Outcome Of Inpatient Treatment Research Articles

SP5.3 - Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: Time to change the traditional practice

Abstract Background To evaluate comparative outcomes of outpatient versus inpatient treatment and antibiotics versus no antibiotics approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis. The protocol of this review was registered in PROSPERO (CRD42023488826). Methods A systematic online search was conducted using electronic databases. Comparative studies of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis were included. The primary outcome was diverticulitis recurrence. Emergency surgical resection, elective surgical resection, development of complicated diverticulitis, mortality rate, and length of hospital (LOS) were the other evaluated secondary outcomes. Results The literature search identified 14 studies (n=3,875) comparing NABX (n=2,008) versus ABX (n=1,867). The NABX group showed a lower disease recurrence rate and shorter LOS compared with the ABX group (P=0.01) and (P=0.004). No significant difference was observed in emergency resections (P=0.33), elective resections (P=0.73), development of complicated diverticulitis (P=0.65), hospital re-admissions (P=0.65) and 30-day mortality rate (P=0.91). Twelve studies (n=2,286) compared OP (n=1,021) versus IP (n=1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P=0.10), emergency surgical resection (P=0.40), elective resection (P=0.30), diverticulitis recurrence (P=0.22), and mortality (P=0.61). Conclusion Compared with the use of ABX, the NABX approach seems to provide similar clinical outcomes and shorter LOS. Moreover, OP treatment of Hinchey 1a acute diverticulitis is comparable with IP management and presumably leads to cost savings in depleted healthcare systems

The Relationship between Patient Self-Reported, Pre-Morbid Physical Activity and Clinical Outcomes of Inpatient Treatment in Youth with Anorexia Nervosa: A Pilot Study.

Links between premorbid physical activity (PA) and disease onset/course in patients with anorexia nervosa (AN) remain unclear. The aim was to assess self-reported PA as a predictor of change in percent median BMI (%mBMI) and length of hospital stay (LOS). Five PA domains were assessed via semi-structured interview in adolescents with AN at hospitalization: premorbid PA in school grades 1-6 (PA1-6); PA before AN onset (PA-pre) and after AN onset (PA-post); new, pathological motivation for PA (PA-new); and high intensity PA (PA-high). Eating disorder psychopathology was measured via the Eating Disorder Examination Questionnaire (EDE-Q), and current PA (steps/day) with accelerometry. PA1-6 was also assessed in healthy controls (HCs). Using stepwise backward regression models, predictors of %mBMI change and LOS were examined. Compared with 22 HCs (age = 14.7 ± 1.3 years, %mBMI = 102.4 ± 12.1), 25 patients with AN (age = 15.1 ± 1.7 years, %mBMI = 74.8 ± 6.0) reported significantly higher PA1-6 (median, AN = 115 [interquartile range IQR = 75;200] min vs. HC = 68 [IQR = 29;105] min; p = 0.017). PA-post was 244 ± 323% higher than PA-pre. PA1-6 was directly associated with PA-pre (p = 0.001) but not with PA-post (p = 0.179) or change in PA-pre to PA-post (p = 0.735). Lower %mBMI gain was predicted by lower baseline %mBMI (p = 0.001) and more PA-high (p = 0.004; r2 = 0.604). Longer LOS was predicted by higher PA-pre (p = 0.003, r2 = 0.368). Self-reported PA may identify a subgroup of youth with AN at risk of less weight gain and prolonged LOS during inpatient treatment for AN.

Willingness to experience unpleasant thoughts, emotions, and bodily sensations at admission does not predict treatment outcome in inpatients with obsessive–compulsive disorder

