Strategies to Locate Lost Persons with Dementia: A Case Study of Ontario First Responders.

Information on strategies and practices in the search of missing persons with dementia is inconsistent which creates challenges for first responders, such as police, when they choose appropriate search and rescue approaches. The purpose of this study was to describe current strategies among police services in Ontario. Telephone interviews with police were conducted. Questions included what strategies were used for locating missing persons living with dementia, and what gaps exist in search practices. Participants described they used high- and low-tech solutions in search and rescue. They identified gaps in education and awareness, proactive strategies, resources, and funding. Information collected from the interviews was used to develop a practice guideline for police in partnership with the Alzheimer Society of Ontario.

Development and validation of a conceptual model and strategy adoption guidelines for persons with dementia at risk of getting lost.

Various solutions are available to address critical wandering; however, no guideline exists to allow for the successful adoption of these strategies. This study developed and validated a conceptual model and series of guidelines to facilitate choice of wander-management strategies. Face and content validity of the model and guidelines were assessed through an online and paper survey, individual interviews and focus groups across stakeholders. Directed content analysis was performed. Overall impression of the conceptual model and guidelines was positive. Valued features included the guidelines' ability to help users in choosing proactive wander-management strategies. Suggested changes included revisions in terminology and more factors and strategies to be added to the model and guidelines. This work is being disseminated and used by persons with dementia, caregivers, health practitioners and community service providers to identify strategies to mitigate the risks associated with critical wandering.

Dissemination and implementation of strategy adoption guidelines for persons with dementia at risk of getting lost.

OBJECTIVES: To address risks associated with critical dementia-related wandering, three guidelines were developed for use by persons living with dementia, their care partners, and professional staff, to choose wander-management strategies. This evidence-based research incorporates knowledge mobilization approaches that directly involve the three types of stakeholders in using the guidelines in the real world. The purpose of this project was to evaluate the knowledge translation of three guidelines on wander-management strategies, and to further deploy these guidelines to organizations across Canada. METHODS: Steering committees across Canada were established for consultation. Guidelines were then shared among these organizations via Google slides. Health professionals, caregivers, community organizations and persons living with dementia completed an online survey (via Google) or paper-based survey to provide feedback on the guidelines. The guidelines were then translated from English to French using a forward-translation method. RESULTS: The guidelines were adopted across ten organizations in four Canadian provinces. Adoption included introduction and formal training to staff. It took 22 months from the development of the guidelines to the dissemination and launch of the guidelines to the organizations. Participants (n = 73) were very satisfied with the developed guidelines and agreed they were easy to navigate, easy to understand, and the information provided was useful. CONCLUSIONS: A stakeholder-driven approach used for guideline development and dissemination were successful methods for minimizing the time for this work to become practice. This in addition to the use of online platforms can replace conventional methods which take longer and become quickly outdated.

Age and sex-related decline of muscle strength across the adult lifespan: a scoping review of aggregated data.

Muscle strength is sex-related and declines with advancing age; yet, a comprehensive comparative evaluation of age-related strength loss in human females and males has not been undertaken. To do so, segmented piecewise regression analysis was performed on aggregated data from studies published from 1990 to 2018 and are available in CINAHL, EMBASE, MEDLINE, and PsycINFO databases. The search identified 5613 articles that were reviewed for physical assessment results stratified by sex and age. Maximal isometric and isokinetic 60°·s-1 knee extension (KE) and knee flexion (KF) contractions from 57 studies and 15 283 subjects (N = 7918 females) had sufficient data reported on females and males for meaningful statistical evaluation to be undertaken. The analysis revealed that isometric KE and KF strength undergo similar rapid declines in both sexes late in the sixth decade of life. Yet, there is an abrupt age-related decline in KE 60°·s-1 peak torque earlier in females (aged 41.8 years) than males (aged 66.7 years). In the assessment of KF peak torque, an age-related acceleration in strength loss was only identified in males (aged 49.3 years). The results suggest that age-related isometric strength loss is similar between sexes while the characteristics of KE and KF peak torque decline are sex-related, which likely explains the differential rate of age-related functional decline. Novelty Inclusion of muscle strength and torque of KE and KF data from >15 000 subjects. Isometric KE and KF strength loss are similar between sexes. Isokinetic 60°·s-1 KE torque decline accelerates 25 years earlier in females and female age-related KF peak torque decline does not accelerate with age.

