Baseline Level Of Function Research Articles

Cognitive profiles across the psychosis continuum

Cognitive impairments are core features in individuals across the psychosis continuum and predict functional outcomes. Nevertheless, substantial variability in cognitive functioning within diagnostic groups, along with considerable overlap with healthy controls, hampers the translation of research findings into personalized treatment planning.Aligned with precision medicine, we employed a data driven machine learning method, self-organizing maps, to conduct transdiagnostic clustering based on cognitive functions in a sample comprising 228 healthy controls, 200 individuals at ultra-high risk for psychosis, and 98 antipsychotic-naïve patients with first-episode psychosis.The self-organizing maps revealed six clinically distinct cognitive profiles that significantly predicted baseline functional level and changes in functional level after one year. Cognitive flexibility in particular, as well as specific executive functions emerged as cardinal in differentiating the profiles. The application of self-organizing maps appears to be a promising approach to inform clinical decision-making based on individualized cognitive profiles, including patient allocation to different interventions. Moreover, this method has the potential to enable cross-diagnostic stratification in research trials, utilizing data-driven subgrouping informed by categories from underlying dimensions of cognition rather than from clinical diagnoses. Finally, the method enables cross-diagnostic profiling across other data modalities, such as brain networks or metabolic subtypes.

Bile Duct Injuries During Urgent Cholecystectomy at a Safety Net Teaching Hospital: Attending Experience and Time of Day May Matter.

Background: Bile duct injury (BDI) is one of the most severe complications during cholecystectomy. Early identification of risk factors for BDI may permit risk reduction strategies and inform patient consent.Objective: This study aimed to define patient, provider, and systemic factors associated with BDI; BDI incidence; and short-term outcomes of BDI after urgent cholecystectomy.Methods: Patients who underwent urgent cholecystectomy for acute cholecystitis were retrospectively screened (2020-2022). All patients who sustained BDI were included without exclusions. Demographics, clinical data, and outcomes were collected and compared with descriptive statistics.Results: During the study period, BDI occurred in 4 (0.5%) of 728 patients who underwent urgent cholecystectomy for acute cholecystitis. Most BDI cases (75%) took place overnight or during the weekend. The attending surgeon was almost exclusively (75%) in their first year of practice. BDI was recognized during index operation in 2 cases (50%). Hepatobiliary surgery performed the bile duct repair in all 4 cases. Two complications occurred (50%). All patients were followed by hepatobiliary surgery in the outpatient setting and returned to their baseline level of function within 2 months of hospital discharge.Conclusion: Most BDI occurred in procedures attended by first-year faculty during after hours cholecystectomies, suggesting a role for increased proctorship in early career attendings in addition to in-hours cholecystectomy for acute cholecystitis. The timely return to baseline function experienced by these patients emphasizes the favorable outcomes associated with early recognition of BDI and involvement of hepatobiliary surgery. Further examination with multicenter evaluation would be beneficial to validate these study findings.

Schizophreniform disorder. Clinical manifestations and diagnosis. Purposely a case

IntroductionSchizophreniform Disorder is described pretty similar to schizophrenia, but with the difference of the symptoms duration which have to last for at least 1 month but less than 6 months. Patients have to be back at their baseline functional level once the disorder has resolved. This is a heterogeneous group of patients who have either a disorder similar to schizophrenia or something closer to a mood disorder.Objectives To analyze clinical, psychopathological and epidemiological characteristics of schizophreniform disorder and also review causes, incidence, prevalence, diagnostic, therapeutic tools and the importance of maintaining the treatment, because of the abandonment of the treatment, which is a predictor of relapses.MethodsA review of the main impact literature concerning schizophreniform disorder is done during the last five years: prevalence, incidence, pathogenesis and its relationship with other psychiatric disorders encoded in DSM-V are studied.ResultsThe etiology is unknown. Psychotic symptoms can be treated with antipsychotics for 3 to 6 months. They usually respond faster than patients with schizophrenia (75% vs 20% respond within 8 days).ConclusionsThe disease has a favorable prognosis, and has similarities with mood disorders. However, some data suggest a close relationship to schizophrenia. In support of the relationship with mood disorders, patients have more affective symptoms and a better outcome than patients with schizophrenia.Disclosure of InterestNone Declared

