The Effects of Distraction and a Brief Intervention on Auditory and Visual-Spatial Working Memory in College Students with Attention Deficit Hyperactivity Disorder

Two studies addressed how young adult college students with attention deficit hyperactivity disorder (ADHD) (n = 44) compare to their nonaffected peers (n = 42) on tests of auditory and visual–spatial working memory (WM), are vulnerable to auditory and visual distractions, and are affected by a simple intervention. Students with ADHD demonstrated worse auditory WM than did controls. A near significant trend indicated that auditory distractions interfered with the visual WM of both groups and that, whereas controls were also vulnerable to visual distractions, visual distractions improved visualWM in the ADHD group. The intervention was ineffective. Limited correlations emerged between self-reported ADHD symptoms and objective test performances; students with ADHD who perceived themselves as more symptomatic often had better WM and were less vulnerable to distractions than their ADHD peers

Orientation to time as a guide to the presence and severity of cognitive impairment in older hospital patients

Background Testing of orientation to time is an important part of mental status examination. The validity of errors in different aspects of temporal orientation was examined in older hospital patients as a guide to the presence of dementia or delirium and as a measure of the severity of dementia, as defined by the Global Deterioration Scale. Methods Inpatients and outpatients attending an acute hospital underwent independent assessments by two doctors on the same day to determine orientation to time and cognitive status. Optimum cut-offs for error scores on the different aspects of temporal orientation were calculated to maximise the sum of sensitivity and specificity for detection of dementia or delirium. Results Of the 262 patients assessed, 62 (23.7%) had dementia or delirium. The best cut-offs for detection of these disorders were: any error in identifying the year, month, day of the month or day of the week; and an error of more than 1 h in identifying the time of day. Failure to identify the year correctly was the most valuable single sign of dementia or delirium (sensitivity 86% and specificity 94%); failure to identify either year or month correctly was 95% sensitive and 86.5% specific for the detection of cognitive impairment. Severity of temporal disorientation, measured using a number of approaches, was strongly associated with severity of dementia. Conclusion Disorientation to time is a useful guide to the presence and severity of dementia or delirium in older hospital patients. Failure to identify the year or month correctly is a sufficiently sensitive and specific indicator of dementia or delirium to warrant more detailed cognitive assessment in this population

Development and implementation of resuscitation guidelines: a personal experience

Objectives: to develop and implement guidelines on the appropriate use of cardiopulmonary resuscitation, which would ensure patient involvement in decision-making about cardiopulmonary resuscitation whenever possible but without offering illusory choices where resuscitation was unlikely to succeed. Design: quantitative guidelines were developed after a review of the Literature on survival after cardiopulmonary resuscitation. Patients were classified according to their estimated likelihood of survival to discharge after resuscitation: <1%, group A; 1-10%, group B; and >10%, group C. Qualitative guidelines were developed after consideration of the legal and ethical principles of cardiopulmonary resuscitation. It was decided to inform competent patients in group A that cardiopulmonary resuscitation would be inappropriate, and to seek the preferences of competent patients in group B. The operation of the guidelines was examined in patients aged 65 years or more admitted under a single consultant in an acute community hospital. Results: 147 patients were studied: 39 in group A, 26 in group B and 82 in group C. Of 36 patients in groups A and B judged competent, cardiopulmonary resuscitation discussions were only undertaken in 17, usually because acute distress or anxiety precluded effective communication. Of the 23 patients or family members from whom cardiopulmonary resuscitation preferences were sought, four opted for full cardiopulmonary resuscitation and six for limited cardiopulmonary resuscitation (usually witnessed-arrest only and no ventilation). Conclusion: it is difficult to involve acutely ill elderly patients in cardiopulmonary resuscitation decision-making. Limited cardiopulmonary resuscitation is a useful option for patients, relatives and doctors

A cross-sectional study of doctors\u27, managers\u27 and public representatives\u27 views regarding acceptable level of risk in discharges from the emergency department

Background: Discharging a patient from the emergency department (ED) always involves some risk of a poor outcome. Aim: This study examined the hypothesis that there would be an increasing gradient of risk aversion from physicians through clinicians in management and managers to public representatives regarding an acceptable level of risk when considering discharging a patient from the ED. Methods: An internet survey was conducted among 180 consultant physicians, 47 clinicians involved in management, 143 senior healthcare managers and 418 public representatives in Ireland. Subjects asked to assess three clinical vignettes for the level of risk for death within the next week that could have been prevented by admission at which discharge from the ED would be acceptable. Choices ranged from 1/100 risk of death to \u27no risk of death is acceptable\u27. The median of each subject\u27s responses was the primary outcome measure. Results: The response rates were 64% for consultant physicians, 57% for clinicians in management, 53% for managers and 29% for public representatives. The median risk choice (interquartile range) was 1/1000 (1/500-1/5000), 1/1000 (1/500-1/10 000), 1/5000 (1/1000-1/10 000) and 1/10 000 (1/1000-0) in the respective groups (Jonckheere-Terpstra test P < 0.0001). All pairwise comparisons between doctors and managers or public representatives were significant. Older clinicians were significantly more risk tolerant than younger clinicians. Conclusions: There are significant differences in risk tolerance when considering discharge from the ED between different groups with doctors being most risk tolerant and politicians most risk averse

