Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion.

In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients.

A pilot study of a school-based prevention and early intervention program to reduce oppositional defiant disorder/conduct disorder.

UNLABELLED: Oppositional defiant disorder (ODD) or conduct disorder (CD) occurs when children's disruptive and antisocial behaviours start to interfere with their academic, emotional and/or social development. Recently, there has been a considerable investment to implement national school-based early intervention programs to help prevent the onset of ODD/CD. AIM: This paper describes the delivery of the Royal Children's Hospital, Child and Adolescent Mental Health Service and Schools Early Action Program: a whole school, multi-level, multidisciplinary approach to address emerging ODD/CD and pre- versus post-delivery assessment in 40 schools over a 4-year period (2007-2010). METHODS: All children from preparatory to grade 3 (ages 4-10 years) were screened for conduct problems (n = 8546) using the Strengths and Difficulties Questionnaire. Universal, targeted and indicated interventions were delivered in school settings. In total, 304 children participated in the targeted group program where the Child Behaviour Checklist was used as a pre- and post-intervention measure. Cohen's d effect sizes and a reliability change index were calculated to determine clinical significance. RESULTS: Significant reductions in both parent- and teacher-reported internalizing and externalizing symptoms were noted. Parent, teacher and child feedback were very positive. CONCLUSIONS: A future randomized controlled trial of the program would address potential placebo and selection bias effects.

Morning dosing of once-daily glaucoma medication is more convenient and may lead to greater adherence than evening dosing.

PURPOSE: To determine if adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening. DESIGN: Prospective, randomized crossover treatment trial. PATIENTS AND METHODS: Thirty patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for 1 month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid. MAIN OUTCOME MEASURES: Adherence was compared between morning versus evening dosing and first versus second month dosing. Demographic characteristics were obtained, treatment effect was measured, and patients completed a post-study questionnaire regarding the convenience of the 2 dosing regimens. RESULTS: Patient adherence overall was good (89.3%). There was no statistically significant difference (P=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%). Adherence in the first month (91.7%) was superior to the second month (86.5%). There was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing. CONCLUSIONS: Early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration.

Postoperative endophthalmitis in a patient with Darier-White disease.

CASE REPORT: We report a case of endophthalmitis after cataract surgery in a patient with Darier-White disease. COMMENTS: A keratotic lid lesion in contact with the ocular surface near the temporal corneal wound is believed to be the source of infection. Such lesions are the predominant manifestation of Darier-White disease and are known to harbour gram-positive skin flora. This has implications for planning intraocular surgery in these patients.

Comparison of pseudophakic dysphotopsia with Akreos Adapt and SN60-AT intraocular lenses.

PURPOSE: To determine the relative incidence of unwanted light images with the AcrySof SN60-AT intraocular lens (IOL) (Alcon) and the Akreos Adapt (Bausch & Lomb) IOL. SETTING: The Eye Clinic, Sir Charles Gairdner Hospital, Nedlands, Australia. METHODS: In a prospective randomized study of 61 patients who had cataract surgery, the relative incidence of unwanted light images with 2 biconvex acrylic double square-edged IOLs, the SN60-AT and Akreos Adapt, was compared. Patients were followed at 1 week and for a minimum of 6 weeks. At both follow-ups, patients were asked to rate their experience of dysphotopic phenomenon according to a set of questionnaire criteria. The Mann-Whitney test was used to analyze the ordinal data. RESULTS: All 61 patients were interviewed at both stages of follow-up. The mean follow-up was 8 weeks +/- 2 (SD). At 1 week, there was significantly more dysphotopsia (positive and negative) with the SN60-AT IOL (37.5%) than with the Akreos Adapt IOL (24.1%) (P = .042). Significantly more patients with the SN60-AT IOL reported negative dysphotopsia at 1 week only. At 8 weeks, the incidence of positive and negative dysphotopsia declined to 31.3% and 20.7% in the SN60-AT group and Akreos Adapt group, respectively, and there was no longer a statistically significant difference between the 2 groups. CONCLUSIONS: More patients with the SN60-AT IOL than with the Akreos Adapt IOL reported dysphotopsia. One week postoperatively, the difference was significant. The difference was primarily a result of the higher incidence of negative dysphotopsia with the SN60-AT IOL. At 8 weeks, the incidence of all types of light phenomena was significantly lower in both groups.

IGF-I has no effect on postexercise suppression of the ubiquitin-proteasome system in rat skeletal muscle.

Both exercise and insulin-like growth factor I (IGF-I) are known to have major hypertrophic effects in skeletal muscle; however, the interactive effect of exogenous IGF-I and exercise on muscle protein turnover or the ubiquitin-proteasome pathway has not been reported. In the present study, we have examined the interaction between endurance exercise training and IGF-I treatment on muscle protein turnover and the ubiquitin-proteasome pathway in the postexercise period. Adult male rats (270-280 g) were randomized to receive 5 consecutive days of progressive treadmill exercise and/or IGF-I treatment (1 mg. kg body wt(-1). day(-1)). Twenty-four hours after the last bout of exercise, the rate of protein breakdown in incubated muscles was significantly reduced compared with that in unexercised rats. This was associated with a significant reduction in the chymotrypsin-like activity of the proteasome and the rate of ubiquitin-proteasome-dependent casein hydrolysis in muscle extracts from exercised compared with unexercised rats. In contrast, the muscle expression of the 20S proteasome subunit beta-1, ubiquitin, and the 14-kDa E2 ubiquitin-conjugating enzyme was not altered by exercise or IGF-I treatment 24 h postexercise. Exercise had no effect on the rates of total mixed muscle protein synthesis in incubated muscles 24 h postexercise. IGF-I treatment had no effect on muscle weights or the rates of protein turnover 24 h after endurance exercise. These results suggest that a suppression of the ubiquitin-proteasome proteolytic pathway after endurance exercise may contribute to the acute postexercise net protein gain.