Dopamine transporter (DAT1) and dopamine receptor D4 (DRD4) genotypes differentially impact on electrophysiological correlates of error processing

Peer reviewedPublisher PD

Optimisation of medications used in residential aged care facilities: a systematic review and meta-analysis of randomised controlled trials

Background: Frail older adults living in residential aged care facilities (RACFs) usually experience comorbidities and are frequently prescribed multiple medications. This increases the potential risk of inappropriate prescribing and its negative consequences. Thus, optimising prescribed medications in RACFs is a challenge for healthcare providers. Objective: Our aim was to systematically review interventions that increase the appropriateness of medications used in RACFs and the outcomes of these interventions. Methods: Systematic review and meta-analysis of randomised control trials (RCTs) and cluster randomised control trials (cRCTs) were performed by searching specified databases (MEDLINE, PubMed, Google scholar, PsycINFO) for publications from inception to May 2019 based on defined inclusion criteria. Data were extracted, study quality was assessed and statistically analysed using RevMan v5.3. Medication appropriateness, hospital admissions, mortality, falls, quality of life (QoL), Behavioural and Psychological Symptoms of Dementia (BPSD), adverse drug events (ADEs) and cognitive function could be meta-analysed. Results: A total of 25 RCTs and cRCTs comprising 19,576 participants met the inclusion criteria. The studies tested various interventions including medication review (n = 13), staff education (n = 9), multi-disciplinary case conferencing (n = 4) and computerised clinical decision support systems (n = 2). There was an effect of interventions on medication appropriateness (RR 0.71; 95% confidence interval (CI): 0.60,0.84) (10 studies), and on medication appropriateness scales (standardised mean difference = − 0.67; 95% CI: − 0.97, − 0.36) (2 studies). There were no apparent effects on hospital admission (RR 1.00; 95% CI: 0.93, 1.06), mortality (RR 0.98; 95% CI: 0.86, 1.11), falls (RR 1.06; 95% CI: 0.89,1.26), ADEs (RR 1.04; 95% CI: 0.96,1.13), QoL (standardised mean difference = 0.16; 95% CI:-0.13, 0.45), cognitive function (weighted mean difference = 0.69; 95% CI: − 1.25, 2.64) and BPSD (RR 0.68; 95% CI: 0.44,1.06) (2 studies). Conclusion: Modest improvements in medication appropriateness were observed in the studies included in this systematic review. However, the effect on clinical measures was limited to drive strong conclusions

Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD) trial

<p>Abstract</p> <p>Background</p> <p>Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD).</p> <p>Methods/Design</p> <p>This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD.</p> <p>Discussion</p> <p>Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to our knowledge it has not been tested as a treatment for DSD. This novel intervention for DSD builds on our prior delirium, recreational activity and cognitive stimulation research, and draws support from cognitive reserve theory.</p> <p>Trial registration</p> <p>ClinicalTrials.gov identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01267682">NCT01267682</a></p

Avaliação pelo P300 de crianças com e sem epilepsia e rendimento escolar Assessment through P300 of epileptic and non-epileptic children and school performance

Dificuldade de aprendizagem é situação comum em crianças com epilepsia. Distúrbios da inteligência têm sido associados com epilepsia. O potencial cognitivo (P300) é um adjunto clínico para mensurar neurofisiologicamente o processo cognitivo. Foram estudadas 99 crianças com 10 anos a 11 anos e 11 meses. Do Grupo I, sem epilepsia, faziam parte 64 crianças, das quais 32 com bom rendimento e outras 32 com mau rendimento escolar. Do Grupo II, com epilepsia, faziam parte 35 crianças, sendo 21 com bom rendimento escolar e 15 com mau rendimento escolar. Não foi encontrada diferença significativa na latência do P300 entre os dois grupos. Quando foram estratificados segundo o desempenho escolar, as crianças do Grupo I, com bom rendimento escolar, apresentaram latência do P300 de 336 ms e as com mau rendimento escolar, latência de 382 ms; as crianças do Grupo II, com bom rendimento escolar, apresentaram latência do P300 de 363 ms e as com mau rendimento escolar, latência de 400 ms, com diferença significativa. Essa diferença estava localizada entre as crianças não epilépticas com bom desempenho escolar e as com mau desempenho escolar, epilépticas ou não.<br>Learning disability is common in epileptic children. Epilepsy has been associated with disorders of intelligence. Cognitive potential (P300) is considered to be a clinical aid in the neurophysiological measurement of the cognitive process. Ninety-nine children between the ages of 10 years and 11 years and 11 months formed our sample, with good and poor school performance. Group I, non-epileptic, had 64 children of whom 32 had good and 32 poor school performance. Group II, epileptic, had 35 children, of whom 21 had good and 15 poor school performance. No significant difference in P300 latency was found between Groups I and II. When groups were stratified based on school performance, Group I children with good school performance had P300 latency of 336 ms, while the ones with poor school performance had latency of 382 ms. Group II children with good school performance had P300 latency of 363, while the ones with poor school performance had latency of 400 ms. There was a statistically significant difference between the non-epileptic children with good school performance and the children with poor school performance, epileptic or not

