Impact of the initial response to COVID-19 on long-term care for people with intellectual disability: an interrupted time series analysis of incident reports.

BACKGROUND: The lockdown-measures in response to COVID-19 taken by long-term care organisations might have impacted problem behaviour and behavioural functioning of people with intellectual disability. This study tested changes in reported incidents, in particular regarding aggression, unexplained absence and, for contrast, medication errors. METHODS: Metadata on weekly incident and near-incident reports from 2016 to June 2020 involving over 14 000 clients with mild to serious intellectual disability of 's Heeren Loo, a long-term care organisation for people with intellectual disability, were subjected to interrupted time series analysis, comparing the COVID-19 with the pre-COVID-19 period. RESULTS: The imposition of lockdown-measures coincided with a significant drop in incidents (total, P < .001; aggression, P = .008; unexplained absences, P = .008; and medication errors, P < .001). Incidents in total (P = .001) and with aggression (P < .001) then climbed from this initial low level, while medication errors remained stably low (P = .94). CONCLUSION: The rise in incidents involving aggression, against the background of generally lowered reporting, underlines the need for pandemic control measures that are suitable for people with intellectual disability in long-term care.

Coronaviruses and people with intellectual disability: an exploratory data analysis.

BACKGROUND: Corona virus disease 2019 (COVID-19) has been announced as a new coronavirus disease by the World Health Organization. At the time of writing this article (April 2020), the world is drastically influenced by the COVID-19. Recently, the COVID-19 Open Research Dataset (CORD-19) was published. For researchers on ID such as ourselves, it is of key interest to learn whether this open research dataset may be used to investigate the virus and its consequences for people with an ID. METHODS: From CORD-19, we identified full-text articles containing terms related to the ID care and applied a text mining technique, specifically the term frequency-inverse document frequency analysis in combination with K-means clustering. RESULTS: Two hundred fifty-nine articles contained one or more of our specified terms related to ID. We were able to cluster these articles related to ID into five clusters on different topics, namely: mental health, viral diseases, diagnoses and treatments, maternal care and paediatrics, and genetics. CONCLUSION: The CORD-19 open research dataset consists of valuable information about not only COVID-19 disease but also ID and the relationship between them. We suggest researchers investigate literature-based discovery approaches on the CORD-19 and develop a new dataset that addresses the intersection of these two fields for further research.

Obstacles and features of health information systems: A systematic literature review.

BACKGROUND: Currently many healthcare systems are supported by an increasing set of Health Information Sys-tems (HISs), which assist the activities for multiple stakeholders. The literature on HISs is, however, fragmented and a solid overview of the current state of HISs is missing. This impedes the understanding and characterization of the required HISs for the healthcare domain. METHODS: In this article, we present the results of a Systematic Literature Review (SLR) that identifies the HISs, their domains, stakeholders, features, and obstacles. RESULTS: In the SLR, we identified 1340 papers from which we selected 136 studies, on which we performed a full-text analysis. After the synthesis of the data, we were able to report on 33 different domains, 41 stakeholders, 73 features, and 69 obstacles. We discussed how these domains, features, and obstacles interact with each other and presented suggestions to overcome the identified obstacles. We recognized five groups of obstacles: technical problems, operational functionality, maintenance & support, usage problems, and quality problems. Obstacles from all groups require to be solved to pave the way for further research and application of HISs. CONCLUSION: This study shows that there is a plentitude of HISs with unique features and that there is no consensus on the requirements and types of HISs in the literature.

[Instability of personality characteristics and personality disorders during the lifespan: effects for assessment in older adults]. / Temporele instabiliteit van persoonlijkheidskenmerken op oudere leeftijd. Een literatuuronderzoek met diagnostische implicaties.

The instability of personality characteristics and personality disorders during the lifespan is the topic of this literature search. It concerns the effects of this instability for personality assessment in older adults. Five longitudinal studies, based on the Big Five model of Costa & McCrae, support the hypothesis that personality characteristics change during the lifespan. Neuroticism, extraversion and openness decrease with age. In contrast, altruism and conscientiousness increase with age. One longitudinal and three cross-sectional studies of personality pathology indicate age-specific changes in the expression of (mal) adaptive personality characteristics. Besides that, nearly one third of the DSM criteria for Axis II personality disorders are insufficiently applicable to older people, based on a large cross sectional study. Therefore the temporal instability of personality characteristics and the limited validity of the Axis II criteria complicate personality assessment in older adults. Improvements could be found in major standardization studies of personality questionnaires in elderly patients in mental health care and nursing home care. Significant changes in the DSM, such as the development of an age specific and multidimensional approach to personality disorders is also recommended.

[Personality disorders in older adults: a Delphi-study conducted among Dutch and Belgian experts concerning specific diagnostic and therapeutic aspects]. / Persoonlijkheidsstoornissen bij ouderen: delphi-onderzoek onder Nederlandse en Vlaamse experts over specifieke diagnostische en therapeutische aspecten.

BACKGROUND: In psychiatry for older adults (> 60 years) personality disorders play an important part in diagnosis and treatment and in the advice given to health professionals and carers on how to deal with this age group. So far, however, research in this area has been inadequate. AIM: To investigate age-related diagnostic and therapeutic aspects of personality disorders occurring in adults over the age of 60. METHOD: A Delphi-study was conducted among 35 Dutch and Belgian experts in the field of personality disorders in older adults. This multidisciplinary panel consisted of psychiatrists, psychologists, psychotherapists, geriatricians and psychiatric nurses. In four rounds 21 gerontological statements to be assessed on a 5-point Likert scale were presented to the panel of experts. Agreement was said to be reached when at least two thirds of the experts agreed or fully agreed with a statement.RESULTS Satisfactory agreement was reached in the case of 20 of the 21 diagnostic and/or therapeutic statements about older adults with personality disorders. CONCLUSION There seem to be various age-specific aspects in the diagnosis and treatment of personality disorders in older adults. Therefore, it is advisable to pay more attention to this highly complex group of older adults when guidelines and protocols are being drawn up and scientific research is being planned or conducted.

Arteriovenous fistula after intervertebral disk surgery at L4-L5.

We describe a 34-year-old woman who had symptoms of heart failure due to an arteriovenous fistula between the right iliac artery and the inferior vena cava caused by surgery for a herniated intervertebral disk. The literature is reviewed. An intra-arterial placed covered stent was successfully used to close the fistula.

[Stable osteosynthesis of unstable per- and subtrochanteric femoral fractures using the 130 degrees double-T plate]. / Die belastungsstabile Osteosynthese instabiler per- und subtrochanterer Oberschenkelfrakturen mit der 130 grade-Doppel-T-Platte.

Operative treatment of instable inter- and subtrochanteric fractures with a new 130 degrees-double-T-plate allowed, in spite of high-risk patients (age x=81 to 84 years, multimorbidity 92%), full maximum load by the third day after operation and a shorter time of hospitalization of 22.5 days. Mortality rate came up to 9%. Load experiments showed that the double-T-profiled 130 degrees-plate with increased lateral moment of resistance could support a weight five times greater than that supported by 130 degrees-implants with transversal blades or DHS-screws. In addition, the double-T (I-Beam) profiled 130 degrees-angled-plate had a resistance to bending two-and-a-half times greater than the hip compression screw from Pohl and has demonstrated its marked clinical success. Follow-up made in 256 patients for 6 to 66 months after double-T-plate osteosynthesis showed good results in 82.2% of the patients satisfied with the outcome of surgery, 13.9% needed two crutches and found the result achieved poor. Only 3.9% of all patients achieved no walking capability.