Early Recovery Phase Research Articles

“Manoeuvring in uncharted waters – a balancing act”: A qualitative exploration of treatment and improvement after mild traumatic brain injury

ABSTRACT Background: Individuals who have sustained mild traumatic brain injury (mTBI) with a protracted course of recovery may experience long-lasting somatic, cognitive, and emotional symptoms affecting activities of daily living. There is limited knowledge regarding individuals’ lived experiences with treatments and advice provided. Purpose: To explore how individuals with mTBI describe and make sense of their injury, recovery process, and their experiences with various treatment approaches. Methods: Eight participants with mTBI were recruited from the intervention group in an ongoing randomized controlled trial regarding return-to-work. They were interviewed once after treatment delivery using a qualitative hermeneutical approach. Thematic analysis was applied, and findings are discussed in light of a salutogenic theory. Results: Participants expressed uncertainty regarding conflicting advice they received in the early phase of recovery. Three main themes were developed: (1) “Ambiguity and hope”; (2) “Uncertainty concerning activity and rest”; and (3) “To become the person I used to be vs. to become a new version of myself.” Conclusion: The findings showed that the participants experienced both uncertainty and hope for further recovery. The recovery process is challenged by the variability of TBI symptoms that affects participation in everyday life, as well as the conflicting advice received by the participants.

Learning about post-disaster phases via ludic activities: A case study of Santiago, Chile

On February 27, 2010, a magnitude 8.8 Mw earthquake struck Chile and provoked a tsunami that wreaked havoc on the Chilean coast. A total of 830 failures in the transportation system were registered on roads, with 91 concession bridges and 221 public bridges suffered damage or collapsed. This study aims to test a methodology for teaching people about the characteristics of each post-disaster phase concerning road infrastructure and business continuity. The methodology is based on ludic activities designed as a non-structural mitigation action to reduce cascading risk and enhance business continuity. Activities include answering questions related to experiences with earthquakes, completing puzzles as a metaphor of a city during the reconstruction process and associating scale models of vehicles and machinery with a specific post-disaster phase. The methodology was tested with Chilean high school students aged 11 to 15. Answers from the participants indicate that girls were more aware of protection techniques during earthquakes than boys. In contrast, boys were more mindful of terminology and engaged in decision-making activities. The similarity between completing a puzzle and a city in reconstruction after an earthquake was easy for participants to understand. Initially, participants only identified relief as a post-disaster phase but did not recognise the other post-disaster phases of early recovery, recovery and development. After the workshop, they managed to identify vehicles related to the relief phase, some vehicles and machinery related to the early recovery and recovery phases, and others that can be used in more than one or two post-disaster phases.

Clinical Experience of an American Academic Ophthalmology Department During the COVID-19 Pandemic.

Background and Objectives:To describe the experience of a large American academic ophthalmology department from the start of the COVID-19 pandemic to the early recovery phase in Summer 2020.Methods:Retrospective review; description of approaches taken by our academic medical center and department regarding supply chain issues, protection of doctors and staff, elimination of nonurgent care, calls for staff and faculty deployment, and reopening. Comparison of surgical and clinic volumes in suburban locations versus the main campus; analysis of volumes compared with pre-pandemic periods.Results:At our medical center, screening and precautions (such as the mask policy) continued to evolve from March through August 2020. Ophthalmologists were not allowed to use N95 respirators except in rare circumstances. Surgical and clinic volume dropped at both urban and suburban locations, but surgery rebounded more quickly at suburban surgery centers once elective procedures resumed. Mandates from administration were not always attainable.Conclusions:During respiratory pandemics such as COVID-19, medical centers should adopt protective measures that are consistent across inpatient and outpatient sectors and consistent with other institutions. Our department's large presence outside the urban center where the main hospital is located allowed faster return of clinical care overall. In the event of another pandemic, a central budget rather than individual divisional budgets should be used for purchase of protective equipment for health care workers of an academic center. Because outpatient care provides important continuity of care and keeps patients away from emergency departments and hospitals, perhaps outpatient care does not have to be curtailed to the extent it was in Spring-Summer 2020, provided that outpatient health care workers have sufficient staff and equipment and the above measures are in place.

