Care Sessions Research Articles

Systematic Review of Kangaroo Care Duration's Impact in Neonatal Intensive Care Units on Infant-Maternal Health.

Kangaroo care (KC), skin-to-skin contact between infants and caregivers, is encouraged in neonatal intensive care units (NICUs) to support health through improved weight, growth, and infant-maternal attachment while reducing the incidence of sepsis and infant pain. However, the optimal duration and frequency of KC to maximize health outcomes is unknown. Given parents' time stressors, identifying optimal KC time is critical. A literature review was undertaken on May 28, 2021 via querying the PubMed database from January 1, 1995, to May 28, 2021, regarding KC and NICUs with 442 results. Eleven studies met the eligibility criteria of (1) comparative KC between infants and adult caregivers in NICUs as a randomized controlled trial, (2) peer-reviewed articles in English, (3) study subjects ≥5, (4) health outcomes, and (5) KC sessions >1. Infant physical growth parameters, infant neurodevelopment, infant stress via salivary cortisol levels, and breastfeeding outcomes appear to increase with KC as compared with standard care (SC) without KC. Improvements were observed with longer KC duration, 2 h/d as compared with 1 h/d, for neurodevelopment and breastfeeding outcomes, but no greater improvement with longer KC duration was shown for reducing infant stress through salivary cortisol levels. Regarding maternal stress, the influence of KC duration showed mixed Parental Stressor Score: NICU scores. Further study on the impact of KC duration and frequency on health outcomes and dose-response relationship would help determine how much and how frequent KC is needed to improve specific health outcomes for infants and their mothers. KEY POINTS: · Data on kangaroo care duration's health impacts is lacking.. · Establishing dose-response for kangaroo care is needed.. · Kangaroo care for longer improves some but not all outcomes..

Cost-Utility Analysis of a Medication Adherence-Enhancing Educational Intervention for Glaucoma

To evaluate the cost utility of a glaucoma medication-enhancing intervention compared to standard of care over a lifetime from the United States Department of Veterans Affairs (VA) payer perspective. Model-based cost-utility analysis of a glaucoma medication-enhancing intervention from a randomized clinical trial. Veterans with glaucoma, or suspected glaucoma who were prescribed topical glaucoma medications, had their visual field assessed within the last 9 months, and endorsed poor glaucoma medication adherence. Veterans were randomized either to a behavioral intervention to promote adherence or to a standard of care (control) session about general eye health. A decision analytic model was developed to simulate lifelong costs and quality-adjusted life years (QALYs) for an intervention tested in a randomized clinical trial at a single VA eye clinic. Costs included direct medical costs that the VA payer would incur, as informed initially by the clinical trial and then by published estimates. Health-state quality of life was based on published utility values. Scenario analyses included addition of booster interventions, a 3% decline in chance of staying medication adherent annually, and the combination of the two. Analyses were also conducted in the following subgroups: those with companion versus not, and those with once-daily versus more than once-daily dosing frequency. Incremental cost-effectiveness ratio (ICER). Compared to standard of care, the intervention dominated resulting in lower costs ($23 339.28 versus $23 504.02) and higher QALYs (11.62 versus 11.58). Among the 4 subgroups, the intervention dominated for 3 of them. In the fourth subgroup, those with more than once-daily dosing, the ICER was $2625/QALY. Compared to standard of care, an intervention with booster interventions led to an ICER of $3278/QALY. Assuming both a 3% annual loss in chance of continuing to be adherent and addition of booster interventions, the ICER increased to $71 371/QALY. From a VA payer perspective over a lifetime, the glaucoma medication-enhancing behavioral intervention dominated standard of care in terms of generating cost savings and greater QALYs. Proprietary or commercial disclosure may be found after the references.

Student transition into higher education: Time for a rethink within the subject of sport and exercise science?