Effects of stepped speech rehabilitation and psychological intervention on speech disorders and cognitive function in Parkinson disease patients

To examine the impact of stepwise speech rehabilitation exercise therapy in the treatment of patients with Parkinson speech problems under psychological intervention on clinical results and cognitive functioning. Parkinson speech disorder patients who met the inclusion criteria were selected and divided into a control group and an observation group for training respectively. The control group used conventional nursing methods, including training in orofacial movement, vocalization, pitch, volume and breath control. The observation group used stepwise speech rehabilitation exercise intervention combined with psychotherapy nursing programme. In the statistical analysis, independent sample t-test and chi-square test were used to test the significance of the data processing methods. In the statistical analysis of baseline functional level (P > .05). The difference was not statistically significant. After 7 weeks of training, the mFDA level and speech intelligibility increased in both the observation and control groups. From the situation analysis of “modified drinking test” and the comparison of UPDRS-I scores, it can be seen that dysphagia and Parkinson dysphasia were reduced in both groups after training. The observation group spontaneous speech dimension was greater than the control group by around 0.07 in the aphasia comparison. Both groups displayed an upward trend in their MMSE and Montreal Cognitive Assessment (MoCA) when measuring cognitive function; the evaluation of P300, constructive function, and quality of life revealed this. The observation group P300 potential score was 0.13 points higher than that of the control group. The therapeutic training of stepped speech rehabilitation exercise care combined with psychological intervention has significant nursing effects on patients with Parkinson disease speech disorders, and the patients’ cognitive functions have been effectively improved.

THE INFLUENCE OF THE TYPE OF ANESTHESIA ON EARLY POSTOPERATIVE RECOVERY IN PATIENTS WITH ABDOMINAL WALL HERNIAS

Introduction. Pathways to improved recovery after surgery are aimed at reducing surgical stress, maintaining physiologic homeostasis and returning to the patient's baseline functional level prior to surgery.A significant number of patients are operated on each year for hernias of the abdominal wall. One of the unwanted frequent complications is chronic postoperative pain. It can begin as an acute postoperative pain that is difficult to control, the provoking factor can be opioid hyperalgesia. A multimodal analgesia strategy involves combinations of analgesics to achieve clinically necessary analgesia while minimizing significant side effects and reduces dependence of any drug and is an important component of enhanced recovery after surgery (ERAS) protocols.
 Goal. To assess the efficiency of the types of anesthesia regarding postoperative analgesia and the speed of recovery from the standpoint of patient safety.
 Materials and methods. 66 patients who underwent surgical treatment of abdominal wall hernias took part in the study. They were divided into 3 groups according to the type of anesthesia (general, neuraxial and fascial blockades of the abdominal wall). Analyzed according to the risk of anesthesia. At different stages of the perioperative period, the use of analgesics was analyzed, the speed of awakening and the intensity of pain according to the VAS scale on the first day were assessed.
 Results and discussion. The number of patients with the risk of ASA II was greater in the first group (general anesthesia), with the risk of ASA III in the second and third groups (neuraxial anesthesia and fascial blocks), which to some extent affected the choice of the type of anesthesia. According to the Aldrete awakening scale, after the operation, the patients of group 3 had the highest score, respectively, and the shortest time of transfer to the postoperative ward. 42% of patients in group 1 and all patients in group 2 received postoperative analgesia with the use of narcotic analgesics once. Patients in group 3 did not receive narcotic analgesics for postoperative analgesia.
 Conclusions. The choice of anesthesia method is important to achieve effective results of rapid recovery. Neuraxial and fascial blocks promote faster recovery and allow to reduce or avoid the use of opioid analgesics during surgery. Fascial blocks of the abdominal wall provide long-term and adequate analgesia in the first day of the postoperative period after hernioplasty of the abdominal wall.

A Study of Physical Resilience and Aging (SPRING): Conceptual framework, rationale, and study design.

