[A global intervention program for institutionalized demented patients]. / Méthode de prise en charge globale non médicamenteuse des patients déments institutionnalisés.

INTRODUCTION: Over the last decades many approaches have been developed to manage cognitive and behavioral disturbances in dementia. The present work describes a global intervention program carried out with moderately to severely demented institutionalized patients. The aims of the intervention program are to stimulate and maintain the preserved abilities of demented patients in a supportive context, to decrease the behavioral disturbance and to avoid burnout of care-unit staff. METHODS: This intervention combines different means: psychosocial care (validation therapy, social interaction), cognitive stimulation (memory and verbal training), and motor and sensitive stimulation. The global intervention program requires a special trained team composed of a supervisor, six aid-nurses, an occupational therapist, a speech therapist, a psychomotor therapist and a psychologist. The team cared for the patients five days per week over a three-month period. Assessments were conducted before and after the intervention program to measure the benefit. RESULTS: Positive effects were shown for cognitive abilities, nutritional problems and staff burnout. However, due to the small sample size for this study, more research is needed to verify the effectiveness of this global intervention program, particularly the implications for nutrition. CONCLUSION: This global intervention combined with pharmacological treatment seems to be useful for managing psychological and behavioral disorders of institutionalized demented patients.

Triplet pregnancy with second trimester abortion and delivery of twins at 35 weeks' gestation.

A triplet pregnancy is described in which there was a second trimester abortion of one fetus at 16 weeks' gestation. A cervical cerclage was placed, and tocolysis was used. The other two triplets were delivered 131 days later (at 35 weeks' gestation) by cesarean section. Both infants survived. This case is unique in the literature.

Rotated hypoplastic hemipelvis: a cause of obstructive dyspareunia.

Repeat Chiari innominate osteotomy in a young woman with traumatic monoplegia and subsequent hypoplasia of the hemipelvis and leg resulted in rotation of the pubic ramus into the vagina, causing obstructive dyspareunia. Resection of the inferior pubic ramus through a transperineal approach allowed successful intromission with resolution of her dyspareunia.