Evaluation of antecedent behaviors of dementia-related wandering in community and facility settings.

Aim: To understand antecedent behaviors to critical wandering among persons living with dementia in or outside of a facility. Materials & methods: Caregivers were asked to write down the type and number of antecedent behaviors they observed in persons with dementia that were about to critically wander for 2-4 weeks. Observations were made through a developed questionnaire. Results: Six antecedent behaviors were observed: stating intent to leave, door lingering/tampering, preparing to go outside, packing up belongings, calling to be picked up and draw to outside stimuli. Conclusion: Information from this study can be used in the education of wander-management strategy adoption among caregivers of persons with dementia at risk of getting lost.

The state of knowledge on technologies and their use for fall detection: A scoping review.

BACKGROUND: Globally, populations are aging with increasing life spans. The normal aging process and the resulting disabilities increase fall risks. Falls are an important cause of injury, loss of independence and institutionalization. Technologies have been developed to detect falls and reduce their consequences but their use and impact on quality of life remain debatable. Reviews on fall detection technologies exist but are not extensive. A comprehensive literature review on the state of knowledge of fall detection technologies can inform research, practice, and user adoption. OBJECTIVES: To examine the extent and the diversity of current technologies for fall detection in older adults. METHODS: A scoping review design was used to search peer-reviewed literature on technologies to detect falls, published in English, French or Spanish since 2006. Data from the studies were analyzed descriptively. RESULTS: The literature search identified 3202 studies of which 118 were included for analysis. Ten types of technologies were identified ranging from wearable (e.g., inertial sensors) to ambient sensors (e.g., vision sensors). Their Technology Readiness Level was low (mean 4.54 SD 1.25; 95% CI [4.31, 4.77] out of a maximum of 9). Outcomes were typically evaluated on technological basis and in controlled environments. Few were evaluated in home settings or care units with older adults. Acceptability, implementation cost and barriers were seldom addressed. CONCLUSIONS: Further research should focus on increasing Technology Readiness Levels of fall detection technologies by testing them in real-life settings with older adults.

EMG Functional tasks recordings determines frailty phenotypes in males and females.

BACKGROUND: Identification of frailty is essential to understanding and mitigating age-related physical impairments. Previous studies have indicated that frailty phenotype can be identified through electromyography (EMG) when collected over the course of an 8-h day. However, long duration recordings challenge both the clinician and the older adults but activities of daily living that are most sensitive to changes in frailty status are currently unknown. The purpose of this study was to determine if muscle activity recorded during specific task, or groups of tasks, could be used to correctly classify middle-aged, non-frail, pre-frail, and frail older adult pheonotypes. METHODS: Fifteen middle-aged (49 ± 5 years) and 76 older adults (77 ± 8 years) participated. Older adults were categorized as non-frail (n = 49), pre-frail (n = 20), or frail (n = 7) using self-selected normal gait speed and a modified frailty index score. Bursts and gaps in EMG of the biceps brachii, triceps brachii, vastus lateralis, and biceps femoris were measured bilaterally during nine different functional tasks. RESULTS: Relatively high levels of success for frailty group classification (near 90%) can be achieved from EMG. Bursts were more frequent and gaps fewer in frail compared with middle-aged and non-frail adults. The numbers of gaps and muscle quiescence in the upper limbs were particularly important. Changes in muscle activity offer predictive value in identifying frailty phenotype. Completing functional tasks (rising from the floor, toilet and chair) while undergoing EMG assessment can contribute to the identification of differences in frailty phenotype among older adults.

Detection of airborne carbon nanotubes based on the reactivity of the embedded catalyst.

