Sleep in care homes

2010 ◽  
Vol 20 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Adam L Gordon ◽  
John RF Gladman
Keyword(s):  
Physical Exercise ◽  
Sleep Problems ◽  
Light Exposure ◽  
Small Sample Size ◽  
Care Home ◽  
Sleep Hygiene ◽  
Small Sample ◽  
Care Homes ◽  
Positive Effects ◽  
Co Morbidity

SummarySleep problems in older adults are common and disturbance in sleep is associated with increased mortality. These problems are more pronounced in the care home population because of institutional factors and a high prevalence of frailty and co-morbidity. This article reviews the randomized controlled trials undertaken to address sleep problems in care homes. These suggest that stand-alone therapies – oral melatonin and light therapy – have no effect on sleep but that combination treatments – physical exercise plus sleep hygiene, physical exercise plus sleep hygiene plus light and melatonin plus light – may have positive effects. These effects are more marked for daytime arousal than nocturnal sleep. Practical considerations for care homes are how to maximize light exposure, incorporate exercise into daily routines and minimize night-time disruption for residents. Trials undertaken so far are compromised by small sample size and inappropriate randomization strategies and further research is therefore required.

scholarly journals Immunological Effects of an Add-On Physical Exercise Therapy in Depressed Adolescents and Its Interplay with Depression Severity

2021 ◽  
Vol 18 (12) ◽  
pp. 6527
Author(s):  
Heidrun Lioba Wunram ◽  
Max Oberste ◽  
Stefanie Hamacher ◽  
Susanne Neufang ◽  
Nils Grote ◽  
...  
Keyword(s):  
Exercise Therapy ◽  
Depressive Disorders ◽  
Small Sample Size ◽  
Small Sample ◽  
Whole Body ◽  
Control Treatment ◽  
Depression Severity ◽  
Post Intervention ◽  
Positive Effects ◽  
Tnf Α

Background: Pro-inflammatory cytokines (PICs) have gained attention in the pathophysiology and treatment of depressive disorders. At the same time, the therapeutic effect of physical activity seems to work via immunomodulatory pathways. The interventional study “Mood Vibes” analyzed the influence of exercise on depression severity (primary endpoint) in depressive adolescents; the influence of PICs on the clinical outcome was analyzed as a secondary endpoint. Methods: Clinically diagnosed depressed adolescents (N = 64; 28.1% male; mean age = 15.9; mean BMI = 24.6) were included and participated either in Whole Body Vibration (WBV) (n = 21) or bicycle ergometer training (n = 20) in addition to treatment-as-usual (TAU). Patients in the control treatment group received TAU only (n = 23). The PICs (interleukin-6—IL-6 and tumor necrosis factor-α—TNF-α) were analyzed before intervention, after 6 weeks of training (t1), and 8 weeks post-intervention (t2). The effects of the treatment on depression severity were rated by self-rating “Depression Inventory for Children and Adolescents” (DIKJ). Results: Basal IL-6 decreased in all groups from t0 to t1, but it increased again in WBV and controls at t2. TNF-α diminished in ergometer and controls from baseline to t1. PIC levels showed no correlation with depression severity at baseline. The influence on DIKJ scores over time was significant for IL-6 in the WBV group (p = 0.008). Sex had an impact on TNF-α (p < 0.001), with higher concentrations in male patients. Higher body mass index was associated with higher IL-6 concentrations over all measurement points (p < 0.001). Conclusions: The positive effects of an intensive add-on exercise therapy on adolescent depression seem to be partly influenced by immunomodulation. A small sample size and non-randomized controls are limitations of this study.

Abstract 3725: Simvastatin but Not Pravastatin Affects Sleep: Findings from the UCSD Statin Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Beatrice A Golomb ◽  
Edwin K Kwon ◽  
Michael H Criqui ◽  
Joel E Dimsdale
Keyword(s):  
Sleep Quality ◽  
Rating Scale ◽  
Sleep Problems ◽  
Small Sample Size ◽  
Case Reports ◽  
Controlled Trial ◽  
Small Sample ◽  
T Test ◽  
Secondary Outcome ◽  
Regression Analyses

