Severe Illness Research Articles

IFITM3 variants point to a critical role in emergent virus infections.

Interferon-induced transmembrane protein 3 (IFITM3) is a cellular protein that restricts numerous viral infections by blocking virus-host membrane fusion. In humans, there are two IFITM3 single nucleotide polymorphisms (SNPs), rs12252-C and rs34481144-A, that decrease IFITM3 activity and have been associated with severe illness following influenza virus infections. Mice lacking IFITM3 show increased influenza severity, supporting this association. However, some studies do not find a consistent link between IFITM3 SNPs and infection severity, causing uncertainty about its role in vivo. Review of the literature indicates that IFITM3 SNPs are primarily associated with increased viral disease in infections with emergent influenza viruses, such as the 2009 H1N1 pandemic virus and zoonotic H7N9 virus. Similarly, IFITM3 SNPs are reported to be risk factors for increased severity in other emergent infections, including SARS-CoV-2, Hantaan virus, and HIV. In contrast, most studies that failed to find an association examined seasonal influenza. We posit that adaptive immune mechanisms, including pre-existing antibodies and memory T cells against seasonally circulating viruses, compensate for IFITM3 deficiencies, therefore masking its role in seasonal influenza. We propose that IFITM3 is most critical in defending against emergent viruses and should be a key focus of public health strategies to prevent the emergence and spread of novel pathogens, with individuals carrying IFITM3 SNPs potentially benefiting from broadened vaccine coverage, avoidance of animal reservoirs, or enhanced masking to protect themselves and the wider population.

Hypochondriacal Doubt: How It Devours Itself Despite Its Seeming Consistence.

Hypochondriasis-currently split into the "somatic symptom disorder" and the "illness anxiety disorder" diagnoses-is characterized by the patient's conviction that minor symptoms are signs of a severe illness, even after undertaking medical exams that could not detect any disorder. In this paper, I analyze the basic hypochondriacal doubt, that is, calling into question the practitioners' reassurance that no evidence of serious disease has been found to account for his symptom. Specifically, I take as reference Ludwig Wittgenstein's posthumous work, On Certainty, to explain how a genuine doubt differs from a behavior that merely seems to be a doubt. On this basis, I clarify in which respects hypochondriacal doubt turns out to be a consistent doubt. But then, I reveal why such doubt makes no sense. Lastly, I show how medical and nurse staff as well as the hypochondriac's family can progressively help him overcome the aforementioned doubt.

Serum Immunoglobulin Levels in Children with Acute Lymphoblastic Leukemia During Maintenance Chemotherapy and its Association with Severe Febrile Illness.

To determine the proportion of children with acute lymphoblastic leukemia (ALL) with hypoglobulinemia during maintenance chemotherapy and to determine its association with severe febrile illnesses. Children with ALL receiving maintenance chemotherapy were prospectively recruited and serum immunoglobulin levels (IgG, IgM, IgA) were measured by turbidimetric method. Children were followed up for severe febrile illnesses for 6months or till the completion of treatment. We enrolled 199 children with mean (SD) age 82.03 (39.34) months; 58, 52, 47, and 42 children had received 0-6, 7-12, 13-18 and 19-24 months of maintenance chemotherapy, respectively. Hypo-IgG, hypo-IgA, and hypo-IgM were seen in 56.8%, 80.4%, and 86.4% of children. 91 (45.7%) children developed 147 episodes of severe febrile illness. Older age (> 5years) was associated with decreased risk [odds ratio 95% CI] of hypo-IgG [0.540 (0.297, 0.982), P = 0.044], hypo-IgA [0.030 (0.011, 0.088), P = 0.001], and hypo-IgM [0.323 (0.117, 0.894), P = 0.030] and female gender had decreased risk of hypo-IgG (0.539 (0.305, 0.953), P = 0.033). Older age decreased the risk [0.585 (0.328, 1.041), P = 0.014] and girls were at increased risk [(1.118, 3.488), P = 0.019] of severe febrile illness. Hypoglobulinemia did not increase the risk of severe febrile illness. Hypoglobulinemia was not found to be an independent risk factor for severe febrile illnesses in children with ALL receiving maintenance chemotherapy.