Understanding the physiological basis of physical resilience to clinical stressors is crucial for the well-being of older adults. This article presents a novel framework to discover the biological underpinnings of physical resilience in older adults as part of the "Characterizing Resiliencies to Physical Stressors in Older Adults: A Dynamical Physiological Systems Approach" study, also known as The Study of Physical Resilience and Aging (SPRING). Physical resilience, defined as the capacity of a person to withstand clinical stressors and quickly recover or improve upon a baseline functional level, is examined in adults aged 55 years and older by studying the dynamics of stress response systems. The hypothesis is that well-regulated stress response systems promote physical resilience. The study employs dynamic stimulation tests to assess energy metabolism, the hypothalamic-pituitary-adrenal axis, the autonomic nervous system, and the innate immune system. Baseline characteristics influencing resilience outcomes are identified through deep phenotyping of physical and cognitive function, as well as of biological, environmental, and psychosocial characteristics. SPRING aims to study participants undergoing knee replacement surgery (n = 100), bone and marrow transplantation (n = 100), or anticipating dialysis initiation (n = 60). Phenotypic and functional measures are collected pre-stressor and at multiple times after stressor for up to 12 months to examine resilience trajectories. By improving our understanding of physical resilience in older adults, SPRING has the potential to enhance resilient outcomes to major clinical stressors. The article provides an overview of the study's background, rationale, design, pilot phase, implementation, and implications for improving the health and well-being of older adults.

‘If in Doubt, Sit Them Out’: How Long to Return to Elite Cycling Competition following a Sports-Related Concussion (SRC)?

A concussion or sports-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. After a SRC diagnosis is made, a concussed individual must undergo a period away from competition while they return to their baseline level of functioning. The Union Cycliste Internationale (UCI) currently recommend a minimum of 6 days restriction from competitive cycling following a SRC but there is a growing feeling amongst those involved in brain injury research that this period is too short. Therefore, how much time should cyclists be removed from competitive sporting action following a SRC? To review the time out of competition following the diagnosis of a SRC for elite cyclists within British Cycling (BC). All medical records for elite cyclists within BC were audited for diagnoses of "concussion" or "sports-related concussions" from January 2017 until September 2022. The days out of competition following the concussion until ready to compete again (that is, returned to full training) was then calculated. All diagnoses and management of SRC were undertaken by the medical team at BC and in-keeping with current international guidelines. Between January 2017 and September 2022, there were 88 concussions diagnosed, 54 being males and 8 in para-athletes. The median duration for time out of competition for all concussions was 16 days. There was no statistical difference between males (median 15.5 days) and females (median 17.5 days) for time out of competition (p-value 0.25). The median duration out of competition following a concussion for able-bodied athletes was 16 (80 athletes) compared to 51 days (8 athletes) in para-cyclists, which was not statistically different (p-value 0.39). This is the first study to report SRC concussion recovery times in elite cycling, including para-athletes. Between January 2017 and September 2022, there were 88 concussions diagnosed at BC and the median duration for time out of competition for all concussions was 16 days. There was no statistically significant difference in recovery times between male and females and para- and able-bodied athletes. This data should be used to help establish minimum withdrawal times post-SRC for elite cycling participation and we call on the UCI to review this data when establishing SRC protocols for cycling, with further research required in para-cyclists.

Percutaneous coronary interventions in patients over 80 years old age with acute coronary syndrome

Age is an important non-modifi able risk factor for cardiovascular disease. Both European and American guidelines recommend offering an invasive reperfusion strategy in elderly patients with ACS, taking into account the patients‘ comorbidities and baseline level of functioning. Materials and methods: All patients over 80 years of age with acute coronary syndrome, treated in the Department of Invasive Cardiology of the National Heart Hospital for the period between January 1, 2016. and December 31, 2018, are retrospectively analyzed. The primary endpoint was defi ned as all-cause mortality during the hospital stay and at follow-up. Predictors of mortality were assessed and independent predictors were identifi ed. Results: During the study period, 179 patients aged 80 years or older were identifi ed as being treated for ACS with PCI. In the study population, in hospital mortality for the index event was 11.8%. At a mean follow-up time of 20.19 ± 11.9 months, mortality rose signifi cantly to 64.6%. When evaluating in-hospital mortality on multivariate analysis, the two independent predictors were Cardiogenic shock (HR 0.005, 95% CI 0.01–0.44; p < 0.001) and acute/exacerbated renal failure (0.986 95% CI 0.984-0.997; p = 0.015). Conclusion: The present study provides important information regarding characteristics and outcomes in very elderly patients undergoing PCI for ACS. In the future, this subset of patients is predicted to grow, meaning that their approach must be evidence-based to ensure safe and effective treatment options.

