Acute Recovery Phase Research Articles

Time-Frequency Analysis of Somatosensory Evoked High-Frequency (600 Hz) Oscillations as an Early Indicator of Arousal Recovery after Hypoxic-Ischemic Brain Injury.

Cardiac arrest (CA) remains the leading cause of coma, and early arousal recovery indicators are needed to allocate critical care resources properly. High-frequency oscillations (HFOs) of somatosensory evoked potentials (SSEPs) have been shown to indicate responsive wakefulness days following CA. Nonetheless, their potential in the acute recovery phase, where the injury is reversible, has not been tested. We hypothesize that time-frequency (TF) analysis of HFOs can determine arousal recovery in the acute recovery phase. To test our hypothesis, eleven adult male Wistar rats were subjected to asphyxial CA (five with 3-min mild and six with 7-min moderate to severe CA) and SSEPs were recorded for 60 min post-resuscitation. Arousal level was quantified by the neurological deficit scale (NDS) at 4 h. Our results demonstrated that continuous wavelet transform (CWT) of SSEPs localizes HFOs in the TF domain under baseline conditions. The energy dispersed immediately after injury and gradually recovered. We proposed a novel TF-domain measure of HFO: the total power in the normal time-frequency space (NTFS) of HFO. We found that the NTFS power significantly separated the favorable and unfavorable outcome groups. We conclude that the NTFS power of HFOs provides earlier and objective determination of arousal recovery after CA.

Antibiotics and probiotics impact gut antimicrobial resistance gene reservoir in COVID-19 patients

ABSTRACT Dysbiosis of gut microbiota is well-described in patients with coronavirus 2019 (COVID-19), but the dynamics of antimicrobial resistance genes (ARGs) reservoir, known as resistome, is less known. Here, we performed longitudinal fecal metagenomic profiling of 142 patients with COVID-19, characterized the dynamics of resistome from diagnosis to 6 months after viral clearance, and reported the impact of antibiotics or probiotics on the ARGs reservoir. Antibiotic-naive patients with COVID-19 showed increased abundance and types, and higher prevalence of ARGs compared with non-COVID-19 controls at baseline. Expansion in resistome was mainly driven by tetracycline, vancomycin, and multidrug-resistant genes and persisted for at least 6 months after clearance of SARS-CoV-2. Patients with expanded resistome exhibited increased prevalence of Klebsiella sp. and post-acute COVID-19 syndrome. Antibiotic treatment resulted in further increased abundance of ARGs whilst oral probiotics (synbiotic formula, SIM01) significantly reduced the ARGs reservoir in the gut microbiota of COVID-19 patients during the acute infection and recovery phase. Collectively, these findings shed new insights on the dynamic of ARGs reservoir in COVID-19 patients and the potential role of microbiota-directed therapies in reducing the burden of accumulated ARGs.

Interaction between age and fatigue on antagonist muscle coactivation during an acute post-fatigue recovery phase.

This study investigated the age-related changes in antagonist muscle coactivation of the biceps femoris (BF) during an acute recovery period following a leg extensor fatiguing protocol. Twenty-three young (mean ± SD: age = 25.1 ± 3.0 years) and twenty-three old men (age = 71.5 ± 3.9 years) participated. Surface electromyography (sEMG) was recorded from the BF muscles for antagonist muscle coactivation. Testing involved participants performing leg extension isometric maximal voluntary contractions (MVCs) and isokinetic MVCs at 240°·s−1 at baseline (Pre) and again after the fatigue protocol at 0 (Post0), 7 (Post7), 15 (Post15), and 30 (Post30) minutes post fatigue. Root mean square (RMS) values were computed from the BF sEMG and were calculated as the first 200 ms from onset for the isometric (IsomCoact200ms) and dynamic isokinetic 240°·s−1 (DynCoact200ms) MVCs, and for the final 10° of the leg extension (DynCoact10°) on the isokinetic 240°·s−1 MVCs. Two-way ANOVAs [age group (young vs. old) × time (Pre vs. Post0 vs. Post7 vs. Post15 vs. Post30)] showed that DynCoact200ms had an effect for time (p = 0.018), with greater antagonist coactivation in Pre than Post0 (p = 0.009) and recovering by Post7 (p = 0.011) with no group differences. DynCoact10° had no age × time interaction (p = 0.070), but had a main effect for time (p = 0.020) with the Post0 being lower than the Pre. However, for this variable the young group showed a more severe Pre to Post0 fatigue decline (−45.9%) than the old group (−6.7%) indicating this may be a more sensitive variable for capturing age-related antagonist coactivation post-fatigue responses. Leg extensor fatigue affects some BF coactivation sEMG variables more than others, and any altered post-fatigue coactivation response recovers rapidly (<7 min) from baseline levels.