Burden to Partners of People with Psoriasis: Results from the FamilyPso International Study.

Psoriatic disease is a lifelong chronic illness for which there is no cure. It is well established that psoriasis leads to a major impairment of health-related quality-of-life and wellbeing. Most people with psoriasis live together with partners, bringing along a major burden for them. The FamilyPso was created to measure this burden in psoriasis. The aim of the FamilyPso international study was to validate this tool and to show feasibility for the use of the FamilyPso across multiple countries. A prospective cohort study was conducted in 11 centers in Austria, Canada, Germany, Italy, Spain, and Turkey. The factor structure of the FamiliyPso was examined by confirmatory factor analysis (CFA) including tests of measurement invariance for gender and language. Subgroups (e.g., countries and gender) were tested for significant differences, and the relationship between the severity of illness and FamilyPso scores was tested for differences between countries using a mixed regression model. Descriptive statistics for items and scores are presented herein. The cohort consisted of 556 people with psoriasis and their partners. Patients agreed that their partners would answer the questionnaire in their absence and return the forms to the centers. The mean age of patients and partners was 51 years. Psoriasis severity was mild in 57.6%, moderate in 31.5%, and severe in 10.9% of cases, and 91.3% received treatment. The results of the CFA confirmed the original factor structure with minor modifications. Self-assessed high severity of psoriasis was a predictor for a higher burden in 4/5 FamilyPso domains. There was an increased burden to partners related to the severity of psoriasis particularly in the domain "general emotional strain," including items such as a "feeling of helplessness." The results of the study showed that the FamilyPso could assess the burden of partners of people with psoriasis and can be used across different countries. The data can improve management of psoriatic disease and should be considered in shared decision-making.

Non-adherence to antidiabetic medications and associated factors among adult type 2 diabetes mellitus patients in Northeast Ethiopia: institutional based cross-sectional study

BackgroundNon-adherence to antidiabetic medication remains a major barrier to achieve optimal health outcomes among individuals with diabetes, particularly in developing countries. This issue exacerbates poor health outcomes and leads to...

Preparation for Residency: Effect of Formalized Patient Handover Instruction for Fourth-Year Medical Students

A major aspect of transition of care is the patient handover, during which miscommunication can significantly cause medical error and harm in patient care. Few medical schools in the U.S. offer formalized instructions on patient handovers, with most medical students learning from interns and residents through unstructured teaching. The aim of this study was to assess the effectiveness of a patient handover curriculum we developed for fourth-year medical students to increase their confidence and skills. Graduating fourth-year medical students (N = 98) enrolled in a two-week Transition to Residency (TTR) course attended an interactive session on patient handovers. During this session, students were presented with the I-PASS (illness severity, patient summary, action items, situation awareness and contingency planning, synthesis by receiver) mnemonic, went over case vignettes, and practiced giving and receiving handovers with a partner using the I-PASS template. At the end of TTR, students participated in an OSCE (Objective Structured Clinical Exam) activity that consisted of two standardized patient cases on blood transfusion and informed consent. Overall, our students did well with including important information in their Patient Summary (P: Case Scenario 1 Mean Score 56%; Case Scenario 2 Mean Score: 68%) and Action List (A: Case Scenario 2 Mean Score; 78%; Case Scenario 2 Mean Score: 87%) in their simulated patient case scenario. Pre-and-post survey results also indicated a significant improvement on student level of confidence (agreed or strongly agreed) in giving a patient handover (Pre: 53.1%; Post: 93.6%, p < 0.001), in receiving a patient handover (Pre: 58.2%; Post: 92.5%, p < 0.001), and in knowing what pertinent information to include in a patient handover (Pre: 62.2%; Post: 89.4%, p < 0.001). This study underscores the importance of systematic and repeated patient handover education throughout medical school training.

