Recovery Scale Research Articles

The Determinants of Mental Illness Self-Management for Patients With Schizophrenia and Type 2 Diabetes: A Self-Determination Theory Approach.

This study based on self-determination theory aimed to assess the relationship between motivation, competence in diabetes management and perceived autonomy support respectively and mental illness self-management; furthermore, the authors intended to explore the determinants of mental illness self-management for patients with schizophrenia and diabetes. This was a cross-sectional study. One hundred ten participants were recruited at the psychiatric hospital and assessed with the Illness Management and Recovery Scale, the Treatment Self-Regulation Questionnaire, the Perceived Competence Scale for Diabetes and the Health-Care Climate Questionnaire. Patients with lower educational levels, who were admitted to the chronic ward, were unemployed, had lower motivation in illness management, lower competence in diabetes management and perceived lower autonomy support all had lower mental illness self-management. Competence in diabetes management, employment status, autonomy support, educational levels and living alone were the determinants of mental illness self-management. Recovery from schizophrenia and comorbid diabetes is an enduring and complicated process requiring support from healthcare providers. Health professionals should assess the levels of illness self-management and provide integrated care interventions for patients with schizophrenia and diabetes, helping them manage both conditions. The illness management programme could apply to patients with schizophrenia and diabetes and address patients' characteristics such as low levels of education, living alone and being unemployed while additionally promoting motivation and competence, and providing supporting autonomy. The STROBE checklist was followed. Patients with schizophrenia and diabetes were recruited for this study and voluntarily completed the questionnaire.

Impact of a 6-month sit-stand desk-based intervention on regional musculoskeletal discomfort and overall post-work fatigue in office workers: a cluster randomised controlled trial

Evaluate the impact of a 6-month sit-stand desk (SSD) intervention on office workers’ regional musculoskeletal discomfort (MD) and overall post-work fatigue (PWF) compared to a control group. A two-arm (1:1) clustered randomised controlled trial including 38 participants (aged 24–60 years, 77% women) assigned to intervention or control groups. The intervention, spanning 6 months, involved psychoeducation, motivational prompts, and SSD. The control group maintained standard working conditions. MD was assessed using the Nordic Musculoskeletal Questionnaire, and PWF with the Need for Recovery Scale. ANCOVA was employed to compare groups, adjusting for covariates, with 5% significance. The intervention group reduced overall MD (p = 0.018) and PWF (p = 0.013), while the control group showed no changes. However, no time*group interactions were found (p > 0.05). A 6-month SSD intervention alleviated office workers’ MD and PWF, suggesting benefits from increasing standing time by at least 30 minutes/day. Future investigations must explore individual heterogeneity in response to SSD. Trial registration https://doi.org/10.17605/OSF.IO/JHGPW.

Effects of 8days intake of hydrogen-rich water on muscular endurance performance and fatigue recovery during resistance training.

Exercise-induced oxidative stress and inflammation can impair muscular function in humans. The antioxidant and anti-inflammatory properties of molecular hydrogen (H2) highlight its potential to be as an effective nutritional supplement to support muscular function performance in healthy adults. However, the effects of H2 supplementation on muscular endurance performance in trained individuals have not been well characterized. This study aimed to assess the effects of intermittent hydrogen-rich water (HRW) supplementation before, during, and after resistance training on muscular endurance performance, neuromuscular status, and subjective perceptual responses after a 48-h recovery period. This randomized, double-blinded, placebo-controlled cross-over study included 18 trained men aged 19.7 ± 0.9years. Participants in this study were instructed to consume 1,920mL of HRW or pure water (Placebo) daily for 7days. Additionally, participants were required to supplement with HRW or pure water five times during the training day (1,260mL total). This included drinking 210mL 30min and 1min before training, 210mL between training sets, 210mL immediately after training, and 420mL 30min into the recovery period. Participants performed half-squat exercises with the load set at 70% of one repetition maximum for six sets (half-squat exercise performed to repetitions failure each set). We measured the power output and number of repetitions in the free barbell half-squat used to assess muscular endurance performance in participants. The countermovement jump (CMJ) height, total quality recovery scale (TQRS), and muscle soreness visual analog scale (VAS) scores were measured to assess fatigue recovery status after training, as well as at 24 and 48h of recovery. The total power output (HRW: 50,866.7 ± 6,359.9W, Placebo: 46,431.0 ± 9,376.5W, p = 0.032) and the total number of repetitions (HRW:78.2 ± 9.5 repetitions, Placebo: 70.3 ± 9.5 repetitions, p = 0.019) in the H2 supplemented group were significantly higher than in the placebo group. However, there was no statistically significant difference (p< 0.05) between the H2 and placebo groups in CMJ, TQRS, and VAS. Eight days of intermittent HRW intake could significantly improve muscular endurance performance in trained individuals, making it a promising strategy for athletes or fitness enthusiasts looking to boost muscular endurance during resistance training or competitions. However, it should be noted that HRW intake alone may not be adequate to accelerate recovery from muscle soreness or fatigue following high-intensity training.

