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Confirmations, advances and recommendations for the daily care of schizophrenia based on the French national FACE-SZ cohort.
Fond, G, Godin, O, Schürhoff, F, Berna, F, André, M, Aouizerate, B, Capdevielle, D, Chereau, I, D' Amato, T, Dubertret, C, et al
Progress in neuro-psychopharmacology & biological psychiatry. 2020;:109927
Abstract
BACKGROUND The National FondaMental Centers of Expertise (FACE) for Schizophrenia (SZ) have been created to shorten the gap between research and clinical practice. OBJECTIVES To synthetize in a review the 10-year findings issued from the FACE-SZ cohort analyses. METHODS More than 1000 patients were evaluated in 10 expert centers since 2010 with a 2-day long comprehensive standardized battery including neuropsychological testes and physical health assessment and followed-up for 3 years. RESULTS 1. The phase 0 cross-sectional analyses have confirmed well-known data: over-prescription of first-generation antipsychotics, antipsychotic polytherapy and long-term benzodiazepine and under-prescription of clozapine, 13% of drug-induced parkinsonism, 18% of akathisia, a mean duration of untreated psychosis of 18 months, one third of poorly-adherent patients, 24% of metabolic syndrome and 52% of current tobacco smokers with poor care for physical illnesses; a yearly mean financial cost of 15,000 euro/patient. 2. FACE-SZ also yielded additional data in insufficiently explored area: a half of major depression issues (among them one third of undiagnosed major depression and 44% of treated patients with unremitted depression), major depression having a strong impact on Quality of Life independently of negative symptoms, 22% of moderated to severe untreated physical pain. 3. FACE-SZ has explored emerging fields of research, including development of 4 stages- model of schizophrenia, chronic low-grade peripheral inflammation, latent Toxoplasma infection, hypovitaminosis D, and a model for relapse prediction at 2 years. DISCUSSION The associated factors and implications for public health programs were discussed. Based on the FACE-SZ findings and literature, the FACE-SZ group has yielded recommendations to improve daily care for schizophrenia and for future research.
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Overview of pharmacological interventions after traumatic brain injuries: impact on selected outcomes.
Kim, S, Mortera, M, Hu, X, Krishnan, S, Hoffecker, L, Herrold, A, Terhorst, L, King, L, Machtinger, J, Zumsteg, JM, et al
Brain injury. 2019;(4):442-455
Abstract
The purpose of this study was to conduct an overview of systematic reviews (SRs) to appraise the published evidence related to pharmacological interventions after traumatic brain injury (TBI). Searches were conducted with Medline, Embase, PsycINFO, Web of Science, PubMed. 780 retrieved SRs underwent a two-level screening to determine inclusion. Data extracted included participant characteristics, TBI severity, study design, pharmacological interventions, and outcomes. SRs were assessed for methodological quality by using the AMSTAR measurement tool. After removing duplicates, 166/780 SRs published between 1990-2017 were reviewed, 62 of which met inclusion criteria. More than 90 drugs and 22 substance-classes were extracted. Most medications were administered during the acute stage. Mild TBI was included in 3% of the SRs. Physiological outcomes comprised 45% of the SRs, primarily mortality. Activities of daily living (ADLs) outcomes constituted 22% of the SRs followed by cognition (13%) and psychological/behavioral outcomes (13%). Only 7% of the SRs assessed adverse events. Inconsistencies in definitions, methods, and heterogeneity of instruments used to measure treatment response were noted. Only a third of the SRs had high methodological quality. Most SRs had heterogeneous TBI samples, outcomes, or methodologies making it difficult to synthesize findings into recommended guidelines. This study demonstrated a need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI. PROSPERO Registration: CRD42015017355.
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Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies.