Neuropsychiatric Outcomes in Children and Adolescents With Perinatally Acquired HIV: A Systematic Review and Meta-Analysis.

The objective of this study is to define the neuropsychiatric challenges including developmental delay, cognitive impairment, and psychiatric illness faced by children with perinatally acquired HIV. Nine databases were searched on May 30, 2023: MEDLINE, Embase, and PsycINFO (all through Ovid SP); CINAHL and Child Development and Adolescent Studies (through EBSCO); the Web of Science Core Collection; Scopus; ProQuest Dissertations and Theses Global; and WHO Global Index Medicus. No limits were applied. Search strategies incorporated keywords and thesaurus headings to describe children and adolescents aged 0-25 years with perinatally acquired HIV and terms to describe the spectrum of neuropsychiatric impairment. Entries were reviewed by 2 independent reviewers. Studies were included if they involved a population of children with perinatally acquired HIV and investigated a neurologic or psychiatric outcome. Hypothesis that children with pHIV would have more neuropsychiatric challenges than children without pHIV was formulated before the study. Main outcome measures include incidence and severity of cognitive impairment, developmental delay, and psychiatric illness in children with pHIV. Forty-five studies on cognitive impairment were included of which 8 studies were included for meta-analysis and demonstrated a standardized mean difference of -0.508 where children without HIV had higher cognitive scores (95% CI: -0.7903 to -0.2272). In total, 15 studies on developmental delay were included, of which 9 were included for meta-analysis and demonstrated, for motor delay, a standardized mean difference (SMD) of -0.794 where children without HIV achieved higher motor function scores (95% CI: -0.9986 to -0.590) and for cognitive delay an SMD of -0.697 where children without HIV achieved higher cognitive function scores (95% CI: -0.976 to -0.417). In total, 39 studies on psychiatric illness were included with an odds ratio for anxiety and depression of 1.105, suggesting that children with HIV had slightly higher odds of developing anxiety or depression, however, this result was not significant (95% CI: 0.778 to 1.571). Children with perinatally acquired HIV may have a greater cognitive impairment, motor and cognitive delay, and would likely benefit from tailored approaches to improve their outcomes.

Advances in functional magnetic resonance imaging research on bipolar disorder and self-stigma

Bipolar disorder (BD) is a chronic, recurrent, and severe mental illness. Individuals with BD often internalize prejudices and stereotypes directed toward them, leading to the development of self-stigma (SS). SS can further exacerbate impairments in cognitive and social functioning and contribute to decreased treatment adherence and poor prognosis. Functional magnetic resonance imaging provides a powerful tool for investigating the neuropathophysiological mechanisms underlying BD and SS, facilitating the early identification of SS in BD patients. A review of studies examining functional connectivity and neurometabolism across various brain regions in BD and SS patients suggests that both conditions can alter the functional connectivity of brain regions involved in emotional regulation, such as the prefrontal cortex (PFC) and amygdala. In addition, BD patients show reduced N-acetylaspartate levels in the PFC and anterior cingulate cortex. However, current research has yet to yield conclusive findings regarding the neurometabolites associated with SS. This paper proposes potential research directions for investigating SS in BD patients and lays the groundwork for the early detection of SS, ultimately contributing to a deeper clinical understanding of SS in this patient population.

Management of Carbapenem Resistant Gram-Negative Infections.

Due to increasing carbapenem usage, resistance to gram negative bacteria is steadily going up in India. Resistance is often enzyme-mediated and transmissible horizontally by plasmids. Use of invasive lines, procedures, prior antibiotic exposure, recent hospitalization, ICU stay, colonization and severity of illness are important risk factors for infections with these bacteria. Before starting therapy, it is important to distinguish colonization from true infection. Early targeted therapy using rapid diagnostic methods is important to ensure optimal outcomes. A growing body of literature recommends the use of novel beta lactam-beta lactamase inhibitors over polymyxins in the management of these infections. Treatment strategies for carbapenem resistant Enterobacterales differs from non-Enterobacterales and is discussed in detail in this review. Infection control and antimicrobial stewardship are crucial preventive measures to curb the emergence of further resistance.