A Comparison among Score Systems for Discharging Patients from Recovery Rooms: A Narrative Review.

The recovery room (RR) is a hospital area where patients are monitored in the early postoperative period before being transferred to the surgical ward or other specialized units. The utilization of scores in the RR context facilitates the assignment of patients to the appropriate ward and directs necessary monitoring. Some scoring systems allow nurses to select patients who can be discharged directly to their homes. The aim of this narrative review was to describe and compare the scoring systems employed to discharge postoperative patients from RR, with a focus on item characteristics. Nine scoring systems were identified and discussed: the "Aldrete Score System" and its modified version, the "Respiration, Energy, Alertness, Circulation, Temperature Score", the "Post Anesthetic Discharge Scoring System", the "White and Song Score", the "Readiness for Discharge Assessment Tool", the "Anesthesia and Perioperative Medicine Service Checklist", the "Post-Anesthetic Care Tool", the "Post-operative Quality Recovery Scale", and the "Discerning Post Anesthesia Readiness for Transition" instrument. To obtain a comprehensive overview, the items included in the scoring systems were compared. Despite the availability of guidelines for patients' discharge readiness from the RR, there is no universally recommended scoring system. Next-generation scores must be improved to ease their use, minimize errors, and increase safety. The main goals of the scores included in this narrative review were to be simple to use, feasible, intuitive, comprehensive, and flexible. However, these goals frequently conflict because patient assessment takes time, and a smart and comprehensive score may not consider some clinical parameters that may be crucial for the discharge decision. Therefore, further research should be conducted on this topic.

Conventional structural magnetic resonance imaging in differentiating chronic disorders of consciousness

BACKGROUND: Differential diagnosis of chronic disorders of consciousness remains one of the most difficult problems even for experienced clinicians. AIM: To evaluate the inter-expert consistency and capacity of the researcher-developed structural scale based on magnetic resonance imaging to differentiate chronic disorders of consciousness, named, DOC-MRIDS, on a larger sample of patients. MATERIALS AND METHODS: Sixty patients with a clinically stable status diagnosed with consciousness disorders (vegetative state, n=32; minimally conscious state, n=28) were enrolled. The revised coma recovery scale (CRS-R) was included in the clinical assessment. All patients underwent structural magnetic resonance imaging with 3.0-T Siemens scanners including T2 and T1 sequences. Structural changes were assessed using the DOC-MRIDS scale and included the following features: diffuse cortical atrophy, ventricular enlargement, gyri dilatation, leukoaraiosis, brainstem and/or thalamic degeneration, corpus callosum degeneration, and focal corpus callosum lesions. A total score was calculated. Magnetic resonance imaging data were analyzed by three neuroradiologists, and inter-observer agreement (Krippendorf’s alpha) was assessed. RESULTS: A high inter-examiner agreement of the DOC-MRIDS scale score was found, with α=0.806 (95% confidence interval 0.757–0.849). The vegetative state group had a higher DOC-MRIDS score than the minimally conscious state group (p 0.005). A negative correlation was obtained between CRS-R and DOC-MRIDS scale scores (ρ=–0.457, p 0.0001), individual clinical scale domains, and magnetic resonance imaging features. CONCLUSION: When assessing structural changes in patients with chronic consciousness disorders, the use of the DOC-MRIDS scale helps differentiate the type of such disorders with sufficient specificity, sensitivity, and inter-rater agreement. This scale can be used in clinical practice as an additional differential diagnostic tool.

