To test the effects of individual, nonfacilitated sessions with PARO (version 9), when compared against a look-alike plush toy and usual care, on the emotional and behavioral symptoms of dementia for ...people living in long-term care facilities.
Parallel, 3-group, cluster-randomized controlled trial conducted between June 14, 2014, and May 16, 2015.
Twenty-eight long-term care facilities operated by 20 care organizations located in South-East Queensland, Australia.
Four hundred fifteen participants aged ≥60 years, with a documented diagnosis of dementia.
Stratified by private/not-for-profit status and randomized using a computer-generated sequence, 9 facilities were randomized to the PARO group (individual, nonfacilitated, 15-minute sessions 3 times per week for 10 weeks); 10 to plush toy (same, but given PARO with robotic features disabled); and 9 to usual care. Treatment allocation was masked to assessors.
Primary outcomes were changes in levels of engagement, mood states, and agitation after a 10-week intervention, assessed by coded video observations (baseline, weeks 1, 5, 10, and 15) and Cohen-Mansfield Agitation Inventory–Short Form (baseline, weeks 10 and 15). Analyses followed intention-to-treat, using repeated measures mixed effects models. Australian New Zealand Clinical Trials Registry (ACTRN12614000508673).
Video data showed that participants in the PARO group were more verbally 3.61, 95% confidence interval (CI): 6.40–0.81, P = .011 and visually engaged (13.06, 95% CI: 17.05–9.06, P < .0001) than participants in plush toy. Both PARO (−3.09, 95% CI: −0.45 to −5.72, P = .022) and plush toy (−3.58, 95% CI: −1.26 to −5.91, P = .002) had significantly greater reduced neutral affect compared with usual care, whilst PARO was more effective than usual care in improving pleasure (1.12, 95% CI: 1.94–0.29, P = .008). Videos showed that PARO was more effective than usual care in improving agitation (3.33, 95% CI: 5.79–0.86, P = .008). When measured using the CMAI-SF, there was no difference between groups.
Although more effective than usual care in improving mood states and agitation, PARO was only more effective than a plush toy in encouraging engagement.
Abstract
Background and Objectives
Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia, and many show promising potential. ...In this study, we sought to explore family members’ perceptions of the Japanese-developed baby harp seal, Paro (version 9), and a look-alike, nonrobotic Plush Toy, when used by their relative with dementia for 15 min, 3 afternoons per week for 10 weeks.
Research Design and Method
The study employed a descriptive qualitative approach, which was nested within a larger cluster randomized controlled trial. A convenience sample of 20 family members (n = 10 each from the Paro and Plush Toy conditions) with relatives in 9 long-term care facilities in Queensland, Australia, completed individual semi-structured interviews (telephone or face-to-face). Inductive, data-driven thematic analysis of the data was undertaken with the assistance of the qualitative management software, ATLAS.ti®.
Results
Family members of long-term care residents with dementia expressed positive perceptions of the Paro, perceiving that it improved mood, reduced agitation, and provided opportunity for communication for their relative. Negative perceptions of the Plush Toy were given by family members, primarily because of its lack of movement and engagement.
Conclusion
Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them, and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life. However, the current cost of Paro was identified by family members as a major limitation to use.
BACKGROUND: Adolescents are more likely than adults to consume energy-dense, micronutrient-poor diets and to experience adverse pregnancy outcomes. OBJECTIVES: The objectives were to assess ...micronutrient intake and blood biomarkers prospectively in pregnant adolescents recruited to the About Teenage Eating (ATE) Study and to determine associations with pregnancy outcome. DESIGN: Pregnant adolescents (n = 500) were recruited from 2 UK inner city populations. Dietary intake was assessed with three 24-h dietary recalls, and micronutrient status was assessed by measurement of third trimester blood biomarkers. Pregnancy outcomes included small-for-gestational age (SGA) birth and preterm delivery. RESULTS: Median iron and folate intakes were lower than UK and US recommended amounts. Folate and vitamin B-12 status were lower in smokers, despite no differences in dietary intake. Serum folate was <7.0 nmol/L in 12% of subjects, and serum total homocysteine (tHcy) was elevated (>10 μmol/L) in 20% of subjects. Fifty-two percent of the subjects had iron deficiency anemia, and 30% had serum 25-hydroxyvitamin D concentrations <25 nmol/L. The incidence of SGA birth was higher in subjects with poorer folate status (red blood cell folate, P = 0.003; serum folate, P = 0.02; tHcy, P = 0.01; simple regression) and those with low folate intakes, regardless of the inclusion (P = 0.021) or exclusion (P = 0.049) of intake from supplements (simple regression). Adjustment for confounding variables confirmed the independence of these associations. The risk of SGA birth was also higher in subjects with low food iron intake (P = 0.049), but not when intake included iron from supplements (P = 0.21). The risk of SGA birth was lower in subjects with iron deficiency anemia (P = 0.002). CONCLUSION: Poor micronutrient intake and status increase the risk of SGA births in pregnant adolescents.
