Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care.Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity.A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care.People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle–Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.RÉSUMÉ Objectif : Il n'y a pas de pratiques exemplaires d'établies pour la réadaptation après une fracture de la hanche chez les personnes aux prises avec la démence. Nous avons procédé à une revue systématique en vue de recueillir les faits cliniques relatifs à la réadaptation chez ce segment de la population, y compris les personnes en soins prolongés. Méthode : Une méthodologie d'examen de documents normalisée a été utilisée pour effectuer une recherche dans huit bases de données afin de recueillir de la documentation sur la réadaptation après une fracture de la hanche chez les personnes souffrant de démence. Les études admissibles traitaient de patients avec démence qui avaient subi une fracture de la hanche; auprès de qui on avait procédé à une intervention en réadaptation; et où au moins une fonction, la marche, le site du congé ou les risques de chutes avaient été évalués. L'échelle de Newcastle–Ottawa a été utilisée aux fins d'évaluation de la validité de ces études. Résultats : Au total, 13 études ont été répertoriées; cinq essais contrôlés randomisés (ECR), sept études de cohorte prospective et une étude de cohorte rétrospective. La qualité moyenne des ECR et des études de cohortes étaient respectivement bonne à moyenne. Les participants avec démence légère à modérée qui recevaient des traitements de réadaptation ont démontré des gains relatifs de fonction similaires à ceux qui ne souffraient pas de démence. Une seule de ces études s'est penchée sur les effets de la réadaptation chez les résidents d'établissements de soins prolongés. Conclusions : Les personnes souffrant de démence légère ou modérée ont démontré une fonction et une ambulation améliorées, de même qu'une réduction des risques de chutes après des soins en réadaptation à la suite d'une fracture de la hanche; ces gains étaient similaires chez les personnes non affectées par la démence. D'autres recherches seront nécessaires pour étudier les effets de la réadaptation chez les personnes souffrant de démence modérée à grave, y compris celles qui résident dans des établissements de soins prolongés.
Plans for multiple use of constructed wetlands should consider that, often, conflicting management strategies may be involved. An examination of wetland management techniques developed for wildlife populations can provide guidance to those seeking to use constructed wetlands for the dual purposes of water quality improvement and wildlife habitat development. Water depth, flow, and the duration and frequency of flooding play major roles in controlling wetland structure and plant community dynamics. A common form of water level manipulation in forested wetlands is the establishment and management of greentree reservoirs (GTRs). Since their first introduction in the 1930s, at least 179 GTRs have been established in the US Wetlands can be dynamic systems where the vegetation changes in response to changing hydrology. Earlier studies have recognized the differential susceptibility of wetland species to flooding and the importance of topographic gradients which allow the displacement of species along water depth gradients.
8064 Background: Combined modality therapy is the standard of care for non-bulky Stage I-II HL. Currently, brief CT +30 Gy involved field (IF) radiotherapy (RT) is associated with a high cure rate. To further limit treatment risk, we tested brief CT (Stanford V–C x 8 weeks) + 20 Gy INRT (G5 study). Methods: Pts with stage I-IIA supra-diaphragmatic non-bulky disease (mediastinal mass ratio <1/3 and no disease >10 cm) were eligible. Stanford V-C (cyclophosphamide substituted for nitrogen mustard) was administered x 8 weeks. G-CSF was permitted for gr ≥3 neutropenia. Two wks after completion of CT, pts received INRT (20 Gy) to initially involved nodes with 1-1.5 cm margins axially and 2-5 cm cephalo-caudad. All pts were treated and followed at Stanford. Endpoints were toxicity and efficacy (PFS and OS). Results: 43 pts (16% stage I and 84% stage II) were accrued with median age 31 yrs (19-66). 20 pts (47%) were “unfavorable” according to German Hodgkin Study Group (GHSG) criteria: >2 nodal sites (n=20) or elevated ESR (≥ 50 mm/hr) (n=3). G-CSF was required in 60% of pts due to gr 3 (n=10) or 4 (n=16) neutropenia. Other gr 3 toxicities reported: fever (n=1), pain (n=3), acute pulmonary embolism (n=1) and epigastric pain (n=2). At median follow-up of 4.8 yrs (0.8-9.6), the overall PFS and OS are 94.6% and 100%, respectively. For pts with unfavorable risk factors the PFS and OS are 88.5% and 100%, respectively. Therapy failed in 2 pts considered “unfavorable” by GHSG criteria with >2 nodal sites. The mean time to relapse was 23 mths (16-30). One pt failed in RT field and the second in-field and distant. Both were salvaged with secondary therapy and stem cell support. No bleomycin lung toxicity or radiation pneumonitis have been noted and to date there have been no second malignancies, AML or cardiac events. Conclusions: The G5 regimen (8 wks Stanford V-C and 20 Gy INRT) has excellent results with minimal toxicity in pts with non-bulky stage I-II HL, including those defined as “unfavorable” by the GHSG criteria. The outcome is comparable to studies using more intense CT and IFRT. Longer follow up is required to assess the impact of this reduced intensity approach on CT and RT related late effects.
In the US, about 11% to 20% of patients presenting to general medical clinics are diagnosed as suffering from alcohol abuse or dependence. Alcohol screening in primary care settings, whether in the US or Singapore, can utilise various strategies for the early detection of alcohol problems. This paper briefly reviews several self-reports and screening procedures to assist general practitioners in identifying problem drinkers. The use of CAGE questionnaire, MAST, and its variation, SAAST and the AUDIT, are discussed and evaluated. Likewise, useful biochemical markers of excessive alcohol consumption like the liver enzymes (AST, ALT, GGT), MCV, CDT are described. They can be combined with each other to improve validity or used in conjunction with self-report screening tests for more accurate detection of problem drinkers. In particular, use of the AUDIT for routine screening of alcohol problems in primary care settings is recommended. Selective administration to those with at least two drinks per setting can overcome time constraints. Alternatively, sequential screening utilising the TRAUMA questionnaire with frequency and quantity questions administered to higher frequency drinkers can circumvent concerns about direct questioning. Use of self-reports and when possible, biochemical screening for alcohol problems should be a standard part of primary care practice.
Thiamine (Th) deficiency is a major problem in alcoholics. In this study, the relationship of alcohol withdrawal syndrome (AWS) to Th and its esters, as well as the diagnostic power of Th and its esters were investigated.Th and its esters were assessed in a series of chronic alcoholics (and in controls) using an improved method.No association was found between AWS severity and Th and its esters, while the diagnostic power of thiamine diphosphate (TDP) and Th was very high. TDP was the most significant among the parameters under study, confirming that erythrocyte TDP is a suitable marker of alcoholism: TDP sensitivity across subjects was 84.1%, specificity 85.4%, positive predictive value 82.4%, and negative predictive value 88.0%.