Perturbational complexity index in assessing responsiveness to rTMS treatment in patients with disorders of consciousness: a cross-over randomized controlled trial study

BackgroundDisorders of Consciousness (DoC) caused by severe brain injuries represent a challenging clinical entity, which is easy to misdiagnosis and lacks effective treatment options. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuroelectric stimulation method that shows promise in improving consciousness for DoC, especially in minimally conscious state (MCS). However, there is little evidence of its effectiveness, especially in RCT studies.MethodsTwenty MCS patients participated in a double-blind, randomized, crossover, sham-controlled clinical study to evaluate the safety and efficacy of rTMS for MCS. Subjects were randomized into two groups: one group received rTMS-active for 10 consecutive days (n = 10), and the other group received rTMS-sham for 10 consecutive days (n = 10). After a 10-day washout period, the two groups were crossed over and received the opposite treatment. the rTMS protocol consisted of 2,000 pulses per day in the left dorsolateral prefrontal cortex (L-DLPFC), sent at 10 Hz. The stimulation intensity was 90% of the resting motor threshold. Coma Recovery Scale Revised (CRS-R), the main evaluation index, was evaluated before and after each phase in a double-blind manner. Meanwhile RS-EEG and TMS-EEG data were acquired and relative alpha power (RAP), and perturbational complexity index based on state transitions (PCIst) were caculated.ResultsOne-way ANOVA revealed significantly higher scores in rTMS-active treatment compared to rTMS-sham across various measures, including CRS-R total score, RAP, PCIst (all P < 0.05). Among the 20 MCS patients, 7 (35%) were identified as responders following rTMS treatment. Compared to rTMS-sham, responder scores for CRS-R, RAP, and PCIst (all P < 0.05) were significantly elevated after rTMS-active treatment. Conversely, there was no significant difference observed in non-responders. Furthermore, post-hoc analysis revealed that baseline PCIst was significantly higher in responders than non-responders. Upon a 6-month follow-up, CRS-R scores significantly increased in all 20 patients (P = 0.026). However, the responder group exhibited a more favorable prognosis compared to the non-responder group (P = 0.031).ConclusionsApplying 10 Hz rTMS to L-DLPFC significantly increased consciousness level in MCS patients. PCIst is a neurophysiological index that has the potential to evaluate and predict therapeutic efficacy.Trial registrationwww.ClinicalTrials.gov, identifier: NCT05187000.

Post-exercise hot or cold water immersion does not alter perception of effort or neuroendocrine responses during subsequent moderate-intensity exercise.

Post-exercise hot (HWI) and cold (CWI) water immersion are popular strategies used by athletes in a range of sporting contexts, such as enhancing recovery or adaptation. However, prolonged heating bouts increase neuroendocrine responses that are associated with perceptions of fatigue. Fourteen endurance-trained runners performed three trials consisting of two 45-min runs at 95% lactate threshold on a treadmill separated by 6h of recovery. Following the first run, participants completed one of HWI (30min, 40°C), CWI (15min, 14°C) or control (CON, 30min rest in ambient conditions) in a randomised order. Perceived effort and recovery were measured using ratings of perceived exertion (RPE) and the Acute Recovery and Stress Scale (ARSS), whilst physiological responses including venous concentrations of a range of neuroendocrine markers, superficial femoral blood flow, heart rate and rectal temperature were measured. Exercise increased neuroendocrine responses of interleukin-6, adrenaline and noradrenaline (all P <0.001). Additionally, perceptions of overall recovery (P <0.001), mental performance capacity (P =0.02), physical performance capability (P =0.01) and emotional balance (P =0.03) were reduced prior to the second run. However, there was no effect of condition on these variables (P>0.05), nor RPE (P =0.68), despite differences in rectal temperature, superficial femoral blood flow following the first run, and participants' expected recovery prior to the intervention (all P <0.001). Therefore, athletes may engage in post-exercise hot or cold-water immersion without negatively impacting moderate-intensity training sessions performed later the same day.

The Cumulative Impacts of Fatigue during Overload Training Can Be Tracked Using Field-Based Monitoring of Running Stride Interval Correlations.