Mediating Effects of Coping Strategies on Quality of Life Following Extremity Injury.

Few researches have explored the self-regulation process in patients with extremity injuries. Knowledge about the role of coping in the postinjury self-regulation process remains scarce. We examined the relationships between illness representations, coping, and quality of life (QoL) based on the self-regulation framework, assuming adaptive and maladaptive coping strategies play mediating roles between illness representation and QoL in patients with extremity injuries. A cross-sectional survey with a correlational model testing design was used. A sample of 192 patients with extremity injury was recruited before hospital discharge at trauma centers in Indonesia. Validated questionnaires were used to assess patients' illness representations, coping, and QoL. Hierarchical regressions were carried out, and multiple mediation analyses were used to identify the mediating role of coping. Patients with extremity injuries who harbored negative illness representations were less focused on using adaptive coping strategies, were more focused on using maladaptive coping strategies, and tended to experience reduced QoL. The mediating effects of coping, which manifested as parallel mediations of adaptive and maladaptive coping strategies, could significantly explain the QoL variance. In postinjury self-regulation, coping has a parallel mediating role that can facilitate the effect of illness representations and directly influence postinjury QoL. Enhancing adaptive coping strategies, reducing maladaptive coping techniques, and reframing negative illness representations during the early recovery phase could improve postinjury QoL. Early screening and preventive efforts using psychologically driven interventions may help redirect patients' focus toward adaptive coping strategies and reframe their illness representations before they transition back into the community.

Assessment of Psychiatric Issues in Post-concussion Syndrome

The term "Post-Concussion Syndrome" (PCS) refers to a group of non-specific symptoms that occur after a concussion or Mild Traumatic Brain Injury (MTBI) and last longer than expected. Headaches, weariness, vertigo/dizziness, irritability, emotional lability or irritability, cognitive problems, sleep disturbance, anxiety, and depression are all possible symptoms. According to Silverberg and Iverson, both neurobiological and psychosocial factors influence symptoms during the early phases of recovery [1].

Middle and low latitudes hemispheric asymmetries in ∑O/N2 and TEC during intense magnetic storms of solar cycle 24

We have investigated the global hemispheric differences in thermospheric ∑O/N 2 and its impact on the ionospheric total electron content (TEC) at mid- and low-latitudes. Four intense storms of solar cycle 24 (SC-24) have been considered, three of them occurred in Spring equinox and one in Summer solstice season. It is found that the mid-latitudes region has exhibited a large decrease in ∑O/N 2 during all the phases of the storms under consideration, which corresponds well to the observed negative storm effects. This decrease is directly related with the storm intensity. The maximum reduction in the ∑O/N 2 is observed for the St. Patrick day storm of 2015 (which was the most intense geomagnetic storm of SC-24), whereas the respective minimum decrease is found for the storm of April 2012. Strong hemispheric asymmetries, in ∑O/N 2 variation, have been observed at the mid-latitudes sector, and can be associated with the asymmetric energy input as indicated by polar cap (PC) indices. The high speed solar winds streams (HSSWs) during the recovery phases of March 2013 and 2015 storms have caused a significant reduction in ∑O/N 2 at mid-latitudes, which could not be reproduced by the coupled thermosphere-ionosphere-plasmasphere electrodynamics (CTIPe) model. On the other hand the low-latitudes region depicts an enhancement in ∑O/N 2 during all the storms except for the early recovery phases. The positive storm effect at low-latitudes agrees well with this ∑O/N 2 increase, thus indicating that the composition change is one of the major drivers of TEC enhancement at low-latitudes. The CTIPe model showed discrepancies in reproducing the satellite data for all the considered storms, especially during the recovery phases. Furthermore, the model is failed to replicate the hemispheric asymmetries at low and mid-latitudes during the main and early recovery phases.