A previously described method for detecting catalyst particles in workplace air((1,2)) was applied to airborne carbon nanotubes (CNT). It infers the CNT concentration indirectly from the catalytic activity of metallic nanoparticles embedded as part of the CNT production process. Essentially, one samples airborne CNT onto a filter enclosed in a tiny chemical reactor and then initiates a gas-phase catalytic reaction on the sample. The change in concentration of one of the reactants is then determined by an IR sensor as measure of activity. The method requires a one-point calibration with a CNT sample of known mass. The suitability of the method was tested with nickel containing (25 or 38% by weight), well-characterized multi-walled CNT aerosols generated freshly in the lab for each experiment. Two chemical reactions were investigated, of which the oxidation of CO to CO2 at 470°C was found to be more effective, because nearly 100% of the nickel was exposed at that temperature by burning off the carbon, giving a linear relationship between CO conversion and nickel mass. Based on the investigated aerosols, a lower detection limit of 1 µg of sampled nickel was estimated. This translates into sampling times ranging from minutes to about one working day, depending on airborne CNT concentration and catalyst content, as well as sampling flow rate. The time for the subsequent chemical analysis is on the order of minutes, regardless of the time required to accumulate the sample and can be done on site.

[Psychotherapeutic interventions in bipolar disorders--treatment programmes, their contents and effectiveness]. / Psychotherapie bei bipolaren Störungen--Therapiekonzepte, ihre Inhalte und Wirksamkeit.

Cognitive-behavioural interventions combined with pharmacotherapy have gained importance in the treatment of bipolar disorders. Based on the vulnerability-stress instability model psychoeducational, cognitive-behavioural, interpersonal and family interventions are provided. This paper gives an overview of treatment programmes and their foci. They include providing knowledge about the illness and its treatment, modifying dysfunctional cognitions and symptom management as well as relapse prevention by promoting a stable life style. There are several English- and German-based randomised controlled follow-up studies in English-speaking countries which provide support for the efficacy of combined treatment. Since 2004 German-based manualised treatment programmes have become available and have been shown to be clinically feasible and promising.

[Cognitive-psychoeducational group programme for bipolar disorder: pilot study with two-year follow-up]. / Kognitiv-psychoedukative Gruppenintervention bei bipolar erkrankten Patienten: Pilotstudie mit Zwei-Jahres-Katamnese.

52 patients with bipolar disorder were treated with psychopharmacotherapy and a cognitive psychoeducational group programme that was established at the Department of Psychiatry and Psychotherapy of the Ludwig Maximilian University, Munich, Germany. The programme covers psychoeducation, identifying and coping with depressive and manic symptoms, relapse prevention and establishing a stable life style. 96 % rated the group to be helpful and felt well informed about their illness. There were significant gains in knowledge (F = 25,714, p < 0.001) and improvements in the severity of the illness (CGI; F = 68,255, p < 0.001) post-treatment. With regard to sociodemographic and clinical variables, only the level of work qualification showed a differential treatment response: patients with higher qualifications had a more favourable course of the illness (F = 4,125, p = 0.048). At one and two year follow-up 25 % and, respectively, 30 % of the sample had to be readmitted. A higher number of previous hospitalisations (p = 0.010) and male sex (p = 0.031) turned out to be significant predictors of relapse (R² = 0.358, p = 0.004) at two year follow-up. This disorder-specific group programme represents a key component of treatment offering emotional support for patients and their relatives. Patients are to be involved in the treatment process and need information about the illness, its psychosocial and pharmacological treatment as well as help in learning practical skills to improve their living with the disease. Being integrated and committed to a supporting network may increase their quality of life.

Renal transplant nuclear tomography using Tc-99m MAG3.