A-182 Depression Symptoms Predict Neurocognitive Functioning Following Pediatric Traumatic Brain Injury in the Acute Recovery Phase

Abstract Objective: Pediatric Intensive Care Unit (PICU) survivors are at elevated risk for developing neurocognitive concerns. Lower premorbid abilities, pediatric traumatic brain injury (pTBI) severity, and post-injury depression symptoms have been shown to predict greater neurocognitive deficits. However, limited extant research has focused on the acute recovery phase or used objective neuropsychological assessment measures. We examined the impact of pTBI severity and post-injury depression symptoms on neurocognitive functioning in the acute recovery phase. Method: Seventy-four trauma patients (8 to 19 years) were assessed 1-3 months after PICU discharge. Demographic and clinical data were extracted from the electronic medical record. Caregivers completed questionnaires about their children’s physical, cognitive and emotional functioning. The direct assessment included measures of WRAT5 word-reading; CMS/WISC-V/WAIS-IV digit span; WISC-V/WAIS-IV coding and symbol search; and DKEFS Trails-4, verbal phonemic and semantic fluencies. Given the high intercorrelations between aspects of executive function, principal components analysis (PCA) was conducted to create a cumulative neurocognitive index (NCI). A simple linear regression was used to test if moderate-severe Glasgow Coma scores and clinically elevated Promis Depression scores predicted NCI, controlling for reading ability. Results: Combining all participant data in the PCA yielded a single component solution accounting for 52.79% of total explained variance. The overall regression was significant (R2=.40), F(df=3,70) =15.23, p&amp;lt;.001. Elevated depression predicted NCI (p=.03) whereas greater pTBI severity was not predictive above the impact of premorbid factors. Conclusions: Neurocognitive functioning in PICU survivors within the acute recovery phase may be more related to concurrent depression symptoms than injury severity markers when premorbid factors are considered.

TH6.13 Post-Operative Pain Management Following Emergency Laparotomy

Abstract Aims Post-operative pain is a common yet challenging presentation. Although an expected part of the acute recovery phase, uncontrolled pain is associated with poorer patient experience, delayed functional recovery and increased morbidity. Up to 40% of patients report severe pain that negatively impacts on their post-operative recovery. We aimed to determine whether post-operative complications and length of hospital admission were associated with choice of analgesic agents. Methods We conducted a retrospective observational study of 42 patients who underwent a laparotomy between March – May 2021. Data was extracted from patients electronic medical records and summarised in Microsoft Excel. Statistical analysis was performed using the Chi-Squared and Mann-Whitney U tests. Results 22 patients (52.4%) experienced post-operative complications whilst 20 (47.6%) did not. In those without post-operative complications, a greater proportion received Patient Controlled Analgesia (PCA) compared to those with post-operative complications (17, 85% vs 11, 50%, p = 0.02). We also observed a trend towards greater use of Oxycodone (11, 55% vs 6, 27%) and Meptazinol (11, 55% vs 7, 32%) in those without post-operative complications (p= 0.07 and p = 0.13 respectively). The length of hospital admission was significantly shorter for patients who received PCA (median = 11 days) compared to those who did not (median = 15 days) (U = 111.5, p = 0.04). Conclusions This study emphasises the importance of effective post-operative analgesia in reducing post-operative complications and improving speed of recovery. We suggest that the use of PCA should be encouraged for post-operative analgesia following emergency laparotomies.