Integrating running gait coordination assessment into athlete monitoring systems could provide unique insight into training tolerance and fatigue-related gait alterations. This study investigated the impact of an overload training intervention and recovery on running gait coordination assessed by field-based self-testing. Fifteen trained distance runners were recruited to perform 1-week of light training (baseline), 2 weeks of heavy training (high intensity, duration, and frequency) designed to overload participants, and a 10-day light taper to allow recovery and adaptation. Field-based running assessments using ankle accelerometry and online short recovery and stress scale (SRSS) surveys were completed daily. Running performance was assessed after each training phase using a maximal effort multi-stage running test-to-exhaustion (RTE). Gait coordination was assessed using detrended fluctuation analysis (DFA) of a stride interval time series. Two participants withdrew during baseline training due to changed personal circumstances. Four participants withdrew during heavy training due to injury. The remaining nine participants completed heavy training and were included in the final analysis. Heavy training reduced DFA values (standardised mean difference (SMD) = -1.44 ± 0.90; p = 0.004), recovery (SMD = -1.83 ± 0.82; p less than 0.001), performance (SMD = -0.36 ± 0.32; p = 0.03), and increased stress (SMD = 1.78 ± 0.94; p = 0.001) compared to baseline. DFA values (p = 0.73), recovery (p = 0.77), and stress (p = 0.73) returned to baseline levels after tapering while performance trended towards improvement from baseline (SMD = 0.28 ± 0.37; p = 0.13). Reduced DFA values were associated with reduced performance (r2 = 0.55) and recovery (r2 = 0.55) and increased stress (r2 = 0.62). Field-based testing of running gait coordination is a promising method of monitoring training tolerance in running athletes during overload training.

The effect of the application of adductor and Infiltration of local anesthetic between the popliteal artery and capsule of the knee (IPACK) block to patients on postoperative recovery and sleep quality following total knee arthroplasty: a randomized, controlled study

Aim: The adductor canal block (ACB) and IPACK (Infiltration of local anesthetic between the popliteal artery and capsule of the knee) block are motor protective blocks that provide effective analgesia and allow early ambulation. The aim of this study was to investigate the effect on postoperative recovery and sleep quality of patients applied with ACB and IPACK for total knee arthroplasty (TKA). Material and Method: This prospective, double-blinded, randomized, controlled study included 80 patients who underwent unilateral TKA under spinal anesthesia. The patients were separated as those applied with ACB+IPACK (Group ACB+IPACK, n=40) and a control group (Group C, n=40). The primary outcome was the postoperative first-day quality of recovery scale (QoR-15). Secondary outcomes were postoperative first and second-day Timed-Up-and-Go (TUG) test and range of motion (ROM), the total amount of rescue opioid drugs required, pain scales at different time points in the first 48 hours postoperatively, sleep evaluation on the postoperative and 6 following nights, and evaluation of sleep quality for 1 month using the Pittsburgh Sleep Quality Index (PSQI). Results: The QoR on postoperative days 1 and 7 were better in the ACB+ IPACK group than in the control group (p= 0.001, p= 0.002, respectively). On postoperative days 1 and 2, the TUG (p= 0.035, p= 0.019, respectively) and ROM (p=0.003, p=0.000) values were higher in the ACB+ IPCAK group. Postoperative opioid consumption was lower in the ACB+IPACK group (p= 0.012). The PSQI values at 1 month postoperatively were similar in both groups (p =0.095). Conclusion: The study results demonstrated that ACB+IPACK applied with ultrasound for TKA postoperative analgesia provided effective analgesia, higher QoR and physical performance, and reduced postoperative opioid consumption. However, there was no effect on postoperative sleep quality.

Efficacy and Safety of Pimodivir Combined with Standard-of-care in Hospitalized and Non-hospitalized High-risk Adolescents and Adults with Influenza A Infection.

