An individualized psychosocial approach for "treatment resistant" behavioral symptoms of dementia among aged care residents

Background: Behavioral symptoms of dementia are common among residents in mainstream aged care settings, and have a substantial impact on residents and professional caregivers. This study evaluated the impact of individualized psychosocial interventions for behavioral symptoms through a small preliminary study.Method: Interventions were delivered to a patient group of 31 psychogeriatric aged care residents who presented with behavioral symptoms of dementia that had failed to respond to pharmacological treatment approaches. Outcome data on severity of behaviors, health service utilization and staff burden of care were collected.Results: A modest but significant reduction in staff ratings of the severity of aggressive and verbally agitated behavioral symptoms was found, with an associated reduction in their perceptions of the burden of caring for these patients. Reduced behavioral disturbance was associated with a reduction in the requirement for primary care consultations, and all participants were able to continue to reside in mainstream aged care facilities, despite an increase in the severity of dementia.Conclusions: This study supported the use of individualized psychological strategies for behavioral symptoms at all stages of dementia. Methodological limitations of this preliminary study are discussed.<br /

Ocular pulse amplitudes in diabetics in South India

OBJECTIVES: Describe the objectives of your study 1. To document any difference in Ocular Pulse Amplitudes with increasing severity of Diabetic retinopathy. 2. To document any difference in Ocular Pulse Amplitudes between Diabetics with and without systemic Hypertension METHODS: Explain the clinical and statistical methods used This study was a prospective non randomised observational study to look at the ocular pulse amplitudes using dynamic contour tonometry in various stages of diabetic retinopathy and also in patients with Hypertension. Participants were divided into groups based on the presence or absence of Diabetes. There were 3 groups, 50 in each group, namely: 1. No diabetes, 2. Diabetes with no diabetic retinopathy and 3. Diabetes with retinopathy. Participants with retinopathy were further divided into 3 sub groups: mild diabetic retinopathy, moderate diabetic retinopathy and severe non proliferative diabetic retinopathy and proliferative diabetic retinopathy being clumped into the last group Statistical analysis was done mostly with hypothesis testing for 2 means, from which the sample size was calculated. ANOVA was also used. RESULTS: The total number of participants included in the study was 172. 3 Patients, who were screened to be selected in the No DM arm, who were found to have raised HbA1c (>6.5 mg/dl) were taken out of the study and referred to Department of Medicine, CMC Vellore. 4 patients enrolled were not able to sit by the slit lamp for the period of time required and therefore the quality index was not 1 or 2 in these participants. Therefore, they were taken out of the study. One of the patients had a neck ailment and mechanically found it difficult to place her chin on the chin rest on the slit lamp. Though not mentioned in the criteria, she was not selected in the study for obvious reasons. 3 patients refused to undergo blood tests to confirm absence of Diabetes. All three were women. Two of them felt that they were too anaemic for blood tests and the third did not want to be poked repeatedly after the trained nursing staff failed to get a vein in two attempts. Therefore, these 3 women were not included in the study. Conclusions: 1. OPA is reduced in diabetics with severe NPDR and PDR as compared to normals and patients with milder grades of retinopathy 2. Reduced OPA is seen in non- hypertensive patients with diabetic retinopathy as compared to normals and hypertensives with diabetic retinopathy 3. Further studies with larger sample sizes in each grade of diabetic retinopathy is needed to evaluate the exact effect of hypertension in these patient

Barriers to care for depressed older people : perceptions of aged care among medical professionals

The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. The implications of these findings for training programs for professional carers are discussed.<br /