Diversity of herpetofauna at restored cranberry bogs: A comparative survey of herpetofaunal diversity at a restored wetland in comparison to a retired cranberry bog to assess the restoration success

Wetlands perform critical ecological functions and provide wildlife habitats. Yet, wetland degradation continues at a global scale. In Massachusetts, USA, wetland restoration has reached remarkable heights, partly promoted by the retirement of cranberry bogs. In this study, to assess the effectiveness of cranberry-farm restoration for conservation of native herpetofauna, we surveyed both retired and restored cranberry bogs in south-eastern Massachusetts. Using both visual encounter surveys and baited aquatic traps, we documented herpetofaunal species and their relative abundance. Both survey methods combined, the cumulative herpetofaunal species richness at the restored bogs (16) exceeded that of the retired bogs (11). Our trap surveys indicated that the amphibian species richness at the retired bog was significantly greater than that of the restored bog. In contrast, reptilian species richness as well as the relative abundance of both amphibians and reptiles were significantly greater at the restored bog compared to the retired bog. Subsequent analyses we performed identified that greater habitat heterogeneity emerging from active restoration intervention was the underlying driver of elevated richness and abundance. Most frequently encountered herpetofauna at the restored versus retired bogs were habitat generalists with broader geographic ranges and are not of conservation concern. Our findings suggest that the restored bog we monitored is still in the early-recovery phase after active intervention. We urge the need for long-term herpetofaunal inventories via systematic, standard surveys to assess restoration success.

Ionospheric Disturbances and Irregularities During the 25–26 August 2018 Geomagnetic Storm

AbstractWe use ground‐based (GNSS, SuperDARN, and ionosondes) and space‐borne (Swarm, CSES, and DMSP) instruments to study ionospheric disturbances due to the 25–26 August 2018 geomagnetic storm. The strongest large‐scale storm‐time enhancements were detected over the Asian and Pacific regions during the main and early recovery phases of the storm. In the American sector, there occurred the most complex effects caused by the action of multiple drivers. At the beginning of the storm, a large positive disturbance occurred over North America at low and high latitudes, driven by the storm‐time reinforcement of the equatorial ionization anomaly (at low latitudes) and by particle precipitation (at high latitudes). During local nighttime hours, we observed numerous medium‐scale positive and negative ionospheric disturbances at middle and high latitudes that were attributed to a storm‐enhanced density (SED)‐plume, mid‐latitude ionospheric trough, and particle precipitation in the auroral zone. In South America, total electron content (TEC) maps clearly showed the presence of the equatorial plasma bubbles, that, however, were not seen in data of Rate‐of‐TEC‐change index (ROTI). Global ROTI maps revealed intensive small‐scale irregularities at high latitudes in both hemispheres within the auroral region. In general, the ROTI disturbance “imaged” quite well the auroral oval boundaries. The most intensive ionospheric fluctuations were observed at low and mid‐latitudes over the Pacific Ocean. The storm also affected the positioning accuracy by GPS receivers: during the main phase of the storm, the precise point positioning error exceeded 0.5 m, which is more than five times greater as compared to quiet days.

Preferential Energization of Lower‐Charge‐State Heavier Ions in the Near‐Earth Magnetotail

AbstractO+ ions make a significant contribution to plasma pressure in the inner magnetosphere during magnetic storms. The storm‐time O+ enhancements are primarily caused by enhanced supply from the ionosphere and preferential energization in the magnetotail. In order to characterize the magnetotail process that dominates the energization, we examine differences in energy spectra of energetic 10–180 keV/q ions between different ion species, namely H+, He++, He+. O++, and O+. We use observations made by the MEP‐i instrument on the Arase (ERG) spacecraft on the nightside in the radial distance range of ∼5–∼7 Re during the main and early recovery phases of the May and July 2017 storms. The comparisons of energy spectra show that, for the same charge states, heavier ions are more energized than lighter ions. For the same mass, lower‐charge‐state ions are more energized than higher‐charge‐state ions. The spectra exhibit a sharp decrease at high energies for all ion species, while the spectra for more energized ions were shifted toward higher energies, compared to those for less energized ions. The results suggest that the preferential energization is due to temperature increases rather than the generation of energetic ions in the high‐energy tail. Considering temporal and spatial scales of heavy ion kinetic motions, we conclude that the preferential energization of lower‐charge‐state heavier ions occurs during the course of dipolarization, likely due to non‐adiabatic heating in the near‐Earth plasma sheet, effective trapping during transport by localized flow channels, and/or non‐adiabatic acceleration within the near‐Earth flow‐braking region.