An unmet need exists for effective antivirals to treat patients hospitalized with influenza. The results of 2 Phase 3 studies evaluating the efficacy and safety of pimodivir in combination with investigator-chosen standard-of-care (SoC) treatment are presented. Hospitalized patients (hospital study; NCT03376321) and high-risk outpatients (outpatient study; NCT03381196) with laboratory-confirmed influenza A infection were randomized 1:1 to 600 mg pimodivir twice daily (BID) + SoC, or placebo BID + SoC for 5 days. For most patients SoC included oseltamivir. Primary endpoints were Hospital Recovery Scale (HRS) at Day 6 (hospital study) and median time to resolution (TTR) of influenza-related symptoms (outpatient study). Pimodivir + SoC (oseltamivir) treatment showed no clinical benefit over placebo + SoC on HRS at Day 6 (common odds ratio, 0.943 [95% CI, 0.609-1.462], P = .397; hospital study). A shorter median TTR of 7 symptoms was estimated with pimodivir + SoC versus placebo (92.6 hours [95% CI, 77.6-104.2] versus 105.1 hours [95% CI, 92.7-128.6], P = .0216; outpatient study). Pimodivir + SoC showed no additional clinical benefit versus SoC treatment alone in hospitalized patients. Pimodivir + SoC demonstrated shorter TTR of influenza symptoms versus placebo + SoC in high-risk outpatients.

Relative effects of serratus anterior plane block performed with dexmedetomidine combined with ropivacaine or ropivacaine alone on quality of recovery in children undergoing ear reconstruction

BackgroundDexmedetomidine (Dex) as a local anesthesia adjuvant for nerve block procedures can improve the quality of patient recovery. However, the impact of utilizing Dex as a local anesthetic adjuvant for serratus anterior plane block (SAPB) procedures on recovery quality for children undergoing ear reconstruction remains unclear. MethodsEighty-four patients undergoing ear reconstruction with autogenous costal cartilage (ACC) were randomized into two groups (n = 42/group) in which SAPB was performed with ropivacaine alone (R group) and one in which SAPB was performed with Dex and ropivacaine (DR group). Primary outcomes were patient 15-item quality of recovery (QoR-15) scale scores on days 1 and 2 post-surgery. Secondary outcomes included postoperative rest and coughing numerical rating scale (NRS) chest pain scores, duration of analgesia, oral rescue analgesic usage, and opioid-related side effects. ResultsForty patients per group completed the study. QoR-15 scores on days 1 and 2 post-surgery in the DR group were significantly increased relative to the R group (126.35±9.81 vs 115.53±8.58 and 131.78±8.67 vs 122.80±8.59, all P<0.001). Rest and coughing NRS chest pain scores at 2, 4, 8, 12, and 24h postoperatively in the DR group were all significantly lower relative to the R group (all P<0.05). The DR group also exhibited a significantly longer analgesic duration (P<0.001), and significantly reduced oral rescue analgesic usage and opioid-related side effect incidence (all P<0.05). ConclusionCombining Dex and ropivacaine for SAPB in children undergoing ear reconstruction with ACC can significantly improve quality of recovery, quality of analgesia, and analgesic duration.

Cognitive Motor Dissociation in Disorders of Consciousness

BackgroundPatients with brain injury who are unresponsive to commands may perform cognitive tasks that are detected on functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). This phenomenon, known as cognitive motor dissociation, has not been systematically studied in a large cohort of persons with disorders of consciousness.MethodsIn this prospective cohort study conducted at six international centers, we collected clinical, behavioral, and task-based fMRI and EEG data from a convenience sample of 353 adults with disorders of consciousness. We assessed the response to commands on task-based fMRI or EEG in participants without an observable response to verbal commands (i.e., those with a behavioral diagnosis of coma, vegetative state, or minimally conscious state–minus) and in participants with an observable response to verbal commands. The presence or absence of an observable response to commands was assessed with the use of the Coma Recovery Scale–Revised (CRS-R).ResultsData from fMRI only or EEG only were available for 65% of the participants, and data from both fMRI and EEG were available for 35%. The median age of the participants was 37.9 years, the median time between brain injury and assessment with the CRS-R was 7.9 months (25% of the participants were assessed with the CRS-R within 28 days after injury), and brain trauma was an etiologic factor in 50%. We detected cognitive motor dissociation in 60 of the 241 participants (25%) without an observable response to commands, of whom 11 had been assessed with the use of fMRI only, 13 with the use of EEG only, and 36 with the use of both techniques. Cognitive motor dissociation was associated with younger age, longer time since injury, and brain trauma as an etiologic factor. In contrast, responses on task-based fMRI or EEG occurred in 43 of 112 participants (38%) with an observable response to verbal commands.ConclusionsApproximately one in four participants without an observable response to commands performed a cognitive task on fMRI or EEG as compared with one in three participants with an observable response to commands. (Funded by the James S. McDonnell Foundation and others.)