The first year of higher education (HE) marks one of the most significant transitions in a student’s life. Within the U.K., the subject area of Sport and Exercise Science (SES) has a problem with effectively supporting and retaining students as they transition into HE. If students’ capabilities to successfully transition are to be fully understood and resourced, it is necessary for research to foreground students’ lived realities. Utilising letter to self-methodology, 58 s- and third-year undergraduate SES students wrote to their younger self, providing guidance on how to successfully transition into HE. Data were analysed using reflexive thematic analysis. Six themes and four sub-themes were identified. Following the development of a single composite version of an “Older, wiser self letter” to represent the identified themes, this resource was integrated into the institution’s pastoral care resources and sessions where personal tutors connected with their tutees. Student member reflections were completed to gather feedback regarding the resource’s effectiveness. The composite letter provides an authentic account of how to face obstacles encountered as students transition into HE. Students’ member reflections highlighted that the letter was a valuable resource as a prompt for discussion regarding their experiences of transitioning into HE. When in the student journey the letter was read was particularly important. The value of this composite letter lies in the implementation of tutor-tutee and student peer-peer conversations at key “moments” throughout their journey in HE, helping students understand the challenges and opportunities for success during transition.

Does group physiotherapy improve pain scores and reduce the impact of pelvic pain for women referred with persistent pelvic pain? A clinical trial

Introduction: This study aimed to test group Physiotherapy sessions – pain education and supervised exercise − in addition to individual consultations, for women referred with persistent pelvic pain (with/without endometriosis), with the primary outcomes being pain scores and pain impact. Methods: Parallel study design with three treatment arms: (1) usual care: a suite of individual Physiotherapy consultations; (2) introductory group pain education session followed by usual care and (3) introductory group pain education session followed by usual care and an 8-week supervised group exercise programme. Results: Ninety women were recruited (30/treatment arm), with 66 women (73%) completing their allocated treatment. Participants were aged between 16 and 51 years; endometriosis was confirmed in 41% ( n = 27/66) of the study population. Data was analysed using descriptive and inferential statistics. Statistically significant gains ( p < 0.05) in pain scores and pelvic pain impact scores were observed in all arms. Between groups, there was statistically significant improvement ( p < 0.05) in pelvic pain impact score for those who attended the group pain education session followed by usual care (arm 2), compared to usual care (arm 1) alone. There was no significant added improvement with the weekly supervised group exercise programme (arm 3), when compared to those who received the group pain education programme and usual care (arm 2). Conclusion: This study has demonstrated positive benefits of a group pain education session on pain scores and pelvic pain impact for women referred with persistent pelvic pain, when added as a precursor to individual Physiotherapy consultations.

Oral Health Status and Oral Hygiene Practices among Urban Slum Dwellers in Rawalpindi, Islamabad, Pakistan

Poor oral hygiene is a major factor for oral diseases. Urban slums are recognized as a risk group population as the burden of oral diseases is highest among them. Objectives: To evaluate the oral health status of slums using Decayed, Missed, and Filled Tooth index. To evaluate the oral health status of slums using Community Periodontal Index for Treatment Need. Methods: A cross-sectional study was carried out on 385 urban slum people aged between 20 to 50 years. A convenient sampling method was adopted. Data were collected by structured questionnaire included information related to patient’s knowledge, attitude, and behavior towards oral hygiene and interviewed by trained staff. Oral examinations were performed in line with WHO guidelines. After taking informed consent oral examinations were done by fresh graduate and DMFT and CPITN index were evaluated. Results: Study participants were assessed for attitude, knowledge and oral health behavior, 47% had Good Attitude, only 6% had Very Good Knowledge and < 1% had Very Good oral health behavior. Mean DMFT and CPITN score among Slums came 8.91 + 7.627 and 1.93 + 0.971 respectively. More than a third of the slums population required emergency levels dental treatments. Conclusions: The residents of slums have poor oral hygiene and high prevalence of dental caries. Low socioeconomic status, and lack of primary dental care programs and session are main reasons for poor oral health

Evaluation of the Injection Pain with the Use of Vibraject during Local Anesthesia Injection for Children: A Randomized Clinical Trial