Use of Life Support and Outcomes Among Patients Admitted to Intensive Care Units.

Nationwide data are unavailable regarding changes in intensive care unit (ICU) outcomes and use of life support over the past 10 years, limiting understanding of practice changes. To portray the epidemiology of US critical care before, during, and after the COVID-19 pandemic. Retrospective cohort study of adult patients admitted to an ICU for any reason, using data from the 54 US health systems continuously contributing to the Epic Cosmos database from 2014-2023. Patient demographics, COVID-19 status, and pandemic era. In-hospital mortality unadjusted and adjusted for patient demographics, comorbidities, and illness severity; ICU length of stay; and receipt of life-support interventions, including mechanical ventilation and vasopressor medications. Of 3 453 687 admissions including ICU care, median age was 65 (IQR, 53-75) years. Patients were 55.3% male; 17.3% Black and 6.1% Hispanic or Latino; and overall in-hospital mortality was 10.9%. The adjusted in-hospital mortality was elevated during the pandemic in COVID-negative (adjusted odds ratio [aOR], 1.3 [95% CI, 1.2-1.3]) and COVID-positive (aOR, 4.3 [95% CI, 3.8-4.8]) patients and returned to baseline by mid-2022. The median ICU length of stay was 2.1 (IQR, 1.1-4.2) days, with increases during the pandemic among COVID-positive patients (difference for COVID-positive vs COVID-negative patients, 2.0 days [95% CI, 2.0-2.1]). Rates of invasive mechanical ventilation were 23.2% (95% CI, 23.1%-23.2%) before the pandemic, increased to 25.8% (95% CI, 25.8%-25.9%) during the pandemic, and declined below prepandemic baseline thereafter (22.0% [95% CI, 21.9%-22.2%]). The use of vasopressors increased from 7.2% to 21.6% of ICU stays. Pandemic-era increases in length of stay and adjusted in-hospital mortality among US ICU patients returned to recent historical baselines. Fewer patients are now receiving mechanical ventilation than prior to the pandemic, while more patients are administered vasopressor medications.

Combining the Risk: The Poly-Environmental Risk Score and Psychotic Symptoms in Adolescents.

Psychotic symptoms are common in adolescents and predictive of psychiatric disorders. Numerous risk factors have been shown to precede psychiatric disorders. However, investigating individual risk factors does not account for the cumulative effect these risk factors may have. Therefore, we combined well-researched environmental risk factors for psychotic disorder in a composite measure: the poly-environmental risk score (PERS). Risk factors were assessed in a cohort of 801 adolescents (aged 15) at risk for psychopathology. Binarized risk factors included winter birth, low gestational age, low birth weight, ethnic minority status, urban living environment, cannabis use, victim of bullying, emotional abuse, physical abuse, sexual abuse, high paternal age, parental severe mental illness, parental divorce, and parental death. The PERS was weighted with the log odds derived from recent meta-analyses. At age 18, self-reported psychotic experiences (PE) and clinician-rated psychotic symptoms (PS) were assessed. This updated PERS was compared to previous PERS models, which included fewer risk factors and different weightings. The PERS was associated with PE and PS. Specifically, a PERS between 3 and 4, and PERS > 4 corresponded with a 2.2- and 5.2-fold increase in the odds of psychotic symptoms in late adolescence. The updated 14-item PERS performed better compared to previous compositions of the PERS. A composite score of childhood and adolescent risk factors measured at age 15 was associated with psychotic symptoms at age 18. Future research should consider the cumulative effect of risk factors when examining the determinants of psychopathology.

Modeling the Potential Impacts of Outpatient Antiviral Treatment in Reducing Influenza-Associated Hospitalizations in the United States.