Man with leg pain.

A 66-year-old-male with a history of type 2 diabetes and hypertension presented as a transfer for rapid progression of lower extremity pain, swelling, and blue-purple discoloration of the entire limb (Figure 1) with concern for a possible necrotizing infection. His symptoms began earlier in the day and progressed over just a few hours. He had no known thromboembolic risk factors. Initial vital signs were notable only for a heart rate of 115. Point-of-care ultrasound revealed extensive deep venous thrombosis burden confirmed by formal duplex sonography. The patient was admitted on a heparin infusion and underwent EKOSTM catheter directed tissue plasminogen therapy with stent placement. He was admitted for 5 days and successfully discharged on oral anticoagulation back to his baseline level of function. Phlegmasia cerulea dolens Phlegmasia cerulea dolens (PCD) is a rare ischemic complication of massive venous thromboembolism with high rates of morbidity and mortality. Patients present with limb edema, pain, and cyanosis that can quickly develop into compartment syndrome, limb ischemia, and venous gangrene with amputation and death rates as high as 50% and 40%, respectively.1 PCD tends to affect the iliofemoral segment of the lower extremities.2 Non-traumatic cases of PCD are most commonly associated with malignancy.3 The preferred imaging modality is Doppler ultrasound and use of point-of-care ultrasound by physicians can expedite treatment of PCD.4 Management includes limb elevation, intravenous fluids, and either systemic anticoagulation, catheter-directed thrombolysis, thrombectomy, or a combination of these definitive therapies.5

927: DABBING LUNG INJURY MANAGED BY VV ECMO

Introduction: E-cigarette or vaping-associated lung injury (EVALI) is an uncommon complication of e-cigarettes or vaping. Most cases are associated with tetrahydrocannabinol (THC) containing products. “Dabbing” refers to the process of ingesting high concentrations of THC-containing oils or waxes with butane solvents to vaporize cannabinoids for inhalation. Another distinction is the presence of impurities and unpurged butane in the vapors inhaled by the users. Description: A 29-year-old male presented with cough, dyspnea, and fever seven days prior to admission. He reported smoking marijuana but denied vaping. Initial chest radiograph demonstrated multifocal pneumonia. PCR for SARS-CoV-2 was negative. He required four liters of supplemental oxygen. Physical exam was remarkable for diffuse pulmonary crackles. Broad spectrum antibiotics for pneumonia were initiated. Oxygen requirements rapidly increased, prompting intubation 48 hours from presentation. Ventilator settings escalated to a positive end-expiratory pressure of 18 cm H2O with 100% FiO2. Computed tomography angiography ruled out pulmonary embolism, however showed diffuse patchy nodular and confluent opacities. Respiratory cultures grew commensal flora and blood cultures were negative. Comprehensive laboratory investigations for an infectious etiology and autoimmune vasculitis were negative. In further discussion with the patient’s wife, he has been “dabbing” for the past six months. High dose intravenous steroids were initiated. The patient continued to have refractory hypoxemic and hypercapnic respiratory failure with ARDS requiring prone positioning. The patient ultimately required transition to veno-venous extracorporeal membrane oxygenation (VV-ECMO). The patient received 12 days of VV-ECMO and was eventually liberated after 19 days of ventilator support. At discharge he was asymptomatic, at his baseline level of function, and required no supplemental oxygen. He was discharged on daily steroids with a taper and outpatient follow-up. Discussion: The necessity of VV-ECMO utilization in “dabbing” associated acute lung injury represents a rare severe presentation. Dabbing is emerging as a trend among young adults and represents an under-investigated cause of severe inhalational lung injury.