In this study, the authors performed SPECT imaging on 12 renal transplant patients immediately after a routine planar study demonstrated tubular stasis. The stasis allowed the authors to obtain good quality tomograms on all of them. In five patients, the findings on the planar and SPECT studies were identical. In five patients, there was decreased upper pole activity on planar images and SPECT imaging differentiated between attenuation (4 patients) and cortical thinning (1 patient). In the remaining two patients, the SPECT images showed unanticipated information. It is not yet clear if this new information is of clinical value. It was concluded that diagnostic quality nuclear tomograms in renal transplant patients with tubular stasis can be easily and consistently obtained.

[Concomitant injuries after upper ankle joint dislocations]. / Begleitverletzungen nach OSG-Distorsionen.

Functional treatment with the Air Stirrup Ankle Brace recommended by C. N. Stover in 1979 can reduce pathological inversion of the ankle joint. In our retrospective study of 109 patients treated by this kind of ankle brace we found 96 patients (88%) with excellent results. Only 13 patients (12%) reported moderate to good results. To detect and characterize their painful conditions of ankles we did a clinical, radiological and MRI-Investigation. In only 2 cases we found a moderate instability after clinical investigation, anterior stress roentgenogram and talar tilt. By using the MRI-investigation 1.0 Tesla with a 512 x 360 Matrix we could find 10 cases with osteochondral lesions of the ankle. In 7 cases there was separated ossicle in the fibulotalar joint, in 1 case we detected a fracture of the processus anterior tali, in another case we could see a posttraumatic lesion of the talus and calcaneus with bone bruise and at least one osteochondral fracture of the distal tibia. The capability of the MRI to detect particularly osteo-chondral lesions of the talus and the tibiofibular joint was shown in 10 of 13 cases. Therefore we recommend to do an MRI-investigation on all patients after ankle sprain if there are painful conditions within the ankle after conservative treatment.

MAG3 renal transplant tomography SPECT with a non-SPECT agent.

The authors encountered a renal transplant patient in whom tubular stasis permitted sufficient time to perform SPECT using Tc-99m MAG3. SPECT revealed a defect that was not apparent on the planar study. Renal biopsy showed acute vascular rejection. On a subsequent Tc-99m MAG3 SPECT study the defect had resolved.

MR imaging of silicone breast implants: evaluation of prospective and retrospective interpretations and interobserver agreement.

MR imaging was used to evaluate the integrity of silicone breast implants in 54 women with 108 implants. MR images were interpreted by relatively inexperienced readers who tried to reproduce the experiences reported in the literature. The study examines the interobserver agreement using different diagnostic signs and the influence of experience on interpretation errors. Prospective and retrospective interpretations were compared with surgical findings at the time of explanation. Diagnostic indicators, including the linguine sign, the inverted tear drop sign, the C sign, water droplets mixed with silicone, and extracapsular globules of silicone, were evaluated for diagnostic efficacy and interobserver agreement. The prospective sensitivity and specificity were 87% and 78%, respectively. With the retrospective interpretations, the sensitivity and specificity increased to 93% and 92%, respectively. Most of the prospective false-positive interpretations were due to misinterpreting radial folds as signs of implant rupture. Six implants interpreted retrospectively as false positives had gross amounts of silicone around the implants at surgery but there were no obvious rents in the implant shells. There was fair to excellent interobserver agreement with the individual diagnostic signs except for extracapsular globules of silicone. All of the signs had specificities of greater than 90%. The sensitivities of the individual signs were less than the overall retrospective sensitivity. With experience, the sensitivity improved from 87% to 93% and the specificity improved from 78% to 92%. This study helps substantiate the use of diagnostic signs used by other authors to detect silicone loss from breast implants by MR imaging; however, questions remain as to the clinical role of MR imaging in evaluating implants for silicone loss.

Placebo-controlled, randomized double-blind clinical trial with Sinupret® sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis.

On the basis of therapy with antibiotics and nasal decongestants the efficacy of an additional treatment with the herbal combination Sinupret containing gentian root, cowslip flowers, sour dock herbs, elder flowers and shop vervain wort herbs was assessed in a randomized, placebo-controlled double-blind clinical trial involving 160 patients with acute bacterial sinusitis. Primary outcome criteria were radiographic findings and patient assessment. Secondary variables were several clinical symptoms of sinusitis which served as indicators of the pharmacological profile. The results showed that, according to the radiographic findings and the patient assessments, therapy with antibiotic and decongestants achieved a significant improvement in the treatment group; changes in clinical signs showed good correlation with the radiographic findings and the patient assessments. Conventional therapy for acute bacterial sinusitis can be improved markedly by including Sinupret in the therapeutic regimen.

Adjustment and vocational satisfaction of patients treated during childhood or adolescence for acute lymphoblastic leukemia.

This investigation evaluated the psychosocial consequences of the diagnosis and treatment of acute lymphoblastic leukemia (ALL) on the long-term adjustment of a sample of 46 patients less than 20 years of age at diagnosis (mean age: 7.46 years). Subjects were followed up for an average of 15.4 years after diagnosis and were a mean of 22.87 years old at assessment. A sample of Hodgkin's disease and non-Hodgkin's lymphoma survivors served as a comparison group. Patients completed standardized measures of well-being, stress reaction, vocational satisfaction, and a questionnaire assessing defensiveness regarding their history of cancer treatment, experienced job discrimination, and social involvement. Overall, the subjects appeared to be well-adjusted; female subjects, however, exhibited an increased tendency to experience anxiety in stressful situations. Vocational discrimination did not appear to be a significant problem for this group of survivors, and subjects exhibited levels of vocational satisfaction that did not differ from population norms. Greater defensiveness regarding a history of cancer treatment was associated with lower levels of well-being and heightened stress reaction. Survivors who received CNS prophylaxis that included cranial irradiation had lower well-being scores than did those survivors receiving only intrathecal methotrexate.

[A cerebral air embolism due to a central venous catheter in the computed tomogram]. / Zerebrale Luftembolie bei zentralvenösem Katheter im Computertomogramm.

A case of air embolism to the brain occurred via a disconnected central venous catheter. Computed tomography disclosed a number of small air bubbles in the right hemisphere. If the clinician suspects air embolism a CT scan should be obtained immediately to verify the presence of intracerebral air. On later CT scans only secondary effects like in any embolism will be seen.

Bone mineral content after renal transplantation. Placebo-controlled prospective study with 1,25-dihydroxy vitamin D3.

Forearm bone mineral content (BMC), as evaluated by photonabsorption densitometry, was measured in 28 cadaver kidney donor recipients who entered the study 8 weeks postoperatively and were followed up for 18 months. BMC decreased significantly (p less than 0.05) but marginally in placebo-treated patients (n = 14) (initial BMC 1.09 +/- 0.25 g/cm; final BMC 1.05 +/- 0.24). Fourteen patients were prophylactically given 1,25(OH)2 vitamin D3 in a dose which avoided hypercalcemia and hypercalciuria (approximately 0.25 microgram/day); under 1,25(OH)2 vitamin D3 prophylaxis a significant decrease of forearm BMC was observed no longer (initial BMC 0.94 +/- 0.21 g/cm; final BMC 0.95 +/- 0.21), but the difference between placebo and 1,25(OH)2 vitamin D3 narrowly missed statistical significance (p = 0.066). It is concluded that the decrease of forearm BMC is negligible in transplant recipients with low steroid regimens. The data suggest a trend for prophylaxis with 1,25(OH)2 vitamin D3 to slightly ameliorate forearm (cortical) BMC loss.

An improved procedure for sampling and analysis of dinitrotoluene vapor concentrations in workplace air.

Allied Chemical Corporation, Specialty Chemicals Division industrial hygienists required an accurate, convenient method for the sampling and analysis of dinitrotoluene vapor concentrations in the workplace air. A method has been developed which combines collection of dinitrotoluene vapor onto silica gel sample tubes, desorption in chloroform, and gas chromatographic determination of the various isomers of dinitrotoluene. Concentrations of less than 10 percent of the TLV can be determined in a 50 liter air sample.