Concussion prolonged with unrestricted screen time

Macnow T, Curran T, Tolliday C, Martin K, McCarthy M, Ayturk D, et al. Effect of Screen Time on Recovery from Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2021;175:1124-31.QuestionAmong adolescents and young adults with concussion, what is the clinical efficacy of unrestricted screen time, compared with screen-time abstinence, as measured by the Post-Concussive Symptom Scale (PCSS)?DesignSingle-center parallel-design randomized clinical trial.SettingUniversity of Massachusetts Medical Center in Worcester.ParticipantsChildren 12-25 years old, presenting to the ED within 24 hours of a head injury.InterventionScreen time permitted vs abstinence for 48 hours after injury.OutcomesDays to resolution of symptoms (resolution = PCSS score ≤ 3).Main ResultsMedian recovery time and screen-time minutes were longer in the screen-time permitted group compared with the abstinence group: 8.0 days and 630 minutes compared with 3.5 days and 130 minutes, P = .03 for recovery time, non-overlapping interquartile ranges for screen-time minutes, respectively.ConclusionsScreen–time abstinence improves concussion recovery time.CommentaryUsing a well-designed RCT, Macnow et al answered a common question from caregivers - should screen time be avoided after acute concussion. The evidence provided is compelling, not just because the difference in outcome was profound, but because the intervention is benign. Asking patients to minimize screen time for 48 hours, provides caregivers with actionable practical advice that is unlikely to cause significant harm. It is important to note that given the subjective nature of concussion symptoms and the inability to blind subjects, screen time restrictions may have had a placebo effect which encouraged reduced symptom reporting. Further research is necessary to replicate these findings, better understand the ideal duration of screen-time restriction, and the biopsychosocial mechanisms underpinning its benefit. However, until that research is completed, restricting screen time during the first 48 hours of injury should become the standard advice in the acute phase of concussion recovery. The pandemic has shown us that for children, screen time is not always discretionary. This study provides the evidence-based guidance that caregivers need to advocate for their children during acute concussion recovery. Macnow T, Curran T, Tolliday C, Martin K, McCarthy M, Ayturk D, et al. Effect of Screen Time on Recovery from Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2021;175:1124-31. QuestionAmong adolescents and young adults with concussion, what is the clinical efficacy of unrestricted screen time, compared with screen-time abstinence, as measured by the Post-Concussive Symptom Scale (PCSS)? Among adolescents and young adults with concussion, what is the clinical efficacy of unrestricted screen time, compared with screen-time abstinence, as measured by the Post-Concussive Symptom Scale (PCSS)? DesignSingle-center parallel-design randomized clinical trial. Single-center parallel-design randomized clinical trial. SettingUniversity of Massachusetts Medical Center in Worcester. University of Massachusetts Medical Center in Worcester. ParticipantsChildren 12-25 years old, presenting to the ED within 24 hours of a head injury. Children 12-25 years old, presenting to the ED within 24 hours of a head injury. InterventionScreen time permitted vs abstinence for 48 hours after injury. Screen time permitted vs abstinence for 48 hours after injury. OutcomesDays to resolution of symptoms (resolution = PCSS score ≤ 3). Days to resolution of symptoms (resolution = PCSS score ≤ 3). Main ResultsMedian recovery time and screen-time minutes were longer in the screen-time permitted group compared with the abstinence group: 8.0 days and 630 minutes compared with 3.5 days and 130 minutes, P = .03 for recovery time, non-overlapping interquartile ranges for screen-time minutes, respectively. Median recovery time and screen-time minutes were longer in the screen-time permitted group compared with the abstinence group: 8.0 days and 630 minutes compared with 3.5 days and 130 minutes, P = .03 for recovery time, non-overlapping interquartile ranges for screen-time minutes, respectively. ConclusionsScreen–time abstinence improves concussion recovery time. Screen–time abstinence improves concussion recovery time.