Seasonal influenza causes an estimated 120 000 to 710 000 hospitalizations annually in the United States. Treatment with antiviral medications, such as oseltamivir, can reduce risks of hospitalization among people with influenza-associated illness. The US Centers for Disease Control and Prevention recommends initiating antiviral treatment as soon as possible for outpatients with suspected or confirmed influenza who have severe or progressive illness or are at higher risk of influenza complications. We developed a probabilistic model to estimate the impact of antiviral treatment in reducing hospitalizations among US outpatients with influenza. Parameters were informed by seasonal influenza surveillance platforms and stratified by age group and whether individuals had a condition associated with higher risk of influenza complications. We modeled different scenarios for influenza antiviral effectiveness and outpatient testing and prescribing practices, then compared our results with a baseline scenario in which antivirals were not used. Across the modeled scenarios, antiviral treatment resulted in 1215 to 14 184 fewer influenza-associated hospitalizations on average when compared with the baseline scenario (0.2%-2.7% reduction). The greatest effects occurred among adults aged ≥65 years and individuals with conditions associated with higher risk of influenza complications. Modeling 50% improvements in access to care, testing, prescribing, and treatment resulted in greater potential impacts, with over 71 000 (13.3%) influenza-associated hospitalizations averted on average compared to baseline. Our results support recommendations to prioritize outpatient antiviral treatment among older adults and others at higher risk of influenza complications. Improving access to prompt testing and treatment among outpatients with suspected influenza could reduce hospitalizations substantially.

Health care experiences and expectations of individuals with severe maternal morbidity in high-income countries: a qualitative systematic review protocol.

The objective of this review is to describe the health care experiences and expectations of people living in high-income countries (HICs) who have had severe maternal morbidity (SMM). It will expand on findings from 2 earlier reviews highlighting structural and systemic factors influencing care to inform health care recommendations. SMM describes conditions and complications during pregnancy, birth, and postpartum associated with severe illness, debilitation, prolonged hospitalization, and high fatality rates. In higher-income countries, SMM is an important indicator of health care quality. With rates of SMM increasing around the world (disproportionately so among some populations), and recognizing suboptimal care as an important modifiable risk factor, this review will focus on the health care experiences and expectations of people who have had SMM to reveal opportunities for maternal health care improvement. This review will include qualitative studies published from 1999 to 2024 involving individuals in HICs who have experienced SMM. Studies will describe participants' health care experiences and expectations (or both) during pregnancy, birth, and postpartum. Using the JBI approach for qualitative systematic reviews, we will search MEDLINE (Ovid), Embase, Web of Science, CINAHL, and ProQuest for qualitative studies available in English. We will then screen titles and abstracts using the predetermined inclusion criteria to select articles for full-text review and critical appraisal. All relevant findings will be extracted from each included study, assessed for credibility, and then pooled and synthesized using JBI's meta-aggregation approach to develop a set of findings that can be used to make health care recommendations. PROSPERO (CRD42024569572).

Thrombocytopenia in Children and Young Adults undergoing Continuous Renal Replacement Therapy: A WE-ROCK Study.

Thrombocytopenia in patients treated with continuous renal replacement therapy (CRRT) in adults is associated with mortality. Pediatric data are limited. We evaluated the association between pre-CRRT thrombocytopenia and platelet decline at 24 hours of CRRT with outcomes. Secondary analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK), including patients birth-25 years who underwent CRRT. Exclusions were end-stage kidney disease, non-acute kidney injury/fluid overload CRRT indication, concurrent extracorporeal membrane oxygenation, missing baseline platelets, platelet disorders, and hematologic malignancy. Primary exposures were (1) pre-CRRT thrombocytopenia, (≤100×103/μL) and (2) ≥30% decline at 24 hours of CRRT in those with pre-CRRT >100×103/μL. Primary outcome was survival to intensive care unit (ICU) discharge. Secondary outcomes included major adverse kidney events at 90 days (MAKE90) [death, dialysis dependence, creatinine >125% baseline]) from CRRT initiation. 805 patients were included. 63.9% had baseline thrombocytopenia, median (IQR) platelets of 38 (20, 63) ×103/μL. Baseline thrombocytopenia occurred in younger septic patients with higher illness severity. A ≥30% decline occurred in 33% of patients. Those with a ≥30% platelet decline were more commonly younger patients and had smaller catheters. Pre-CRRT thrombocytopenia and platelet decline were associated with ICU mortality in univariate but not multivariate models. There was no association with MAKE90. Thrombocytopenia is common prior to CRRT initiation and is associated with greater illness severity. Mechanical factors (blood flow and line size) may contribute to platelet decline. Prospective studies are needed to delineate the clinical and mechanical factors associated with thrombocytopenia and associated outcomes.

