Intensive Unit Research Articles

Using the Diagnostic Odds Ratio to Select Patterns to Build an Interpretable Pattern-Based Classifier in a Clinical Domain: Multivariate Sequential Pattern Mining Study.

BackgroundIt is important to exploit all available data on patients in settings such as intensive care burn units (ICBUs), where several variables are recorded over time. It is possible to take advantage of the multivariate patterns that model the evolution of patients to predict their survival. However, pattern discovery algorithms generate a large number of patterns, of which only some are relevant for classification.ObjectiveWe propose to use the diagnostic odds ratio (DOR) to select multivariate sequential patterns used in the classification in a clinical domain, rather than employing frequency properties.MethodsWe used data obtained from the ICBU at the University Hospital of Getafe, where 6 temporal variables for 465 patients were registered every day during 5 days, and to model the evolution of these clinical variables, we used multivariate sequential patterns by applying 2 different discretization methods for the continuous attributes. We compared 4 ways in which to employ the DOR for pattern selection: (1) we used it as a threshold to select patterns with a minimum DOR; (2) we selected patterns whose differential DORs are higher than a threshold with regard to their extensions; (3) we selected patterns whose DOR CIs do not overlap; and (4) we proposed the combination of threshold and nonoverlapping CIs to select the most discriminative patterns. As a baseline, we compared our proposals with Jumping Emerging Patterns, one of the most frequently used techniques for pattern selection that utilizes frequency properties.ResultsWe have compared the number and length of the patterns eventually selected, classification performance, and pattern and model interpretability. We show that discretization has a great impact on the accuracy of the classification model, but that a trade-off must be found between classification accuracy and the physicians’ capacity to interpret the patterns obtained. We have also identified that the experiments combining threshold and nonoverlapping CIs (Option 4) obtained the fewest number of patterns but also with the smallest size, thus implying the loss of an acceptable accuracy with regard to clinician interpretation. The best classification model according to the trade-off is a JRIP classifier with only 5 patterns (20 items) that was built using unsupervised correlation preserving discretization and differential DOR in a beam search for the best pattern. It achieves a specificity of 56.32% and an area under the receiver operating characteristic curve of 0.767.ConclusionsA method for the classification of patients’ survival can benefit from the use of sequential patterns, as these patterns consider knowledge about the temporal evolution of the variables in the case of ICBU. We have proved that the DOR can be used in several ways, and that it is a suitable measure to select discriminative and interpretable quality patterns.

WE4.6 Postoperative muscle atrophy: an overlooked cause of morbidity

Abstract Aims A significant proportion of patients never fully recover baseline activity levels following major abdominal surgery. Postoperative muscle atrophy may be a major contributing factor to this, but is often overlooked. This study aimed to quantify the degree of muscle loss in patients undergoing routine recovery following major abdominal surgery and in patients admitted to critical care. Methods Fifteen patients undergoing major open colorectal resection were recruited. Cross surface area (CSA) and muscle thickness (MT) of a quadriceps muscle, Vastus Lateralis (VL) were measured pre-operatively and on post-operative day (POD) 5 using ultrasound. Knee extension strength was also measured pre-operatively and on POD5 using a handheld dynamometer. A systematic literature review was performed to identify studies reporting muscle loss in patients admitted to an intensive treatment unit (ITU), with pooled means of changes in quadriceps muscle CSA calculated. Results By POD 5 VL CSA had decreased by 9.16% (± 2.0), and MT had decreased by 8.14% (± 5.93). Associated with this, knee extensor strength decreased by 19.69% (± 12.91). Systematic review identified 4 studies reporting muscle loss in ITU patients, including a total of 126 patients. Pooled mean of quadriceps CSA in patient admitted to ITU decreased by 13.9% (-12.5% -20.75%) by POD7. Conclusions Major abdominal surgery is associated with a significant loss of muscle mass and function. Losses are larger in patients requiring ITU admission. This may have a significant impact on patients’ full recovery to baseline function and further work is required to investigate this.