EFFECTS OF EXHAUSTIVE EXERCISE AND CONTUSION ON AUTOPHAGY-RELATED FACTORS IN SKELETAL MUSCLE OF RATS

ABSTRACT Objective: To study the effects of exhaustive exercise and contusion on autophagy-related factors Beclin1, LC3 and PINK1 expression in the skeletal muscle of rats. Methods: Forty-two male SD rats were randomly divided into 7 groups, 6 rats in each group: C, D0, D24, D48, E0, E24, and E48. Each group of rats was killed and dissected at the different respective time points specified above. The whole quadriceps femoris of the left hind limbs were removed and divided into two parts, one for mRNAs of Beclin1, LC3 and PINK1 by real-time fluorescent quantitative PCR, and the other for LC3 protein by Western blotting. Results: Compared with group C, the contents of Beclin1 mRNA, PINK1 mRNA, and LC3 mRNA in the immediate exhaustive exercise group (E0) were significantly reduced p<0.01. However, the levels of PINK1 mRNA, LC3 mRNA, and LC3 protein in skeletal muscle cells increased significantly in the 48 hours after exhaustion (E48) p<0.05, suggesting that cell autophagy had an increasing trend during the recovery period. Meanwhile, compared with the C group, the contents of Beclin1 mRNA, PINK1 mRNA, and LC3 mRNA in the immediate blunt contusion group (D0) increased significantly p<0.01 and were followed by a downward trend. Conclusion: Generally, there were differences between the blunt contusion and exhausted exercise models at each recovery phase. The gene expression of the autophagy-related factors was not high in the early exhaustive exercise recovery phase and subsequently followed an upward trend. But the above factors increased significantly in the immediate and early recovery phases after blunt contusion. Injury from blunt contusion may be more severe than exhaustive exercise-induced-injury, so the autophagy starts earlier according to the changes in autophagy-related factors. Level of evidence III; Therapeutic studies investigating the results of treatment.

β-hydroxy β-methylbutyric acid (hmb) supplementation reduced whole body protein breakdown in the early recovery phase of sepsis in the pig

Rationale: Optimal feeding in patients recovering from sepsis is critical to preserve muscle mass. β-Hydroxy β-methylbutyric acid (HMB) supplementation potentially attenuates whole body protein breakdown (WbPB) in healthy subjects, but it is unclear whether HMB reduces WbPB during the recovery phase of sepsis. Therefore, we studied WbPB and untargeted amino acid productions (WBP) during a HMB intervention in the early recovery phase of sepsis in the pig.

High-Density Clonal Analysis Reveals Highly Active Contribution of Multipotent Hematopoietic Stem Cells during Early Phases of Hematopoietic Recovery after Transplantation