Feng, Z, Lugtenberg, M, Franse, C, Fang, X, Hu, S, Jin, C, Raat, H
PloS one. 2017;(6):e0178383
Abstract
INTRODUCTION Frailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are associated with frailty are poorly understood. We performed a systematic review of longitudinal studies in order to identify the sociodemographic, physical, biological, lifestyle-related, and psychological risk or protective factors that are associated with frailty among community-dwelling older adults. METHODS A systematic literature search was conducted in the following databases in order to identify studies that assessed the factors associated with of frailty among community-dwelling older adults: Embase, Medline Ovid, Web of Science, Cochrane, PsychINFO Ovid, CINAHL EBSCOhost, and Google Scholar. Studies were selected if they included a longitudinal design, focused on community-dwelling older adults aged 60 years and older, and used a tool to assess frailty. The methodological quality of each study was assessed using the Quality of Reporting of Observational Longitudinal Research checklist. RESULTS Twenty-three studies were included. Significant associations were reported between the following types of factors and frailty: sociodemographic factors (7/7 studies), physical factors (5/6 studies), biological factors (5/7 studies), lifestyle factors (11/13 studies), and psychological factors (7/8 studies). Significant sociodemographic factors included older age, ethnic background, neighborhood, and access to private insurance or Medicare; significant physical factors included obesity and activities of daily living (ADL) functional status; significant biological factors included serum uric acid; significant lifestyle factors included a higher Diet Quality Index International (DQI) score, higher fruit/vegetable consumption and higher tertile of all measures of habitual dietary resveratrol exposure; significant psychological factors included depressive symptoms. CONCLUSIONS A broad range of sociodemographic, physical, biological, lifestyle, and psychological factors show a longitudinal association with frailty. These factors should be considered when developing interventions aimed at preventing and/or reducing the burden associated with frailty among community-dwelling older adults.
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Cerebral palsy.
Graham, HK, Rosenbaum, P, Paneth, N, Dan, B, Lin, JP, Damiano, DL, Becher, JG, Gaebler-Spira, D, Colver, A, Reddihough, DS, et al
Nature reviews. Disease primers. 2016;:15082
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Abstract
Cerebral palsy is the most common cause of childhood-onset, lifelong physical disability in most countries, affecting about 1 in 500 neonates with an estimated prevalence of 17 million people worldwide. Cerebral palsy is not a disease entity in the traditional sense but a clinical description of children who share features of a non-progressive brain injury or lesion acquired during the antenatal, perinatal or early postnatal period. The clinical manifestations of cerebral palsy vary greatly in the type of movement disorder, the degree of functional ability and limitation and the affected parts of the body. There is currently no cure, but progress is being made in both the prevention and the amelioration of the brain injury. For example, administration of magnesium sulfate during premature labour and cooling of high-risk infants can reduce the rate and severity of cerebral palsy. Although the disorder affects individuals throughout their lifetime, most cerebral palsy research efforts and management strategies currently focus on the needs of children. Clinical management of children with cerebral palsy is directed towards maximizing function and participation in activities and minimizing the effects of the factors that can make the condition worse, such as epilepsy, feeding challenges, hip dislocation and scoliosis. These management strategies include enhancing neurological function during early development; managing medical co-morbidities, weakness and hypertonia; using rehabilitation technologies to enhance motor function; and preventing secondary musculoskeletal problems. Meeting the needs of people with cerebral palsy in resource-poor settings is particularly challenging.
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Psychological vulnerability to daily stressors in old age: Results of short-term longitudinal studies.