To compare the outcomes of the conventional syringe and the outcomes of the vibraject-assisted injection (VAI) in terms of the pain of the needle insertion during various intraoral injections of local anesthesia in children aged 6-9 years. A total number of 75 children aged 6-9 years were selected from patients visiting the pediatric dental clinic at Damascus University. The children were assigned into three equal groups (25 children each) according to the type of intraoral injection needed for the treatment: Groups [Group I: received upper buccal infiltrations (UBI), Group II: received posterior palatal infiltrations (PPI), and Group III: received inferior alveolar nerve block (IANB)]. This study was conducted considering the split-mouth design. Each child was subjected to both anesthetic injections: the conventional and the vibration-assisted in two separate dental visits 2 weeks apart. At each clinic visit, subjective and objective pain levels were assessed using the visual analog scale (VAS) and Face, Leg, Activity, Cry, Consolability (FLACC) scale. Children who received local anesthesia using the Vibraject method had lower VAS and FLACC scores than those who received local anesthesia using the conventional method. Vibraject was more effective in reducing the pain with local anesthetic injection compared to the conventional injection technique in clinical dental procedures for children. In a pediatric dental clinic, pain management is considered a pillar that influences actions. Using the VAI may achieve the ease, cooperation, and compliance during the dental care session.

PSYCHOSIS OR ENCEPHALITIS? HAVE A LOW INDEX OF SUSPICION FOR ANTI-N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ENCEPHALITIS

PSYCHOSIS OR ENCEPHALITIS? HAVE A LOW INDEX OF SUSPICION FOR ANTI-N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ENCEPHALITIS

WEST NILE-INDUCED MYASTHENIA GRAVIS CRISIS: AN UNEXPECTED CASE OF RESPIRATORY FAILURE

WEST NILE-INDUCED MYASTHENIA GRAVIS CRISIS: AN UNEXPECTED CASE OF RESPIRATORY FAILURE

TOO HOT TO GET DRESSED?

TOO HOT TO GET DRESSED?

IMPROVING THE UTILIZATION OF RESOURCES: CAN MILD TO MODERATE DIABETIC KETOACIDOSIS PATIENTS BE TREATED WITH SUBCUTANEOUS INSULIN ON THE MEDICAL WARD?

IMPROVING THE UTILIZATION OF RESOURCES: CAN MILD TO MODERATE DIABETIC KETOACIDOSIS PATIENTS BE TREATED WITH SUBCUTANEOUS INSULIN ON THE MEDICAL WARD?

IMMUNE CHECKPOINT INHIBITOR-INDUCED DIABETIC KETOACIDOSIS: A RARE SIDE EFFECT

IMMUNE CHECKPOINT INHIBITOR-INDUCED DIABETIC KETOACIDOSIS: A RARE SIDE EFFECT

A CASE OF SECONDARY ORGANIZING PNEUMONIA FROM INFLIXIMAB

A CASE OF SECONDARY ORGANIZING PNEUMONIA FROM INFLIXIMAB

BABESIA MICROTI INFECTION WITH LOW-GRADE PARASITEMIA CAUSING ARDS IN AN IMMUNOCOMPETENT PATIENT

BABESIA MICROTI INFECTION WITH LOW-GRADE PARASITEMIA CAUSING ARDS IN AN IMMUNOCOMPETENT PATIENT

ACUTE KIDNEY INJURY AS A PREDICTOR OF MORTALITY IN PATIENTS WITH COVID-19

ACUTE KIDNEY INJURY AS A PREDICTOR OF MORTALITY IN PATIENTS WITH COVID-19

LEUKOENCEPHALOPATHY FROM HEROIN INHALATION: CHASING THE DRAGON

LEUKOENCEPHALOPATHY FROM HEROIN INHALATION: CHASING THE DRAGON

DOCTORS WITHOUT "BOARDERS": EFFECTS OF BOARDING MEDICAL ICU PATIENTS

DOCTORS WITHOUT "BOARDERS": EFFECTS OF BOARDING MEDICAL ICU PATIENTS

EFFICACY AND SAFETY OF THERAPEUTIC VERSUS PROPHYLACTIC ANTICOAGULATION IN PATIENTS WITH COVID-19 INFECTION: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

EFFICACY AND SAFETY OF THERAPEUTIC VERSUS PROPHYLACTIC ANTICOAGULATION IN PATIENTS WITH COVID-19 INFECTION: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