\u27LUCAS\u27: the library assistant robot, implementation and localisation

In modern ageing society, robots are been designed to play an increasing role in the lives of elderly people This paper describes a mobile robotic assistant, named ‘LUCAS’, Limerick University Computerised Assistive System, that is currently being developed to assist elderly individuals with mild cognitive or physical impairments within a library environment. The aim of the project is to provide an assistive socially interactive robotic aid. The main focus of this paper is on the localisation system of ‘LUCAS’. A continuous localisation process is used which relies on monocular vision and ultrasonic range readings. The process employ’s methods of straight-line-extraction, vanishing point estimation and ultrasonic pattern detection. The correspondence space is reduced by splitting the navigable space into localisation variant regions. The pose is calculated for each localisation hypothesis within the particular region and is used to correct the motion of the robot before it enters the next localisation region

High frequency of potential entrapment gaps in beds in an acute hospital

Objective: dimensional guidelines for bedrails have been developed to minimise the risk of patient entrapment within the bed. We examined whether bedrails in a large Irish teaching hospital complied with these standards. Design and setting: survey of 60 accessible beds in six hospital wards. Methods: a specialised cone and cylinder tool that mimics the size and weight of a small adult neck and head was used to determine gaps in the four zones most associated with entrapment. Results: the number of failures for each zone was 15 beds for zone 1 (any space between the perimeters of the rail); 42 beds for zone 2 (the space under the rail); 41 beds for zone 3 (the space between the inside surface of the bedrail and the mattress) and 13 beds for zone 4 (the space between the mattress and rail at the end of the rail). Failures were more common with hydraulic adjusted than with electric profiling beds. Mattresses that were the wrong size (usually too narrow) or too soft and bedrails that were loose or were poorly maintained accounted for many failures. Conclusion: many beds used in our hospital did not comply with dimensional standards to minimise entrapment risks. This emphasises the need for careful selection of patients for whom bedrails are to be used as well as the need for monitoring and maintenance of bed systems

Delusions of pregnancy in older women: a case series: table 1.

Background: delusions of pregnancy have been reported in a wide variety of functional and organic psychiatric conditions but rarely with dementia. Most such delusions arise in women of child-bearing age. We report five cases in older women all of whom had severe constipation that probably precipitated this delusion. Case reports: of the five women (age 74-89 years), two had dementia, two had delirium and one had both. All patients had borne healthy children. Three women reported that they were in labour, and one was concerned that the baby was not moving. All had severe constipation on examination or imaging, and three had faecal impaction. All were treated with laxatives or enemas, and only one patient required brief antipsychotic therapy. The delusions lasted from a few hours to 5 days. In general, resolution of the delusion occurred in concert with improvement in bowel function, although in one case a large bowel movement was followed by the delusion that a baby had been born. Conclusion: these cases suggest that misinterpretation of abdominal symptoms due to severe constipation in cognitively impaired women may trigger the delusion of being pregnant and that treatment of constipation often leads to resolution of the delusion

Prevalence and predictors of bedrail use in an acute hospital

Objective: to determine the prevalence and predictors of bedrail use in an acute hospital. Design and setting: overnight survey in a University teaching hospital. Subjects: Three-hundred and twenty-seven beds and patients in 14 wards. Methods: data were collected on bedrail use and on the bed system, ward and patient characteristics. Medical, nursing and physical therapy notes were examined and the night and day nurses and, if necessary, the doctors and therapists caring for the patient interviewed to determine patients\u27 diagnoses, functional and cognitive status. Results: there were 133 (40.7%) beds with one or more raised rails. Independent predictors of bedrail use were use of electric profiling beds, confusion, reduced alertness and any difficulty with transferring from bed. The most common reported indication for bedrail use was \u27to prevent rolling out of bed\u27 (59%); \u27to prevent getting out of bed\u27 was recorded in 11% of cases. Use of bedrails was judged inappropriate in 27/133 (20.3%) patients and in 14/43 (32.6%) patients with abnormal mental status; misuse was particularly common in those with confusion or agitation [13/34 (38.2%)]. Failure to use bedrails was potentially inappropriate in 32/194 (16.5%) of those without bedrails. Conclusion: this study using individual patient data shows that the use of electric profiling beds, abnormal mental states and difficulty transferring from bed are the main predictors of bedrail use in acute hospitals. Inappropriate use of bedrails is common in those with cognitive impairment or with agitation

A review of nocturnal leg cramps in older people

Nocturnal leg cramps are common and troublesome, especially in later life, and have a significant impact on quality of life, particularly sleep quality. This article reviews the current state of knowledge regarding the diagnosis, frequency, pathophysiology and management of cramps. Recent evidence suggests that diuretic and long-acting beta-agonist therapy predispose to leg cramps. There is conflicting evidence regarding the efficacy of prophylactic stretching exercises in preventing cramps. Quinine remains the only medication proven to reduce the frequency and intensity of leg cramps. However, the degree of benefit from quinine is modest and the risks include rare but serious immune-mediated reactions and, especially in older people, dose-related side effects. Quinine treatment should be restricted to those with severe symptoms, should be subject to regular review and requires discussion of the risks and benefits with patients

Dairy Ingredients for Chocolate and Confectionery Products.

End of Project ReportHigh free-fat, spray-dried powders were successfully produced at a lower fat content (40% rather than 56%) using ultrafiltration. Chocolates made from these powders had improved flow properties and superior quality. The stability, viscosity and firmness of toffees were improved by optimising the casein, whey protein and lactose levels of skim milk powders used in their manufacture.Department of Agriculture, Food and the Marin