BackgroundSome persons with obsessive–compulsive disorder (OCD) refuse or drop out of treatment because of the aversive nature of exposure and response prevention therapy when they have to face and tolerate unpleasant thoughts, emotions, and bodily sensations. Indeed, one study suggested that a higher willingness to experience unpleasant thoughts, emotions, and bodily sensations (WTE) predicts a better treatment outcome, but this finding has not been replicated yet.MethodsWe examined whether WTE at admission predicted treatment outcome in a sample of 324 inpatients with OCD who received a multimodal treatment that included cognitive-behavioral therapy with exposure and response prevention sessions.ResultsObsessive–compulsive symptoms (based on OCD-specific self-report questionnaires) decreased with medium-to-large effect sizes (all ps < 0.001) and global functioning (based on therapist ratings) increased with a large effect size (d = 1.3, p < 0.001) from admission to discharge. In contrast to previous findings, however, WTE did not predict treatment outcome (all ps > 0.005). The effect of WTE on treatment outcome remained non-significant when controlling for any comorbidity, age, sex, length of stay, and antidepressant medication and was not moderated by these variables.ConclusionsResults indicate that higher WTE at the beginning of inpatient treatment does not facilitate improvements in obsessive–compulsive symptoms from admission to discharge. However, they also indicate that lower WTE at the beginning of inpatient treatment does not adversely affect treatment outcome, that is, even patients who indicate that they are unwilling to face the negative experiences associated with exposure and response prevention can still achieve considerable symptom reductions.

Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: time to change traditional practice

BackgroundTo evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis.MethodsA systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters.ResultsThe literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61).ConclusionObservation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis.

Inpatient Treatment Outcome in a Large Sample of Adolescents with Anorexia Nervosa.

Anorexia nervosa is an illness affecting primarily adolescent girls and young women. Clinical guidelines recommend early intervention, with inpatient treatment for more severe cases. We present an evaluation of a multi-modal cognitive-behavioral inpatient treatment (CBT-E) involving carers in specialized units for adolescents. Routine data of 962 adolescent inpatients (26 boys) (mean age 15.48 [1.26]; range 12-17 years) were analyzed. Predictors of good body weight outcome (achieving a discharge BMI of at least 18.5 kg/m2) were identified by logistic regression analysis. Mean inpatient treatment lasted 96.69 (45.96) days. The BMI increased significantly from 14.93 (1.38) kg/m2 at admission to 17.53 (1.58) kg/m2 at discharge (z = 26.41; p < 0.001; d = 1.708). Drive for thinness decreased from 29.08 (9.87) to 22.63 (9.77; z = 18.41; p < 0.001; d = 0.787). All other subscores of the Eating Disorder Inventory also decreased significantly, with small to medium effect sizes. General psychopathology also showed significant decreases. The Beck Depression Inventory-II score decreased from 26.06 (11.74) to 16.35 (12.51; z = 18.41; p < 0.001; d = 0.883). A good body weight outcome was predicted by a higher BMI at admission (OR = 1.828), age at onset at 15 years or higher (OR = 1.722), and higher Somatization (OR = 1.436), Anxiety (OR = 1.320), and Bulimia (OR = 1.029) scores. CBT-E involving carers is an efficient intervention for adolescents with anorexia nervosa.

The Effect of COVID-19 Restrictions on General and HIV Positive Inpatient Admissions and Treatment Outcomes: An Uncontrolled Before-and-after Study at a Ugandan Tertiary Hospital.

Measures to contain the Corona Virus Disease 2019 (COVID-19) pandemic curtailed access to prevention and treatment services for endemic infectious diseases like HIV. We used an uncontrolled before-and-after study design to compare general and HIV positive (HIV+) inpatient outcomes at a tertiary hospital in Uganda, using electronic records of medical inpatients. Data was downloaded, cleaned in Microsoft Excel, and exported to STATA for analysis. We determined the difference in number of admissions and median length of hospital stay using Mann-Whitney U test; and difference in median survival and incidence rates of mortality using Kaplan - Meier statistics, between the pre- and peri-COVID-19 groups. Of 7506 patients admitted to Kiruddu NRH, 50.8% (3812) were female and 18.7% (1,401) were aged 31-40 years, and 18.8% (1,411) were HIV+. Overall, 24.6% (1849) died. Total admissions were lower (2192 vs. 5314 patients), overall mortality rate higher (41.8% vs. 17.6%, p < 0.01), median length of hospital stay longer (6 vs. 4 days, p < 0.01) and median survival shorter (11 vs. 20 days, Chi-square = 252.05, p < 0.01) in the peri- than in pre-COVID-19 period. The adjusted hazard ratio (aHR) of death was 2.08 (95% CI: 1.85-2.23, p < 0.01) in the peri- compared to the pre-COVID-19 period. These differences were more pronounced in HIV + patients. Compared to pre-COVID-19, the peri-COVID-19 period registered lower inpatient admissions but poorer treatment outcomes for general and HIV + inpatients. Emerging epidemic responses should minimize disruption to inpatient care, especially for HIV + individuals.