Schilling, OK, Diehl, M
Zeitschrift fur Gerontologie und Geriatrie. 2015;(6):517-23
Abstract
A growing numbers of intensive longitudinal studies examine the short-term variability of behavior in response to daily stressors. Collectively, these studies address the vulnerability for stress-related emotional burden as assessed in terms of the intraindividual association between daily stressors and negative affect (NA). This article provides a brief overview of the relevant research on so-called affective reactivity to daily stressors and focuses on findings on development of age-related stressor reactivity across the adult lifespan. Two theoretical propositions have been put forward. Firstly, it has been postulated that aging should be associated with increased affective reactivity, i.e. it has been assumed that the vulnerability in terms of physiological stress reactivity increases across the adult life span and, thus, a higher stress-induced emotional reactivity should result with increasing age. Secondly, it has been argued that due to the continued development of emotional self-regulation skills, there should be an age-related decrease in stress reactivity and, hence, an increased resilience. Findings on age differences in NA reactivity to daily stressors, however, have been inconsistent. A possible explanation for the inconsistent findings may lie in the fact that the postulated dynamics of increased vulnerability or resilience imply different time-related reactions to stressors. In particular, the activation and effectiveness of emotional self-regulation strategies increase with increasing time intervals from the stressors. This leads to the conclusion that with increasing age the resilience for longer periods of stress and accumulated stress should increase. Results from our own research support this hypothesis, where older adults reacted to multiple stressors in a more adaptive way than younger adults.
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Patient independence in chronic kidney disease and anaemia: implications of the 2012 KDIGO guideline.
Bennett, L
Journal of renal care. 2013;(2):108-17
Abstract
BACKGROUND A common complication of chronic kidney disease (CKD) is anaemia; how well this is treated may influence a patient’s independence. The use and the time-consuming nature of intravenous (IV) iron therapies can impose considerable challenges for patients. Time spent receiving and travelling to receive IV iron treatment can impact a patient’s feelings of independence. By recommending increased prescription of IV iron and minimising erythropoiesis-stimulating agent use, the recent Kidney Disease: Improving Global Outcomes (KDIGO) Guideline on anaemia in CKD may compound this situation by increasing the number of hospital visits for therapy. METHODS To assess the potential influence of the KDIGO Guideline on patient independence, this review explores factors that can impact the independence of a person with CKD and proposes how these potential issues may be addressed in the light of this new set of guidelines. CONCLUSIONS Although the KDIGO Guideline has the potential to reduce patient independence, by acknowledging the needs of the individual early on and employing a multi-disciplinary approach, a balance can be found between utilising the most recent guidelines and meeting the needs of the individual to ensure their on-going independence.
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[Nutrition in older persons. Basis for functionality and quality of life].
Bauer, JM
Der Internist. 2011;(8):946-54
Abstract
With increasing age alterations of metabolism, appetite regulation, and body composition have been observed. As a consequence the risk of malnutrition is much higher in older than in younger persons. Though the highest prevalence rates have been described for the hospital and rehabilitation setting, most older persons with overt malnutrition are found in the community. Here persons with chronic comorbidity and low functionality show the highest risk. Routine screening for malnutrition is therefore indicated in older persons. For the successful treatment of malnutrition it is important to consider also medical and social etiologic factors before starting nutritional therapy. With regard to the preservation of muscle mass and muscle strength, adequate protein intake deserves careful consideration. Besides the implementation of regular snacks between meals, temporary application of oral supplements which are high in energy and protein is indicated. Especially during and after hospital stays, the beneficial interaction between nutrition and exercise has to be considered with regard to functionality and quality of life in older persons.
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[Educational role of a nurse in medical care of patients with outer intestinal stoma].
Chrobak, A
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 2009;(155):579-81
Abstract
Nurse staff plays an important role in a process of professional nursing of patients suffering from intestinal stoma. Those functions are aimed at fast adaptation to life with the illness. The first important stage for a patient is to agree for artificial anus. At this time nurse supports patient and his family in a psychological way, giving tips and advice at the same time. It is crucial for patient's cognitive, motivating and information sphere. It helps patient to accept his body after changes, with unusual place of expelling a stool. That stage is the beginning for the patient to learn how to care for soma, which is a necessity to continue active career, family and social life. Patient is given information in range of stoma care and use of stoma equipment. Nursing staff provides patient with necessary knowledge about proper lifestyle, diet, clinics, supporting groups, stoma equpment refund and how to prevent distension. It is very crucial to involve whole family of a patient in educational process. Recovery strictly depends on the quality of information that patient and his family receive. Education is a fundamental condition to keep satisfactory level of fitness, independence and ability to deal with problems caused by stoma. It also has direct impact on life standard of a patient.