Nursing interventions to improve care of people with dementia in hospital: a mixed methods systematic review protocol

OBJECTIVE

This review will focus on the effectiveness of, and experience with, nursing interventions to improve the care of people with dementia in hospital.

INTRODUCTION

Acute care for people with dementia has been identified as an area for improvement. Admission to hospital can be upsetting and difficult for people with dementia and can be associated with negative outcomes. Nurses play a significant role in shaping the experience of hospitalization and are the focus of many related interventions.

INCLUSION CRITERIA

This mixed methods review will examine literature on improving acute care for people with dementia. The quantitative component will consider studies that evaluate nursing interventions to improve care of people with dementia, comparing the intervention with usual care, other therapies, or no comparator. Outcomes will include behavioral, health, and health system indicators. The qualitative component will consider studies that explore the experience of nursing interventions from the perspective of people with dementia, their family- or friend-caregivers, and nurses.

METHODS

This review will be conducted in accordance with JBI methodology for mixed methods systematic reviews. Twelve databases and gray literature sources will be searched for published and unpublished studies. Titles, abstracts, and full-text selections will be screened by two or more independent reviewers and assessed for methodological validity using the standard JBI critical assessment tools. This review will follow a convergent segregated approach to data synthesis and integration.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021230951.

Calorie restriction induces mitochondrial biogenesis and bioenergetic efficiency

Age-related accumulation of cellular damage and death has been linked to oxidative stress. Calorie restriction (CR) is the most robust, nongenetic intervention that increases lifespan and reduces the rate of aging in a variety of species. Mechanisms responsible for the antiaging effects of CR remain uncertain, but reduction of oxidative stress within mitochondria remains a major focus of research. CR is hypothesized to decrease mitochondrial electron flow and proton leaks to attenuate damage caused by reactive oxygen species. We have focused our research on a related, but different, antiaging mechanism of CR. Specifically, using both in vivo and in vitro analyses, we report that CR reduces oxidative stress at the same time that it stimulates the proliferation of mitochondria through a peroxisome proliferation-activated receptor coactivator 1 alpha signaling pathway. Moreover, mitochondria under CR conditions show less oxygen consumption, reduce membrane potential, and generate less reactive oxygen species than controls, but remarkably they are able to maintain their critical ATP production. In effect, CR can induce a peroxisome proliferation-activated receptor coactivator 1 alpha-dependent increase in mitochondria capable of efficient and balanced bioenergetics to reduce oxidative stress and attenuate age-dependent endogenous oxidative damage.

Indicators of patient suitability for topical anesthesia

PURPOSE

To determine whether a patient's suitability for phacoemulsification under topical anesthesia can be predicted preoperatively by their performance during tonometry and A-scan.

SETTING

Whipps Cross Hospital Ophthalmology Department, London, England.

METHODS

Fifty consecutive patients who were considered suitable for phacoemulsification were selected for the study. Using a scoring system we devised, observers assessed the patients for the ease with which intraocular pressure and axial length were measured. These scores were compared with an assessment of how well they tolerated phacoemulsification under topical anesthesia. Correlation between the scores was measured with Spearman's rank correlation coefficient, Kendall's rank correlation coefficient, and the Goodman-Kruskal gamma statistic.

RESULTS

Phacoemulsification and posterior chamber intraocular lens implantation were completed in all patients. Statistical analysis showed that tonometry and A-scan scores correlated highly with surgery scores. Age was also a significant variable in predicting the surgery score. A significant discrepancy between tonometry and A-scan and surgery scores was found in only one patient, and it was noted that he was one of the youngest patients in the study.

CONCLUSION

How well a patient performs during tonometry and A-scan was a good predictor of how well he or she tolerated having phacoemulsification under topical anesthesia. The decision about type of anesthesia should, however, also involve other factors, including communication, cooperation, and the age of the patient.

Relative efficacy of alcohol and propranolol in action tremor

Thirty-nine patients with a variety of diseases, including essential tremor, Parkinson's Disease, olivopontocerebellar degeneration, ataxia telangiectasia, and cervical cord injury with action tremor, were evaluated for the effect of one ounce of absolute alcohol ingestion. Tremor significantly subsided in 61.9% of E.T.; 46.6% of P.D.; one patient with A.T.; and one patient with C6 lesion. The tremor became worse in one patient with O.P.C.D. Twenty of these patients were treated with propranolol, an average dose of 92 mgm. per day, and re-evaluated three to six months later. All those who improved on alcohol improved on propranolol and the one whose tremor accentuated with alcohol had a similar response to propranolol. It is concluded that the tremorilytic effect of alcohol is neither specific for, nor limited to, essential tremor and is of no value in differentiating various neurological disorders which manifest as action tremor. It is recommended that one ounce of absolute alcohol by mouth be used as an office procedure to predict the response of patients' tremor to propranolol.