The integrity of thalamo-dorsolateral prefrontal cortex tract: a key factor in residual consciousness in disorders of consciousness patients.

The mesocircuit model describes a complex network that includes the prefrontal cortical-striatopallidal-thalamo-cortical loop systems and is involved in the mechanism underlying consciousness in patients with disorders of consciousness (DoC). Inhibitory signals to the thalamus become hyperactive in DoC patients, leading to a loss of consciousness. Reactivating this mesocircuit system is important for recovering consciousness in these patients. We investigated how the residual integrity of the thalamo-dorsolateral prefrontal cortex tract (TDLPFCT) influences consciousness in patients with DoC. This retrospective case-control study included three groups: prolonged DoC (n = 20), stroke without DoC (n = 20), and healthy controls (n = 20). Diffusion tensor imaging (DTI) was performed at least 4 weeks after the onset. Thalamo-DLPFC tracts were reconstructed using diffusion tensor tractography, and fractional anisotropy (FA) and tract volume (TV) were measured for each hemisphere. Consciousness was assessed using the revised coma recovery scale (CRS-R) within a week of brain imaging. Significant differences in DLPFCT TV were observed across all three groups, in both affected and less-affected lobes, with the DoC group showing the greatest reduction. A significant correlation was found between the TV of the less-affected TDLPFCT and CRS-R score. The integrity of the TDLPFCT, particularly in the less affected hemisphere, is associated with consciousness levels in patients with prolonged DoC. This finding suggests its potential importance in assessing prognosis and further developing therapeutic strategies for patients with DoC.

Study About the Stages of Recovery with Patients Hospitalized in Psychiatric Clinic According to Sociodemographic and Clinical Factors

Objective: This study aims to describe the stages of recovery and the effect of sociodemographic and clinical factors on the recovery stages of individuals with mental illness under inpatient treatment. Methods: 171 patients who received inpatient treatment between April 2021 and June 2021 were taken to the study. Data were collected by using the Introductory Information Form and the Stages of Recovery Instrument from participants. Results: According to the nurse, awareness was the highest level of the recovery stages and, according to the patient, growth was the highest level of the recovery stages. The average of the subscales of stages of recovery scale was found as 12.57±7.54 for moratorium, 19.26±5.84 for awareness, 19.22±6.40 for preparation, 19.52±7.03 for rebuilding and 20.03±7.73 for growth. Social support was found effective in all stages of recovery except moratorium stage; income level was found effective in preparation, rebuilding, and growth stages; diagnosis of the illness was found effective in the awareness stage; going to the Community Mental Health Center (CMHC) was found effective in preparation stage and child presence was found effective in rebuilding stage of recovery. Conclusion: Our findings are important for identifying the effects of situations that can be changed by intervention, such as level of social support, income level, and going to CMHC, on improvement, and for drawing attention to actions that legislators should take regarding to collaboration between mental health professionals and institutions.

Oxycodone vs. sufentanil combined with quadratus lumborum block vs. transverse abdominis plane block in laparoscopic major gastrointestinal surgery: A randomized factorial trial protocol

BackgroundMultimodal analgesia plays a key role in enhanced recovery after surgery. Herein, we describe a trial protocol investigating the effects of oxycodone-vs. sufentanil-based patient-controlled analgesia in combination with quadratus lumborum block (QLB) vs. transverse abdominis plane block (TAPB) on quality of recovery following major laparoscopic gastrointestinal surgery. Methodsand analysis: This is a prospective, randomized, controlled clinical trial with a 2 × 2 factorial design. A total of 120 adult patients undergoing laparoscopic major gastrointestinal surgery will be randomized, in a 1:1:1:1 ratio, to receive one of two patient-controlled analgesia regimens (based on oxycodone or sufentanil) and one of two regional blocks (QLB or TAPB). The primary outcome measure of this trial is the quality of recovery at 24 h after surgery, assessed using the 15-item quality of recovery (QoR-15) scale. The secondary outcomes include QoR-15 scores at 48 and 72 h after surgery; visceral and incisional pain at rest and while coughing at 1, 6, 24 and 48 h postoperatively; analgesic consumption within 0–24 h and 24–48 h postoperatively; need for rescue analgesia; postoperative flatus time; postoperative adverse events (sedation, nausea and vomiting, use of antiemetics, respiratory depression, and dizziness); and length of postoperative hospital stay. DiscussionThe results of this trial will provide evidence for the optimal multimodal analgesic strategy to improve the quality of recovery for patients undergoing laparoscopic major gastrointestinal surgery. Trial registrationThis trial was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, identifier: ChiCTR2400080766).