Assessing the Recovery Process after a Vaso Occlusive Crisis

Introduction: Adults with sickle cell disease (SCD) suffer from vaso-occlusive pain episodes (VOEs) for which they often receive care in infusion clinics (ICs). Typically, 80% of patients treated for VOE are discharged home but it is not clear how long it takes to recover to baseline functioning after an acute visit.1 Recent clinical trials have struggled to identify practical and useful outcomes for novel therapies that decrease the length of VOE or pain during hospitalization. As many patients with VOE are seen and treated in an IC and discharged home, identifying potential endpoints for novel therapies in this site of care are needed. The purpose of this study was to measure time to recovery for two weeks post an IC visit for management of VOE and to identify patient characteristics that predict a return visit for pain management within that time period. Methods: A convenience sample of adults with SCD (≥18YO) were consented to and enrolled into this IRB-approved study during a visit to the IC for VOE. Medical records of all subjects were reviewed to collect data on the number of acute visits, hospitalizations, use of disease-modifying therapies, use of pain medications, baseline laboratory data, and comorbidities. Data was collected on the date VOE pain started, pain scores before and after treatment, and analgesic management. Baseline surveys were collected on the day of the visit and patients were sent follow-up surveys after discharge electronically through REDCap on post-discharge days 2,4,6,8,10,12,14. Participants were asked to rate their pain on a 0-10 Visual Analog Scale. The PROMIS pain interference and Fatigue scales were used to assess pain impact and the Subjective Opioid Withdrawal Scale (SOWS) was used to assess for signs of opioid withdrawal. Return to baseline functioning was estimated by asking participants at each contact post-visit to rate their current level of functioning in activities of daily living on a scale of 0-100, with 100 being their baseline level of function. A similar scale was used to measure the resolution of pain, with the anchor being "back to your usual, non-crisis, level of daily pain." Subjects were encouraged to complete surveys through text message reminders and were compensated with a fifty-dollar gift card if all surveys were completed. Cox proportional hazards modeling was used to examine predictors of time to a return acute care visit within 14 days of the index visit. Results: Table 1 shows the characteristics of the 48 patients enrolled in the study. Despite multiple text/email reminders, few patients completed all the surveys (8/48). Thirty-two out of 48 people completed initial surveys. Of the 17 patients who completed a day 2 or later SOWS score 7 had moderate or severe withdrawal symptoms and of those 3 had a return visit within 14 days while 5/10 of those with mild scores had a return visit. Nineteen out of 48 patients returned for treatment within 14 days. Controlling for pain at discharge, sex, and genotype only the number of acute visits in the six months prior to the index visit was associated with a return visit in 14 days (HR 1.31, 95% CI: 1.13 1.53). The figure shows the probability of a return visit over time by genotype. The median number of visits the entire cohort had in the six months prior to the index visit was 4.5 (IQR: 2,10) however, in those patients that returned for treatment within 14 days the median number of visits in the last six months was 8 (IQR: 5,11). Conclusions: In this study of patients' experience post an acute visit for pain management at an IC, we identified that the number of acute visits in the six months prior to the index visit predicted a return visit within 14 days. It was challenging for patients to complete surveys after their acute visits suggesting that this was not a feasible way to collect these important patient-reported outcomes. With almost 40% of patients returning for an acute care visit within 14 days, decreasing the percentage of patients with return visits may be a potential outcome for trials of novel therapies to treat VOE in the IC setting. 1. Lanzkron S, Carroll CP, Hill P, David M, Paul N, Haywood C, Jr. Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis. Am J Hematol. 2015;90(5):376-380. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

P.67 Development and evaluation of a time to event endpoint for clinical trials in Duchenne muscular dystrophy (DMD)