Co-production of a CArdiac Brief INtervention (CABIN) for patients prior to discharge following acute myocardial infarction (AMI)

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Public Health Agency Northern Ireland, Research and Development PhD Fellowship Background Recovery from AMI can be challenging for patients without adequate psychosocial support to overcome anxiety, address misconceptions and initiate lifestyle change (1,2). Reduced length of stay has minimised the opportunity for nurses to evaluate patients’ holistic needs and initiate effective in-hospital interventions (3). Patients and nurses discussed these challenges openly and worked together in this co-design study to develop a brief intervention for the pre-discharge period. Method A multi-site, co-design project was conducted with an exploratory phase of interviewing and focus groups with patients and staff involved in CR. The data from this exploratory phase informed a series of working-group meetings during which this intervention was developed. Results The CABIN (CArdiac Brief INtervention) offers brief, reassuring and compassionate discussions alongside educational content. CABIN consists of 8 components as seen in figure 1. It is designed to be used by nursing staff in the acute setting with patients following their AMI. Staff delivering the intervention must have full understanding of the local CR programme to offer practical advice if necessary. Conclusion CABIN provides a tangible means to emotionally support patients in the acute phase of recovery following AMI. It is envisaged that CABIN will empower acute clinical nursing staff to address the emotional needs of patients in a way which will encourage attendance at CR and subsequent recovery.

Breath sound analyses of infants with respiratory syncytial virus acute bronchiolitis.

The reliability of a breath sound analysis using an objective method in infants has been reported. Breath sounds of infants with respiratory syncytial virus (RSV) acute bronchiolitis were analyzed via a breath sound spectrogram to evaluate their characteristics and examine their relationship with the severity. We evaluated the inspiratory and expiratory breath sound parameters of 33 infants diagnosed with RSV acute bronchiolitis. The sound powers of inspiration and expiration were evaluated at the acute phase and recovery phase of infection. Furthermore, the relationship between the breath sound parameters and the clinical severity of acute bronchiolitis was examined. Analyses of the breath sound spectrogram showed that the power of expiration as well as the expiration-to-inspiration sound ratio in the mid-frequency (E/I MF) was increased in the acute phase and decreased during the recovery phase. The E/I MF was inversely correlated with the SpO2 and positively correlated with the severity score. In infants with RSV acute bronchiolitis, the sound power of respiration was large at the acute phase, significantly decreasing in the recovery phase. In 61% of participants, nonuniform, granular bands were shown in the low-pitched region of the expiratory spectrogram.

Patient Factors and Preferences in Choosing Sleep Surgery for Obstructive Sleep Apnea: A Qualitative Study.

There are several obstructive sleep apnea (OSA) treatment options available to patients, including surgery and less invasive therapies. Little is known about the factors that influence patient preferences for treatment. We aimed to understand factors influencing patient experience and decision making for undergoing sleep surgery. Retrospective qualitative study. Tertiary sleep surgery clinic. We conducted semistructured interviews with adults who previously underwent any nasal and/or pharyngeal sleep surgery. We asked open-ended questions about their decision-making process within a preconceived thematic framework of chief OSA symptoms, expectations for recovery, and sources of information. The interviews were audio recorded and transcribed, and content was analyzed for defined, emergent, and prevalent themes. Ten patients were interviewed from December 11, 2020 through January 29, 2021. Six patients underwent nasal surgery, 1 underwent pharyngeal surgery, and 3 underwent staged nasal and pharyngeal procedures. All patients were beyond the acute recovery phase. Reasons for pursuing surgical consultation varied from sleep apnea burden to external factors, such as recommendations from significant others. Duration of sleep surgery consideration varied from months to years. Major concerns about sleep surgery involved anesthesia and postoperative pain. External factors influencing patients' decisions to pursue sleep surgery included family and friend support. Postoperative outcomes of surgery included patient satisfaction with decision for surgery, given OSA improvements. Understanding patient factors that influence decision making for sleep surgery may guide clinicians in patient-centered counseling that engages patients in decision making, aligning with clinical symptoms and patient preferences.

