Period Of Impairment Research Articles

Occupational Advance Directives: Do You Have One?

Occupational Advance Directives: Do You Have One?

EComment. Negative effect of delirium beyond the immediate postoperative period

In this interesting publication, Otomo et al. [1] highlights the relationship between pre-existing silent cerebral infarcts assessed by magnetic resonance imaging and postoperative delirium. They clearly demonstrated that pre-existing multiple cerebral infarctions are an independent predictor of postoperative delirium after cardiac surgery. Postoperative delirium is an acute confusional state with fluctuating consciousness and is very common after cardiac surgery. This transit mental syndrome is associated with many negative short-term consequences such as prolonged hospital stay, readmission to the hospital, poorer cognitive and functional recovery yielding an increase in economic and social costs [2-3]. Although delirium may resolve during hospital stay, it may have long-term functional and cognitive consequences, up to two years after the index hospitalization. Recently, Saczynski et al. [4] demonstrated in a prospective study of 225 patients undergoing cardiac surgery that postoperative delirium was a significant risk factor for a decline in cognitive function followed by a prolonged period of impairment up to one year after the cardiac procedure. The authors of the above-mentioned study concluded that postoperative delirium should be added to the list of risk factors of prolonged impairment after cardiac surgery, which include de novo atrial fibrillation, pre-existing cerebral disease, a low level of education and a history of major depression. Of note, Martin et al. [5] found that development of delirium after coronary artery bypass grafting increased the risk of stroke up to five years after the surgery. We fully agree with Otomo et al. that delirium is a marker of impaired cerebral microcirculation and that patients developing delirium have a more vulnerable central nervous system. Postoperative delirium negatively affects early and long-term outcomes. Every efforts to prevent, early detect and rapidly treat delirium are of utmost importance. Postoperative delirium should not be considered as only an inconvenient complication of cardiac surgery. Conflict of interest: none declared

Low bispectral index values following electroconvulsive therapy associated with memory impairment

It has been reported some patients have opened eyes with low bispectral index (BIS) values immediately following electroconvulsive therapy (ECT). We investigated the time course of the recovery from amnesia and BIS values. Five patients with depression requiring repeated ECT procedures were enrolled. The patients were asked to recall an object presented prior to anesthesia at four specific points (prior to induction, upon regaining consciousness following ECT, when they returned to their ward, and when their BIS values had returned to pre-anesthetic levels). BIS data were recorded continuously until BIS values returned to the pre-anesthetic levels at their ward. The area under a receiver-operating characteristic (ROC) curve was used to detect associations between the BIS values and disturbance of memory function. A total of 41 ECT stimuli were administered. After returning to their ward, patients generally fell asleep, with BIS values of between 50 and 70, and they woke up 1-2 h later. All the patients could recall the presented object prior to anesthesia and when the BIS values had returned to pre-anesthetic levels. The area under the ROC curve for the detection of memory disturbance was 0.902. The present study demonstrated a high frequency of patients falling asleep and the frequent occurrence of prolonged periods of low BIS values following ECT. The results of memory testing showed that ECT procedures resulted in amnesia. The ROC curve findings suggest a strong association of memory disturbance with BIS values. In conclusion, patients generally fell asleep, with low BIS values, for 1-2 h after ECT, and a prolonged period of impairment of memory formation was associated with low BIS values.

Issues Involving Informed Consent for Research Participants with Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia which is estimated to impact 350,000 people over 65 years of age in Canada. The lack of effective treatment and the growing number of people who are expected to be diagnosed with Alzheimer’s disease in the near future are compelling reasons why continued research is in this area is necessary. With additional research, there needs to be greater recognition of the complexity of seeking ongoing informed consent from those with Alzheimer’s disease. This complexity is because the impairment of memory and cognitive ability does not diminish in a linear manner, but rather fluctuates between periods of impairment and relatively normal cognitive lucidness. There is limited discussion in the guidelines of those progressing from early stages of Alzheimer’s disease who have intermittent cognitive function. Guidelines to research and Research Ethics Boards require further development to facilitate researcher including those with Alzheimer’s disease while protecting this growing pool of potential participants.

Generalization in olfactory detection of chemical cues containing carbonyl functions by tiger salamanders (Ambystoma tigrinum)

Tiger salamanders generalize behaviorally between carbonyl-containing odorants (e.g., aldehydes or cycloalkanones). However, responding does not generalize from such odorants to stimulus compounds with comparable molecular shapes and dimensions but different functional groups. Discrimination between aldehydes and a ketone is temporarily impaired by two-step covalent modification of the olfactory epithelium. Two-step modification of the olfactory epithelia also impairs, but does not obliterate, olfactory detection, and generalization persists even during the period of impairment. These results are interpreted as implying the existence of carbonyl-binding, "generalist" olfactory receptors in addition to other classes of "generalist" receptors that are not affected by two-step modification. Generalization is inferred to require overlap in the response profile of more than one class of receptor.

Identifying Characteristics in the Handwriting of the Visually Impaired

ABSTRACTThe relationship between levels of visual impairment and the number and type of features found in handwriting by impaired writers is discussed. Consideration is given to variables such as education, use of writing aids and period of impairment.

Prevalence of psychological impairment in city and country samples.

A study was conducted of the psychological health of 125 married French women aged between 35 and 39 years, divided into five professional groups of 25 subjects. Two of these groups were taken from a rural area, three from Paris. The criteria of health have been psychiatric symptomatology, psychological impairment, and the frequency of the periods of impairment. A significant difference was found between the farmers and all the other groups. Differential data are also given regarding the medical assistance received by the groups.