Parental dieting impacts inpatient treatment outcomes for adolescents with restrictive eating disorders.

Parental feeding practices and disordered eating are potential risk factors for the development of disordered eating in children and adolescents. This study measured the relationship between parental dieting behaviours and inpatient treatment outcomes for adolescents with restrictive eating disorders (EDs). Parents of adolescents with restrictive EDs (N=45) admitted to a specialty integrated inpatient-partial hospital meal-based ED treatment programme completed questionnaires assessing parental eating and exercise behaviours. Adolescent clinical data, including percentage median body mass index (%mBMI) at admission and discharge and rate of weight gain, were abstracted from the electronic medical record. Adolescents whose parents reported dieting had a slower rate of weight gain (3.47 lbs./week) compared to participants whose parents were not dieting (4.54 lbs./week; p=0.017). Additionally, participants whose parents reported dieting had a lower %mBMI at programme discharge (M=93.56) than participants whose parents did not report dieting (M=95.99; p=0.033). Parental dieting behaviours may impact an adolescent's response to inpatient ED treatment. Findings suggest a need to assess parental dieting behaviour, and when appropriate, provide additional psychoeducation regarding the potential risks of weight or shape-focussed dialogue and the benefits of modelling adaptive meal behaviours.

Comparing illness duration and age as predictors of treatment outcome in female inpatients with anorexia nervosa

ABSTRACT It has been widely assumed that longer illness duration predicts poorer treatment outcome in persons with anorexia nervosa (AN). However, studies on the prognostic effects of illness duration have produced mixed results. Thus, the aim of the current study was to examine the relationship between illness duration and short-term treatment outcome in a large sample of female inpatients with AN (n = 902, aged 12–73 years). Treatment outcome variables included body mass index, therapist-rated global functioning (Global Assessment of Functioning scale and Clinical Global Impression–Improvement scale) and subscales of the Eating Disorder Inventory–2. Longer illness duration predicted smaller weight gain, smaller improvements in global functioning, and smaller decreases in self-reported eating disorder symptoms. However, illness duration was almost perfectly correlated with patients’ age (r = .81, 95% CI [.76, .85]), and comparing regression models revealed that models using either illness duration or age were indistinguishable. Results suggest that longer illness duration does indeed relate to worse short-term treatment outcome in inpatients with AN. This effect, however, does not add significant information above and beyond patients’ age and, thus, the importance of illness duration for anticipating treatment outcome both in research and in clinical practice must be critically examined.

Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings

BackgroundInpatient treatment of anorexia nervosa can be lifesaving but is associated with high rates of relapse and poor outcomes. To address this, the Oxford service has adapted the enhanced cognitive behavioural treatment (CBTE) model, first developed for inpatients in Italy to a UK national health service (NHS) setting. In this study, we compared the outcomes from treatment as usual (TAU), integrated CBTE (I-CBTE), and alternative treatment models in routine UK clinical practice.MethodsThis is a longitudinal cohort study, using routinely collected data between 2017 and 2020 involving all adults with anorexia nervosa admitted to specialist units from a large geographical area in England covering a total population of 3.5 million. We compared TAU with (1) I-CBTE (13 weeks inpatient CBTE, restoration to a healthy weight, combined with 7 weeks day treatment followed by 20 weeks of outpatient CBTE; (2) standalone inpatient CBTE (due to insufficient resources since the pandemic; and (3) 6–8 weeks admission with partial weight restoration as crisis management. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: (1) good outcome: Body Mass Index (BMI) > 19.5 and no abnormal eating or compensatory behaviours; (2) poor outcome: BMI < 19.5 and/or ongoing eating disorder behaviours; (3) readmission; or (4) deceased. Secondary outcomes were BMI on discharge, and length of stay.Results212 patients were admitted to 15 specialist units in the UK depending on bed availability. The mean age was 28.9 (18–60) years, mean admission BMI was 14.1 (10–18.3), 80% were voluntary. At minimum 1-year follow up after discharge, 70% of patients receiving I-CBTE and 29% standalone inpatient CBTE maintained good outcomes, in contrast with < 5% TAU and crisis management admission. Readmission rates of I-CBTE were 14.3% vs ~ 50% (χ2 < 0.0001) in the other groups. The main predictors of good outcome were reaching healthy BMI by discharge, I-CBTE and voluntary status. Age, psychiatric comorbidity and length of stay did not predict outcomes. BMI on discharge and length of stay were significantly better in the CBTE groups than in TAU.ConclusionsOur main finding is that in a real-life setting, I-CBTE has superior short- and minimum 1 year outcomes as compared with alternative inpatient treatment models. Dissemination of I-CBTE across the care pathway has the potential to transform outcomes of inpatient treatment for this high-risk patient population and reduce personal and societal costs.