The effect of taurine supplementation on delirium post liver transplantation: A randomized controlled trial

Delirium is a prevalent complication of liver transplantation (LT). It may enhance the risk of morbidity and mortality. Taurine is considered to have antioxidant and neuroprotective activities. The aim of this study was to evaluate taurine supplementation effect on post-LT delirium. Patients older than 18 years old who had received LT in Abu-Ali Sina transplantation center in Shiraz, Iran from September 2020 to June 2021, were enrolled in this double-blinded randomized clinical trial. Exclusion criteria was known hypersensitivity to taurine, pregnancy or breast-feeding and death within 72h post-LT. Patients were randomly divided into two groups, each received 2g/day placebo or taurine from the first day post-LT for 30 days. Delirium was assessed using Confusion Assessment Method-Intensive Care Unit (CAM-ICU). Mortality and rejection rates and length of Intensive Transplantation Unit (ITU) and hospital stays were evaluated within one month after transplantation. Two hundred and seven patients were divided into two groups. Twenty-eight and 23 patients were excluded due to their refuse to participate in the study and death within 72h post-LT, respectively. Delirium rate within the first month was 23.08% and was significantly lower in taurine group (9.46%) compared with placebo (35.36%, P=0.012). Length of ITU stay was significantly higher among delirious patients (P=0.015) in this analysis. we reached to the result that taurine can prevent post-LT delirium, dramatically. Placebo receiving and longer stay in ITU were the only independent risk factors in this trial. The study was registered at the Iranian Registry of Clinical Trials (IRCT20200312046755N1; http://www.irct.ir/).

Robotic Verticalization plus Music Therapy in Chronic Disorders of Consciousness: Promising Results from a Pilot Study.

Background: Music stimulation is considered a valuable form of intervention in disorders of consciousness (DoC); for instance, verticalization may improve motor and cognitive recovery. Our purpose is to investigate the effects of a novel rehabilitative approach combining robotic verticalization training (RVT) with personalized music stimulation in people with DoC. Methods: Sixteen subjects affected by minimally conscious state due to traumatic brain lesions who attended our Intensive Neuro-Rehabilitation Unit were enrolled in this randomized trial. They received either music robotic verticalization (MRV) using the Erigo device plus a personalized music playlist or only RVT without music stimuli. Each treatment was performed 2 times a week for 8 consecutive weeks in addition to standard neurorehabilitation. Results: We found significant improvements in all patients’ outcomes in the experimental group (who received MRV): Coma Recovery Scale-Revised (CRS-R) (p < 0.01), Level of Cognitive Functioning (LCF) (p < 0.02), Functional Independence Measure (FIM) (p < 0.03), Functional Communication Scale (FCS) (p < 0.007), Trunk Control Test (TCT) (p = 0.05). Significant differences between the two groups were also found in the main outcome measure CRS-R (p < 0.01) but not for TCT and FIM. Conclusions: Our study supports the safety and effectiveness of RVT with the Erigo device in chronic MCS, and the achievement of better outcomes when RVT is combined with music stimulation.

Predicting outcome of patients with prolonged disorders of consciousness using machine learning models based on medical complexity

Patients with severe acquired brain injury and prolonged disorders of consciousness (pDoC) are characterized by high clinical complexity and high risk to develop medical complications. The present multi-center longitudinal study aimed at investigating the impact of medical complications on the prediction of clinical outcome by means of machine learning models. Patients with pDoC were consecutively enrolled at admission in 23 intensive neurorehabilitation units (IRU) and followed-up at 6 months from onset via the Glasgow Outcome Scale—Extended (GOSE). Demographic and clinical data at study entry and medical complications developed within 3 months from admission were collected. Machine learning models were developed, targeting neurological outcomes at 6 months from brain injury using data collected at admission. Then, after concatenating predictions of such models to the medical complications collected within 3 months, a cascade model was developed. One hundred seventy six patients with pDoC (M: 123, median age 60.2 years) were included in the analysis. At admission, the best performing solution (k-Nearest Neighbors regression, KNN) resulted in a median validation error of 0.59 points [IQR 0.14] and a classification accuracy of dichotomized GOS-E of 88.6%. Coherently, at 3 months, the best model resulted in a median validation error of 0.49 points [IQR 0.11] and a classification accuracy of 92.6%. Interpreting the admission KNN showed how the negative effect of older age is strengthened when patients’ communication levels are high and ameliorated when no communication is present. The model trained at 3 months showed appropriate adaptation of the admission prediction according to the severity of the developed medical complexity in the first 3 months. In this work, we developed and cross-validated an interpretable decision support tool capable of distinguishing patients which will reach sufficient independence levels at 6 months (GOS-E > 4). Furthermore, we provide an updated prediction at 3 months, keeping in consideration the rehabilitative path and the risen medical complexity.

