[Retrospective study--pregnancy after assisted medical reproduction from 2001 to 2009 at the Central Hospital of Luxembourg (first section)]. / Etude retrospective--suivis de grossesses après Procréation Médicalement Assistée (PMA) de 2001 à 2009 au Centre Hospitalier de Luxembourg (1re partie).

Retrospective study on a nine year ART practice focusing on pregnancy outcomes and multiple pregnancies, their complications, the gestational duration, delivery options, the new born weights and health statements til the age of two. Post ART pregnancies seem to have an increased complication rate; multiple births are more frequent than with spontaneous conception. The first chapter deals with the entire group. The second chapter analyses several sub-groups according to the ART method employed. The results are compared to publications in PubMed and Medline.

[Retrospective studies of pregnancies after assisted medical reproduction from 2001-2009 and Central Hospital in Luxembourg (part 2)]. / Etude rétrospective--suivis de grossesses après Procréation Médicalement Assistée (PMA) de 2001 à 2009 au Centre Hospitalier de Luxembourg (2e partie).

The first chapter analyses the ART methods of the Centre Hospitalier of Luxembourg, in the department of reproductive medicine between 2001 and 2009. The second chapter examines the techniques individually, their influence on pregnancy outcomes, the complications on offsprings and their health. The results coincide with literature in that risks are acceptable as long as good medical and biological conditions are maintained. Multiple pregnancies remain the most frequent complication, particularly once out of IVF. These are analysed separately as well as the pregnancies after egg and semen donation.

The nursing home life-space diameter. A measure of extent and frequency of mobility among nursing home residents.

We developed the Nursing Home Life-Space Diameter (NHLSD) as a measure of the extent and frequency of mobility among skilled nursing facility (SNF) residents. Intrarater and interrater reliability was assessed in a small sample of SNF residents. The means and ranges of NHLSD scores, the characteristics associated with NHLSD score, and the association between NHLSD score and other functional characteristics were then determined among 398 residents of 12 SNFs. NHLSD scores ranged from 0, signifying bed- or chair-bound to 50, signifying leaving the facility daily. The correlation between NHLSD scores by two nurses was 0.951; the correlation between scores at two points of time was 0.922. Mean score among the 398 subjects was 27.05. Decreased vision, presence of a neurologic disease, and arthritis were all associated with lower NHLSD score. Mobility (NHLSD) score was moderately correlated with other functional characteristics such as participation in social activities (Spearman's correlation = +0.565). The NHLSD, which represents a simple and reliable assessment of mobility among SNF residents, could be used to assess the effect of interventions and to monitor changes among SNF residents.

Numerical simulation of ultrasound-thermotherapy combining nonlinear wave propagation with broadband soft-tissue absorption.

Ultrasound (US) thermotherapy is used to treat tumours, located deep in human tissue, by heat. It features by the application of high intensity focused ultrasound (HIFU), high local temperatures of about 90 degrees C and short treating time of a few seconds. Dosage of the therapy remains a problem. To get it under control, one has to know the heat source, i.e. the amount of absorbed US power, which shows nonlinear influences. Therefore, accurate simulations are essential. In this paper, an improved simulation model is introduced which enables accurate investigations of US thermotherapy. It combines nonlinear US propagation effects, which lead to generation of higher harmonics, with a broadband frequency-power law absorption typical for soft tissue. Only the combination of both provides a reliable calculation of the generated heat. Simulations show the influence of nonlinearities and broadband damping for different source signals on the absorbed US power density distribution.

Falls in the nursing home: preventable or inevitable?

1. Falls in the elderly are frequent occurrences and are usually a result of the complex interaction of environmental, physiological, and pathological variables. Fall-related injuries happen much less frequently. 2. Physical restraints have not been found effective in preventing falls and may be associated with increased risk of fall-related injury. 3. Because of the complex nature of falls in the elderly, fall prevention programs must emphasize the critical assessment of each resident's risks for falling with targeted interventions.

[Numerical modeling of ultrasound thermotherapy]. / Numerische Modellierung der Ultraschall-Thermotherapie.

In ultrasound thermotherapy (USTT) high intensity focused ultrasound (HIFU) is used for noninvasive thermal treatment of human tissue deep inside the body. In this paper a FDTD-model is presented to simulate USTT. It combines nonlinear ultrasound propagation and broadband tissue attenuation together with the bio-heat transfer equation for calculation of temperature distribution in tissue. The temperature dependence of parameters is integrated in the complete model. Simulation results demonstrate the potentialities of this simulation tool to analyze and optimize thermotherapy.