FACTORS ASSOCIATED WITH FAVORABLE OUTCOMES IN CARDIAC ARREST AND TARGET TEMPERATURE MANAGEMENT

SESSION TITLE: Late Breaking Posters in Critical CareSESSION TYPE: Original Investigation PostersPRESENTED ON: 10/18/2022 01:30 pm - 02:30 pmPURPOSE: While guidelines strongly recommend targeted temperature management (TTM), whether early initiation of TTM or time-to-target temperature (TTT) are associated with better outcomes remains elucidated.METHODS: This is a retrospective observational study at a tertiary care hospital in Honolulu, Hawaii. Those who had an out-of-hospital or in-hospital cardiac arrest (OHCA or IHCA) undergoing TTM from November 1, 2020 to August 31, 2021 were included. Patients were dichotomized by the median time to TTM initiation, time from initiation of TTM to achieve target temperature, and TTT (into early and delayed groups).RESULTS: 86 patients (53 with OHCA and 33 with IHCA), mainly including Asian and Native Hawaiian and Pacific Islanders, were included. In multinominal logistic regression analysis, both Δ-temperature and TTT were not identified as factors associated with favorable neurological outcomes in neither OHCA nor IHCA groups. In the IHCA group, however, Δ-temperature and TTT were identified as factors associated with mortality, with a higher chance of survival in higher Δ-temperature (p = 0.039) and higher mortality in longer TTT patients (p = 0.017).CONCLUSIONS: There may be specific groups of patients who are likely to benefit from the prompt initiation of TTM, focusing on Δ-temperature as a variable of interest. Further studies are warranted to identify underlying mechanisms associated with the results and response to TTM in different races/ethnicities.CLINICAL IMPLICATIONS: The present study showed that there might be specific groups of patients who are likely to benefit from the prompt introduction of TTM, focusing on patients with baseline hyperthermia such as sepsis. Also, the results suggest the need to investigate the difference in response to TTM based on race and ethnicity since existing large-scale studies mainly included Caucasian patients.DISCLOSURES:No relevant relationships by Hangyul Chung-EsakiNo relevant relationships by Nobuhiko KimuraNo relevant relationships by Yoshito Nishimura SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: While guidelines strongly recommend targeted temperature management (TTM), whether early initiation of TTM or time-to-target temperature (TTT) are associated with better outcomes remains elucidated. METHODS: This is a retrospective observational study at a tertiary care hospital in Honolulu, Hawaii. Those who had an out-of-hospital or in-hospital cardiac arrest (OHCA or IHCA) undergoing TTM from November 1, 2020 to August 31, 2021 were included. Patients were dichotomized by the median time to TTM initiation, time from initiation of TTM to achieve target temperature, and TTT (into early and delayed groups). RESULTS: 86 patients (53 with OHCA and 33 with IHCA), mainly including Asian and Native Hawaiian and Pacific Islanders, were included. In multinominal logistic regression analysis, both Δ-temperature and TTT were not identified as factors associated with favorable neurological outcomes in neither OHCA nor IHCA groups. In the IHCA group, however, Δ-temperature and TTT were identified as factors associated with mortality, with a higher chance of survival in higher Δ-temperature (p = 0.039) and higher mortality in longer TTT patients (p = 0.017). CONCLUSIONS: There may be specific groups of patients who are likely to benefit from the prompt initiation of TTM, focusing on Δ-temperature as a variable of interest. Further studies are warranted to identify underlying mechanisms associated with the results and response to TTM in different races/ethnicities. CLINICAL IMPLICATIONS: The present study showed that there might be specific groups of patients who are likely to benefit from the prompt introduction of TTM, focusing on patients with baseline hyperthermia such as sepsis. Also, the results suggest the need to investigate the difference in response to TTM based on race and ethnicity since existing large-scale studies mainly included Caucasian patients. DISCLOSURES: No relevant relationships by Hangyul Chung-Esaki No relevant relationships by Nobuhiko Kimura No relevant relationships by Yoshito Nishimura