A tele-health primary care rehabilitation program improves self-perceived exertion in COVID-19 survivors experiencing Post-COVID fatigue and dyspnea: A quasi-experimental study

Current evidence suggests that up to 70% of COVID-19 survivors develop post-COVID symptoms during the following months after infection. Fatigue and dyspnea seem to be the most prevalent post-COVID symptoms. To analyze whether a tele-rehabilitation exercise program is able to improve self-perceived physical exertion in patients with post-COVID fatigue and dyspnea. Sixty-eight COVID-19 survivors exhibiting post-COVID fatigue and dyspnea derived to four Primary Health Care centers located in Madrid were enrolled in this quasi-experimental study. A tele-rehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was structured on eighteen sessions (3 sessions/week). Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and distance walked and changes in oxygen saturation and heart rate during the 6-Minute walking test were assessed at baseline, after the program and at 1- and 3-months follow-up periods. Daily living activities, dyspnea severity and quality of life improved significantly at all follow-ups (p<0.001). Additionally, a significant increase in oxygen saturation before and after the 6-Minute Walking test was found when compared with baseline (P<0.001). Heart rate adaptations at rest were found during the follow-up periods (P = 0.012). Lower perceived exertion before and after the 6-Minute Walking test were also observed, even if larger distance were walked (P<0.001). Tele-rehabilitation programs could be an effective strategy to reduce post-COVID fatigue and dyspnea in COVID-19 survivors. In addition, it could also reduce the economic burden of acute COVID-19, reaching a greater number of patients and releasing Intensive Unit Care beds for prioritized patients with a severe disease. The international OSF Registry registration link is https://doi.org/10.17605/OSF.IO/T8SYB.

Microwave-assisted synthesis of cross-linked chitosan-metal oxide nanocomposite for methyl orange dye removal from unary and complex effluent matrices

Textile/Dyeing industries have been considered as one of the intense water-consuming units, resulting in the generation of a large volume of dye(s) contaminated effluent posing a heavy burden on the receiving water bodies. Therefore, the identification of methods to synthesize bulk quantity of adsorbent(s) and further their evaluation for the efficient treatment of effluent is one of the most prominent topics. Hence, microwave-assisted method was proposed for the rapid synthesis of nanocomposite (C-CS@ZnO) from natural biomolecule (chitosan-CS), a well-known crosslinker (tripolyphosphate) and metal-oxide (ZnO) nanoparticles. Detailed characterization was performed to identify the structure (SEM, XRD) and composition (FT-IR, XPS) of the sorbent. Sorption experiments with methyl orange (MO) dye solution were carried out under different pH (2.0–12.0), dye concentrations (150–350 mg L−1), reaction times (0–210 min) and temperature (25–45 °C) to establish the adsorbent at the lab-scale. The maximum sorption capacity (185.2 mg g−1) was obtained because of the ligand-exchange, Yoshida H-bonding and electrostatic interactions and was best elucidated by Freundlich (R2 ≥ 0.99) and pseudo-second-order (R2 ≥ 1) models. To simulate the field conditions, the effects of co-existing ions (anions/cations), cocktail dyes/ions mixture and regenerant were also studied. The obtained results suggest its promising applicability at a large scale for textile effluent treatment.

Fat Embolism Syndrome and in-Hospital Mortality Rates According to Patient Age: A Large Nationwide Retrospective Study.

IntroductionFat embolism syndrome (FES) is a rare life-threatening condition that can develop after traumatic orthopedic injuries. Controversy remains concerning the epidemiology in the elderly population. Therefore, this study aims to report FES related to in-hospital mortality stratified by age.MethodsA retrospective trauma cohort study was conducted using data from the National Trauma Data Bank (NTDB) from 2007 to 2014. All FES cases were included in the study with the diagnosis of FES (ICD9 958.1). Death on arrival cases were excluded. Patients were stratified by age cohort: less than 40 (G1), 40–64 (G2), and greater than 65 (G3) years of age. The primary outcome evaluated was in-hospital mortality. Multivariable regression models were performed to adjust for potential confounders.ResultsBetween 2007 and 2014, 451 people from a total of 5,836,499 trauma patients in the NTDB met the inclusion criteria. The incidence rate was 8 out of 100,000. The inpatient mortality rate was 11.8% for all subjects with the highest mortality rate of 17.6% in patients over 65. Multivariable analyses demonstrated that age greater than 65 years was an independent predictor of mortality (aOR 24.16, 95% CI 3.73, 156.59, p=0.001), despite higher incidence and injury severity of FES among patients less than 40. No significant association with length of hospital stay, length of intensive unit care, or length of ventilation use was found between the groups. Subgroup analysis of the elderly population also showed a higher mortality rate for FES in femoral neck fracture patients (18%) than other femoral fractures (14%).ConclusionIn this retrospective cohort analysis, old age (≥ 65 years) was found to be an independent risk factor for in-hospital mortality among fat embolism syndrome patients. Elderly patients specifically with femoral neck fractures should be monitored for the development of FES.