Background : Case reports have suggested possible effects of lipophilic statins on sleep in some subjects. Most randomized studies evaluating the effect of statins on sleep have had small sample size and short duration (≤ 6 weeks). Whether statins affect sleep on average, favorably or adversely, has been unclear. Goal : To assess the effects of lipophilic and hydrophilic statins on sleep. Subjects : 1016 adult men and women without diabetes or heart disease, with LDL-cholesterol 115–190mg/dL. Design : Randomized double blind placebo-controlled trial of simvastatin 20mg, pravastatin 40mg or placebo for 6 months. Sleep was a prespecified secondary outcome. It was assessed by both an adaptation of the Leeds sleep scale (a visual analog scale of sleep quality); and a rating scale of sleep problems. Both items were measured at baseline and on-treatment. Analysis : Baseline comparability of randomization groups including sleep measures was affirmed. T-test of mean on-treatment sleep scores across randomization groups was performed. This complemented regression analyses, adjusted for baseline values of the respective sleep assessment. Results : Groups were comparable at baseline on variables including both sleep measures. Simvastatin use was associated with significantly worse sleep quality, and significantly greater reported sleep problems than either pravastatin or placebo, by t-test and regression analyses. Pravastatin did not differ significantly from placebo on any sleep outcome. Conclusion : Findings were compatible with the hypothesis that statins may impair sleep in some subjects, and that this impairment may arise selectively with lipophilic statins. Table 1. Effects of Statins on Sleep: Regression Analysis

scholarly journals Developing Product Liability Index for Korean Manufacturing Companies

2017 ◽  
Vol 21 (2) ◽  
pp. 20 ◽  
Author(s):  
JunHyeok Seo ◽  
SungMin Bae
Keyword(s):  
Evaluation System ◽  
Small Sample Size ◽  
Product Liability ◽  
Small Sample ◽  
Response Strategy ◽  
Corporate Management ◽  
Organized Activities ◽  
Manufacturing Companies ◽  
Financial Loss ◽  
Positive Effects

<p><strong>Purpose:</strong> PL (product liability) response system is an enterprise-wide system that prevents company’s financial loss due to PL-related accidents. This study aims at developing an evaluation system for objectively assessing the extent to which companies carry out systematic and organized activities for product liability, including product safety activities, preventive actions, and protective measures.</p><p><strong>Methodology/Approach:</strong> We used the Delphi and analytical hierarchy process methods to develop an evaluation system with product liability experts to present the relative importance of response strategy based on selected evaluation criteria. And then, we carried out systematic and organized PL activities of each industry, scale, and growth stage of the Korean manufacturing companies through PLI.</p><p><strong>Findings:</strong> In terms of the scale of the manufacturer, Large-sized firms has the highest PLI of 92.32. Also, middle- to large sized firms and middle-sized firms have the highest PLI of 90.63 and 77.35, respectively. And then In terms of the importance of all manufacturers, Awareness was identified as the most important component influencing corporate management activities, with the highest PLI of 78.59.</p><p><strong>Research Limitation/implication:</strong> This study is limited due to the small sample size and the number of examples.</p><strong>Originality/Value of paper:</strong> Our paper will enable consumers to determine a manufacturer’s response to product liability, and the subsequent positive effects, such as the increase of quality in consumption life.

scholarly journals Test-Retest Reliability of a Measure of Independence in Everyday Activities: The ADL Profile

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Élisabeth Dutil ◽  
Carolina Bottari ◽  
Claudine Auger
Keyword(s):  
Goal Attainment ◽  
Small Sample Size ◽  
Community Integration ◽  
Care Home ◽  
Small Sample ◽  
Retest Reliability ◽  
Everyday Activities ◽  
Moderate Agreement ◽  
Test Retest Reliability ◽  
Goal Planning

Background. Very few performance-based measures used in occupational therapy have established test-retest reliability coefficients. Objectives of Study. This study presents the test-retest reliability of the task and operation scores of a performance-based measure of independence in everyday activities called the ADL Profile. Methods. 20 adults with severe traumatic brain injury (mean age 28.4 years; SD 9.9) were tested on two occasions with the 17 tasks (personal care, home, and community) of the ADL Profile. Kappa coefficients were calculated on both task and operation scores (formulating goal, planning, executing, and goal attainment). Findings. Test-retest reliability was moderate to almost perfect on task and operation scores of all 17 tasks. The three tasks with only moderate agreement were more novel and complex (e.g., making a budget) for the participants. Relevance to Clinical Practice. Use of measures that are stable over time is essential for treatment planning and research. Repeat testing is crucial with clients that require long periods of treatment (acute care, rehabilitation, and community integration) and multiple measurements of ADL independence. Limitations. The small sample size is a limit of the study. Recommendations for Further Research. Alternate versions of the three tasks with only moderate agreement would need to be developed and other psychometric properties established.