Melanoma-Specific Clinical Outcomes of Inpatient Immune Checkpoint Blockade Treatment.

BackgroundLittle is known about patient outcomes with advanced melanoma following inpatient initiation or continuation of immune checkpoint blockade (ICB).Methods and ResultsWe conducted a single institution retrospective case series of advanced melanoma patients who initiated ICB as an inpatient (initial inpatient cohort, n = 9), or continued ICB as an inpatient after previously starting as an outpatient (outpatient then inpatient cohort, n = 5). One patient had a partial response to ICB initiated as an inpatient, but ultimately died of melanoma after 13.5 months. Median overall survival for initial inpatient cohort was 1.0 month (95% CI: 0.2-11.2), and 1.4 months (95% CI: 0.4-58.0) for the outpatient then inpatient cohort. Three patients were alive >6 months after inpatient ICB administration.ConclusionDespite overall poor outcomes, some patients may benefit from inpatient ICB. This study provides additional information for clinicians to appropriately counsel patients on expectations following inpatient ICB.

Somatic symptom profiles are associated with pre-treatment depression and anxiety symptom severity but not inpatient therapy outcomes

Objective. Although somatic symptoms are common among mental health patients, their association with symptom severity and inpatient treatment outcomes is not yet well understood. Methods. Using a pre–post design and latent class analysis (LCA), 641 inpatients (63.4% female) were classified based on their self-reported somatic symptoms. We examined how the resulting somatic symptom classes related to depression and anxiety symptom severity pre-treatment (T1) and to symptom reduction post-treatment (T2). Results. Our results suggest four somatic symptom classes, namely (1) unspecific/low somatic symptom burden, (2) sexual problems, (3) gastrointestinal symptoms with pain syndrome, and (4) cardiopulmonary symptoms. While class 1 indicated the lowest pre-treatment depression and anxiety symptom severity, class 2 reported high depressive symptoms coupled with low anxiety, class 3 reported moderate depressive and anxiety symptom severity, and class 4 reported the highest depressive and anxiety symptom burden. Somatic symptom classes, however, did not predict the degree of reduction in either depression or anxiety symptoms post-treatment. Conclusions. These findings demonstrate somatic heterogeneity in mental health patients and reveal the relationship of somatic symptom patterns to affective symptom severity. Clinical implications are discussed.

Influence of Identity Development on Weight Gain in Adolescent Anorexia Nervosa.

BackgroundAnorexia Nervosa (AN) typically begins during early adolescence, an important phase of personality development. A substantial proportion of adolescent AN patients shows impaired personality functioning, which might be a relevant but understudied aspect of illness severity. The developmental status of identity as key element of personality is suggested to influence inpatient treatment outcome in adolescents with AN.MethodsThis study analyzed existing data of N = 60 adolescents with AN. Multilevel models assessed the influence of identity functioning, measured by the Assessment of Identity Development in Adolescence (AIDA) at admission, on weight gain [BMI (body mass index), BMI-SDS (BMI standard deviation score)] during 10 weeks of inpatient treatment. Moreover, the influence of other indicators of illness severity, i.e., eating disorders and comorbid psychopathologies, was explored.ResultsAs expected, higher AIDA scores negatively influenced the course of weight gain. A similar effect was observed for other psychopathology measures, especially body image distortion. In general, higher weight at admission was associated with less weight gain. Higher weight at admission was also predicted by higher other psychopathology measures, but not AIDA scores.ConclusionThe course of weight gain during inpatient treatment was hampered in adolescent AN patients who have difficulties developing a stable identity. Unlike other aspects of psychopathology, this was independent of the initial weight. Thus, in addition to the level of underweight and other aspects of psychopathology, difficulties in identity development constitute a relevant aspect of illness severity in AN. This recommends consideration of identity development during treatment.