Barotrauma and its complications in COVID-19 patients: a retrospective study at tertiary care hospital of Eastern India

BackgroundThe development of barotrauma in COVID-19 patients who were ventilated and admitted to the intensive treatment unit seemed to have been a problematic issue in the COVID era. This study aimed to explore the possibility of developing the barotrauma-related issues with mechanical ventilation in the cases of individuals suffering from COVID-19.ResultsOut of 48 patients who developed barotrauma, 30 (62.5%) presented with pneumothorax, 22 (45.8%) with pneumomediastinum, 10 (20.8%) with subcutaneous emphysema, and 2 (4.1%) with pneumopericardium. Of those that developed barotrauma, 45 (93.7%) patients were in acute respiratory distress syndrome. In patients with and without barotrauma, significant factors were white blood cell count (p = 0.001), neutrophil percentage (p = 0.012), and lymphocyte percentage (p = 0.014). There were no statistically significant differences in CRP, procalcitonin, d-dimer test, LDH, or ferritin.ConclusionsPatients infected with COVID-19 have a high risk of barotrauma when on mechanical ventilation. As a result, the death rate in this patient group is higher.

Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

BackgroundDuring the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom.MethodsNorfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions.ResultsBetween October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology.ConclusionsThe MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.

Performance of Pediatric Risk of Mortality III and Pediatric Index of Mortality III Scores in Tertiary Pediatric Intensive Unit in Saudi Arabia.

ObjectiveTo assess the performance of the Pediatric Risk of Mortality III (PRISM III) and Pediatric Index of Mortality III (PIM III) indices in a tertiary pediatric intensive care unit (PICU) in Saudi Arabia and to identify the factors affecting the observed performance.DesignRetrospective, single-center study using data collected from the Virtual Pediatric Systems web-based database.SettingKing Fahad Medical City PICU, Saudi Arabia.PatientsAll pediatric patients <14 years of age admitted between 1 January 2015, and 31 December 2019.InterventionsComparison of PRISM III and PIM III performances in predicting mortality across different age groups, disease categories, and resuscitation decision statuses.MeasurementsNormality of distribution was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests. Patient characteristics were compared between survivors and non-survivors. The medians and ranges were calculated for continuous data, whereas frequencies and percentages were used for nominal data. The Mann–Whitney U test, Kruskal–Wallis test, and Chi-square test were used to compare the characteristics of survivors and non-survivors.Main ResultsThere was a significant difference between the predicted mortality and observed mortality in both the PRISM III and PIM III. Better discrimination was found after excluding do-not-resuscitate (DNR) patients. The worst calibration and discrimination were recorded for infants <12 months of age. The PRISM III performed significantly better in patients with metabolic/genetic and central nervous system illnesses. Non-DNR patients had a lower standardized mortality rate using the PRISM III and PIM III. The PRISM III and PIM III indices performed better in patients who died within the first week of admission.ConclusionThese models had sufficient discrimination ability and poor calibration. Since they were designed for particular patient characteristics and PICUs, further testing in different environments is necessary before utilization for planning and assessing performance. Alternatively, new models could be developed which are suitable for local PICUs.