Identifying mobility dysfunctions in elderly patients. Standard neuromuscular examination or direct assessment?

The need to assess functions such as mobility in elderly patients is increasingly recognized. Lacking other methods, clinicians may rely on the standard neuromuscular examination to evaluate mobility. Therefore, we checked the sensitivity of the neuromuscular examination for identifying mobility problems by comparing relevant neuromuscular findings with performance during four routine mobility maneuvers: (1) getting up from a chair, (2) sitting down, (3) turning while walking, and (4) raising the feet while walking. The subjects investigated were 336 elderly persons living in the community. Many subjects who performed poorly during mobility maneuvers did not have the corresponding neuromuscular abnormalities. For example, although hip and knee flexion are needed to sit down safely, abnormal hip flexion was found in only 15% and abnormal knee flexion in only 30% of the subjects who had difficulty sitting down. The relationship between neuromuscular findings and functional mobility was not predictable enough to rely on neuromuscular findings for identifying mobility problems. Therefore, a simple assessment that reproduces routine daily mobility maneuvers should be developed for use in the clinical care of elderly patients.

Risk factors for falls among elderly persons living in the community.

To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.

Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities.

OBJECTIVE: To evaluate the association between mechanical restraint use and the occurrence of injurious falls among persons residing in skilled nursing facilities. DESIGN: Prospective observational cohort study. SETTING: Twelve skilled nursing facilities in southern Connecticut. PARTICIPANTS: The 397 persons who were mobile and unrestrained at baseline. MEASUREMENTS: Restraint use was defined both as the number of days restrained and as "never," "intermittently," or "continually" restrained. The primary outcome measure was the occurrence of a serious fall-related injury. Analyses were done on the entire cohort as well as on a subgroup hypothesized as having a high risk for falls. MAIN RESULTS: During one year of follow-up, 122 subjects (31%) became restrained, 83 intermittently and 39 continually. A serious fall-related injury was experienced by 5% (15 of 275) of unrestrained, compared with 17% (21 of 122) of restrained, subjects (chi-square = 12.478; P less than 0.001). Restraint use remained independently associated with serious injury after adjusting for other factors, both in the entire cohort (adjusted odds ratio, 10.2; 95% CI, 2.8 to 36.9) and in the high-risk subgroup (adjusted odds ratio, 6.2; CI, 1.7 to 22.2). Among the 305 subjects who experienced two or fewer falls, the proportion having a serious injury was 15% for restrained subjects compared with 4% for unrestrained subjects (difference in proportions 11%, CI, 4% to 17%), whereas the comparable proportions for the 92 subjects who experienced more than two falls were 20% and 16%, respectively. Results were similar in the high-risk subgroup. CONCLUSIONS: Mechanical restraints were associated with continued, and perhaps increased, occurrence of serious fall-related injuries after controlling for other injury risk factors. Study results suggest the need to consider whether restraints provide adequate, if any, protection.

Mechanical restraint use among residents of skilled nursing facilities. Prevalence, patterns, and predictors.

The patterns of and risk factors for mechanical restraint use were determined in 12 skilled nursing facilities. Restraints were being used for 59% of residents at the beginning of the study; 31% of remaining residents were restrained during the follow-up year. No facility characteristic was associated with restraint use. The resident characteristics independently associated with initiation of restraints were older age, disorientation, dependence in dressing, greater participation in social activities, and nonuse of antidepressants. Unsteadiness (72%), disruptive behavior such as agitation (41%), and wandering (20%) were the most frequently cited reasons for initiation of restraints.

KIE: The aims of this 1-year, prospective observational cohort study were to 1) describe the prevalence and incidence of restraint use among elderly residents in 12 New Haven, Connecticut area nursing homes; 2) describe the patterns and duration of restraint use; 3) identify the reasons for initiating restraints; and 4) identify the resident and nursing home characteristics associated with mechanical restraint use. The authors found that the use of mechanical restraints in nursing homes was common and usually intermittent for reasons of safety and behavior in disoriented, active residents. While their results verify the impression that restraint use is perceived as involving a choice between safety and independence, the authors discovered little data concerning the effectiveness of restaints on reducing injury or improving behavior among elderly nursing home patients.