There is a growing trend towards using virtual models within medical programs. In some disciplines, the use of human samples or cadavers is increasingly being replaced by technology-enhanced modes of ...delivery. Although this transition can occur with some success, the impact of virtual representations to replace depictions of disease states from dissected samples displayed in acrylic pathological specimen jars has never been investigated. This study assessed medical student perceptions of replacing teaching through physical specimens (i.e. specimen jars or real tissue) with virtual models across cardiovascular, neural, musculoskeletal, haematology, endocrine and immunological pathology curricula. Seventy-four year 2 (
n
= 31) and year 5 (
n
= 43) medical students participated in the study. After being provided with a demonstration of a potential tablet-based lesson on lung pathology using augmented reality, participants completed a Likert-scale survey and provided written feedback. Questions requested thoughts on the usefulness of the 3D-virtual model compared to physical specimens and whether current teaching in pathology could be replaced by technology-enhanced practices. Most students (58.15%) disagreed on the replacement of physical specimens with virtual models. Furthermore, over half the students (55.4%) indicated that the replacement of physical specimens with augmented reality models would not be beneficial for pathology learning. Nearly two-thirds of students believed that the absence of physical specimens would negatively impact their knowledge. Nonetheless, many students would appreciate the opportunity to revise pathology away from the labs with virtual options. As such, an overwhelming number of students (89.2%) would prefer having both physical specimens and virtual models for learning. This study identifies that technology-enhanced learning may be a suitable supplement alongside traditional hands-on teaching but should not replace the use of pathological specimens within a medical curriculum.
A series of phosphoramidate-based prostate specific membrane antigen (PSMA) inhibitors of increasing lipophilicity were synthesized (4, 5, and 6), and their fluorine-18 analogs were evaluated for use ...as positron emission tomography (PET) imaging agents for prostate cancer. To gain insight into their modes of binding, they were also cocrystallized with the extracellular domain of PSMA. All analogs exhibited irreversible binding to PSMA with IC50 values ranging from 0.4 to 1.3 nM. In vitro assays showed binding and rapid internalization (80-95%, 2 h) of the radiolabeled ligands in PSMA(+) cells. In vivo distribution demonstrated significant uptake in CWR22Rv1 (PSMA(+)) tumor, with tumor to blood ratios of 25.6:1, 63.6:1, and 69.6:1 for (18)F4, (18)F5, and (18)F6, respectively, at 2 h postinjection. Installation of aminohexanoic acid (AH) linkers in the phosphoramidate scaffold improved their PSMA binding and inhibition and was critical for achieving suitable in vivo imaging properties, positioning (18)F5 and (18)F6 as favorable candidates for future prostate cancer imaging clinical trials.
Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians' ability to conduct screenings. MyCog Mobile is a ...newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics' time, encourage broader screening practices, and increase early detection of cognitive decline.
The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile. Research questions included (1) Can older adults complete MyCog Mobile remotely without staff support? (2) Are the internal consistency and test-retest reliability of the measures acceptable? and (3) How do participants rate the user experience of MyCog Mobile?
A sample of adults aged 65 years and older (N=51) self-administered the MyCog Mobile measures remotely on their smartphones twice within a 2- to 3-week interval. The pilot version of MyCog Mobile includes 4 activities: MyFaces measures facial memory, MySorting measures executive functioning, MySequences measures working memory, and MyPictures measures episodic memory. After their first administration, participants also completed a modified version of the Simplified System Usability Scale (S-SUS) and 2 custom survey items.
All participants in the sample passed the practice items and completed each measure. Findings indicate that the Mobile Toolbox assessments measure the constructs well (internal consistency 0.73 to 0.91) and are stable over an approximately 2-week delay (test-retest reliability 0.61 to 0.71). Participants' rating of the user experience (mean S-SUS score 73.17, SD 19.27) indicated that older adults found the usability of MyCog Mobile to be above average. On free-response feedback items, most participants provided positive feedback or no feedback at all, but some indicated a need for clarity in certain task instructions, concerns about participants' abilities, desire to be able to contact a support person or use in-app technical support, and desire for additional practice items.