Clinical Presentation of Pleural Effusion Among Patients after CABG and its Prevalence

Objective: Pleural effusion often occurs after CABG. Usually, this effusion is slight and asymptomatic. There is also high symptomatic effusion, but in a small percentage of patients. Pleural effusion after CABG may be associated with significant morbidity and prolonged hospital stay. Early diagnosis and treatment can reduce morbidity of patients and extent of hospital stay. Aim: The aim of the study is to determine the risk factors and the severity of pleural effusion in patients after CABG. Place and Duration: In the Cardiology department of Qazi Hussain Ahmed Medical Complex, Nowshera for six-months duration from July 2020 to December 2020. Material and methods: The study was held among 120 patients after meeting the inclusion criteria and selected for the study. Patients were included in study population before referral for CABG from QHAMC to multicenters of Khyber Pakhtunkhwa. Their records were closely followed during admissions for CABG and post CABG and also assessed on various follow up visits. The study procedure was described to the patient and informed consent was obtained. Demographics, name, age, gender, surgery details, comorbidities such as COPD, EF and smoking were recorded on the attached form. The patients stayed in the intensive cardiac surgery unit for at least 7 days. The presence and severity of pleural effusion was assessed on the CXR. A chest x-ray was done on daily basis and evaluated by a chest specialist in the morning round. The amount of effusion in CXR was classified as follows: low effusion covering less than half of the chest, high effusion covering more than half of the chest. Possible risk factors for the development of pleural effusion in post-CABG patients have been reported. Results: The majority 99(82.5%) of the 120 subjects who had pleural effusion done with CABG were male. The patients mean age was 55.28 ± 10.47 years. Most patients 93(77.5%) had left pleurotomy. LIMA harvesting was reported in 98(81.7%) of patients. Most patients 100(83.3%) had left sided pleural effusions and 5(4.2%) had right sided and bilateral pleural effusions in 15(12.5%) of cases. A total of 102 patients (85%) had low (less than half of the chest) pleural effusion and large symptomatic pleural effusion in 18(18%) (more than half of the chest). 104 patients (86.7%) required pleural aspiration. Most of the patients 110(91.7%) had decreased serum albumin. Of the patients requiring effusion aspiration, 46 (38.3%) had dyspnea, 18 (15.0%) cough, 34 (28.3%) ABGs abnormalities, and 8 (7.7%) had atelectasis. Preoperative EF was normal in 80 (66.7%) patients, but poor EF was present in 50 (33.3%) patients on the 7th postoperative day. Conclusion: A slight left-sided effusion developed in the majority of patients after CABG. There was also large size of pleural effusion, but occurs in small extent. The effusion mainly causes some respiratory symptoms that require pleural aspiration. LIMA harvesting, pleurotomy and hypoalbuminemia were the main risk factors for pleural effusion in patients after CABG. Keywords: CABG = coronary artery bypass grafting, LIMA = Left internal mammary artery, CXR = chest X-ray, ICU = intensive care unit, COPD = chronic obstructive pulmonary disease and EF = ejection fraction.

A protocol of drug and infusion fluid: Preparation, administration, compatibility and stability in neonatal intensive unit care

A protocol of drug and infusion fluid: Preparation, administration, compatibility and stability in neonatal intensive unit care

Effects of Conventional and Organic Agriculture on Soil Arbuscular Mycorrhizal Fungal Community in Low-Quality Farmland.

Arbuscular mycorrhizal (AM) fungi have promising applications in low-quality farmlands all over the world, but research on their responses to conventional and organic farming systems in low-quality soil is limited. We hypothesized that the colonization activity and community diversity of AM fungi in conventional farming systems may not be lower than in organic farming on low-quality farmlands where beneficial symbiosis is required. We collected soil and maize root samples from medium to low fertility farmlands with conventional or organic farming systems in western Jilin Province, China. The colonization percentage and intensity, taxonomic and phylogenetic diversity, community composition of soil AM fungi, and soil factors were detected and compared between the two farming systems. The colonization intensity and operational taxonomic unit (OTU) taxonomic diversity on conventional farms were higher than on organic farms. Glomus was the most common genus on conventional farms, whereas Paraglomus and Glomus were the most common on organic farms. We also found a simpler AM fungal network structure with lower OTU phylogenetic diversity on conventional farms. Our findings suggested that though the conventional farming system resulted in different compositions and simpler structures of soil AM fungal community, there are potential diverse OTU resources currently present on conventional farms. This work has potential impacts on understanding the influence of different farming systems on soil AM fungi in low-quality farmlands and the development of efficient mycorrhizal inoculant production.

Laboratory predictors for COVID-19 Intensive Care Unit admissions in Trinidad and Tobago.

