Abstract
We have previously developed a bispectral electroencephalography (BSEEG) device, which was shown to be effective in detecting delirium and predicting patient outcomes. In this study we aimed ...to apply the BSEEG approach for a sepsis. This was a retrospective cohort study conducted at a single center. Sepsis-positive cases were identified based on retrospective chart review. EEG raw data and calculated BSEEG scores were obtained in the previous studies. The relationship between BSEEG scores and sepsis was analyzed, as well as the relationship among sepsis, BSEEG score, and mortality. Data were analyzed from 628 patients. The BSEEG score from the first encounter (1st BSEEG) showed a significant difference between patients with and without sepsis (
p
= 0.0062), although AUC was very small indicating that it is not suitable for detection purpose. Sepsis patients with high BSEEG scores showed the highest mortality, and non-sepsis patients with low BSEEG scores showed the lowest mortality. Mortality of non-sepsis patients with high BSEEG scores was as bad as that of sepsis patients with low BSEEG scores. Even adjusting for age, gender, comorbidity, and sepsis status, BSEEG remained a significant predictor of mortality (
p
= 0.008). These data are demonstrating its usefulness as a potential tool for identification of patients at high risk and management of sepsis.
Aims and objectives
To examine the unmet supportive care needs of long‐term head and neck cancer caregivers, and the factors associated with those needs.
Background
Research on the unmet needs of ...head and neck cancer caregivers is lacking, particularly in the long‐term survivorship period.
Design
Survey of 197 caregivers.
Methods
The study collected information on caregivers’ demographic characteristics and their unmet supportive care needs (as measured by the Partners and Caregivers Supportive Care Needs Survey). An overall score of unmet need was generated, as were scores for four separate domains of unmet needs (emotional, health, information and work/social).
Results
Seventy six percentage of respondents were female, and 88% reported being married or living with a partner. Mean age was 57 years. Most caregivers had low levels of unmet needs. Managing fears about the cancer recurring was the most commonly reported individual need, described by slightly more than one in five respondents. The highest levels of need were located in the emotional and the health services domains. Loneliness and financial stress were consistently and significantly associated with high levels of unmet need in the multivariable analysis.
Conclusions
Most head and neck cancer caregivers appear to have low levels of unmet need in the extended survivorship period. The greatest levels of unmet need that are experienced occur in relation to emotional and health service domains. Needs diminish over time.
Relevance to clinical practice
Health professionals should be aware that a minority of long‐term head and neck caregivers continue to experience strong fears of cancer recurrence. To reduce unmet needs across multiple domains, health professionals should seek to reduce caregivers’ feelings of loneliness, and to assist caregivers to reduce the financial burdens that they experience as a result of long‐term caring.
We have developed the bispectral electroencephalography (BSEEG) method for detection of delirium and prediction of poor outcomes.
To improve the BSEEG method by introducing a new EEG device.
In a ...prospective cohort study, EEG data were obtained and BSEEG scores were calculated. BSEEG scores were filtered on the basis of standard deviation (s.d.) values to exclude signals with high noise. Both non-filtered and s.d.-filtered BSEEG scores were analysed. BSEEG scores were compared with the results of three delirium screening scales: the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Delirium Rating Scale-Revised-98 (DRS) and the Delirium Observation Screening Scale (DOSS). Additionally, the 365-day mortalities and the length of stay (LOS) in the hospital were analysed.
We enrolled 279 elderly participants and obtained 620 BSEEG recordings; 142 participants were categorised as BSEEG-positive, reflecting slower EEG activity. BSEEG scores were higher in the CAM-ICU-positive group than in the CAM-ICU-negative group. There were significant correlations between BSEEG scores and scores on the DRS and the DOSS. The mortality rate of the BSEEG-positive group was significantly higher than that of the BSEEG-negative group. The LOS of the BSEEG-positive group was longer compared with that of the BSEEG-negative group. BSEEG scores after s.d. filtering showed stronger correlations with delirium screening scores and more significant prediction of mortality.
We confirmed the usefulness of the BSEEG method for detection of delirium and of delirium severity, and prediction of patient outcomes with a new EEG device.
To investigate the relationship between history of anti-inflammatory medication use and delirium risk, as well as long-term mortality.