Post-Intensive Care Syndrome in a Cohort of School-Aged Children and Adolescent ICU Survivors: The Importance of Follow-up in the Acute Recovery Phase

AbstractPediatric intensive care unit (PICU) survivors experience a collection of physical, cognitive, emotional, and social symptoms named post-intensive care syndrome (PICS). We aimed to quantify PICS morbidities from multiple stakeholder perspectives across domains. Using physician, neuropsychologist, and parent/caregiver-completed outcome measures across domains in a cross-sectional analysis of 186 children between the ages of 8 and 19 years with data from a PICU follow-up clinic 1 to 3 months after PICU discharge, we quantified PICS morbidities and used Spearman correlation to evaluate interdependence of PICS domains. Compared with pre-hospitalization functioning, new PICS-related morbidities were observed and significant correlations were identified between the PICS domains. Results highlight the need to identify and support patients and families for multiple morbidities simultaneously across all relevant PICS domains; moreover, an important divergence between caregiver report, physician, and neuropsychologist assessment was also found, showcasing the importance of multiple assessments and perspectives. New PICS morbidities across domains are common after discharge from the PICU, and timely follow-up care is needed that involves collaboration/integration of physicians, neuropsychologists, youth, and families to effectively identify and treat PICS-related issues.

Chronic Supplementation of 2S-Hesperidin Improves Acid-Base Status and Decreases Lactate at FatMax, at Ventilatory Threshold 1 and 2 and after an Incremental Test in Amateur Cyclists.

Simple SummaryCurrently, hesperidin is a molecule found mainly in citrus fruits and is being widely researched in the area of chronic disease, but also in the field of sports nutrition. Some studies have shown its antioxidant, anti-inflammatory, lipid and carbohydrate metabolism modulating effects, including the enhancement of nitric oxide synthesis. However, few human studies have demonstrated a positive effect of hesperidin intake, in particular 2S-hesperidin, on sports performance, particularly in anaerobic and aerobic tests. However, the biochemical mechanisms that may be responsible for this enhanced performance have not yet been described. Therefore, one of the aims of this study was to assess whether an eight-week intake of 2S-hesperidin can improve acid-base status and metabolic status (lactate and glucose) in an incremental test in amateur cyclists. The results showed that amateur cyclists chronically supplemented with 2S-hesperidin improved acid-base status and lactate at FatMax, ventilatory thresholds 1 and 2, and in the acute phase of recovery after maximal effort.Chronic supplementation with 2S-hesperidin improves performance; however, the mechanisms underlying this effect have not yet been explored. Therefore, the aim of this study was to assess whether changes in acid-base status may be associated with improved performance after 2S-hesperidin supplementation compared to microcellulose (placebo). Forty amateur cyclists (n = 20 per group) underwent a rectangular test where capillary blood samples were taken at baseline, FatMax1, VT1, VT2, PMAX, FatMax2 and EPOC to measure acid-base parameters. After eight weeks of 2S-hesperidin supplementation (500 mg/d) increased HCO3−, SBC, ABE (p ≤ 0.05) and decreased Lac were found at FatMax1, VT1, FatMax2 and EPOC (p ≤ 0.05), while decreased Lac at VT2 was found with a large effect size (ES = 1.15) compared to placebo. Significant group differences in the area under the curve were observed when comparing pre-post-intervention pH changes (p = 0.02) between groups. Chronic supplementation with 2S-hesperidin improved acid-base status and Lac, both at low-moderate and submaximal intensities, improving recovery after exercise-to-exhaustion in amateur cyclists.