A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions

2020 ◽  
Vol 50 (13) ◽  
pp. 2113-2127
Author(s):  
Elsa Caballeria ◽  
Clara Oliveras ◽  
Laura Nuño ◽  
Mercedes Balcells-Oliveró ◽  
Antoni Gual ◽  
...  
Keyword(s):  
Systematic Review ◽  
Working Memory ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Small Sample Size ◽  
Small Sample ◽  
Long Term Memory ◽  
Positive Effects ◽  
Jadad Scale ◽  
No Gold Standard

AbstractAlcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI. We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale. Twenty-six studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and methylphenidate improved working memory, long-term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions. Therefore, no gold-standard intervention can yet be recommended for clinical practice, and further research based on promising strategies (e.g. digital interventions, thiamine) is required.

scholarly journals Traditional Chinese Herbal Medicines for Treating HIV Infections and AIDS

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Wen Zou ◽  
Ying Liu ◽  
Jian Wang ◽  
Hongjuan Li ◽  
Xing Liao
Keyword(s):  
Hiv Infection ◽  
Small Sample Size ◽  
Oral Candidiasis ◽  
Herbal Medicines ◽  
Hiv Infections ◽  
Integrated Treatment ◽  
Antiretroviral Drugs ◽  
Small Sample ◽  
Positive Effects ◽  
Peripheral Leukocytes

To assess the effects of TCHM on patients with HIV infection and AIDS, we reviewed eleven randomized placebo-controlled trials involving 998 patients. Due to the limited number of RCTs for included trials and the small sample size of each study, we are not able to draw firm conclusions concerning TCHM therapy in treating patients with HIV infection and AIDS. However, some high-quality clinical studies do exist. Studies of diarrhea and oral candidiasis, which are challenging symptoms of AIDS, were demonstrated to have positive effects. Study of peripheral leukocytes, which are a side effect of antiretroviral drugs, suggested that an integrated treatment approach may be of benefit. The overall methodological quality of the trials was adequate; however, randomization methods should be clearly described and fully reported in these trials according to the Consolidated Standards of Reporting Trials (CONSORT).

scholarly journals Comparison of two different doses of citicoline in patients with traumatic brain injury

2020 ◽  
pp. 8-15
Keyword(s):  
Muscle Strength ◽  
Small Sample Size ◽  
Head Injuries ◽  
Study Groups ◽  
Small Sample ◽  
Positive Effects ◽  
Number Of Patients ◽  
Significant Difference ◽  
Traumatic Head ◽  
The Mean

Introduction: The ever-increasing and common occurrence of head traumas highlight the importance of adopting therapeutic measures for the reduction of the associated morbidity and mortality. Citicoline, as a safe medicine with positive effects on improving traumatic injuries, has been proven to be useful in various studies. However, there are still no data on the specific standard method and dosage of citicoline for the treatment of patients with traumatic head injuries. Regarding this, the present study was performed to determine the effective therapeutic dosage of citicoline and its impact on patients with traumatic head injuries. Methods: This double-blind clinical trial was performed on 30 patients with traumatic concussion (a Glasgow coma scale [GCS] of ≤8) admitted to the intensive care unit and neurosurgery department. The patients were randomly divided into three groups of A (control), B (citicoline with a dosage of 0.5 g/twice a day), and C (citicoline with a dosage of 1.5 g/twice a day). The GCS, degree of muscle strength, Glasgow outcome score (GOS), contusion volume, and cerebral edema (based on brain CT scans) were calculated at specific times and intervals. In addition, the patients' dependency on a ventilator and their length of ICU stay were registered. Results: Mean GCS on the first day of stay, GCS changes on the third and fourth days of stay, first and seventh days of stay, seventh and fourteenth days of stay, and first and fourteenth days of stay in the three study groups showed the significant statistical difference (P<0.05). Significant statistical differences were seen between the GOS of the 30th day of stay in the three study groups (P<0.05). The contusion volume difference was only significant between the first and seventh days of stay in groups A and C (P<0.05). No significant difference was observed in the mean length of stay in ICU and duration of dependency on a ventilator in the three study groups (P<0.05). The mean degree of muscle strength was only significantly different on the first day of stay between groups B and C (P=0.008). Conclusions: In contrary to similar studies, the results of the current study revealed that citicoline had no positive effect on patient healing. This result may be due to the small sample size and the inconsistent first-day GCSs of the patients in all three groups. Therefore, given the confirmation of the effectiveness of citicoline even at higher dosages in other studies in future studies, it is recommended to use populations with a larger number of patients.