Treatment of depression in low-level residential care facilities for the elderly

Background: The rate of recognition and treatment of depressed older people in nursing homes is low. Data from the low-level residential care population have not been reported. This study aimed to collect information about the treatment of depression among older persons living in low-level residential care (hostels).Method: The participants comprised 300 elderly residents from ten low-level residential care facilities from various suburbs in metropolitan Melbourne. The participants were interviewed by a trained clinical psychologist to determine the presence or absence of major or minor depressive disorder using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). Each participant was also administered the Standardized Mini-mental State Examination (SMMSE) to determine level of cognitive function. The clinical psychologist then reviewed all cases in consultation with a geropsychiatrist experienced in the diagnosis of depression among older people, prior to assigning a diagnosis of depression.Results: An important finding in this study was the low treatment for currently depressed residents, with less than half of those in the sample who were depressed receiving treatment. However, 61 of the 96 residents out of the sample of 300 who were on antidepressants were not currently depressed.Conclusion: There is an under recognition and under treatment of currently depressed older people in low-level residential care facilities (hostels) just as has been reported in studies in nursing homes. However, there are high numbers receiving antidepressants who are not currently depressed.<br /

Knowledge of late-life depression : an empirical investigation of aged care staff

Objectives: This study examined knowledge of late-life depression among staff working in residential and community aged care settings, as well as their previous training in caring for older people with depression. Method: A sample of 320 aged care staff (mean age = 42 years) completed a survey questionnaire. Participants included direct care staff, registered nurses and Care Managers from nursing and residential homes and community aged care services. Results: Less than half of the participating aged care staff had received any training in depression, with particularly low rates in residential care. Although aware of the importance of engaging with depressed care recipients and demonstrating moderate knowledge of the symptoms of depression, a substantial proportion of staff members saw depression as a natural consequence of bereavement, aging or relocation to aged care. Conclusion: Experience in aged care appears to be insufficient for staff to develop high levels of knowledge of depression. Specific training in depression is recommended for staff working in aged care settings in order to improve the detection and management of late-life depression, particularly among direct carers, who demonstrated least knowledge of this common disorder. <br /

The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment

Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed

Upcycling Formal Specifications for Similar Implementations with Arís

We describe the Arís system for creating new formal specifications for source code by transferring existing specifications to similar implementations. We show the code graphs underlying its operation, graph matching supports retrieval, and pattern completion enables transfer of specifications to new implementations. A theorem prover formally verifies the new specifications

Creating new Program Proofs by Combining Abductive and Deductive Reasoning

We describe recent work on the Aris system that creates and verifies new formal specifications for pre-existing source code. We describe Aris in terms of the abductive reasoning system that suggest possible specifications and then uses an existing deductive verifier to evaluate these creations. This paper focuses on the abduction system that creates new formal specifications by leveraging a small set of inspiring artefacts to augment a subset of candidate problems. This employs knowledge graphs to represent the raw data (i.e., source code), discovering latent similarities between graphs using a graph-matching process. Results are presented for the C# programming language with novel creations and its sister language called Code Contracts. We outline ampliative creativity, whereby newly created artefacts drive subsequent creative episodes beyond the initially perceived limitations. We also outline some recent work towards transferring specifications between the C# and Java programming languages

Transport of organic solvents through natural rubber/nitrile rubber/organically modified montmorillonite nanocomposites

International audienceThe article describes the transport phenomenon of some commonly used laboratory organic solvents which differ in their solubility parameter value through polymer blend nanocomposites membrane prepared by melt mixing. The three solvents that were used are hexane, toluene and xylene which differed widely in their solubility parameter values. The motivation for the study was to know the effect of solubility parameter on the diffusion transport properties of NR/NBR (natural rubber/nitrile rubber) blends. The solvent uptake, diffusion, sorption and permeation constants were investigated and were found to decrease with organically modified montmorillonite (OMt) content at lower loading. The mode of transport through NR/NBR nano-composites was found to be anomalous. The difference in solubility parameter value greatly influenced the transport properties. The dependence of various properties on OMt content was supported by morphological analysis data. The effect of blend ratio, solvent size and OMt loading on the diffusion of aromatic and aliphatic solvents through NR/ NBR blend systems were investigated. The swelling coefficient values also decreased upon the addition of fillers indicating the presence of hindered path for solvents to diffuse into the polymer matrix. The better reinforcement at lower filler loading was confirmed from the cross-link density values and mechanical properties. The transport data obtained were applied to mathematical models for predicting the diffusion behaviour through nanocomposite membranes and to elucidate the physical mechanism of transport