Understanding symptoms associated with COVID-19 cases requiring intensive care unit(ICU) attention is important in management of the life-threatening cases of the disease. This study aimed to determine laboratory indicators of ICU admission for COVID-19 patients. For this retrospective chart review study, data from 116 patients(ICU, n = 18, Non-ICU, n = 98) with confirmed SARS-CoV-2, managed at two hospitals in Trinidad and Tobago, from March 12th to April 12th 2020, were analyzed. The median age of non-ICU patients was 59.0(IQR = 23.5) years; ICU patients had a median age of 62.5(IR = 17.5). From univariate analysis, laboratory indicators significantly associated with ICU admission included WBC(P = 0.037), lymphocyte(P = 0.016), LDH(P = 0.002), AST(P = 0.005) and CRP(P = 0.0001). However, multivariate analysis including WBC, neutrophil, lymphocyte, PLT, AST, LDH, ALT and CRP indicated that only AST was associated with high odds of ICU admission(OR 0.002, 95% CI 0.000–0.004, P = 0.017). Statistically significant AUC were obtained for neutrophil(AUC = 0.704, P = 0.007), CRP (AUC = 0.81, p = 0.00) and LDH(AUC = 0.766, P = 0.00) and AST (AUC = 0.729, P = 0.003). The findings indicate that neutrophils, AST and LDH's ROC curves are good tests, CRP curve is a very good test, but lymphocyte curve is a poor test, in determining COVID-19 patients for ICU admission. Neutrophil, AST, LDH and CRP are suitable predictors of COVID-19 patients that should receive intensive unit care. The study provides significant insights into laboratory parameters that can be used to predict COVID-19 severity and important considerations for healthcare providers in making evidence-based decisions regarding COVID-19 patient management, especially in the context of limited ICU facilities. This study was not funded.

Efficacy and safety of corticosteroid regimens for the treatment of hospitalized COVID-19 patients: a meta-analysis.

To evaluate the efficacy and safety of corticosteroids for treating hospitalized COVID-19 patients. Efficacy outcomes included time to negative SARS-CoV-2 tests, length of stay, duration and incidence of intensive unit care stay, incidence of mortality andduration and incidence of mechanical ventilation. Safety outcomes included the incidence of adverse events and severe adverse events, incidence of hyperglycemia and incidence of nosocomial infections. Ninety-five randomized controlled trials (RCTs) and observational studies (n=42,205) were included. Corticosteroids were associated with increased length of stay (based on RCT only), increased time to negative tests, decreased length of mechanical ventilation and increased odds of hyperglycemia. Corticosteroids should be considered in patients requiring mechanical ventilation, and glycemic monitoring may be needed when administering corticosteroids.

Creation of a brief group intervention to reduce caregivers burden in an intensive home treatment unit

IntroductionIntensive home-treatment (IHT) for people experiencing a mental health crisis has been progressively established in many European countries as an alternative to in-ward treatment. However, the management of acute episodes at home can cause burden in the caregivers of these patients.ObjectivesTo create a brief group intervention (BGI) to reduce burden in the caregivers of the patients admitted to an IHT unit.MethodsA preliminary version of the BGI (BGI 1.0) was designed based on literature’s review. It consisted of 4 sessions of 90 minutes (one per week), on-line (COVID-19), focused on caregivers burden, stress and self-care, communication skills, and self-compassion. All the caregivers of the patients admitted for IHT from 10/01/2020 to 06/01/2021 were offered the BGI 1.0. At the end of the intervention, participants (caregivers and therapists) were asked about their opinion on its contents and usefulness.Results A total of 31 caregivers received the BGI 1.0. Most of them felt satisfied with the intervention. Opinions varied as to which contents should be expanded or included. The therapists thought that the number of sessions should be increased to take a closer look at some contents or to include new ones. They also believed that the on-line format hindered the adherence and the interaction between the participants.ConclusionsThe BGI 1.0 seems to be a good starting point to design the final version of the intervention. However, an exhaustive assessment of the construct of burden in a larger sample of caregivers should be performed prior to its design.DisclosureNo significant relationships.

Conventional and Investigational Approaches Leveraging Clinical EEG for Prognosis in Acute Disorders of Consciousness.

Prediction of recovery of consciousness after severe brain injury is difficult and limited by a lack of reliable, standardized biomarkers. Multiple approaches for analysis of clinical electroencephalography (EEG) that shed light on prognosis in acute severe brain injury have emerged in recent years. These approaches fall into two major categories: conventional characterization of EEG background and quantitative measurement of resting state or stimulus-induced EEG activity. Additionally, a small number of studies have associated the presence of electrophysiologic sleep features with prognosis in the acute phase of severe brain injury. In this review, we focus on approaches for the analysis of clinical EEG that have prognostic significance and that could be readily implemented with minimal additional equipment in clinical settings, such as intensive care and intensive rehabilitation units, for patients with acute disorders of consciousness.

