Person-centered care for older people with dementia in the acute hospital

Introduction Patients with dementia (PWDs) are often subjected to enforced dependency and experience functional decline and emotional distress during hospital stay. Person-centered care (PCC) with specialized psychosocial interventions, minimally obtrusive medical care, and physical restraints-free practice holds potential to improve patient outcomes. We evaluate the effectiveness of an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]) that adopts a PCC protocol. Methods Prospective naturalistic cohort study whereby PWDs in the CAMIE unit (n = 170) were compared with a control group in usual care wards (n = 60) over 6 months. Assessments included patient demographics, dementia type and stage, comorbidities (Charlson's Comorbidity Index), acute illness severity, Well-Being, Ill-Being, functional status (Modified Barthel Index), agitation levels (Pittsburgh Agitation Scale), and quality of life (EuroQoL), assessed on admission and discharge. Multivariate analysis of covariance examined the effect of CAMIE versus usual care on pre-post outcomes. Results CAMIE patients showed statistically significant greater gains in Modified Barthel Index function and Well-Being, decreased Ill-Being and agitation, and greater improvement in EuroQoL index score (effect size: Δ = 0.18) after adjusting for baseline differences that translated to a quality-adjusted life years gain of 0.045, assuming stability over 3 months. Estimating added cost of CAMIE stay over usual care at SGD 1500 (USD 1040) for average length of stay of 15 days per patient, the incremental cost-effectiveness ratio fell within the threshold for cost-effectiveness at USD 23,111. Discussion PCC for PWDs in acute hospitals not only improves clinical outcomes for patients but is also cost-effective. The results support the adoption of PCC on a wider scale for better care of PWDs. © 2017 The Author

Precipitation phenomena in Al-Zn-Mg alloy matrix composites reinforced with B4C particles

Abstract To provide insight into precipitation phenomena in age-hardening Al-Zn-Mg(-Cu) matrix composites, an Al 7075 alloy composite reinforced with B4C particles was selected as a model system. The bulk composites were fabricated via plasma activated sintering and followed by a peak aged (T6) heat treatment. Two types of Al matrix zones were identified in the composite: (1) the regions in the vicinity of the matrix/reinforcement interface, defined as “matrix plastic zone” (MPZ) hereafter, and (2) the regions away from the matrix/reinforcement interface, simply defined as matrix hereafter. The precipitation behavior in the MPZ was characterized and compared to that in the matrix. The MPZ contained a high density of dislocations. The number density of GP zones in the MPZ is lower than that in the matrix while the average size of the GP zones in MPZ is coarser. In addition, semi-coherent platelet η′ precipitates were observed but only in the MPZ. The dislocations and the Al/B4C interfaces provide more heterogeneous nucleation sites for the η′ precipitates in the MPZ. The growth and coarsening of the η′ precipitates caused rapid depletion of Mg and Zn solute atoms in the MPZ