Event-driven clinical trials, commonly used in oncology, offer several benefits over continuous outcome measures: i) each patient is assessed individually, ii) after the event has occurred, patients can receive therapy without breaking the blind. This study aimed to develop a time-to-event outcome measure for the North Star Ambulatory Assessment (NSAA) corresponding to clinically meaningful disease progression in DMD. Three candidate definitions based on changes in NSAA were investigated: A) Loss of 3 NSAA total score points; B) Loss of 2 distinct NSAA items; C) Loss of 3 NSAA points or loss of 2 NSAA items. To evaluate these definitions, 619 DMD patients with expected decline in motor function (baseline rise from supine ≥5 seconds) were studied from 3 clinical trial placebo arms and 4 natural history studies. At baseline, mean age was 9.3 years (range: 6-18yrs), mean NSAA total score was 22 (range:12-34); 63% were receiving prednisone, 37% deflazacort, and 0.4% no steroids. For each definition, median time to progression was 11.0, 14.0 and 8.3 months, respectively, based on Kaplan-Meier analyses. As a measure of prognostic validity, a progression event during the first year of follow-up was associated with significantly shorter time to loss of ambulation, with hazard ratios of 2.5, 6.5 and 3.2, respectively (all p<0.05), based on landmark analyses. Stability of the progression definitions varied, with approximately 10%, 19% and 12%, respectively, regaining their baseline level of function within a year. Definition A exhibited a favorable combination of event rate, prognostic validity, and stability. A hypothetical, well-powered, randomized, event-driven trial based on endpoint A and enrolling 160 DMD patients over a period of 9 months would require an expected duration of 10, 14, or 25 months to detect treatment effects delaying progression by 13.0, 8.4 or 5.4 months, respectively. Thus, event-driven trials may be viable for drug development in ambulatory DMD.

Examining the Long-Term Sequelae of SARS-CoV2 Infection in Patients Seen in an Outpatient Psychiatric Department.

BackgroundThe acute phase of Coronavirus disease-19 (COVID-19) is well known. However, there is now an increasing number of patients suffering from the post-acute sequelae of COVID-19 (PASC Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis), including neuropsychiatric symptoms. The purpose of this report is to describe the sociodemographic, diagnostic and treatment characteristics of patients evaluated in an outpatient psychiatric setting for PASC.MethodsA retrospective review of 30 individuals with documented COVID-19 illness treated at a university hospital-based Post-COVID-19 Recovery Program were referred to an outpatient psychiatric department for consultation and treatment from December 2020 to July 2021. All individuals complained of neuropsychiatric symptoms including anxiety, depression, fatigue and cognitive problems. Data on sociodemographic characteristics, psychiatric diagnosis, prominent psychological themes and treatment prescribed were described and, where applicable, analyzed with SPSS software.ResultsThe study population consisted of patients between 25 and 82 years old, with a predominance of women between 46 and 60 years. Approximately half of the patient population had a primary diagnosis of major depressive disorder, often combined with prominent anxiety. Over two-thirds of the patient population reported a combination of depression, fatigue and cognitive complaints, predominantly memory and slowed processing speed. Prominent stressors and psychological themes included social and occupational decline, isolation, lack of empathy and understanding from family, friends and employers, and apprehension about future ability to return to their baseline level of function. Treatments recommended included individual and group psychotherapy, medication and cognitive rehabilitation. Modafinil and antidepressants, often in combination, were the most commonly used medications, intended to target the pervasive fatigue, depressive, and anxiety these individuals were facing.ConclusionClinical experience from this patient population underscored the significant medical, emotional, neurocognitive and functional sequelae of PASC. Management of these individuals requires a collaborative approach with the availability of psychotherapeutic interventions, pharmacologic treatment, neurocognitive assessment and remediation to address these symptoms.

Baseline Gross Motor Function Affects the Outcome of Robot-Assisted Therapy in Ambulatory Individuals with Spastic Cerebral Palsy.

Robotic-assisted therapy (RAT) is a task-specific approach for treating gait disorders in individuals with neurological impairments. However, the effectiveness of RAT is not clear for different severities of involvement, pathologies, and ages. This study aimed to assess the functional and clinical status outcomes after RAT in individuals with cerebral palsy (CP). Twenty-eight individuals with bilateral spastic CP were enrolled (female = 10; male = 18; age = 15.2 ± 2.0 years). The RAT program consisted of 30 sessions: five sessions weekly for six weeks. Gross Motor Function Measure (GMFM) and clinical physical examinations were evaluated before and after RAT. Our results suggested that the RAT program with the described protocol can improve the general gross motor functions of individuals with CP in Gross Motor Function Classification System (GMFCS) levels I and II, and primarily improves performance on less complex GMFM items for those in GMFCS levels III and IV. The lower baseline functional level was related to a greater functional improvement. Older individuals were noticed to improve more in GMFM dimension D. Regarding impairments evaluated by clinical examinations, no change was found after RAT intervention. It is worth mentioning that the strength of knee muscles was not affected either.