In this retrospective cohort study, subjects recruited between ...January 2016 and March 2020 were analyzed. Information about anti-inflammatory medication use history including aspirin, NSAIDs, glucosamine, and other anti-inflammatory drugs, was collected. Logistic regression analysis investigated the relationship between anti-inflammatory medications and delirium. Log-rank analysis and cox proportional hazards model investigated the relationship between anti-inflammatory medications and one-year mortality.
The data from 1274 subjects were analyzed. The prevalence of delirium was significantly lower in subjects with NSAIDs usage (23.0%) than in those without NSAIDs usage (35.0%) (p < 0.001). Logistic regression analysis controlling for age, sex, dementia status, and hospitalization department showed that the risk of delirium tended to be reduced by a history of NSAIDs use (OR, 0.76 95% CI, 0.55 to 1.03). The one-year mortality in the subjects with NSAIDs (survival rate, 0.879 95% CI, 0.845 to 0.906) was significantly lower than in the subjects without NSAIDs (survival rate, 0.776 95% CI, 0.746 to 0.803) (p < 0.001). A history of NSAIDs use associated with the decreased risk of one-year mortality even after adjustment for age, sex, Charlson Comorbidity Index, delirium status, and hospitalization department (HR, 0.70 95% CI, 0.51 to 0.96).
This study suggested that NSAIDs usage was associated with decreased delirium prevalence and lower one-year mortality. The potential benefit of NSAIDs on delirium risk and mortality were shown.
•History of NSAIDs use was associated with decreased delirium risk and mortality.•It might be possible that NSAIDs has benefits for patients to prevent delirium and decrease mortality.•Subjects with a history of glucosamine use had lower prevalence of delirium.
Background and objective
NSAIDs inhibit cyclooxygenase, but their role in aging and other diseases is not well understood. Our group previously showed the potential benefit of NSAIDs in decreasing ...the risk of delirium and mortality. Concurrently, epigenetics signals have also been associated with delirium. Therefore, we sought to find differentially methylated genes and biological pathways related to exposure with NSAIDs by comparing the genome-wide DNA methylation profiles of patients with and without a history of NSAIDs use.
Methods
Whole blood samples were collected from 171 patients at the University of Iowa Hospital and Clinics from November 2017 to March 2020. History of NSAIDs use was assessed through a word-search function in the subjects’ electronic medical records. DNA was extracted from the blood samples, processed with bisulfite conversion, and analyzed using Illumina’s EPIC array. The analysis of top differentially methylated CpG sites and subsequent enrichment analysis were conducted using an established pipeline using R statistical software.
Results
Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) showed several biological pathways relevant to NSAIDs’ function. The identified GO terms included “arachidonic acid metabolic process,” while KEGG results included “linoleic acid metabolism,” “cellular senescence,” and “circadian rhythm.” Nonetheless, none of the top GO and KEGG pathways and the top differentially methylated CpG sites reached statistical significance.
Conclusion
Our results suggest a potential role of epigenetics in the mechanisms of the action of NSAIDs. However, the results should be viewed with caution as exploratory and hypothesis-generating given the lack of statistically significant findings.
To explore the effect that treatment-related commuting has on carers of patients with head and neck cancer.
Semi-structured interviews, thematically analysed, with 31 carers.
Treatment-related ...commuting had a considerable impact on carers of patients with head and neck cancer, both in practical terms (economic costs, disruption) and also in psychological terms. Many carers of patients with head and neck cancer described becoming distressed by their commute. Some carers from large urban cities appeared to have hidden commuting burdens. Some carers respond to commuting stress by ‘zoning out’ or becoming ‘like zombies’.
Treatment-related travel for head and neck cancer can have significant practical and psychological impacts. Health professionals should be aware of the impacts that commuting can have on head and neck caregivers. Health services may be able to take practical steps, such as providing subsidized parking, to address head and neck carergivers’ difficulties.
•Treatment-related commuting can be extremely stressful for head and neck carers.•Head and neck carers can deal with commuting by ‘zoning out’ or becoming ‘like zombies’.•Urban cancer commuters may have hidden commuting burdens.
