The Effectiveness of Training Programs on the Fidelity of Neuropsychological Tests

Background: There will probably be an exponential increase in the number of seniors suffering from dementia, as aging is the greatest risk factor for this disease. Therefore, neuropsychological tests to assessing dementia are likely to play an increasingly important role for medical services in Japan. This study developed and evaluated the usefulness of a training program on neuropsychological tests aimed at promoting the understanding of testers with regard to the cognitive functions and communication required in the neuropsychological testing process. Methods: The subjects of this study comprised 20 individuals engaged in administrating neuropsychological tests at the Japan-Multidomain Intervention Trial for Prevention of Dementia in Older Adults with Diabetes. A four-hour training session was held. The first part of the training program focused on “cognitive functions and communication;” the second addressed “neuropsychological tests.” As the main evaluation criteria, a fidelity checklist was created with 14 items designed to measure success or failure with regard to important and easily mistakable aspects of implementing each neuropsychological test. They were conducted three times: before, immediately after, and six months after the training. Results: The main effect of time was significant for the “fidelity” score. The effect size was large at η2 = 0.69. A simple main effect test using the Bonferroni method revealed significant differences between the pre-training and post-training values and between the pre-training and six-month point values. However, no significant differences were found in self-efficacy scores before, immediately after, and six months after the training. Conclusion: This outcome indicates that the fidelity of the subjects to neuropsychological tests increased as a result of the training program, and that this improvement was maintained through the six-month period following the program. Moreover, the large effect size suggests that the training program may be effective in facilitating the mastery of neuropsychological tests in testers

The Effect of the Kampo

Background. Preoperative anxiety can lead to unfavorable physiological response such as tachycardia and hypertension. Prevention of preoperative anxiety improves surgical outcome and decreases inpatient stay. Yokukansan is one of prescriptions in Kampo, traditional Japanese herbal medicine, and is known to exert anxiolytic effects. The aim of the present study was to compare the effects of diazepam and Yokukansan on preoperative anxiety, salivary amylase activity, and sedation levels. Methods. Seventy American Society of Anesthesiologists physical status I or II patients presenting for hemicolectomy under general anesthesia combined with epidural anesthesia were enrolled. The Diazepam group received diazepam 5 mg orally and the Yokukansan group received Yokukansan 2.5 g orally. Results. Although levels of anxiety and salivary amylase activity were not different between the two groups, the modified Observer’s Assessment of Alertness/Sedation Scale of the Yokukansan group was significantly higher compared to that of the Diazepam group. Conclusion. Yokukansan alleviated preoperative anxiety without undesirable sedation, when compared with diazepam

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo