The criterion validity of the Geriatric Depression Scale: a systematic review.

OBJECTIVE: The objective was to provide a systematic review of the screening accuracy of both versions of the Geriatric Depressions Scale (GDS-30, GDS-15). METHOD: An electronic search was performed by using Medline, Embase, Cinahl, Psyndex and the Cochrane library. The selection and examination of papers were performed by two reviewers independently. RESULTS: Among the 42 papers included, important methodological aspects such as sampling methods or blinding of research workers often were not reported. For both GDS versions, similar validity indices were found (GDS-30: sensitivity 0.753, specificity 0.770; GDS-15: sensitivity 0.805, specificity 0.750). Using comparative studies based on the identical samples, both GDS versions showed significantly better validity indices than the 'Yale-1-question' screen, but were similar to the 'Center for Epidemiological Studies Depression scale' (CES-D). CONCLUSION: The GDS does not show a better criterion validity than the CES-D, but methodological limitations of primary studies hamper the generalizability of pooled analyses.

Dietary effects on bifidobacteria and Clostridium perfringens in the canine intestinal tract.

Dietary effects on the intestinal microflora have gained increasing interest because of the evidence that a balanced micro ecology in the gut is important for health and well being. The aim of the present study was to evaluate the effect of different diets on faecal counts of bifidobacteria and Clostridium perfringens in dogs. Two extruded, dry diets, one supplemented with 3% chicory (1.5% inulin), a non-digestible oligosaccharide (NDO) and the other with 3% glucose (GLU) were compared with a protein rich diet (PR+) based on low quality animal derived protein sources (NDO 265, GLU 259, PR+ 726 g crude protein/kg dry matter; greaves meal and bovine lung as protein sources in PR+). Nine adult beagles were subjected to a consecutive cross-over trial. All dogs started with diet PR+, after which groups of four dogs (group A) received GLU and the other five dogs (group B) received NDO. After an intermediate wash-out period with diet PR+ for 3 weeks the A dogs were switched to diet NDO and B dogs to GLU. In the final period all dogs were fed with diet PR+. Faecal samples were collected during each period for dry matter and pH measurements. Faecal bifidobacteria and Cl. perfringens were quantified in fresh samples at the end of each feeding period and additionally on the first days after feed change from the dry diets to diet PR+. Diets NDO and GLU increased faecal dry matter and reduced faecal pH from 6.9 to 7.4 with the high protein diet to 5.9-6.5. The dry diets induced a firmer faecal consistency and a lower faecal pH, with no significant difference between NDO or GLU. Clostridium perfringens was found in all faecal specimens after feeding PR+ with counts of log 8.2-8.8 colony forming units (cfu)/g faeces. Both dry diets reduced the counts of Cl. perfringens significantly (log 3.3-4.0 cfu/g faeces). Switching from the dry diets to the high protein diet induced an increase of Cl. perfringens within 1 day, independent of the previous diet. In dogs fed PR+, bifidobacteria were detected in only four faecal samples and exclusively in the initial feeding period. During the remainder of the experiment the counts fell below the detection limit (log 6 cfu/g faeces). The faecal concentrations of bifidobacteria increased with both dry diets. Slightly higher concentrations (log 9.6-9.7 cfu/g faeces) were obtained from dogs fed the dry diet containing NDO compared with the diet containing glucose (log 9.3-9.4 cfu/g faeces). The increase was small which may be related to the level of total fermentable carbohydrates in both diets which alone increase remarkably the total counts of bifidobacteria. In conclusion, distinct dietary effects on the faecal counts of Cl. perfringens and bifidobacteria with a clear antagonistic pattern were observed. The main factor was the protein source and level in the diet. In this case, NDO favoured the concentrations of bifidobacteria to a limited degree. Further studies are needed to evaluate time effects, metabolic consequences and the potential implication for health promotion in pets.

[NO inhalation in heart surgery procedures: relevance for right heart function?]. / NO-Inhalation bei herzchirurgischen Eingriffen: Relevanz für die Rechtsherzfunktion?

UNLABELLED: The right ventricle is more jeopardized by a cardiopulmonary bypass than the left one. Impaired right ventricular performance may profit from an afterload reduction. A selective reduction in pulmonary artery pressure (PAP) or pulmonary vascular resistance (PVR) without impairment of the systemic circulation seems to be possible by inhalation of nitric oxide (NO). Therefore in the present study we looked for influences of NO inhalation on PAP, PVR and right heart parameters immediately after weaning from the bypass. The dependence of endothelial function on age, preoperative heart function and extracorporeal circulation is well established. The relevance of such parameters on NO inhalation was also investigated. METHODS: After ethical approval and informed consent were obtained, 20 patients with moderately increased PAP were included in the study. Ten patients inhaled NO at a concentration of 30 ppm; the other group served as a control group. Measurement points were 10 min after the end of extracorporeal circulation (baseline), 3, 10, and 20 min after the start, as well as 10 min after the end of NO inhalation. NO was injected near the tube into the tubing system during inspiration; dosage and monitoring of the concentration were achieved by means of a chemiluminometer. Measured parameters consisted of PAP, PVR, right ventricular ejection fraction and volumes, systemic blood pressure and resistance, central venous pressure, pulmonary capillary wedge pressure, and oxygenation parameters (paO2, pvO2, paCO2). RESULTS: The decrease in PAP (from 29.7 +/- 3.9 to a minimal 25.4 +/- 4.3 mm Hg, P < 0.005) and in PVR (from 169.4 +/- 51.9 to a minimal 116.3 +/- 60.9 dyn.s.cm-5, P.0.05) did not improve right heart function. A similar significant increase in SVR was observed in the NO group and in the control group. Age, haemodynamic parameters or duration of the ischaemic phase of the cardiopulmonary bypass did not influence the course of PAP or PVR. Changes in PAP (from 30.0 +/- 4.0 to a minimal 26.7 +/- 3.6 mm Hg, P < 0.05) and PVR (from 149.0 +/- 41.5 to a minimal 125.2 +/- 51.5 dyn.s.cm-5, in the control group were not statistically different from those in the NO group. Indicators of intoxication like an increase in NO2 or methaemoglobin concentrations or changes in compliance or resistance were not observed. CONCLUSIONS: Patients with moderate pulmonary hypertension did not profit from NO inhalation immediately after weaning from the cardiopulmonary bypass. The decreases in PAP and PVR found in the NO or control group did not improve right-heart function. When the NO and control group were compared, specific effects of NO inhalation on PAP and PVR must be questioned. This could perhaps be explained by data from animal experiments, which found high endogenous NO levels in situations with elevated cytokine levels. Cytokines are increased after extracorporeal circulation. Oxygenation was not impaired by inhalation of relatively high concentrations of NO. For all investigations with NO inhalation not preceded by steady-state conditions, a control group is recommended.