Recovery after conditioning and transplantation of hematopoietic stem and progenitor cells (HSPC) is thought to be biphasic, with short-term engrafting progenitors driving the recovery for 6-9 months and multipotent hematopoietic stem cells (HSCs) providing long-term repopulation. Recent clonal tracking data from autologous human gene therapy trials seems to support this model (Biasco et al. 2016, Cell Stem Cell; Six et al. 2020, Blood). These recent reports investigating the contribution of HSCs in patients are based on the longitudinal tracking of thousands of gene-marked cells using retroviral integration site analysis (ISA). While this technology is very reliable to follow gene therapy patients and monitor the potential outgrowth of dominant or malignant clones, low sensitivity and high error rates require significant data exclusion and sophisticated statistical tests to ensure data reliability (Adair et al. 2020, Molecular Therapy MCD). Lack of sensitivity can be overcome by increasing the frequency (high density) of sampling. However, limited material from patients remains a bottleneck for improved data quality and, consequently, correct interpretation of such complex datasets.To overcome the limitations of ISA and determine the onset of HSC contribution we performed high-density sampling for ISA in nonhuman primates (NHPs) transplanted with gene-modified HSCs. In the first month of hematopoietic recovery weekly blood samples were taken to enhance data density and increase the reliablity to detect clones with low abundance. Animals were followed up to 5 years to confirm that identified HSC clones persist long-term. Finally, clonal tracking data from the NHPs was used to inform a simulation of hematopoietic reconstitution, determine the temporal involvement of HSCs, and refine the phases of hematopoietic recovery after myeloablation and HSC transplantation.In contrast to the current biphasic model, contribution of multipotent HSCs clones was detected in the very first blood samples taken 2 to 3 weeks post-transplant during neutrophil recovery. HSC clones found in these early time points persisted long-term throughout the entire follow-up and were detected in bone marrow CD34 + cells 4 years later. Most surprisingly, multipotent HSCs became the dominant source for mature blood cells in the peripheral blood as early as 50 days post-transplant. To understand the observed kinetics of HSC contribution and change in clonal diversity in our dataset, we simulated the clonal outgrowth and differentiation of multipotent clones. Simulations predicted that hematopoietic recovery is primarily HSC driven and HSC contribution follows a stochastic pattern. Finally, to confirm that HSCs proliferation and differentiation is a stochastic process, in vitro experiments in colony-forming cell (CFC) assays were carried out. As predicted, the decision of individual HSCs to either grow into a larger pool or differentiate and get lost followed the same kinetics as observed in vivo.Here, we show evidence that long-term persisting multipotent HSCs actively contribute during early hematopoietic reconstitution after myeloablation and HSC transplantation. Enhanced sampling showed that multipotent HSCs produce neutrophils during recovery and become the predominant source of mature blood cells as early as 50 days post-transplant. Most importantly, observed changes in the clonal diversity during early recovery suggest a stochastic engraftment of HSCs rather than a bi-phasic reconstitution initially driven by short-term progenitors. These findings should have important implications for the design of ex vivo and in vivo HSC gene therapy and genome editing approaches. [Display omitted] DisclosuresRadtke: 47 Inc.: Consultancy; Ensoma Inc.: Consultancy. Kiem: Homology Medicines: Consultancy; VOR Biopharma: Consultancy; Ensoma Inc.: Consultancy, Current holder of individual stocks in a privately-held company.

Relative Contribution of ULF Waves and Whistler‐Mode Chorus to the Radiation Belt Variation During the May 2017 Storm

AbstractWe investigate the time and location where ULF waves and whistler‐mode chorus contributed to the net flux enhancement of relativistic electrons during the magnetic storm of May 2017. During the early recovery phase, both ULF and chorus waves contribute to the enhancement of relativistic electron fluxes, but ULF waves play roles of the inward diffusion. During the late recovery phase, both Van Allen Probe‐B and Arase show that whistler‐mode chorus contributes to the flux enhancement confined in the L‐value. The CRCM coupled with BATS‐R‐US simulation qualitatively reproduces the global evolution of ULF waves. Although the electron flux is underestimated by the simulation, this study reveals a large anisotropy of hot electrons in the region where whistler‐mode chorus waves were actually observed by satellites. In addition, the estimated magnetic field curvature on the dayside is small during the recovery phase. Furthermore, we investigate the control of wave evolution. Both observations and the simulation suggest that the observed ULF waves in the frequency range of ∼2–5 mHz are excited by the enhancement of the solar wind dynamic pressure. Observations also indicate that whistler‐mode chorus on the nightside is predominantly excited by hot electrons with temperature anisotropy, whereas the dayside chorus is enhanced by the change of the magnetic field line configuration. The estimated spatial distributions of electron anisotropy and magnetic field curvature provide an explanation for the presence of enhanced whistler‐mode chorus in the dusk sector, which is far from the usual location of wave generation.

