychological examination, laboratory tests; MRI of the brain. Results. There was no significant difference among patients of the main clinical groups on the frequency of pre-mild and mild cognitive impairment; however the incidence of post-stroke dementia was significantly higher among patients with MS comparing with those without MS. There was significant augmentation of PSCI severity with age in patients with MS and without it. According to the results of neuropsychological tests, the best cognitive functions recovery in 6 months after the stroke (in the early recovery period) was observed in patients without MS, especially in the cases of left hemisphere ischemic lesions. Conclusions. Patients with MS had significantly more pronounced PSCI than patients without MS. The increase in age had a negative effect on the PSCI severity both in patients with and without metabolic syndrome. The presence of MS worsened the process of cognitive functions restoration in patients with PSCI

Alleviating neuropsychiatric symptoms in dementia: the effects of Ginkgo biloba extract EGb 761®. Findings from a randomized controlled trial

Natalia Bachinskaya1, Robert Hoerr2, Ralf Ihl3For the GOTADAY Study Group1Institute of Gerontology, Academy of Medical Sciences, Kiev, Ukraine; 2Clinical Research Department, Dr Willmar Schwabe Pharmaceuticals, Karlsruhe, Germany; 3Geriatric Psychiatry Center, Maria-Hilf Hospital Krefeld, Krefeld, GermanyPurpose: To examine the effects of Ginkgo biloba extract EGb 761® on neuropsychiatric symptoms of dementia.Patients and methods: Randomized, controlled, double-blind, multicenter clinical trial involving 410 outpatients with mild to moderate dementia (Alzheimer’s disease with or without cerebrovascular disease, vascular dementia), scoring at least 5 on the Neuropsychiatric Inventory (NPI), with at least one item score of 3 or more. Total scores on the SKT cognitive test battery (Erzigkeit’s short syndrome test) were between 9 and 23. After random allocation, the patients took 240 mg of EGb 761® or placebo once daily for a period of 24 weeks. Changes from baseline to week 24 in the NPI composite and in the SKT total score were the primary outcomes. The NPI distress score was chosen as a secondary outcome measure to evaluate caregivers’ distress.Results: The NPI composite score improved by -3.2 (95% confidence interval -4.0 to -2.3) in patients taking EGb 761® (n = 202), but did not change (-0.9; 0.9) in those receiving placebo (n = 202), which resulted in a statistically significant difference in favor of EGb 761® (P < 0.001). Treatment with EGb 761® was significantly superior to placebo for the symptoms apathy/indifference, sleep/night-time behavior, irritability/lability, depression/dysphoria, and aberrant motor behavior. Caregivers’ distress evaluation revealed similar baseline pattern and improvements.Conclusion: Treatment with EGb 761®, at a once-daily dose of 240 mg, was safe, effectively alleviated behavioral and neuropsychiatric symptoms in patients with mild to moderate dementia, and improved the wellbeing of their caregivers.Keywords: Alzheimer's disease, vascular dementia, patients, caregivers, Ginkgo biloba, EGb 761&reg