Large hour-to-hour variability has previously been demonstrated in the cerebrospinal fluid (CSF) concentrations of Alzheimer's disease (AD) biomarkers amyloid β(42) (Aβ(42)) and Aβ(40) in healthy younger subjects. We investigated the within-subject variability over 36 hours in CSF Aβ and tau proteins, in older subjects and AD patients. Six patients with mild stage AD (59-85 years, Mini Mental State Examination (MMSE) 16-26) and 6 healthy older volunteers (64-77 years) received an intrathecal catheter from which, during 36 hours, each hour 6 mL of CSF was drawn. Concentrations of Aβ(42), Aβ(40), total tau, and phosphorylated tau were determined and the variability was analyzed. Within-subject variability within 3-hour periods was assessed as the coefficient of variation, which was comparable for these 4 biomarkers in controls (4.2%-4.6%) and AD (3.1%-5.8%). Variability over 12 hour periods was 5.3% to 9.5%. These findings suggest that CSF biomarker variability is relatively low in healthy older controls and AD patients. Furthermore, continuous sampling of CSF proved to be a useful and robust method, which may also be used to investigate AD pathogenesis and to evaluate pharmacotherapeutic interventions.
Background Society is facing a global shortage of 17 million health care workers, along with increasing health care demands from a growing number of older adults. Social robots are being considered as solutions to part of this problem. Objective Our objective is to evaluate the quality of care perceived by patients and caregivers for an integrated care pathway in an outpatient clinic using a social robot for patient-reported outcome measure (PROM) interviews versus the currently used professional interviews. Methods A multicenter, two-parallel-group, nonblinded, randomized controlled trial was used to test for noninferiority of the quality of care delivered through robot-assisted care. The randomization was performed using a computer-generated table. The setting consisted of two outpatient clinics, and the study took place from July to December 2019. Of 419 patients who visited the participating outpatient clinics, 110 older patients met the criteria for recruitment. Inclusion criteria were the ability to speak and read Dutch and being assisted by a participating health care professional. Exclusion criteria were serious hearing or vision problems, serious cognitive problems, and paranoia or similar psychiatric problems. The intervention consisted of a social robot conducting a 36-item PROM. As the main outcome measure, the customized Consumer Quality Index (CQI) was used, as reported by patients and caregivers for the outpatient pathway of care. Results In total, 75 intermediately frail older patients were included in the study, randomly assigned to the intervention and control groups, and processed: 36 female (48%) and 39 male (52%); mean age 77.4 years (SD 7.3), range 60-91 years. There was no significant difference in the total patient CQI scores between the patients included in the robot-assisted care pathway (mean 9.27, SD 0.65, n=37) and those in the control group (mean 9.00, SD 0.70, n=38): P=.08, 95% CI –0.04 to 0.58. There was no significant difference in the total CQI scores between caregivers in the intervention group (mean 9.21, SD 0.76, n=30) and those in the control group (mean 9.09, SD 0.60, n=35): P=.47, 95% CI –0.21 to 0.46. No harm or unintended effects occurred. Conclusions Geriatric patients and their informal caregivers valued robot-assisted and nonrobot-assisted care pathways equally. Trial Registration ClinicalTrials.gov NCT03857789; https://clinicaltrials.gov/ct2/show/NCT03857789
BACKGROUND Society is facing a global shortage of 17 million healthcare workers, along with increasing healthcare demands from a growing number of older adults. Social robots are being considered as solutions to part of this problem. OBJECTIVE To evaluate the quality of care perceived by patients and caregivers for an integrated care pathway in an outpatient clinic using a social robot for patient-reported outcome measurement (PROM) interviews versus the currently used professional interviews. METHODS Multicentre two parallel groups, non-blinded, randomised controlled trial testing for non-inferiority of the quality of care delivered through robot-assisted care. The randomisation was by computer-generated table. The setting concerned two outpatient clinics in the period July–December 2019. Of 419 subsequent patients visiting the participating outpatient clinics, 110 older patients fit the recruitment criteria. Inclusion criteria were ability to speak and read Dutch and being assisted by a participating healthcare professional. Exclusion criteria were serious hearing or vision problems, serious cognitive problems, paranoia or similar psychiatric problems. The intervention concerned a social robot conducting a 36-item PROM. As main outcome measure the Customised Consumer Quality Index (CQI) was used, as reported by patient and caregiver for the outpatient pathway of care. RESULTS In total 80 intermediately frail older patients (38 females, total mean age 77.8 (60-91) years) were included and randomly assigned to the intervention (40) and control groups (40). There was no significant difference in the total patient CQI scores of the patients with the robot pathway (M=9.19, SD=0.83, n=38) and those in the control group (M=9.00, SD=0.70, n=38); P=.29, 95% CI (-0.16 to 0.54), and no significant difference for their caregivers (intervention group M=9.15, SD=0.78, n=32; control group M=9.12, SD=0.61, n=36); P=.85, 95% CI (-0.31 to 0.37). No harm or unintended effects occurred. CONCLUSIONS Geriatric patients and their informal caregivers valued robot-assisted and non-robot-assisted care pathways equally. CLINICALTRIAL ClinicalTrials.gov NCT03857789, status completed.
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