Changes and roles of IL-17A, VEGF-A and TNF-α in patients with cerebral infarction during the acute phase and early stage of recovery

Background and purposeInterleukin 17A (IL-17A), vascular endothelial growth factor A (VEGF-A) and tumour necrosis factor alpha (TNF-α) are important cytokines detected mostly within two weeks after stroke in previous clinical studies. Longer clinical studies investigating these cytokines are lacking. We aimed to explore the roles of these cytokines in patients within 35 days after cerebral infarction. MethodsThirty patients with cerebral infarction and 30 healthy individuals were enrolled. Venous blood was collected from each patient at specific times and from each healthy individual only once. Coma and neurological functional deficits of the patients were evaluated by the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS), respectively. Three cytokines were measured. The correlations among the three cytokines and between each cytokine and the GCS/NIHSS scores were analysed. ResultsIL-17A and TNF-α began to increase on day 1 after cerebral infarction, peaked on day 4, then decreased, and increased again on day 18. IL-17A returned to normal on day 35, but TNF-α remained higher than normal on day 35. VEGF-A began to increase on day 1, peaked on day 7, and returned to normal on day 35. From days 18 to 35, IL-17A was positively correlated with the GCS scores, and both IL-17A and VEGF-A were negatively correlated with the NIHSS scores. ConclusionAfter cerebral infarction, VEGF-A from the acute phase and IL-17A from the early stage of recovery may be important for nerve protection and repair; TNF-α plays a complex role within 35 days.

Nutritional support practices at an intensive care unit in Johannesburg, South Africa

Objectives: Nutritional support is a fundamental component of holistic patient care in the intensive care unit (ICU). There is a paucity of local data pertaining to nutritional support practices at ICUs in South Africa. The aim of this study was to determine nutritional support practices at an academic hospital ICU in Johannesburg, South Africa. Methods: In this cross-sectional, descriptive and retrospective study, a simple random sampling method was utilised to select 50 data collection days from a three-month period (1 August–31 October 2018). Data relevant to the study were extracted from the ICU charts of patients who received formulae-based enteral and/or parenteral nutrition on the selected days. Charts were categorised into acute phase days (≤ 72 hours from ICU admission) and recovery phase days (> 72 hours from ICU admission). Results: A total of 387 ICU charts were included in the final sample, comprising 114 acute phase and 273 recovery phase days. Overall, enteral nutrition was prescribed on 296 (76.5%) chart days while parenteral nutrition was prescribed on 111 (28.7%) chart days. The median daily fluid balance was approximately 600 ml positive. Target protein and calorie intake was achieved on 67 (17.3%) and 110 (28.4%) chart days respectively. Conclusion: Although protein and calorie intake was suboptimal in comparison with the recommended targets, it is in keeping with general international trends. Regular audits, training of staff, attention to minimising feeding interruptions and encouraging the timely initiation of enteral nutrition are recommended interventions that may be useful in achieving nutritional targets.

Secondary Analysis of Walking Activities during the Acute Stroke Hospital Stay and Cerebrovascular Health.

Physical activity within the hospital post-stroke is recommended for cardiovascular and musculoskeletal health, but no studies have examined cerebrovascular health. We hypothesized individuals who walked farther distances (FARhigh) during the acute phase of stroke recovery in a hospital setting would have a higher resting middle cerebral artery blood velocity (MCAv) and a greater cerebrovascular response (CVR) to moderate-intensity exercise at 3-months post-stroke, compared to individuals who walked shorter distances (FARlow). At 3-month post-stroke, we recorded 90-seconds of resting baseline (BL) MCAv followed by 6-minutes of moderate-intensity exercise. We calculated CVR as the change in MCAv from BL to steady-state exercise. We retrospectively collected farthest distance walked within the hospital post-stroke from the electronic medical record. Participants were classified as FARhigh or FARlow based on average farthest walking distance. Twenty participants completed the study, age 63 (15) years. BL MCAv was not different between groups (p = 0.07). In comparison to FARlow, we report a higher CVR in FARhigh's ipsilesional ( = 7.38 (5.42) vs = 2.19 (3.53), p = 0.02) and contralesional hemisphere ( = 8.15 (6.37) vs = 2.06 (4.76), p = 0.04). Physical activity during the hospital stay post-stroke may support cerebrovascular health after discharge. Prospective studies are needed to support this finding.