Higher Resting Cardiovagal Activity Predicts Larger Decrease of Depressive Symptoms in Inpatients Treated for Stress-Related Depression

Abstract. Depression is one of the most prevalent mental disorders, with treatment outcomes generally being unsatisfactory. The identification of outcome predictors could contribute to improving diagnosis, treatment, and outcome. Heart rate variability (HRV), an index of cardiovagal activity, has been proposed as a potential correlate of depression as well as a predictor of treatment effectiveness. The aim of the present study was to examine if HRV at baseline could predict the outcome of inpatient treatment for stress-related depressive disorder (SRDD). Depressive symptoms of n = 57 inpatients with an SRDD, who were treated in a specialized burnout ward, were assessed using the Beck Depression Inventory (BDI) at the beginning, the end of treatment, and at 3-month follow-up. HRV (i.e., RMSSD, the root mean square of successive RR interval differences) was determined from a five-minute measurement in the supine position. RMSSD was not significantly associated with the BDI score at the beginning, end, and follow-up. Higher RMSSD was revealed to be a significant predictor of a stronger decrease in depressive severity from the beginning to the end of the treatment. Thereby, the regression model explained 7.6% of the total variance in the BDI decrease. The results revealed initial HRV to predict a larger decrease in depressive severity. Therefore, resting HRV represents a physiological resource and index of successful neurovisceral interaction, which supports inpatients in benefitting from specialized treatment.

Psychiatric Comorbidities of Substance Use Disorders: Does Dual Diagnosis Predict Inpatient Detoxification Treatment Outcomes?

Comorbidity of substance use and psychiatric disorders, particularly depressive disorders, are well established. The impact of comorbidity on treatment outcomes, particularly following short-term inpatient detoxification and medical management units, has yet to be fully explored. This study reviewed 456 records of patients voluntarily presenting for medical management of substance misuse in Sydney, Australia. Documented psychiatric comorbidities and primary substance of misuse were extracted and used to predict length of stay, discharge against medical advice and number of readmissions. Our results showed that psychiatric comorbidity did not significantly predict treatment outcomes, although depression was reported in more than half our cohort, along with elevated rates of Post-traumatic Stress Disorder, anxiety disorders and bipolar affective disorders. Medication non-compliance and primary substance of misuse significantly predicted length of stay and discharge against medical advice. Further research into how specific substances interact and affect specific psychiatric disorders is needed to guide optimal treatment options.

Antibiotic prescription rationality and associated in-patient treatment outcomes in children under-five with severe pneumonia at Bwizibwera health center IV, Mbarara District, South-Western Uganda

BackgroundPneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia. Pneumonia accounted for approximately 16% of the 5.6 million under-five deaths word wide in 2016. In Uganda, it kills approximately 2,400 children per year. Early diagnosis and appropriate case management with rational use of antibiotics remain the most effective intervention to reduce pneumonia-related mortality. This study aimed at determining antibiotic prescription rationality and associated in-patient treatment outcomes in children aged 2–59 months with severe community-acquired pneumonia at Bwizibwera Health Centre IV from 1st May 2018 to 30th April 2019.MethodsWe conducted a retrospective cohort study design; data were collected from in-patient records of all children aged 2–59 months with severe community-acquired pneumonia who met the eligibility criteria for a period of one year. Data abstraction template was used for data collection. Health care records of children aged 2–59 months who had other co-morbidities and were on medication that could influence or impact on in-patient treatment outcomes from 1st May 2018 to 30th April 2019 were excluded. Data was entered and analyzed using Epi-info v 7.2 and STATA v 13.0 respectively, Descriptive statistics were reported and Chi-square test was used to compare the proportions.ResultsOf the total records of children retrieved and screened (N = 847), 229 prescription records of children fulfilled inclusion criteria, 57 (24.9%) had rational prescriptions with good outcomes and 172 (75.1%) had irrational prescriptions with 10 (4.4%) having unfavorable outcomes. The majority (73.7%) of those who received rational prescription were on treatment with a combination of benzyl penicillin plus gentamycin while (26.3%) were on ampicillin plus gentamycin. The majority (32.4%) of patients with good treatment outcomes were aged 6 – 11 months. This age category also doubled as the group that experienced the highest percentage (40.0%) of unfavorable outcomes. There were no statistically significant associations between patient characteristics and treatment outcomes.ConclusionIn conclusion, the majority of children had irrational antibiotic prescriptions and 40 percent of children aged 6–11 Months had unfavorable treatment outcomes with 20 percent death. This study also found out that majority of antibiotic prescription among children under five was irrational and it’s against Uganda clinical guideline for treatment of severe pneumonia among children under five.