English

Introduction: Mental fatigue, caused by cognitive/emotional efforts that are inherent to daily life activities, impairs performance and predisposes people to health problems. Although older people may be more vulnerable to mental fatigue, there are many gaps in the literature. Objectives: This study aimed to clarify the effects of mental fatigue in ageing, to test the moderating role of cognitive decline and Brain Endurance Training for its prevention in ageing. Thirty people aged 65 to 76 years (17 women, 13 men), sedentary but without severe physical or mental illness, participated in the study. Material and method: Based on their results in the Mini-Mental State Examination, and normative scores, they were divided into 2 groups: Low Cognitive Impairment (≥ 25 points) and Medium (≤ 24 and ≥ 21). Subsequently, 2 sessions were conducted in counterbalanced order, where physical (Chair-stand test, Arm-curl test, Walking test, RPE) and cognitive (Psychomotor Vigilance Test and Incongruent Stroop) performance, and mental fatigue (Visual Analogue Scale) were measured, after 20 min. of documentary (control condition, rest) or Time Load Dual Back (experimental condition, mental fatigue). Then, a 2-month intervention (3 trainings/week) with Brain Endurance Training was performed on 12 subjects (7 women, 5 men) with medium cognitive impairment. Results: The results show that mental fatigue worsens performance and increases health risks, especially in people with cognitive impairment. Brain Endurance Training appears to be effective in counteracting the effects of mental fatigue in ageing. Conclusions: To conclude, mental fatigue has clinical considerations in ageing. Then, it is recommended to quantify it and promote active ageing for its prevention/mitigation.

COVID-19 vaccination and pregnancy-induced hypertension risk in women undergoing assisted reproduction.

Does COVID-19 vaccination affect the risk of pregnancy-induced hypertension (PIH) in women undergoing ARTs, and does this risk differ based on vaccine type (inactivated vs recombinant) and timing relative to embryo transfer? Women who received inactivated COVID-19 vaccines before undergoing ART had a significantly increased risk of developing PIH, particularly when vaccinated with two or more doses or when embryo transfer occurred within 1 month of vaccination. COVID-19 vaccination during pregnancy reduces the risk of severe COVID-19 illness with no significant safety concerns for the mother or fetus. PIH is a common complication in ART pregnancies, particularly in older women and those with higher BMI, but the effects of different COVID-19 vaccine types on PIH risk in ART pregnancies remain unclear. A retrospective cohort study analyzing 3911 women undergoing ART after receiving COVID-19 vaccines. The study period spanned from 1 December 2020 to 30 September 2022. Participants were categorized based on COVID-19 vaccination status, vaccine type (inactivated vs recombinant), and the timing of vaccination relative to embryo transfer. The primary outcome was the development of PIH. Multivariate robust Poisson regression was used to assess the association between vaccination and PIH, while subgroup analyses explored the risk across variables like age, BMI, and embryo transfer type. Women vaccinated with an inactivated COVID-19 vaccine prior to embryo transfer had a significantly higher incidence of PIH compared to unvaccinated counterparts (relative risk [RR] = 1.45; 95% CI 1.10-1.92; P = 0.009). In contrast, recombinant vaccines did not show a significant association with increased PIH risk (RR = 1.19; 95% CI 0.69-2.05; P = 0.537). The risk was particularly pronounced among women receiving two or more doses of the inactivated vaccines and those who had embryo transfers within 1 month of vaccination. Subgroup analyses showed elevated PIH risk in women aged ≥30 years old, those with BMI ≥22 kg/m2, individuals with secondary infertility, and those undergoing cleavage-stage or fresh embryo transfers. The study's retrospective design limits causal inference. The sample is from a single ethnic background, and familial hypertension history was not available, potentially introducing residual confounding. The study suggests that the type and timing of COVID-19 vaccination may influence PIH risk in ART pregnancies. These findings underscore the need for careful consideration of vaccination type and timing in ART protocols and highlight the importance of further prospective studies to validate these results before influencing clinical decision-making. This work was supported by the Hunan High-Level Talent Aggregation Project [2022RC4007]; the National Natural Science Foundation of China [72004148]; the Hunan Provincial Enterprise Joint Fund [2024JJ9093]; the Hunan Provincial Grant for Innovative Province Construction [2019SK4012]; the Deutschlandstipendium of the Charite; the non-restricted research grant of Boehringer Ingelheim Ltd.; and the Research Grant of CITIC-Xiangya [YNXM-202304, 202217]. The authors report no conflicts of interest. N/A.