124 The Relationship Between Social Functioning and Psychological Status: A preschool-libre1-5 Study

IntroductionDallas ages one to five are learning to make friends and interact with peers in situations where their social functioning may have a direct relationship with their mood. Dallas may be isolated from peers during the acute phase of burn recovery and face rejection by their peers during recovery. This could influence their psychological health through feelings of anxiety, loneliness, social withdrawal and/or defiant behavior. This study evaluates the relationship between social and psychological functioning using the data collected from the field-tested Preschool-LIBRE1-5 instrument.MethodsParents of burn survivors (n=426) completed Preschool-LIBRE1-5. Items from the psychological (48 items) and social (37 items) functioning domains were coded on a 5-point Likert scale ranging from 0 (never) to 4 (always) where higher scores denote better functioning. Confirmatory factor analysis was conducted for individual items in the social and psychological domains respectively. Regression model assessed the relationship between the social and psychological domains, controlling for demographic characteristics (gender, race, ethnicity, age at survey completion, burn size, and pain severity).ResultsFactor analysis identified three factors for social functioning: play, peer relations, and peer rejection. The psychological items confirmed a single factor that included dysregulation (negative behaviors and sleep), externalization (impulsivity and aggression), internalization (general anxiety and depression), and trauma (fear and avoidance). Distress items, also in the internalizing subdomain, weren’t strongly confirmed as part of this single scale. The subdomains with the lowest and highest mean scores in psychological domain were dysregulation (2.68 + 0.58) and depression (3.50 + 0.37), and in social domain were peer relation (2.39 + 0.95) and peer rejection (3.42 + 0.64) respectively. Adjusted regression analysis demonstrate that the social functioning domain has a significant relationship with psychological status (p < 0.004).ConclusionsAnalysis suggests a significant association between social functioning and psychological status. Results provide a basis for understanding the importance of these domains in relationship to each other.

The Effects of Exercise and Activity-Based Physical Therapy on Bone after Spinal Cord Injury.

Spinal cord injury (SCI) produces paralysis and a unique form of neurogenic disuse osteoporosis that dramatically increases fracture risk at the distal femur and proximal tibia. This bone loss is driven by heightened bone resorption and near-absent bone formation during the acute post-SCI recovery phase and by a more traditional high-turnover osteopenia that emerges more chronically, which is likely influenced by the continual neural impairment and musculoskeletal unloading. These observations have stimulated interest in specialized exercise or activity-based physical therapy (ABPT) modalities (e.g., neuromuscular or functional electrical stimulation cycling, rowing, or resistance training, as well as other standing, walking, or partial weight-bearing interventions) that reload the paralyzed limbs and promote muscle recovery and use-dependent neuroplasticity. However, only sparse and relatively inconsistent evidence supports the ability of these physical rehabilitation regimens to influence bone metabolism or to increase bone mineral density (BMD) at the most fracture-prone sites in persons with severe SCI. This review discusses the pathophysiology and cellular/molecular mechanisms that influence bone loss after SCI, describes studies evaluating bone turnover and BMD responses to ABPTs during acute versus chronic SCI, identifies factors that may impact the bone responses to ABPT, and provides recommendations to optimize ABPTs for bone recovery.