scholarly journals Provision of NHS generalist and specialist services to care homes in England: review of surveys

2015 ◽  
Vol 17 (02) ◽  
pp. 122-137 ◽  
Author(s):  
Steve Iliffe ◽  
Susan L. Davies ◽  
Adam L. Gordon ◽  
Justine Schneider ◽  
Tom Dening ◽  
...  
Keyword(s):  
Primary Care ◽  
Access To Health Care ◽  
Data Extraction ◽  
Care Home ◽  
Grey Literature ◽  
Healthcare Services ◽  
Care Homes ◽  
Specialist Services ◽  
Co Morbidity ◽  
Health And Social Care

BackgroundThe number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective.ObjectivesTo critically evaluate how the NHS works with care homes.MethodsA review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose.ResultsFive surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient.ConclusionsHistorical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population. Clinical commissioners seeking to improve the quality of care of care home residents need to consider how best to provide fair access to health care for older people living in a care home, and to establish a specification for service delivery to this vulnerable population.

Evaluation of a resilience intervention for Filipino displaced survivors of Super Typhoon Haiyan

2018 ◽  
Vol 27 (3) ◽  
pp. 346-359 ◽  
Author(s):  
Maria Regina Hechanova ◽  
Pierce S. Docena ◽  
Liane Peña Alampay ◽  
Avegale Acosta ◽  
Emma E. Porio ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Small Sample ◽  
Control Group ◽  
Adaptive Coping ◽  
Middle Income ◽  
Content Type ◽  
Positive Effects ◽  
Super Typhoon ◽  
Quasi Experimental ◽  
Resilience Intervention

Purpose The purpose of this paper is to evaluate the effect of a community-based resilience intervention for Filipino displaced survivors of Super Typhoon Haiyan. Design/methodology/approach The researchers used a quasi-experimental and mixed-method design comparing a treatment group with a control group across three time periods: before, immediately after, and six months after the intervention. Findings Results showed significant improvements in survivors’ anxiety scores and resilience scores compared to those who did not undergo the program. However, although there was an increase in adaptive coping of participants immediately after the program, there was a reduction in adaptive coping behaviors for all groups six months after the program. Focus group discussions revealed this might be due to significant environmental challenges among displaced survivors. Research limitations/implications A limitation of the study was the lack of randomization and a small sample size due to attrition. Practical implications The study highlights the positive effects of culturally adapted group interventions. Social implications The results suggest the importance of a systemic approach to enabling the recovery of displaced survivors in developing countries. Originality/value This study provides evidence for a resilience intervention developed in a low-middle income country in Southeast Asia.

scholarly journals Pharmacodynamic Gene Testing in Prader-Willi Syndrome

2020 ◽  
Vol 11 ◽  
Author(s):  
Janice Forster ◽  
Jessica Duis ◽  
Merlin G. Butler
Keyword(s):  
Small Sample Size ◽  
Genetic Disorder ◽  
Statistical Significance ◽  
Case Series ◽  
Population Data ◽  
Small Sample ◽  
Prader Willi Syndrome ◽  
Gene Testing ◽  
Co Morbidity ◽  
Genetic Subtype

Prader-Willi syndrome (PWS) is a rare genetic disorder with a complex neurobehavioral phenotype associated with considerable psychiatric co-morbidity. This clinical case series, for the first time, describes the distribution and frequency of polymorphisms of pharmacodynamic genes (serotonin transporter, serotonin 2A and 2C receptors, catechol-o-methyltransferase, adrenergic receptor 2A, methylene tetrahydrofolate reductase, and human leucocytic antigens) across the two major molecular classes of PWS in a cohort of 33 referred patients who met medical criteria for testing. When results were pooled across PWS genetic subtypes, genotypic and allelic frequencies did not differ from normative population data. However, when the genetic subtype of PWS was examined, there were differences observed across all genes tested that may affect response to psychotropic medication. Due to small sample size, no statistical significance was found, but results suggest that pharmacodynamic gene testing should be considered before initiating pharmacotherapy in PWS. Larger scale studies are warranted.

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