Pilot evidence suggests that the MyCog Mobile cognitive screener can be reliably self-administered by older adults on their smartphones. Participants in our study generally provided positive feedback about the MyCog Mobile experience and rated the usability of the app highly. Based on participant feedback, we will conduct further usability research to improve support functionality, optimize task instructions and practice opportunities, and ensure that patients feel comfortable using MyCog Mobile. The next steps include a clinical validation study that compares MyCog Mobile to gold-standard assessments and tests the sensitivity and specificity of the measures for identifying dementia.
Abstract
Objectives
As medication experts, pharmacists can play a significant role in helping people living with dementia and their informal carers make the best use of medications. However, little ...is known about this population’s needs and expectations of their pharmacists. The objective of this study was to report informal carers’ perceptions about the role of their pharmacists.
Methods
In a previous study, informal carers were interviewed to explore factors influencing medication adherence in older people living with dementia. The interview transcripts from the previous study were analysed thematically using an inductive approach to explore carers’ perceptions about the role of community pharmacists in helping carers and people living with dementia use medications as prescribed.
Key findings
The interviews of 20 informal carers were analysed. Carers were primarily females (85%), married (60%), completed university (60%) and unemployed (70%). The majority of care recipients had comorbidities (75%), and the number of medications ranged from 1 to 20. Three significant roles emerged: (1) provision of medication information, (2) advising on medication organisation and (3) conducting medication reviews.
Conclusions
Informal carers face several challenges in administering the medications to older people living with dementia. Pharmacists are expected to play a more active role in helping people living with dementia, and their carers make safe and effective use of medications.
Media researchers have called for new business models that could be the salvation of news. This article builds on case studies of two local media entrepreneurs, one in a very rural location and one ...in the most urban area of the United States, and how they looked beyond the barriers that were presented to them to create successful media organizations. The theory of the creative class has argued that location is important for entrepreneurial behavior, but it is too one-dimensional to capture context dimensions in more detail. These two cases are polar opposites and represent different contexts, yet both are successful, calling for more cautiousness in interpreting statistical probabilities for entrepreneurship policy or support.
The detection of maternal depression can be improved with routine screening. This practice is expected to be integrated into midwifery practice under the Australia National Perinatal Depression ...Initiative.
To describe midwives’ self-reported practice in caring for women suffering from antenatal and postpartum depressive symptoms; and assess midwives’ ability to detect depression and their knowledge of therapeutic interventions for depressive symptoms in childbearing women.
Using a descriptive cohort study design, a postal survey was sent to all members of the Australian College of Midwives (n=3000). The survey consisted of items drawn from beyondblue's “National Baseline Survey – Screening Evaluation Questionnaire” and questions relating to a hypothetical case study of a depressed woman “Mary” developed by Buist et al.25
A total of 815 completed surveys were received. 69.1% of midwives reported screening for antenatal and postpartum depression using instruments such as the Edinburgh Postnatal Depression Scale. Time constraints were perceived as the major barrier to effective emotional care. 63.3% of midwives correctly recognised depression in the case study and 82.4% reported that “Mary” required assistance. Antidepressants were more likely to be recommended postnatally (93.2%) than antenatally (61.5%) by midwives.
Further training is required to ensure midwives’ competency in psychosocial assessment and management of women experiencing antenatal and postpartum depression. Systemic issues (e.g. time constraints) encountered by midwives need to be addressed to support the delivery of effective emotional care to childbearing women.
to assess Australian midwives' attitudes towards caring for women with emotional distress and their perceptions of the extent to which workplace policies and processes hindered such care.
a postal ...survey.
members of the Australian College of Midwives.
815 Australian midwives completed the survey.
a modified version of the 17-item REASON questionnaire (McCall et al., 2002) that was originally developed for used by General Practitioners to measure their attitudes towards their role in the management of patients with mental health disorders.
An exploratory factor analysis with Varimax rotation identified four factors that reflected midwives' (1) perceptions of systemic problems that hindered emotional care, (2) attitudes towards working with women experiencing emotional health problems, (3) perceived competence in using treatment techniques and (4) attitudes and perceived competence towards the referral of women with depression and anxiety to other health professionals.
participating midwives indicated their willingness to offer assistance and acknowledged the importance of providing emotional care to women. In practice, emotional care by midwives is impeded by perceived lack of competency rather than a lack of interest. Midwives' competency in the assessment and care of women with conditions such as depression and anxiety may be enhanced through continuing professional education.
PDF
