Dataset Information

Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia.

ABSTRACT: Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake.To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand (DH), Over Hand (OH), and Under Hand (UH).A prospective pilot study using a within-subjects experimental Latin square design with randomization to one of three handfeeding technique sequences.30 residents living with advanced dementia in 11 U.S. NHs.Time required for assistance; meal intake (% eaten); and feeding behaviors, measured by the Edinburgh Feeding Evaluation in Dementia (EdFED) scale.Research Assistants provided feeding assistance for 18 video-recorded meals per resident (N = 540 meals). Residents were assisted with one designated technique for 6 consecutive meals, changing technique every 2 days.Mean time spent providing meal assistance did not differ significantly between techniques. Mean meal intake was greater for DH (67 ± 15.2%) and UH (65 ± 15.0%) with both significantly greater than OH (60 ± 15.1%). Feeding behaviors were more frequent with OH (8.3 ± 1.8%), relative to DH (8.0 ± 1.8) and UH (7.7 ± 1.8).All three techniques are time neutral. UH and DH are viable options to increase meal intake among NH residents with advanced dementia and reduce feeding behaviors relative to OH feeding.

SUBMITTER: Batchelor-Murphy MK

PROVIDER: S-EPMC5397360 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia.

Batchelor-Murphy Melissa K MK McConnell Eleanor S ES Amella Elaine J EJ Anderson Ruth A RA Bales Connie W CW Silva Susan S Barnes Angel A Beck Cornelia C Colon-Emeric Cathleen S CS

Journal of the American Geriatrics Society 20170206 4

<h4>Background</h4>Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake.<h4>Objectives</h4>To compare efficacy of three handfeeding techniques for assisting NH residents with dementia with meals: Direct Hand (DH), Over Hand (OH), and Under Hand (UH).<h4>Design</h4>A prospective pilot study using a within-subje ...[more]

PMID: 28165618

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Project description:PurposeThe purpose of this study was to evaluate three different methods of attachment of continuous loop suspensory cortical preparation of all soft tissue central quad tendon grafts compared to a bone block control for anterior cruciate ligament reconstruction on construct displacement and load to failure.MethodsThirty-two cadaveric central quadriceps tendon (CQT) specimens were harvested, using three clinical techniques for graft fixation: cortical button alone (BTB EB), BTB cortical button with rip-stop suture (BTB RS), and continuous loop cortical button (BTB CL). A control group was also included that consisted of a bone block secured within testing clamps (BTB CON). Specimens were preloaded to 150 N. Tendons were then cyclically loaded between 50 N and 250 N for 1,000 cycles at .5 Hz. Displacement was measured at the point of fixation of the CQT after the 150 N preload, 250 N initial load and every 100th cycle. The specimens were loaded to failure after 1,000 cycles.ResultsThere was a significant increase in displacement from .32 ± .56 mm for the BTB CON to 1.91 ± 1.13 mm for the BTB RS (P = .014) and 3.85 ± 2.32 mm for the BTB CL condition (P = .023). There was no significant increase in displacement for BTB EB (P = .182). Failure occurred for all of the BTB CL and 62.5% of the BTB EB specimens within the first 50 cycles. Twenty-five percent of the BTB CON specimens and 12.5% BTB RS failed at ∼400 and 500 cycles, respectively. Similar failure loads were observed for the BTB CON and the BTB RS (446.4 ± 151.46 N vs 505.74 ± 131.41 N; P = .99) Failure testing was not feasible for the BTB CL and BTB EB preparation methods.ConclusionIn response to cyclic loading, the three all-soft tissue suspensory conditions experienced significantly greater displacement compared to the bone block controls. None of the soft-tissue conditions appeared superior when compared to each other.Clinical relevanceIt remains unknown which method of soft-tissue suspensory provides optimal fixation. As these autografts become more common, it is essential to evaluate which fixation methods provide superior outcomes.

Project description:Background and purposeTo reduce the diagnostic gap of dementia, three strategies can be employed for case finding of cognitive impairment in ambulatory care settings, namely using informant report, brief cognitive test or a combination of informant report and brief cognitive test. The right strategy to adopt across different healthcare settings remains unclear. This diagnostic study compared the performance of the three strategies for detecting dementia (primary aim), as well as for detecting both mild cognitive impairment (MCI) and dementia (secondary aim).MethodsParticipants aged ≥65 years (n = 11 057) were recruited from Alzheimer's Disease Centers across the USA. Participants provided data on an informant report (Functional Activities Questionnaire), brief cognitive test (four-item short variant of Montreal Cognitive Assessment) and a combined measure with informant report and brief cognitive test (sum of Functional Activities Questionnaire and Montreal Cognitive Assessment short variant). They also received standardized assessments (clinical history, physical examination and neuropsychological testing) to diagnose MCI and dementia. Areas under the receiver operating characteristic curve (AUCs) of the three strategies were compared using the DeLong method, with AUC > 90% indicating excellent performance.ResultsAll three strategies had excellent performance in detecting dementia, although informant report [AUC, 95.9%; 95% confidence intervals (CI), 95.4-96.3%] was significantly better than brief cognitive test (AUC, 93.0%; 95% CI, 92.4-93.6%) and the combined measure had the best performance (AUC, 97.0%; 95% CI, 96.7-97.4%). However, to detect both MCI and dementia, only the combined measure had excellent performance (AUC, 93.0%; 95% CI, 92.5-93.4%), whereas stand-alone informant report or brief cognitive test performed suboptimally (AUC < 90%). Performance of the three strategies was not affected by participants' age, educational attainment or underlying prevalence of MCI and dementia.ConclusionsFor case finding of dementia in ambulatory care settings, informant reports would suffice as first-line measures and brief cognitive tests may optionally be added on, in services with available resources, to further improve the accuracy of detection. For case finding of both MCI and dementia, a combination of informant reports and brief cognitive tests remains the most appropriate strategy.

Dataset Information

Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia.

Publications

Experimental Comparison of Efficacy for Three Handfeeding Techniques in Dementia.

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