Evaluating antimicrobial stewardship strategies in candidemia: a novel desirability of outcome ranking (DOOR) analysis comparing blood culture versus T2Candida diagnostic approaches.

The T2Candida Panel (T2 Biosystems, Lexington, MA) is a rapid diagnostic test that detects Candida from whole blood within 3-5 hours. We developed and applied a desirability of outcome ranking (DOOR) analysis to investigate if an antimicrobial stewardship program (ASP) strategy centered on T2Candida diagnosis is associated with improved outcomes compared to an ASP strategy that relies on conventional blood culture diagnosis in critically ill patients with candidemia. This is a retrospective, observational cohort of patients with candidemia identified ≤72 h of intensive care unit admission at two medical centers in Detroit, MI (one T2Candida site and one blood culture site) from 2016 to 2023. Management strategies for candidemia were compared using an original DOOR analysis with inverse probability of treatment weighting (IPTW) to account for confounding. Two hundred patients were included, 100 from each site. Baseline illness severity, race, and Candida species varied between groups; however, source control procedures, echocardiogram, and ophthalmologic exam occurred at similar frequencies. T2Candida/ASP was associated with faster median (interquartile range [IQR]) detection of candidemia (7.0 [5.0-10.75] h vs 45.5 h [34.25-68.75], P < 0.001) and timelier median (IQR) initiation of directed antifungal therapy (6.0 [0-11.0] h vs 49.0 [34.0-77.0] h, P < 0.001). T2Candida/ASP patients had a 58.0% probability of achieving an overall better outcome compared to those managed with blood culture/ASP (95% confidence interval: 50.4-65.2%) in IPTW-adjusted DOOR analysis. An ASP strategy incorporating T2Candida was associated with an overall better patient outcome compared to patients managed via conventional blood culture diagnosis.IMPORTANCECandida species are a significant cause of bloodstream infections in critically ill patients. Conventional diagnostic methods, such as blood cultures, have poor sensitivity and delayed results. The T2Candida Panel is a diagnostic tool that rapidly detects Candida directly from the blood in 3-5 h, enabling faster initiation of antifungal therapy. Antimicrobial stewardship programs (ASPs) optimize the management of bloodstream infections and may benefit from incorporating T2Candida to improve patient outcomes. This study examined whether an ASP intervention based on T2Candida diagnosis, compared to one relying on traditional blood culture methods, could improve outcomes in candidemia using a desirability of outcome ranking (DOOR) analysis. The DOOR method provides a comprehensive evaluation by integrating multiple outcomes into a single end point, which is ideal given the complexity of patients with candidemia. The T2Candida/ASP intervention resulted in an overall better patient outcome, considering infectious complications, treatment failure, and all-cause mortality.

Latest findings challenge behavioural approaches to the management of antipsychotic-induced weight gain.