Treatment gaps, 1-year readmission and mortality following myocardial infarction by diabetes status, sex and socioeconomic disadvantage

AimsWe evaluated variation in treatment for, and outcomes following, myocardial infarction (MI) by diabetes status, sex and socioeconomic disadvantage.MethodsWe included all people aged ≥30 years who were discharged alive from...

Post-COVID-19 Multisystem Inflammatory Syndrome in Children and Adults: What Happens After Discharge?

IntroductionClassification criteria and practice guidelines for inpatient management of multisystem inflammatory syndrome (MIS) exist, but reports on outpatient management and clinical outcomes are lacking. Here we describe the management and clinical outcomes of four children and four adults with MIS seen at Walter Reed National Military Medical Center (WRNMMC) from diagnosis to six months follow-up.MethodsThis retrospective, case-series describes the initial presentation and management of MIS in four children and four adults seen at WRNMMC from March 2020 to September 2021. Data on each patient was collected from the time of exposure to the SARS-CoV-2 virus to six months post-diagnosis with MIS. Extracted data includes: demographics, comorbidities, initial MIS presentation, inpatient treatment, outpatient treatment, and clinical outcomes.ResultsA total of 62.5% of patients presented in shock. All pediatric patients received IVIG, methylprednisolone, and anakinra; no adult received this combination. Steroids and immunomodulatory medications were discontinued in 1-2 months outpatient. Three children and two adults had full symptomatic resolution. One child and two adults had persistent deconditioning at six months follow-up. One adult had persistent dyspnea.ConclusionsMIS appears to be monophasic with no recurrences at six months follow-up in our patients who only required 1-2 months of glucocorticoid or immunomodulatory medications. The better outcomes in children raise the question of how much of this difference can be attributed to early combination therapy versus physiologic differences in children and adults.

Negative Mood Regulation Expectancies (NMRE) as a Moderator of the Association Between Stress and Treatment Outcomes in Interdisciplinary Chronic Pain Treatment.

Negative mood regulation expectancies (NMRE) describe the expectancies of an individual regarding his or her ability to regulate or reduce negative mood states by certain cognitive or behavioral strategies. NMRE are closely associated with the actual emotion regulation and potentially buffer the negative psychological and physical health consequences of stress. In the context of chronic pain, stress plays a central role, as long-term stress can have additional negative consequences regarding pain and its progression. The present study investigated the relationship of NMRE with treatment outcome, and more importantly, its buffering role in the association between stress and treatment outcomes. Two hundred six chronic pain inpatients (fulfilling the International Classification of Diseases, 10th Revision [ICD-10] diagnosis of F45.41) of an interdisciplinary treatment completed standardized self-report questionnaires at intake and discharge. Hierarchical linear regression analyses were used to test the main effects of the Negative Mood Regulation Scale-Short Form on pain intensity, pain-related disability, and psychological distress as treatment outcomes and its moderating role in the association of stress and the 3 outcome measures. A significant main effect of NMRE on treatment outcome was only found for psychological distress. However, for all 3 outcome measures, a significant moderating effect of NMRE on the association between stress level and treatment outcome was found. NMRE appear to play an important role for the outcome of inpatient treatment for chronic pain. Due to their buffering effect on the negative association between stress and therapy outcome, they should be targeted in the treatment of chronic pain.

Changes in Loss Sensitivity During Treatment in Concurrent Disorders Inpatients: A Computational Model Approach to Assessing Risky Decision-Making.