Monetary Policy Uncertainty and Economic Fluctuations at the Zero Lower Bound

We propose a TVP-VAR with stochastic volatility for the unemployment rate, core inflation and the federal funds rate augmented with survey-based interest rate expectations and uncertainty and a FAVAR with a wider set of observable variables and alternative monetary policy measures in order to explore U.S. monetary policy, accounting for the zero lower bound. We find that a rise in monetary policy uncertainty increases unemployment and lowers core inflation; the effects on unemployment in particular are robust (a gradual 0.4 percentage point increase), lasting more than two years after the initial shock. Interest rate uncertainty shocks explain a significant portion of macro fluctuations, particularly after the 2007-09 global financial crisis contributing to push the unemployment rate one percentage point higher during the early phase of the subsequent recovery. Furthermore, we find that higher interest rate uncertainty makes forward guidance shocks (but also federal funds rate shocks) less effective at moving unemployment and core inflation. We also posit a theoretical model to provide the structural backbone for our empirical results, via an “option value” channel. Theory yields sizeable real effects and a muted monetary policy transmission mechanism as firms choose to postpone investment decisions in response to heightened interest rate uncertainty.

A Study of Biofeedback Gait Training in Cerebral Stroke Patients in the Early Recovery Phase with Stance Phase as Target Parameter.

Walking function disorders are typical for patients after cerebral stroke. Biofeedback technology (BFB) is currently considered effective and promising for training walking function, including in patients after cerebral stroke. Most studies recognize that BFB training is a promising tool for improving walking function; however, the data on the use of highly selective walking parameters for BFB training are very limited. The aim of our study was to investigate the feasibility of using BFB training targeting one of the basic parameters of gait symmetry—stance phase duration—in cerebral stroke patients in the early recovery period. The study included 20 hemiparetic patients in the early recovery period after the first hemispheric ischemic stroke. The control group included 20 healthy subjects. The BFB training and biomechanical analysis of walking (before and after all BFB sessions) were done using an inertial system. The mean number of BFB sessions was nine (from 8 to 11) during the three weeks in clinic. There was not a single negative response to BFB training among the study patients, either during the sessions or later. The spatiotemporal parameters of walking showed the whole syndrome complex of slow walking and typical asymmetry of temporal walking parameters, and did not change significantly as a result of the study therapy. The changes were more significant for the functioning of hip and knee joints. The contralateral hip amplitude returned to the normal range. For the knee joint, the amplitude of the first flexion increased and the value of the amplitude of hyperextension decreased in the middle of the stance phase. Concerning muscle function, the observed significant decrease in the function of m. Gastrocnemius and the hamstring muscles on the paretic side remained without change at the end of the treatment course. We obtained positive dynamics of the biomechanical parameters of walking in patients after the BFB training course. The feasibility and efficacy of their use for targeted correction need further research.

Targeting white matter neuroprotection as a relapse prevention strategy for treatment of cocaine use disorder: Design of a mechanism-focused randomized clinical trial

Cocaine use continues to be a significant public health problem with limited treatment options and no approved pharmacotherapies. Cognitive-behavioral therapy (CBT) remains the mainstay treatment for preventing relapse, however, people with chronic cocaine use display cognitive impairments that are associated with poor response to CBT. Emerging evidence in animal and human studies suggests that the peroxisome proliferator-activated receptor-gamma (PPAR- γ) agonist, pioglitazone, improves white matter integrity that is essential for cognitive function. This project will determine whether adjunctive use of pioglitazone enhances the effect of CBT in preventing relapse during the early phase of recovery from cocaine use disorder. This paper describes the design of a mechanism-focused phase 2 randomized clinical trial that aims first to evaluate the effects of pioglitazone on targeted mechanisms related to white matter integrity, cognitive function, and cocaine craving; and second, to evaluate the extent to which improvements on target mechanisms predict CBT response. Positive results will support pioglitazone as a potential cognitive enhancing agent to advance to later stage medication development research.