Major depressive disorder: Validated treatments and future challenges.

Depression is a prevalent psychiatric disorder that often leads to poor quality of life and impaired functioning. Treatment during the acute phase of a major depressive episode aims to help the patient reach a remission state and eventually return to their baseline level of functioning. Pharmacotherapy, especially selective serotonin reuptake inhibitors antidepressants, remains the most frequent option for treating depression during the acute phase, while other promising pharmacological options are still competing for the attention of practitioners. Depression-focused psychotherapy is the second most common option for helping patients overcome the acute phase, maintain remission, and prevent relapses. Electroconvulsive therapy is the most effective somatic therapy for depression in some specific situations; meanwhile, other methods have limits, and their specific indications are still being studied. Combining medications, psychotherapy, and somatic therapies remains the most effective way to manage resistant forms of depression.

Evolución funcional y del estado de ánimo de pacientes tras ingreso por COVID-19 en una unidad de Cuidados Intensivos

ObjectiveDescribe the functional situation of patients one and two months after admission for COVID-19 pneumonia in an intensive care unit (ICU) and affect their mood one month after hospital discharge. DesignProspective cohort study was carried out. PatientsPatients admitted to the ICU for COVID-19 pneumonia during the months of February to July 2020. Primary variables of interestDemographic data, mortality, ICU stay and hospital stay, destination at discharge, functional status at baseline (Barthel Index), after discharge, at one month and two months, physiotherapy treatment and impact on mood (Hospital Anxiety and Depression Scale). Results89 patients were admitted in ICU with a mortality rate of 48.3% in the ICU. Among the survivors, 42 patients completed the follow-up at two months. Functional deterioration was observed at ICU discharge in 97.6% and at hospital discharge in 76.2%. At follow-up, 66.7% of patients had recovered their baseline functional level one month after leaving the hospital and 85.7% had done so after two months. One month after discharge, 12% of the patients had results compatible with anxiety and 20% had results compatible with depression. ConclusionsPatients admitted to the ICU for COVID-19 pneumonia have high hospital mortality, and those who survive show severe functional deterioration after admission. Two months after hospital discharge, most survivors recover their baseline functional status and mood prior to admission.

Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol

BackgroundTransitional care involves time-limited interventions focusing on the continuity of care from hospital to home, to optimize patient functioning and management. Providing interventions, as part of transitional care, that optimize the functioning of older people with dementia is critical due to the small window of opportunity in which they can return to their baseline levels of functioning. Yet prior research on transitional care has not included interventions focused on functioning and did not target older people with dementia in rural communities, limiting the applicability of transitional care to this population. Accordingly, the goal of this study is to align hospital-to-home transitional care with the function-related needs of older people with dementia and their family-caregivers in rural communities.MethodsIn this multimethod study, two phases of activities are planned in rural Ontario and Nova Scotia. In phase I, a purposive sample of 15–20 people with dementia and 15–20 family-caregivers in each province will rate the acceptability of six evidence-based interventions and participate in semi-structured interviews to explore the interventions’ acceptability and, where relevant, how to improve their acceptability. Acceptable interventions will be further examined in phase II, in which a purposive sample of healthcare providers, stratified by employment location (hospital vs. homecare) and role (clinician vs. decision-maker), will (1) rate the acceptability of the interventions and (2) participate in semi-structured focus group discussions on the facilitators and barriers to delivering the interventions, and suggestions to enable their incorporation into rural transitional care. Two to three focus groups per stratum (8–10 healthcare providers per focus group) will be held for a total of 8–12 focus groups per province. Data analysis will involve qualitative content analysis of interview and focus group discussions and descriptive statistics of intervention acceptability ratings.DiscussionFindings will (1) include a set of acceptable interventions for rural transitional care that promote older patients’ functioning and family-caregivers’ ability to support patients’ functioning, (2) identify resources needed to incorporate the interventions into rural transitional care, and (3) provide high-quality evidence to inform new transitional care practices and policies and guide future research.

Dementia in people with severe or profound intellectual (and multiple) disabilities: Focus group research into relevance, symptoms and training needs.