Obesity is a major health problem among people with severe mental illness, linked to increased risk of chronic diseases and reduced life expectancy. This is attributable to a combination of factors, including lifestyle, social circumstances, medication side-effects and the illness itself. Second-generation antipsychotics are particularly associated with weight gain, affecting treatment adherence, symptoms and quality of life.

Family members’ experiences of supporting black and South Asian women with perinatal mental illness: a qualitative study in the UK

BackgroundWomen from Black and South Asian backgrounds with perinatal mental health difficulties face significant barriers to accessing healthcare. Clinical guidelines recommend that services collaborate with families, as they not only influence women’s decisions to seek help and engage with care but also serve as a vital source of support. However, family members’ experiences in providing this support remain poorly understood. This study aims to address this evidence gap.MethodsIndividual semi-structured qualitative interviews were conducted with family members of Black and South Asian women who had experienced moderate to severe perinatal mental illness. The interviews explored the family members’ experiences, the personal impact of their relative’s condition, and their perspectives on accessing help and support. Interview transcripts were analysed using framework analysis, by a multidisciplinary team including psychiatrists, psychologists, methodologists, and people with a lived experience of perinatal mental illness.ResultsFifteen family members of women with perinatal mental illness were interviewed; twelve husbands and/or partners, and three Mothers and/or Mothers-in-Law. Three themes were identified: (1) Recognising and understanding their relative’s perinatal mental illness was important to make sense of the situation (2) High emotional cost of supporting a relative with perinatal mental illness and (3) Varied experiences and expectations of services, with opportunities for improvement. Family members described how their relative’s illness had a pronounced negative impact on their own physical and mental health and wellbeing, and on relationships within their families. Whilst many family members felt listened to and well supported by services, several barriers that prevented or delayed getting professional support were identified. Families would value improved communication, more information and proactive care from perinatal mental health services.ConclusionsThis paper offers valuable insights into perinatal mental illness for Black and South Asian women from a family perspective. Despite individual experiences being varied and wide-ranging, the suggestions for service improvement were congruent and often repeated, indicating a widespread need for a greater awareness and wider support for the family members of women in perinatal services, who are often struggling themselves.

Risk Factors and Consequences of Financial Hardship among Family of Critically Ill Patients.

Major knowledge gaps persist in understanding factors that contribute to family financial hardship and its association with other family-reported outcomes when patients experience critical illness. Identify factors associated with family financial hardship and associations with family-reported outcomes. Prospective cohort study conducted at three hospitals within a large academic healthcare system in the Pacific Northwest of the US. Participants included family of patients admitted to the ICU (4/ 2019-2/ 2023) and diagnosed with a chronic life-limiting illness or severe acute illness. Clustered bivariate and multiple linear regression models evaluated potential predictors of financial hardship; clustered linear and probit regression models, adjusted for pre-specified covariates, measured associations of hardship with family-reported outcomes. 783 family participants provided information on financial hardship 1 month after patients' ICU admission by responding to a modified version of the Comprehensive Score for financial Toxicity (FACIT-COST) instrument. Financial hardship was greater for respondents who were younger (p=0.019), had less education (p=0.034), were the patient's spouse (p=0.016), lived with the patient (p=0.018), had dependent children at home (p<0.001), experienced work-status changes related to patient's illness (p<0.001), had poorer health (p<0.001), lacked emotional support (p=0.001), assessed hardship while patient was alive (p=0.005) and had been in the hospital longer (p=0.011). Reported hardship was lower when the patient had a cancer diagnosis (p=0.030), and it varied by racial/ethnic group (p=0.003) and insurance type (p=0.045). Financial hardship was associated (p<0.001) with increased family depression and anxiety and with reduced emotional preparedness and quality of life at one and three months after the patient's ICU admission. For family of critically ill patients, social and demographic factors may play a larger role in financial hardship than clinical factors. Financial hardship is predictive of lower family quality of life. These findings add to the literature demonstrating the prevalence and adverse consequences of financial hardship, its inequitable distribution, and the need for evidence on supports and interventions to mitigate poor outcomes and inequities.