Abstract Purpose Researchers have recently called for more work to be conducted on positive outcomes and head and neck cancer. The purpose of this study was to investigate the factors associated with ...posttraumatic growth in head and neck cancer caregivers. Methods and sample 197 carers were surveyed. A descriptive cross-sectional survey design was used. Results In multivariate analysis the following factors were statistically significantly associated with increased posttraumatic growth: social support, longer time since diagnosis, increased worry about cancer and increased financial stress and strain stemming from caring. Conclusions While HNC carers in the post-treatment phase of the illness trajectory can experience considerable psychological burdens, this study suggests that these burdens can lead some carers to experience growth and change and an expanded sense of themselves and their social worlds. Implications for nursing practice are discussed.
AbstractBackground: The teaching of the discipline of pharmacology is in constant flux. In order to meet the challenges of teaching pharmacology effectively we investigated a new teaching and ...learning strategy. Aim: Our aim was to investigate whether structured periodic review sessions could improve teaching and learning for students in a multidisciplinary undergraduate pharmacology module. Methods: Following each lecture students were asked to identify topics of difficulty in pharmacology using the one minute paper classroom assessment technique (CAT). Three review sessions were then introduced based on the problematic issues identified by students. They completed a pre- and post-review session MCQ examination to gauge improvements in their learning. Feedback was obtained from students at the end of the module regarding the acceptability, advantages and limitations of the CATs and the review sessions. Results: There was active participation by students in all thirteen CATs (71.15% ± 1.2%), three review sessions (78.3% ± 1.6%) and the end of module questionnaire (81%). A significant increase in student learning across all disciplines was observed in all three review sessions (**, p<0.01; ***,p<0.001 and **, p<0.01 for review sessions 1-3 respectively). The majority of students (99%) expressed the opinion that the review sessions enhanced their learning of pharmacology. A limitation expressed by some students was the necessity to complete multiple CATs to support each of the three review sessions. Conclusion: Strategically structured student directed review sessions which are carefully designed and executed are an interesting and effective educational tool for improving and complementing student learning across the disciplines in pharmacology.
Evidence-based practices to manage distress behaviors in dementia (DBD) are not consistently implemented despite demonstrated effectiveness. The Veterans Health Administration (VA) trained teams to ...implement Staff Training in Assisted Living Residences (STAR)-VA, an intervention to manage DBD in VA nursing home settings, or Community Living Centers (CLCs). This paper summarizes multiyear formative evaluation results including challenges, adaptations, and lessons learned to support sustained integration into usual care across CLCs nationwide.
STAR was selected as an evidence-based practice for DBD, adapted for and piloted in VA (STAR-VA), and implemented through a train-the-trainer program from 2013 to 2018. Training and consultation were provided to 92 CLC teams. Evaluation before and after training and consultation included descriptive statistics of measures of clinical impact and survey feedback from site teams regarding self-confidence, engagement, resource quality, and content analysis of implementation facilitators and challenges.
STAR-VA training and consultation increased staff confidence and resulted in significant decreases in DBD, depression, anxiety, and agitation for Veterans engaged in the intervention. Implementation outcomes demonstrated feasibility and identified facilitators and barriers. Key findings were interpreted using implementation frameworks and informed subsequent modifications to sustain implementation.
STAR-VA successfully prepared teams to manage DBD and resulted in improved outcomes. Lessons learned include importance of behavioral health-nursing partnerships, continuous engagement, iterative feedback and adaptations, and sustainment planning. Evaluation of sustainment factors has informed selection of implementation strategies to address sustainment barriers. Lessons learned have implications for integrating team-based practices into system-level practice.
In this phase 1 study involving 76 healthy volunteers in England, a single dose of a monovalent chimpanzee adenovirus vaccine elicited immune responses to Ebola virus. The immune response was ...superior after a booster dose of a modified vaccinia Ankara strain.
The recent outbreak of Ebola virus disease (EVD) in West Africa has led to more than 11,000 deaths, with a peak in mortality from August through December of 2014 and a subsequent decline in the number of new cases. The development of a durable and effective Ebola vaccine is a priority both to eliminate the remnants of the outbreak and to prevent and control future epidemics. Several candidate vaccines have shown promising results in phase 1 trials,
1
–
6
and a recombinant vesicular stomatitis virus–based vaccine expressing the surface glycoprotein of
Zaire ebolavirus
(rVSV-ZEBOV) showed efficacy in an interim analysis of . . .
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