BackgroundRecent studies have employed computational modeling to characterize deficits in aspects of decision-making not otherwise detected using traditional behavioral task outcomes. While prospect utility-based modeling has shown to differentiate decision-making patterns between users of different drugs, its relevance in the context of treatment has yet to be examined. This study investigated model-based decision-making as it relates to treatment outcome in inpatients with co-occurring mental health and substance use disorders.Methods50 patients (Mage = 38.5, SD = 11.4; 16F) completed the Cambridge Gambling Task (CGT) within 2 weeks of admission (baseline) and 6 months into treatment (follow-up), and 50 controls (Mage = 31.9, SD = 10.0; 25F) completed CGT under a single outpatient session. We evaluated 4 traditional CGT outputs and 5 decisional processes derived from the Cumulative Model. Psychiatric diagnoses and discharge data were retrieved from patient health records.ResultsGroups were similar in age, sex, and premorbid IQ. Differences in years of education were included as covariates across all group comparisons. All patients had ≥1 mental health diagnosis, with 80% having >1 substance use disorder. On the CGT, patients showed greater Deliberation Time and Delay Aversion than controls. Estimated model parameters revealed higher Delayed Reward Discounting, and lower Probability Distortion and Loss Sensitivity in patients relative to controls. From baseline to follow-up, patients (n = 24) showed a decrease in model-derived Loss Sensitivity and Color Choice Bias. Lastly, poorer Quality of Decision-Making and Choice Consistency, and greater Color Choice Bias independently predicted higher likelihood of treatment dropout, while none were significant in relation to treatment length of stay.ConclusionThis is the first study to assess a computational model of decision-making in the context of treatment for concurrent disorders. Patients were more impulsive and slower to deliberate choice than controls. While both traditional and computational outcomes predicted treatment adherence in patients, findings suggest computational methods are able to capture treatment-sensitive aspects of decision-making not accessible via traditional methods. Further research is needed to confirm findings as well as investigate the relationship between model-based decision-making and post-treatment outcomes.

Vacuum-assisted laparostomy with staged peritoneal lavage in management of secondary postoperative diffuse peritonitis: a prospective comparative non-randomised clinical trial

Background. Secondary postoperative diffuse peritonitis (SPDP) associates with a high incidence of abdominal sepsis and 35–92% mortality rate. An optimal surgical doctrine in this complication in lacking to date.Objectives. An efficacy assessment of vacuum-assisted laparostomy (VAL) with staged lavage relative to relaparotomy on demand (RD) in SPDP patients.Methods. Patient enrolment and analyses were conducted within period 01.11.2017-31.12.2020, totalling for 141 SPDP patients, 77 (54.6%) males and 64 (45.4%) females aged 64.5 (5972.7) years. Cohort I patients (n = 52) had post-abdominal-lavage VAL using Suprasorb® SNP (SNP-1 and SNP-2) equipment and consumables (Lohmann &amp; Rauscher GmbH, Austria). Staged lavage was performed 48-72 h apart. Cohort II (n = 78) had a standard RD technique. Cohort III (n = 11) treatment included RD-to-VAL transition. The endpoint was the inpatient treatment outcome, a favourable completion or death. The additional estimated criteria were complications rate and severity (in ACCORDION-modified Clavien-Dindo classification), sepsis rate, C-reactive protein level, abdominal index dynamics, patient’s intensive-care and total-hospital lengths of stay.Results. Cohort I included 157 staged-lavage VALs, cohort II — 107 RDs, cohort III — 49 operations. The mortality rate was 3/52 (5.8%), 24/78 (30.8%) and 7/11 (63.6%) in cohorts I, II and III (respectively, p &lt; 0.001). No difference was observed in the length of hospital stay, with a shorter intensive care stay after final abdominal closure in cohort I. Clavien — Dindo grade 3a complications were observed for 25.0% of cohort I, 60.3 and 45.5% — of cohorts II and III (respectively, p &lt; 0.01); grade 3b complications were 0 (0%), 24.4 and 100% in cohorts I, II and III (respectively, p &lt; 0.001; all 11 patients were reoperated). Multiple organ failure (grade 4b) was reported in 5.8, 30.8 and 63.6% of cohorts I, II and III (respectively, p &lt; 0.001). By end of treatment, sepsis had resolved in 9/11 (81.8%) patients in cohort I, 5/24 (20.8%) and 1/6 (16.7%) — in cohorts II and III (respectively, p = 0.002).Conclusion. Programmed staged-lavage VAL is an optimal surgical treatment tactics in SPDP. Relative to RD, VAL provides a more effective management of local and systemic abdominal sepsis, lower mortality, fewer and less sever complications, shorter intensive care stays after abdominal closure.