BackgroundDifferentiating dementia from baseline level of functioning is difficult among people with severe/profound intellectual (and multiple) disabilities. Moreover, studies on observable dementia symptoms are scarce. This study examined (a) the relevance of dementia diagnosis, (b) observable symptoms and (c) training/information needs.MethodsFour explorative focus groups were held with care professionals and family members who have experience with people with severe/profound intellectual (and multiple) disabilities (≥40 years) and decline/dementia.ResultsThematic analysis showed that participants wanted to know about a dementia diagnosis for a better understanding and to be able to make informed choices (question 1). Using a categorisation matrix, cognitive and behavioural changes were shown to be most prominent (question 2). Participants indicated that they needed enhanced training, more knowledge development and translation, and supportive organisational choices/policies (question 3).ConclusionsTimely identifying/diagnosing dementia allows for a timely response to changing needs. This requires a better understanding of symptoms.

Prehabilitation for gastrointestinal cancer patients

Gastrointestinal cancer and related treatments (surgery and chemoradiotherapy) are associated with declined functional status (FS) that has impact on quality of life, clinical outcome and continuum of care. Psychological distress drives an impressive burden of physiological and psychiatric conditions in oncologic care. Cancer patients often experience anxiety, depression, low self-esteem and fears of recurrence and death. Cancer prehabilitation is a process from cancer diagnosis to the beginning of treatment, which includes psychological, physical and nutritional assessments for a baseline functional level, identification of comorbidity, and targeted interventions that improve patient's health and functional capacity to reduce the incidence and the severity of current and future impairments with cancer, chemoradiotherapy and surgery. Multimodal prehabilitation program encompasses a series of planned, structured, repeatable and purposive interventions including comprehensive physical exercise, nutritional therapy, and relieving anxiety and depression, which integrates into best perioperative management ERAS pathway and aims at using the preoperative period to prevent or attenuate the surgery-related functional decline, to cope with surgical stress and to improve the consequences. However, a number of questions remain in regards to prehabilitation in gastrointestinal cancer surgery, which consists of the optimal makeup of training programs, the timing and approach of the intervention, how to improve compliance, how to measure functional capacity, and how to make cost-effective analysis. Therefore, more high-level evidence-based studies are expected to evaluate the value of implementation of prehabilitation into standard practice.

Revisions and updates to the Everyday Cognition (ECog) scales

AbstractBackgroundAccurate and reliable assessment of everyday functional abilities among older adults is important in clinical and research settings. The Everyday Cognition scale (ECog) was designed over a decade ago to measure early everyday functional limitations across multiple domains: Everyday Memory, Language, Visuospatial Abilities, Planning, Organization, and Divided Attention. The ECog has been shown to be sensitive to early detection of neurodegenerative disease such as Alzheimer’s, and in tracking disease progression. The goal of the current study was to update the content of the ECog and ensure its culturally applicable to diverse older adult populations.Method42 individuals were included in the study. Participants included older adults with and without Mild Cognitive Impairment (MCI) and their informants/study partners. 66% of the sample was of an ethnic minority. We utilized iterative cognitive interviewing methods to examine the understandability and cultural relevance/applicability of ECog items. This information was then used to modify existing items, delete poor items, and develop new items as needed. Two rounds of interviews were completed with older adults and informants. The purpose of Round 1 was to inform the revision of existing items and elicit new items. The purpose of Round 2 was to confirm the understandability of items revised or produced from Round 1. All interviews were transcribed verbatim and analyzed using standard qualitative methods.ResultBased on analysis of interview feedback, instructions to the ECog were modified slightly to emphasize current performance is being compared to an individual’s own baseline level of function. Response options remained primarily unchanged from the original version. When evaluating each of the individual items, participant feedback lead to 15 of the 39 original items being revised to improve item clarity and understandability. A total of 4 items were deleted;3 due to outdated content (e.g., using a map, balancing a checkbook) and 1 because it was vague. A total of 6 entirely new items were developed, primarily to cover more contemporary activities (e.g., use of technology).ConclusionThe final revised ECog includes 41 items. Future work will validate the revised ECog by measuring it in association with neuropsychological performance, external measures of disease, and other functional measures.