Readmission after discharge from a medium secure service between 1999 and 2017: A retrospective cohort study.

Previous research into outcomes after treatment in medium secure psychiatric hospitals has mostly relied on pre-millennium data. To examine patient and inpatient service-related factors associated with readmission within 2 years following discharge to the community or open conditions from conditions of medium security. A retrospective cohort study of 137 patients discharged either to the community or to open conditions from one 64-bed South Wales Regional Medium Secure Hospital Unit between July 1999 and November 2017 was completed using data from healthcare records to document demographics, diagnosis and nature of index offences together with researcher-completed ratings of inpatient progress using the Dangerousness Understanding Recovery and Urgency Manual (DUNDRUM) Programme Completion and DUNDRUM Recovery scales. Binary logistic regression analyses were used to identify independent associations between inpatient progress according to these measures and readmission. Forty-three patients (31%) were readmitted within 2years of discharge and 23 (17%) in breach of legal conditions on discharge. Most readmitted patients (n=29, 67%) returned directly to medium secure care. There were significant binary level associations between readmission and severity of the index offences (lower), number of adverse childhood experiences (higher), history of drug misuse (more likely) and number of previous psychiatric admissions (higher). Binary logistic regression confirmed that these relationships were not independent. No inpatient service-related variables, according to DUNDRUM scale scores, showed an independent association with readmission within 2years post-discharge. The proportion of medium security hospital patients who were readmitted within 2years of discharge aligns with estimates found in earlier national research using the same follow-up period. Since levels of inpatient progress bore little if any relationship to longer term outcomes, our findings highlight the need for investigating factors in the discharge environment that are linked to readmission. It is possible that readmission may indicate effective monitoring and responsive care to the changing needs of patients, but a better understanding of this is essential.

Examining the Motor Scale Items From the Coma Recovery Scale–Revised

Abstract Date Presented 03/23/24 We provide an empirical evaluation of the item hierarchy within the Coma Recover Scale–Revised (CRS–R), an assessment used with patients with disorders of consciousness.This evaluation is critical for determining whether the challenge of the items aligns with the order in which they are presented in the assessment. Primary Author and Speaker: Jill Calvani Additional Authors and Speakers: Trudy Mallinson, Jennifer Weaver Contributing Authors: Katherine O’Brien

Effects of Robotic Postural Stand Training with Epidural Stimulation on Sitting Postural Control in Individuals with Spinal Cord Injury: A Pilot Study.

(1) Background. High-level spinal cord injury (SCI) disrupts trunk control, leading to an impaired performance of upright postural tasks in sitting and standing. We previously showed that a novel robotic postural stand training with spinal cord epidural stimulation targeted at facilitating standing (Stand-scES) largely improved standing trunk control in individuals with high-level motor complete SCI. Here, we aimed at assessing the effects of robotic postural stand training with Stand-scES on sitting postural control in the same population. (2) Methods. Individuals with cervical (n = 5) or high-thoracic (n = 1) motor complete SCI underwent approximately 80 sessions (1 h/day; 5 days/week) of robotic postural stand training with Stand-scES, which was performed with free hands (i.e., without using handlebars) and included periods of standing with steady trunk control, self-initiated trunk and arm movements, and trunk perturbations. Sitting postural control was assessed on a standard therapy mat, with and without scES targeted at facilitating sitting (Sit-scES), before and after robotic postural stand training. Independent sit time and trunk center of mass (CM) displacement were assessed during a 5 min time window to evaluate steady sitting control. Self-initiated antero-posterior and medial-lateral trunk movements were also attempted from a sitting position, with the goal of covering the largest distance in the respective cardinal directions. Finally, the four Neuromuscular Recovery Scale items focused on sitting trunk control (Sit, Sit-up, Trunk extension in sitting, Reverse sit-up) were assessed. (3) Results. In summary, neither statistically significant differences nor large Effect Size were promoted by robotic postural stand training for the sitting outcomes considered for analysis. (4) Conclusions. The findings of the present study, together with previous observations, may suggest that robotic postural stand training with Stand-scES promoted trunk motor learning that was posture- and/or task-specific and, by itself, was not sufficient to significantly impact sitting postural control.

