Bioethical implications of end-of-life decision-making in patients with dementia:a tale of two societies

End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices.</p

Postural instability during attacks of migraine without aura

Background and purpose: Migraine has long been associated with unsteadiness and dizziness but postural control has not been studied in the ictal state. Here, the stability of upright stance during migraine attacks was measured. Methods: Static balance was assessed prospectively in migraine patients (n = 30) during quiet stance for 40 s on a posturographic force platform. Recordings were performed both ictally and in the pain-free interval. Subjects were assessed under four different conditions yielding different visual and proprioceptive feedback environments. Both ictal and interictal data were compared with age-matched healthy controls (n = 30). Results: Postural instability increased significantly under all experimental conditions during migraine attacks. Whilst standing on a foam pad with eyes closed, median sway area was 353 mm2 in control subjects, 318 mm2 in migraineurs in the pain-free period and 618 mm2 in the ictal state. However, Romberg and vestibular Romberg quotients were not altered during migraine attacks. Spectral analyses of postural sway also showed similar profiles in migraineurs and controls. The severity of headache was inversely correlated to Romberg quotients. Conclusions: The demonstrated pattern of balance disorder during migraine attacks suggests a transient cerebellar dysfunction. Our findings also indicate that intense headache induces a re-weighting of sensory processing toward less dependence on visual and proprioceptive information. © 2018 EA

Testamentary Capacity Assessment: Legal, Medical, and Neuropsychological Issues

Introduction: The increase in the aging population and the number of patients with dementia led to the research in older adults’ capacity assessment over the last 3 decades. Many cases of contested wills occur due to lack of testamentary capacity (TC), especially in cases of dementia. Aim: Purpose of the present study was to overview the legal, medical, and neuropsychological aspects of TC as well as the instruments used for TC assessment. Findings: The testator/testatrix with intact TC has realistic perception of his or her property value, lack of psychopathology affecting contact with reality, and intact intention of how and to whom he or she will dispose his or her assets. It is frequent for the health practitioners to serve as “gold standards assessors” by examining an individual’s ability to make a valid will and giving evidence to the court to support or not a will contest. The TC assessment is a complex process of clinical and legal practice requiring usually a variety of methods, that is, interviews, evaluation of clinical records, and administration of neuropsychological instruments. Conclusion: The evaluation of TC is a multidimensional process that integrates both the legal and medical field, requiring a collaborative approach to its definition and assessment. © 2017, © The Author(s) 2017

Testamentary Capacity Assessment Tool (TCAT): A Brief Instrument for Patients with Dementia

Background: In current practice, it is common for the medical practitioner to assess a person&apos;s testamentary capacity (TC) and give evidence to the Courts about a potential will contest. TC is an advanced cognitive activity that is both situation-and task-specific. Objective: The aim of the present study was the development of a brief, specialized instrument for TC assessment in patients with dementia. Method: We developed a short tool consisting of four subtests, assessing the person&apos;s core functions which are required for TC: memory (orientation, autobiographical memory and realistic perception of beneficiaries), absence of serious psychopathology, knowledge of financial parameters (value of assets, everyday life products, bills), and intention (vignettes, theory of mind). For its validation, we examined 64 outpatients from the Cognitive Disorders/Dementia Unit, 2nd Department of Behavioral Neurology, University of Athens. The decision of the expert served as the gold standard for the evaluation of TC. Results: Of the 64 participants, 39 were judged by the expert as capable of TC and the remaining 25 as incapable. For the total scale (maximum score of 48), the best combination of sensitivity (82.6%) and specificity (100%) was obtained for a cut-off score of 32/33. Cronbach&apos;s alpha showed high levels of internal reliability for the scale (= 0.86) and the point-biserial correlation coefficients showed high levels of criterion-related validity (rbp = 0.797, p &lt; 0.001). Conclusion: The new instrument appears to be a reliable screening tool for the evaluation of TC in dementia, which can be used by both the expert and the non-expert. Further research is needed to confirm these promising findings. © 2018-IOS Press and the authors. All rights reserved

Relationship of quality of life, psychopathologic symptoms and ways of coping in Greek nursing staff [Relación entre calidad de vida, síntomas psicopatológicos y formas de afrontamiento en las enfermeras griegas]