Roundtable Discussion Groups Summary Papers: Environmental Bio-Indicators in Coral Reef Ecosystems: the Need to Align Research, Monitoring, and Environmental Regulation

Editors\u27 Note: At the 14th International Conference on Environmental Bioindicators (14th ICEBI) held in Linthicum Heights, Maryland, USA on 24–26 April 2006, the Conference Chairs and Program Committee initiated the Roundtable Discussion Groups as a regular feature of this and future conferences. The Discussions are designed to generate focused debate around key topic areas, led by academic, government and industry experts, and are structured to produce definitive papers for peer review and publication in EBI\u27s first-quarter issue of each publication year, albeit this year the papers will be published over the first two issues of 2007. The three Roundtables of the 14th ICEBI posed questions revolving around the chosen topic areas of Mercury Bioindicators, Marine Ecosystem-level Indicators, and Regulatory and Policy Uses of Bioindicators, and moved from “what we know” to “where we need to go” and “what are the policy implications from our discussions and conclusions.” The following paper on coral reef indicators is the first product of this undertaking. The second Roundtable paper on Mercury Bioindicators, along with a summary of the third Roundtable on Regulatory and Policy Uses of Bioindicators, will occur in our next issue. A roundtable workshop was held on 24–26 April 2006 at the 14th International Conference on Environmental Bioindicators (14th ICEBI) to discuss environmental bioindicators as they apply to the coral reefs. Participants discussed procedures and potential bioindicators currently being used to monitor these ecosystems, those showing promise for future use, and candidates for future research and development. Attendees represented research and educational institutions, environmental consulting firms, and US federal government regulatory agencies. Despite the fact that these three interest-groups have similar ultimate objectives of protecting coral reef ecosystems, they are engaged in different activities, using different jargon and techniques, and are pursuing different proximal objectives. Their different perspectives presented challenges for information transfer among the groups. Coral reef scientists, both descriptive and experimental, are attempting to explain the underlying processes controlling reef health, and assign functional relationships within that system, making it possible to predict effects of natural or anthropogenic perturbations. Individuals involved in monitoring are attempting to document components of the ecosystem and their characters that might indicate the state of reef health through time, generally at the macro-scale. Such monitoring generally utilizes at least some of the basic ecological, geological, chemical, or physical relationships defined by the first group. The third group – the environmental regulators and resource managers – is attempting to set limits for defining methods that will defensively document transgressions by parties causing damage to the environment. They also provide guidance for remediation. Management objectives almost universally require “reference points” or “bands” or standards against which alleged violations can be compared and which can be confidently and demonstrably traced to some anthropogenic source, within the guidelines of the law. One of the problems recognized in the workshop was that differences in their respective objectives created communication and information gaps. Each group is encouraged to become conversant with the terminology and objectives of the other groups to provide a legal framework to effect environmental protection. Thus, for research and monitoring groups, reviewing the effectiveness of one bioindicator over another for predicting anthropogenic effects, although important, may be premature. Rather, it is more important to first understand the ultimate requirements of local, state, and federal governments, understand the staff and funding limitations of the resource management agencies, and become conversant with resource management terminology and needs. Then specific and relevant information can be channeled to the responsible regulatory bodies that will assist in achieving the common ultimate goal of environmental protection of coral reefs. A clear conclusion from this workshop is that a bioindicator review process must “start with the end in mind.