Comparative Effectiveness of Behavioral Interventions to Prevent or Delay Dementia: One-Year Partner Outcomes

BACKGROUND/OBJECTIVE

Various behavioral interventions are recommended to combat the distress experienced by caregivers of those with cognitive decline, but their comparative effectiveness is poorly understood.

DESIGN/SETTING

Caregivers in a comparative intervention study randomly had 1 of 5 possible interventions suppressed while receiving the other four. Caregivers in a full clinical program received all 5 intervention components. Care partner outcomes in the study group were compared to participants enrolled in a full clinical program.

PARTICIPANTS

Two hundred and seventy-two dyads of persons with amnestic mild cognitive impairment (pwMCI) and care partners enrolled in the comparative intervention study. 265 dyads participated in the full clinical program.

INTERVENTION

Behavioral intervention components included: memory compensation training, computerized cognitive training, yoga, support group, and wellness education. Each was administered for 10 sessions over 2 weeks.

MEASUREMENTS

A longitudinal mixed-effect regression model was used to analyze the effects of the interventions on partner burden, quality of life (QoL), mood, anxiety, and self-efficacy at 12 months follow-up.

RESULTS

At 12 months, withholding wellness education or yoga had a significantly negative impact on partner anxiety compared to partners in the clinical program (ES=0.55 and 0.44, respectively). Although not statistically significant, withholding yoga had a negative impact on partner burden and mood compared to partners in the full clinical program (ES=0.32 and 0.36, respectively).

CONCLUSION

Our results support the benefits of wellness education and yoga for improving partner's burden, mood, and anxiety at one year. Our findings are the first to provide an exploration of the impact of multicomponent interventions in care partners of pwMCI.

Randomized clinical trial of liposomal bupivacaine transverse abdominis plane block versus intrathecal analgesia in colorectal surgery

Background

Transverse abdominis plane (TAP) block is considered an effective alternative to neuraxial analgesia for abdominal surgery. However, limited evidence supports its use over traditional analgesic modalities in colorectal surgery. This study compared the analgesic efficacy of liposomal bupivacaine TAP block with intrathecal (IT) opioid administration in a multicentre RCT.

Methods

Patients undergoing elective small bowel or colorectal resection were randomized to receive TAP block or a single injection of IT analgesia with hydromorphone. Patients were assessed at 4, 8, 16, 24 and 48 h after surgery. Primary outcomes were mean pain scores and morphine milligram equivalents (MMEs) administered within 48 h after surgery. Secondary outcomes included duration of hospital stay, incidence of postoperative ileus and use of intravenous patient-controlled analgesia.

Results

In total, 209 patients were recruited and 200 completed the trial (TAP 102, IT 98). The TAP group had a 1·6-point greater mean pain score than the IT group at 4 h after surgery, and this difference lasted for 16 h after operation. The TAP group received more MMEs within the first 24 h after surgery than the IT group (median difference in MMEs 10·0, 95 per cent c.i. 3·0 to 20·5). There were no differences in MME use at 24 and 48 h, or with respect to secondary outcomes.

Conclusion

IT opioid administration provided better immediate postoperative pain control than TAP block. Both modalities resulted in low pain scores in patients undergoing elective colorectal surgery and should be considered in multimodal postoperative analgesic plans. Registration number: NCT02356198 ( http://www.clinicaltrials.gov).

Judging the accuracy of children's recall: a statement-level analysis

Three experiments were conducted to examine fact finders' judgments of children's answers to cued recall questions about a recent dental visit. Participants performed better than chance at judging the correctness of the children's answers in all 3 experiments, and judgment accuracy was consistently better when the children's answers were correct. Judgment performance did not decline when confidence information was removed, and when all confidence information was removed, the best performance was obtained by parents and by professionals who work with children. The findings of these experiments provide support for the use of written transcripts in presentations of child testimony and highlight the importance of child- and event-related knowledge in judgments of children's testimony.

Resource-Allocation Strategies: A Verbal Protocol Analysis

The current study examined the strategies used by people to solve resource-allocation problems. Verbal protocols were recorded as participants provided meal choices for seven consecutive days with limited resources available to spend on meals and with daily constraints imposed on meal consumption. None of the participants incorporated the established mathematical procedures (i.e., Linear Programming) to arrive at the optimum number of meals possible in a week. However, the strategies they did use enabled them to achieve meal totals on average at 94% of this optimal amount. A few participants attempted to first solve the maximum meals possible in a week before scheduling this solution across the seven days (solve-and-schedule strategy), but the majority of participants simply selected meals on a day-to-day basis while checking resource availability each day to allow for full resource consumption (consume-and-check strategy). The findings of this study provide a preliminary step toward understanding how people make intuitive resource-allocation decisions. Copyright 1998 Academic Press.

The interactive effect of velocity on coincident timing performance

For 16 men and women (18–29 years) analysis of movement coincident with a moving target showed task variables influenced each other (e.g., shorter target durations produced faster movements) and combined additively to produce marked changes in performance (e.g., fastest responses to the fastest targets resulted in the most consistent timing).