Objective: Our aim was to investigate the relationship of quality of life, psychopathological symptoms and ways of coping of nursing staff in two General Hospitals in Greece. Method: This was a cross-sectional study of 302 nurses in two General Hospitals in Greece between October and November of 2015. Data collection was performed using three questionnaires: the World Health Organisation Quality Of Life BREF; the Falk Self-Reporting Questionnaire for the detection of possible psychiatric comorbidity, and the Ways of Coping Scale for Stressful Situations. Results: From a sample of 302 nurses, the poorer the mental and physical health of the nursing staff, the more their quality of life was impaired in all dimensions (physical, psychological, social and environmental) (P &lt;.001, P =.047, P =.001). Also, while the scores in coping strategies “positive approach-positive reappraisal”, “positive approach-problem solving” and “positive approach (overall)” rose, the score in the General Scale dropped; in other words, the employees’ general health improved. Conclusion: Coping strategies such as positive approach, improved the nurses’ general health. In contrast, their mental health deteriorated when they adopted the wishful thinking/daydream and/or the escape/avoidance strategies. Finally, as their general health worsened, their quality of life was impaired in all dimensions, whereas poor mental health of nurses was associated with lower quality of life in the physical and psychological dimensions. © 2018 Elsevier España, S.L.U

Stochastic Transformer Networks With Linear Competing Units: Application To End-to-End SL Translation

Automating sign language translation (SLT) is a challenging real-world application. Despite its societal importance, though, research progress in the field remains rather poor. Crucially, existing methods that yield viable performance necessitate the availability of laborious to obtain gloss sequence groundtruth. In this paper, we attenuate this need, by introducing an end-to-end SLT model that does not entail explicit use of glosses; the model only needs text groundtruth. This is in stark contrast to existing end-to-end models that use gloss sequence groundtruth, either in the form of a modality that is recognized at an intermediate model stage, or in the form of a parallel output process, jointly trained with the SLT model. Our approach constitutes a Transformer network with a novel type of layers that combines: (i) local winner-takes-all (LWTA) layers with stochastic winner sampling, instead of conventional ReLU layers, (ii) stochastic weights with posterior distributions estimated via variational inference, and (iii) a weight compression technique at inference time that exploits estimated posterior variance to perform massive, almost lossless compression. We demonstrate that our approach can reach the currently best reported BLEU-4 score on the PHOENIX 2014T benchmark, but without making use of glosses for model training, and with a memory footprint reduced by more than 70%

Reliability and validation of the greek version of the boston carpal tunnel questionnaire

Background: The Boston Carpal Tunnel Questionnaire (BCTQ) is an easy, brief, self-administered questionnaire developed by Levine et al for the assessment of severity of symptoms and functional status of patients with carpal tunnel syndrome. The aim of our study was to develop and validate the Greek version of BCTQ. Methods: We conducted a cross-sectional study of 90 patients with idiopathic carpal tunnel syndrome. The original English version of BCTQ was adapted into Greek using forward and backward translation. Reliability was assessed by internal consistency (Cronbach α and item-total correlation) and reproducibility. Validity was examined by correlating the Boston Questionnaire scores to Canterbury severity scale for electrodiagnostic severity grading. Results: The Greek version showed high reliability (Cronbach α 0.89 for Symptom Severity Scale and 0.93 for Functional Status Scale) and construct validity (Pearson correlation coefficient 0.53 for Symptom Severity Scale and 0.68 for Functional Status Scale). Test-retest were 0.75 for Symptom Severity Scale and 0.79 for Functional Status Scale (P &lt;.05). Receiver operating characteristic curve analysis showed that the optimal cutoff of Symptom Severity Scale for the discrimination of subjects with low electrodiagnostic severity grading than subjects with high electrodiagnostic severity grading was 1.95 with sensitivity equal to 75.5% and specificity equal to 68.3%. Conclusions: The Greek version of the BCTQ is a valid, reliable screening tool for assessment in daily practice of symptoms and functional status in patients with carpal tunnel syndrome. © The Author(s) 2017

Job stress and burnout in the care staff of Leros PIKPA Asylum 25 years after the first Deinstitutionalisation and Rehabilitation Greek Project

Aims and method: To identify correlates between burnout and job stress of care staff at Leros PIKPA Asylum. Forty-nine asylum employees were assessed by Maslach&apos;s Burnout Inventory, a sociodemographic questionnaire, the Perceived Stress Scale and the Job Content Questionnaire. Results: Emotional exhaustion is related negatively to social support (P = 0.010, r =70.362). Lack of job achievements is related positively to overall job responsibility (P = 0.040) and negatively to lack of job satisfaction (r =70.430). Depersonalisation was negatively associated with support from superiors (P = 0.036). Employees with high levels of perceived stress reported higher levels of fatigue (P = 0.050). Positive associations of perceived stress with depression (P = 0.011) and sleep problems (P &lt; 0.001) were also detected. Positive correlation was found between monthly salary and lack of sense of personal achievement (P = 0.020). Clinical implications: It is necessary to address these issues through staff education and stress management. © 2016 The Authors