Exploring the experiences of the cardiac rehabilitation journey among South Asian patients

Background/AimsIndividuals from South Asian backgrounds are at greater risk of developing coronary heart disease. Cardiac rehabilitation reduces the risk of future cardiac events, yet uptake is low among South Asian populations. This study explored South Asian patients' understanding and experiences of cardiac rehabilitation.MethodsThis qualitative, semi-structured study identified a purposeful sample of 36 eligible patients, of whom six participated in an interview that explored their experiences and perceptions of cardiac rehabilitation. Data were analysed using inductive analysis.ResultsThree themes were identified: starting the conversation; expectation vs reality; and meeting patient needs. Patients perceived cardiac rehabilitation as additional support rather than a fundamental part of care. Moreover, they considered the content of cardiac rehabilitation programmes to lack cultural sensitivity, which influenced both attendance and perceived relevance.Conclusions:Nurses must promote cardiac rehabilitation during the acute phase of recovery, while considering South Asian patients' beliefs, perceptions and cultural acceptance of cardiac rehabilitation. Invitations to attend and cardiac rehabilitation delivery must be personalised, accounting for cultural influences on lifestyle.

Effect of COVID-19 on development and progression of endocrinopathies in children

Introduction. An outbreak of coronavirus (COVID-19) declared an emergency of international public health importance. More information is now available on how COVID-19 affects people, including children and adolescents. SARS-CoV-2 is a new virus, and so far, there is insufficient data on what endocrinopathies it can cause in children, and how it affects patients with a history of endocrine pathology. Aim. Review containing data from foreign studies on the effects of coronavirus infection on the development and progression of child and adolescent endocrinopathies. Materials and methods. An analysis of publications containing data from studies of COVID-19 cases in children was carried out. Results. Currently, foreign studies indicate the provoking effect of COVID-19 on the development and progression of endocrinopathies in children and adolescents. Conclusion. Future studies should include a comprehensive assessment of the endocrine system during the acute phase and recovery phase after undergoing COVID-19, as there is no long-term follow-up until the significant impact of this virus on the development of endocrinopathies in children can be ruled out.

Effects of computer-based therapy versus therapist-mediated therapy in stroke-related aphasia: Pilot non-inferiority study

PurposeThe burgeoning growth of computer-based rehabilitation technologies has led to a paradigm shift in the delivery of aphasia intervention. The aim of this study was to conduct a pilot non-inferiority study comparing computer-based training for people with aphasia versus traditional therapist-mediated training on language skills, functional communication and quality of life outcomes in the hospital setting. MethodsTwenty-two fluent, monolingual Italian speakers with stroke-related aphasia in the acute phase of recovery were enrolled in the study. Participants were assigned randomly to computer-based or therapist-mediated aphasia treatment. Both groups received one, 50-minute session for 5 days per week over a period of 8 weeks. During the training, they were administered words and sentence comprehension, written naming, word completion, fluency, word and sentence reorganization tasks. The complexity of each task was increased progressively based on the severity of each person's language deficits. ResultsParticipants in both computer-based and traditional therapist-mediated aphasia intervention showed significant gains in language skills, functional communication and quality of life from pre- to post-treatment. Statistically significant within-group differences were found across all outcome measures. In contrast, no significant between-group and group x time interaction effects were found across language skills, functional communication and quality-of-life measures. ConclusionsThe overall pattern of findings suggested computer-based intervention was not inferior to traditional therapist-based intervention for enhancing functional communication deficits in stroke-related aphasia during the acute phase of recovery. A follow-up, fully-powered clinical trial is needed to confirm the reliability of these results.

Safety and Feasibility of an Interdisciplinary Treatment Approach to Optimize Recovery From Critical Coronavirus Disease 2019.

Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019. Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways. ICU Recovery Clinic in an academic medical center. Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019. Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training. Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway (n = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, t = 6.06, p < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post (n = 29, t = 6.93, p < 0.0001), which was similar between the two groups (110 vs 80 meters, t = 1.34, p = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life. A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.