1372-P: Hyperglycemia Impacts Mouse Skeletal Muscle in a Sex-Specific Manner

Functional Exercise Capacity (FEC) , a universal predictor of cardiovascular and all-cause mortality, is lower in adults and youth with diabetes for reasons that are poorly understood. Skeletal muscle is key determinant of FEC. We hypothesized that skeletal muscle capillary and mitochondrial density are lower with hyperglycemia and respond to exercise training. To test this hypothesis we generated a model of short-term hyperglycemia (HG) with inducible beta cell deletion of glucokinase (GKlox/lox;PdxCreER) . Male (M) and female (F) HG mice and euglycemic littermate controls (EG) completed 3 weeks of treadmill training (Ex) or remained sedentary (Sed) . The gastrocnemius was collected 24 hours after the final exercise bout. Expression of COX1 (mitochondrial marker) , Dystrophin (muscle fiber sarcolemma boundary marker) , and CD31 (capillary marker) was detected by immunofluorescence. Sirtuin 3 (SIRT3) , an NAD+ dependent deacetylase (mitochondrial homeostasis) was measured using the JESS system. (Fig 1) Mitochondrial density (mitochondria per fiber as quantified by fluorescence intensity units per fiber [FIU/fiber]) was significantly lower in HG vs. EG (p&amp;lt;0.0001) and differed by sex (p=0.0048 sex x glycemia interaction) . Ex resulted in greater mitochondrial density (p=0.0265) independent of sex and glycemia. Capillary density and SIRT3 were unchanged. Sex-differences in muscle response to HG warrant further investigation. Disclosure L.Knaub: None. G.Pott: None. N.A.Hulett: None. S.Hull: None. R.L.Scalzo: None. J.Reusch: Advisory Panel; Medtronic. Funding VA Merit (BX002046)

ACUTE ST-ELEVATION MYOCARDIAL INFARCTION IN OBESE HYPERTENSIVE PATIENTS – CAN WE CONSIDER A DIFFERENT APPROACH?

Objective: Several risk factors, including smoking habits, hypertension, obesity and diabetes, are negatively associated with adverse cardiovascular events. Acute ST-elevation myocardial infarction (STEMI) is a serious problem associated with a high burden of cardiac disease. To determine if obese hypertensive patients had a different clinical presentation and/or a poorer outcome, mainly related to hemorrhagic complications and major adverse cardiovascular events (MACE). Design and method: Retrospective single center cohort study enrolled 121 patients with STEMI diagnosis, admitted to our intensive unit care. In-hospital hemorrhagic complications (IHHC) included intracerebral hemorrhage, resulting in hemodynamic compromise or requiring a blood transfusion were accessed. MACE was a composite endpoint of in-hospital cardiovascular death and sustained ventricular arrhythmic events. Results: The mean age was 58.3 ± 12.7 years and 102 were male (84.3%). Thirty-six patients (29.8%) were overweight and twenty-four (19.8%) were obese. Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes (42.1% vs. 13.8%, respectively; p 0.021). Obese hypertensive patients were mainly women (52.6% vs. 27.5%; p 0.030). There were no statistically differences in other comorbidities between genders. All obese hypertensive patients were medicated for hypertension, 15 (39.5%) with one drug and 7 (18.4%) with two drugs. The mean systolic blood pressure (SBP) at presentation was 126 ± 2.3 mmHg and diastolic blood pressure was 78.5 ± 1.5 mmHg. Obese hypertensive patients had higher blood pressure values (SBP mean 136 ± 33 mmHg), but no differences in symptoms (p 0.20) or Killip-Kimball classification (p 0.93) were evident. Regarding to in-hospital hemorrhagic complications, females had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), but it was independent of other comorbidities, including hypertension, obesity or diabetes (r = 0.249; ANOVA p-value &lt; 0.005). In the subset of obese hypertensive patients, no differences in IHHC (p 0.56) or MACE (p 0.18) were detected. Conclusions: Obese hypertensive patients were mainly women medicated with one drug. Despite higher blood pressure values, this group had similar outcomes, including hemorrhagic events. The authors advocate that a good control of risk factors is crucial to minimize their impact on clinical outcomes.