Prognosis of patients with prolonged disorders of consciousness after brain injury: a longitudinal cohort study.

The findings regarding the prognosis of prolonged disorders of consciousness (PDOC) vary widely among different studies. This study aims to investigate the mortality, consciousness recovery and disabilities of patients with PDOC after brain injury. A total of 204 patients with PDOC were included in a longitudinal cohort study, including 129 males and 75 females. There were 112 cases of traumatic brain injury (TBI), 62 cases of cerebral hemorrhage (CH), 13 cases of cerebral infarction (CI) and 17 cases of ischemic hypoxic encephalopathy (IHE). The status of consciousness at 1, 2, 3, 6, 12, 18, 24, 36, 48 months of the disease course was assessed or followed up using the Revised Coma Recovery Scale (CRS-R). If the patients were conscious, the disability Rating Scale (DRS) was also performed. The prognosis of different PDOC including coma, vegetative state (VS) and minimal conscious state (MCS) was analyzed. The survival patients were screened for variables and included in multivariate binary Logistic regression to screen the factors affecting the recovery of consciousness. The mortality rates at 12, 24, 36, and 48 months were 10.7, 23.4, 38.9, and 68.4%, respectively. The median time of death was 18 months (8.75, 29). The probability of MCS regaining consciousness was higher than VS (p < 0.05), with the degree of disability left lower than VS (p < 0.05). There was no significant difference between MCS- and MCS+ groups in terms of the probability of regaining consciousness, the extent of residual disability, and mortality rates (p > 0.05). The mortality rate of coma was higher than that of other PDOC (p < 0.05). The mortality rate of MCS was lower than that of VS, but the difference was not statistically significant (p > 0.05). The probability of consciousness recovery after TBI was the highest and the mortality rate was the lowest. The possibility of consciousness recovery in IHE was the least, and the mortality rate of CI was the highest. The cause of brain injury and initial CRS-R score were the factors affecting the consciousness recovery of patients (p < 0.05). The prognosis of MCS is more favorable than VS, with comparable outcomes between MCS- and MCS+, while comatose patients was the poorest. TBI has the best prognosis and IHE has the worst prognosis.

Frequency and clinical significance of Herpes simplex virus type 1/2 reactivation in adult patients with mild to moderately severe community-acquired pneumonia: a multicentre cohort study.

This study assessed the frequency, clinical significance, and risk factors for Herpes simplex virus (HSV) reactivation in immunocompetent patients with community-acquired pneumonia (CAP). The study included adult CAP-patients who were enrolled in the CAPNETZ study between 2007 and 2017 and had a residual sputum sample available for analysis. In addition to routine diagnostics, sputum and blood samples were tested for HSV-1/2 using PCR. Demographics, comorbidities, and CRB-65 score were compared between HSV-positive and negative patients using Fisher exact or Mann Whitney test. Logistic regression analyses investigated the influence of HSV reactivation on a modified hospital recovery scale (HRS) until day 7, divided into 3 categories (no oxygen therapy, oxygen therapy, ICU admission or death). Among 245 patients, HSV-1 and HSV-2 were detected in 30 patients (12.2%, 95%CI 8.7-16.9) and 0 patients, respectively. All HSV-positive patients were hospitalized, had a CRB-65 severity score of 0-2 and survived the first 28day. In the HSV-positive group, patients had a non-significantly higher median age (70.5 versus 66years) and a higher rate of oncological comorbidities (16.7% versus 8.8%) compared to the HSV-negative group. Distribution of co-pathogens and outcome parameters did not significantly differ between both groups. In a multivariate logistic regression model, age (AOR 1.029, p = 0.012) and CRB-65 score (AOR 1.709, p = 0.048), but not HSV-1 as single or co-pathogen were independently associated with higher HRS. Our study suggests that HSV-1 reactivation is common in CAP but might not be associated with specific risk factors or a complicated disease course.