DASATINIB-INDUCED CHYLOTHORAX: A RARE CASE REPORT OF A 50-YEAR-OLD MAN WITH CHRONIC MYELOID LEUKEMIA

DASATINIB-INDUCED CHYLOTHORAX: A RARE CASE REPORT OF A 50-YEAR-OLD MAN WITH CHRONIC MYELOID LEUKEMIA

EFFECT OF MODAFINIL ON TIME TO WEAN FROM MECHANICAL VENTILATION

SESSION TITLE: Late Breaking Posters in Critical CareSESSION TYPE: Original Investigation PostersPRESENTED ON: 10/18/2022 01:30 pm - 02:30 pmPURPOSE: Modafinil is a wake promoting agent commonly used in sleep disorders. Sedation during mechanical ventilation in the ICU disrupts circadian rhythms and results in sleep disturbances and delirium. Wakefulness and ability to follow commands is a key component of successful extubation. This study evaluates the effect of modafinil on time to wean from mechanical intubation.METHODS: This study was a retrospective study conducted at a single urban center. Chart review was performed on 511 patients. Exclusion criteria included patients who expired, were transferred to hospice for terminal extubation or those who required tracheostomy (n=256). Sub-group analysis was done on patients intubated at least 5 days prior to initiation of weaning trials (n=81). Data was analyzed with medcalc statistical software.RESULTS: Patients who were treated with Modafinil had an overall longer time to wean from the ventilator as compared to patients who were not treated with Modafinil. Further evaluation showed patients who received Modafinil were intubated at least 5 days or more prior to initiation of the weaning process. Sub-group analysis of these patients intubated at least 5 days or more showed a decrease in mean time to wean from ventilation by 1 day (4 days with Modafinil and 5 days without Modafinil) with findings not statistically significant (p=0.673).CONCLUSIONS: Although our study showed reduction in mean number of days to wean from ventilation with Modafinil, these results were not statistically significant due to reduction in the power of the study after further exclusion of patients intubated less than 5 days during sub-group analysis. Future studies should involve a higher number of patients for increased power and assess other variables such as dosage effect of Modafinil, RASS score, GCS score, presence of other sedating medications, and reason for failure of pressure support trial.CLINICAL IMPLICATIONS: This research may serve as the basis for future studies regarding the effect of Modafinil on time to wean from ventilation. Implications include potentially decreasing time to wean from the ventilator and may serve as a strategy to decrease total time of intubation in patients by promoting wakefullness and restoring circadian rhythms. Decreasing time of intubation is beneficial to shorten ICU stay and minimize risks associated with prolonged mechanical ventilation.DISCLOSURES:No relevant relationships by AdeYinka AdeniyiNo relevant relationships by Chelsae Keeney SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Modafinil is a wake promoting agent commonly used in sleep disorders. Sedation during mechanical ventilation in the ICU disrupts circadian rhythms and results in sleep disturbances and delirium. Wakefulness and ability to follow commands is a key component of successful extubation. This study evaluates the effect of modafinil on time to wean from mechanical intubation. METHODS: This study was a retrospective study conducted at a single urban center. Chart review was performed on 511 patients. Exclusion criteria included patients who expired, were transferred to hospice for terminal extubation or those who required tracheostomy (n=256). Sub-group analysis was done on patients intubated at least 5 days prior to initiation of weaning trials (n=81). Data was analyzed with medcalc statistical software. RESULTS: Patients who were treated with Modafinil had an overall longer time to wean from the ventilator as compared to patients who were not treated with Modafinil. Further evaluation showed patients who received Modafinil were intubated at least 5 days or more prior to initiation of the weaning process. Sub-group analysis of these patients intubated at least 5 days or more showed a decrease in mean time to wean from ventilation by 1 day (4 days with Modafinil and 5 days without Modafinil) with findings not statistically significant (p=0.673). CONCLUSIONS: Although our study showed reduction in mean number of days to wean from ventilation with Modafinil, these results were not statistically significant due to reduction in the power of the study after further exclusion of patients intubated less than 5 days during sub-group analysis. Future studies should involve a higher number of patients for increased power and assess other variables such as dosage effect of Modafinil, RASS score, GCS score, presence of other sedating medications, and reason for failure of pressure support trial. CLINICAL IMPLICATIONS: This research may serve as the basis for future studies regarding the effect of Modafinil on time to wean from ventilation. Implications include potentially decreasing time to wean from the ventilator and may serve as a strategy to decrease total time of intubation in patients by promoting wakefullness and restoring circadian rhythms. Decreasing time of intubation is beneficial to shorten ICU stay and minimize risks associated with prolonged mechanical ventilation. DISCLOSURES: No relevant relationships by AdeYinka Adeniyi No relevant relationships by Chelsae Keeney