Covid Reinfection versus Asymptomatic Carrier State: A Case Report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first discovered in China in December 2019, has been implicated in the current coronavirus disease 2019 (COVID-19) pandemic. Although much has been learned about the virus which peaked with the development of the vaccine, there is still a lot of unanswered questions. Maximum duration of positive SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction (RT-PCR) from symptom onset may be up to 3 months [1], however it is not known if the continued detection of the viral genome implies prolonged infectivity or presence of a non-viable virus [2]. Most people with COVID-19 develop antibodies after resolution of acute infection [2]. The exact duration of these antibodies in the body is unknown, but some studies have shown that both memory T-cells and B-cells can persist up to 6 to 8 months after acute SARS-CoV-2 infection [3]. These SARS-CoV-2 antibodies may confer some immunity to the person after the acute infection and have been associated with protection against subsequent infection in nonhuman primates by the same viral strain during the early recovery phase [4]. In humans, however, it is unknown to what extent this immune response indicates a protective immunity to subsequent infection with SARS-CoV-2 [5]. Few cases of reinfection have been documented worldwide with varying symptom severity; the first case in the US was published in January 2021 (reinfection occurred in June 2020) [5]. None of the initial cases reported the presence of SARS-CoV-2 antibodies at the time of reinfection. We present a patient who tested positive to SARS-CoV-2 RT-PCR twice in 10 months (Table 1). At both times, she was asymptomatic and the second time, she had coexisting SARS-CoV-2 antibodies.

STUDY ON FACTORS AFFECTING POSTOPERATIVE QUALITY OF RECOVERY FOR PATIENTS UNDERGOING SURGERY IN A TERTIARY CARE HOSPITAL

BACKGROUND: Quality of recovery (QoR) after surgery is an important measure of the early postoperative health status of patients. The recovery phases after surgery can be categorized as early, intermediate and late. The early postoperative recovery phase has been dened as the rst 24 h or the rst seven days. Recovery after surgery and anaesthesia is a complex process that could be inuenced by many factors that effect on its quality. OBJECTIVES: This study aims to assess the predictive factors affecting postoperative quality of recovery for patients undergoing surgery through assessment of the postoperative quality of recovery in patients undergoing surgery and also predictive factors affecting the same. MATERIAL AND METHODS: It was a cross-sectional descriptive research done between July 2020 to December 2020 at Hind Institute of Medical Sciences. Purposive samples of 100 patients who were admitted to the previously mentioned settings and fullled the inclusion criteria were included in the study. Quality of Recovery Score Questionnaire (QoR-40) translated into Hindi language and then back translated by the researchers in order to assess postoperative health status of the patient. RESULTS: The results showed that 36% of patients had good total quality of recovery, 19% had excellent recovery, 39% had acceptable quality of recovery, while 6% only had poor quality of recovery. There were highly statistically signicant differences between total quality of recovery and age, gender, type and duration of surgery and presence of other diseases. CONCLUSION: It was concluded that there are several factors affecting the postoperative quality of recovery for patients undergoing surgery such as patient's gender, age, type of surgery, duration of surgery, presence of other diseases, as well as pain control.

To persist or not to persist? The dilemma of goal adjustment in chronic pain.

To persist or not to persist? The dilemma of goal adjustment in chronic pain.

Effects of mirror therapy on motor aphasia after acute cerebral infarction: A randomized controlled trial.

Mirror therapy (MT) has proven to be beneficial for treating patients suffering from motor aphasia after stroke. However, the impacts of MT on neuroplasticity remain unexplored. In this paper we conducted a randomized controlled trial to evaluate the treatment using the MT on motor aphasia following acute cerebral infarction. We randomly assigned 30 patients into test and control groups, with test group patients treated with MT, whereas control group patients were treated with sham MT. At 24 hours prior to and after the intervention, we obtained functional magnetic resonance imaging (fMRI) data from study subjects. At baseline, after treatment and 12-week follow-up, we additionally evaluated patients with the Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the aphasia quotient (AQ) in the western aphasia test. After 2 weeks of treatment, the test group demonstrated significant improvements in AQ values, naming, repetition, spontaneous speech, and mRS scores compared to the control group (P < 0.05). Furthermore, in the follow-up time point (12 weeks), we found that the test group exhibited significantly better NIHSS scores and AQ evaluation indicators than the control group (P < 0.05). Specifically, the fMRI study shows that functional connectivity significantly improved in test group patients mainly among frontal, temporal, and parietal lobes of the left hemisphere with each other than controls group. Meanwhile, we found significantly enhanced functional connectivity with the hippocampus (P < 0.01). Our results indicate that the MT can expedite the recovery of language function during the early phases of stroke recovery. These findings may elucidate the underlying mechanism of MT and the application of this therapy as an adjunct rehabilitation technique in language recovery.