The Drinkwater-Ross anthropometric fractionation of body mass: comparison with measured body mass and densitometrically estimated fat and fat-free masses

The Drinkwater-Ross anthropometric fractionation of body mass (mass = sigma skeletal, residual, fat and muscle masses), lean body mass (LBM = sigma skeletal, residual and muscle masses) and fat mass (FM) were compared with the measured body mass, together with the densitometrically estimated fat-free mass (FFM) and fat mass (FM), of 205 male (mean +/- S.D.: 74.66 +/- 10.55 kg; 10.1 +/- 3.7% BF by densitometry) and 177 female (mean +/- S.D.: 59.14 +/- 8.85 kg; 18.5 +/- 5.1% BF by densitometry) South Australian State representatives in a variety of sports. Most absolute differences (d) between the measured body masses and those resultant from the sum of the four fractionated masses (male: d = 2.15 kg or 2.9%; female: d = 1.27 kg or 2.2%) were within what one would expect from random day-to-day variation. However, this was not so for the comparisons between the fractionated LBM (male: d = 2.54 kg or 3.8%; female: d = 2.45 kg or 5.2%) and FM scores (male: d = 1.67 kg or 30.0%; female: d = 2.40 kg or 20.0%) and their densitometric counterparts. These differences are probably related to a combination of the densitometric and fractionation assumptions.

A comparison of the effects of measured, predicted, estimated and constant residual volumes on the body density of male athletes

The aim of this study was to use the measured residual volume (RV) of male athletes (n = 207) as a criterion and assess the error in their RV, body density (BD) and relative body fat (%BF) associated with using RVs predicted from regression equations, RVs estimated from vital capacity (VC) and an assumed constant RV of 1300 ml. The ventilated residual volume (RV) was determined both before and after the underwater weighing by helium dilution with the subject immersed to neck level. The mean of the absolute differences Idl and SEE between the 2 RV trials were 66 and 89 ml, respectively. These increased to values ranging 195-747 and 259-308 ml, respectively, when the means of the 2 RV trials for each subject were compared with the RVs predicted via regression equations, estimated from the VC and assumed to be a constant of 1300 ml. A similar trend emerged with variation of only the RV in the BD formula for each subject. The 2 RV trials resulted in a Idl and SEE of .00109 (.5% BF) and .00145 g.cm-3 (.6% BF), respectively, but these increased to values ranging .00306 (1.3% BF)-.01207 (5.1% BF) and .00394 (1.7% BF)-.00441 g.cm-3 (1.9% BF), respectively, for predicted, estimated and assumed constant RVs. In all cases the lowest Idl and SEE were associated with the RVs predicted by a multiple regression equation (R = .616; SEE = 259 ml) which was generated on our sample.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship of target and response complexity in coincident timing performance

This paper reports two experiments concerned with the interaction of response and target factors in a coincident timing situation. Coincident timing involves executing a response to intercept a moving target. The target response relationship was manipulated in the first experiment by providing some targets with no structure (linear path) and others containing 1 and 2 bounce points. In the second experiment, responses required 0, 1, or 2 reversals in direction. The results provide tentative support for the notion that structure in the target path could be linked to the key temporal response dynamics for improved performance consistency, and that subjects may alter their response structure to incorporate this linkage. This can be further extended to the advantage of simply moving while perceiving movement. This paper stresses the importance of examining the perceptual and motor requirements of the coincident timing skill in unison.

A comparison of the effects of measured, predicted, estimated and constant residual volumes on the body density of female athletes

The body density (BD), and hence the relative body fat (% BF) was measured for 182 female athletes. The residual volume (RV) was determined both before and after the underwater weighing by a multiple breath helium dilution technique with the subject immersed to neck level. The absolute mean difference (lXdl) and SEE between the two RV trials were 63 and 75 ml, respectively. These increased to values ranging 144-685 and 187-252 ml, respectively, when the mean of the two RV trials for each subject was compared with the RVs predicted via regression equations, estimated from the vital capacity (VC) and assumed to be a constant of 1000 ml. A similar trend resulted from variation of only the RV in the BD formula for each subject. The two RV trials resulted in an lXdl and SEE of .00121 (.5% BF) and .00141 g.cm-3 (.6% BF), respectively, but these increased to values ranging .00283 (1.3% BF) -.01291 (5.7% BF) and .00362 (1.6% BF) -.00527 g.cm-3 (2.5% BF), respectively, for predicted, estimated and assumed constant RVs. In all cases, the lowest lXdl and SEE were associated with the RVs predicted by a multiple regression equation (R = .725; SEE = 187 ml) which was generated on our sample while the largest lXdl values were registered by the other regression equations. These data emphasize that the use of predicted, estimated and constant RVs result in substantial errors in BD and % BF compared with those when the RV is measured.