Abstract
Patients with schizophrenia (SCZ) represent a vulnerable population who have been understudied in COVID-19 research. We aimed to establish whether health outcomes and care differed between ...patients with SCZ and patients without a diagnosis of severe mental illness. We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. Cases were patients who had a diagnosis of SCZ. Controls were patients who did not have a diagnosis of severe mental illness. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. A total of 50 750 patients were included, of whom 823 were SCZ patients (1.6%). The SCZ patients had an increased in-hospital mortality (25.6% vs 21.7%; adjusted OR 1.30 95% CI, 1.08–1.56, P = .0093) and a decreased ICU admission rate (23.7% vs 28.4%; adjusted OR, 0.75 95% CI, 0.62–0.91, P = .0062) compared with controls. Significant interactions between SCZ and age for mortality and ICU admission were observed (P = .0006 and P < .0001). SCZ patients between 65 and 80 years had a significantly higher risk of death than controls of the same age (+7.89%). SCZ patients younger than 55 years had more ICU admissions (+13.93%) and SCZ patients between 65 and 80 years and older than 80 years had less ICU admissions than controls of the same age (−15.44% and −5.93%, respectively). Our findings report the existence of disparities in health and health care between SCZ patients and patients without a diagnosis of severe mental illness. These disparities differed according to the age and clinical profile of SCZ patients, suggesting the importance of personalized COVID-19 clinical management and health care strategies before, during, and after hospitalization for reducing health disparities in this vulnerable population.
The Brief Coping Orientation to Problems Experienced (Brief COPE) inventory is the most usual measure to identify the nature of coping strategies implemented by individuals and explore 14 coping ...strategies. The availability of a structure with fewer factors rather than the initial 14-factor structure may be of interest for both healthcare professionals and researchers. We report the validation process of a 4-factor structure of the French version of the Brief COPE in a French sample of individuals facing a singular life event, such as cancer, including patients and their caregivers.
The cross-sectional study included cancer patients and their caregivers. Self-administered data were collected including: socio-demographic (age, gender, marital status, employment status, and education level), coping strategies using the French version of the Brief COPE, quality of life (QoL) using the French version of the short form health survey questionnaire (SF36). Construct validity, internal consistency, reliability, and external validity were tested.
The sample included 398 individuals. The principal component factor analysis identified a 4-factor structure. The dimensions were labeled according to their constitutive items: social support (8 items), problem solving (4), avoidance (10), and positive thinking (6). The 4-factor structure was supported by different theoretical models of coping and showed satisfactory psychometric properties.
The 4-factor structure of the French version of the Brief COPE, validated in a sample of individuals facing a singular stressful event, including cancer patients and their caregivers, makes the instrument easier to use both in clinical practice and clinical research.
Purpose
The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly ...defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO
2
)/fractional inspired oxygen (FiO
2
) ratio.
Methods
A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included.
Results
One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68–0.87;
p
< 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO
2
/FiO
2
ratio below 357.
Conclusion
In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.
Background
In patients with severe sepsis, no randomized clinical trial has tested the concept of de-escalation of empirical antimicrobial therapy. This study aimed to compare the de-escalation ...strategy with the continuation of an appropriate empirical treatment in those patients.
Methods
This was a multicenter non-blinded randomized noninferiority trial of patients with severe sepsis who were randomly assigned to de-escalation or continuation of empirical antimicrobial treatment. Recruitment began in February 2012 and ended in April 2013 in nine intensive care units (ICUs) in France. Patients with severe sepsis were assigned to de-escalation (
n
= 59) or continuation of empirical antimicrobial treatment (
n
= 57). The primary outcome was to measure the duration of ICU stay. We defined a noninferiority margin of 2 days. If the lower boundary of the 95 % confidence interval (CI) for the difference in patients assigned to the de-escalation group was less than 2 days, as compared with that of patients assigned to the continuation group, de-escalation was considered to be noninferior to the continuation strategy. Secondary outcomes included mortality at 90 days, occurrence of organ failure, number of superinfections, and number of days with antibiotics during the ICU stay.
Results
The median duration of ICU stay was 9 interquartile range (IQR) 5–22 days in the de-escalation group and 8 IQR 4–15 days in the continuation group, respectively (
P
= 0.71). The mean difference was 3.4 (95 % CI −1.7 to 8.5). A superinfection occurred in 16 (27 %) patients in the de-escalation group and six (11 %) patients in the continuation group (
P
= 0.03). The numbers of antibiotic days were 9 7–15 and 7.5 6–13 in the de-escalation group and continuation group, respectively (
P
= 0.03). Mortality was similar in both groups.
Conclusion
As compared to the continuation of the empirical antimicrobial treatment, a strategy based on de-escalation of antibiotics resulted in prolonged duration of ICU stay. However, it did not affect the mortality rate.
Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a ...handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes.
A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group).
We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 10-25 min vs. 34 15-40 min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group (p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53).
Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809 .
Little is known on the end-of-life (EOL) care of terminal breast cancer in women with severe psychiatric disorder (SPD). The objective was to determine if women with SPD and terminal breast cancer ...received the same palliative and high-intensity care during their end-of-life than women without SPD. Study design, setting, participants. This population-based cohort study included all women aged 15 and older who died from breast cancer in hospitals in France (2014-2018). Key measurements/outcomes. Indicators of palliative care and high-intensity EOL care. Multivariable models were performed, adjusted for age at death, year of death, social deprivation, duration between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 1742 women with SPD (287 with bipolar disorder, 1075 with major depression and 380 with schizophrenia) and 36,870 women without SPD. In multivariate analyses, women with SPD had more palliative care (adjusted odd ratio aOR 1.320, 95%CI 1.153-1.511, p < 0.001), longer palliative care follow-up before death (adjusted beta = 1.456, 95%CI (1.357-1.555), p < 0.001), less chemotherapy, surgery, imaging/endoscopy, and admission in emergency department and intensive care unit. Among women with SPD, women with bipolar disorders and schizophrenia died 5 years younger than those with recurrent major depression. The survival time was also shortened in women with schizophrenia. Despite more palliative care and less high-intensity care in women with SPD, our findings also suggest the existence of health disparities in women with bipolar disorders and schizophrenia compared to women with recurrent major depression and without SPD. Targeted interventions may be needed for women with bipolar disorders and schizophrenia to prevent these health disparities.
Major depressive disorder (MDD) is a leading cause of suffering for both patients and their natural caregivers. A preliminary study highlights the association of emotional intelligence (EI) and ...coping strategies with quality of life. However, there is a lack of studies concerning dyadic (i.e., patient and natural caregiver) characteristics’ impact on anxious and depressive symptoms. In a sample of MDD patients-caregivers dyads, we explored the influence of EI and coping strategies on anxious and depressive symptoms using the actor-partner interdependence model (APIM).
The cross-sectional study included 79 MDD patient-caregiver dyads. Self-reported data, completed by patients and their primary caregivers, were collected including socio-demographic, EI using TEIQue-SF, coping strategies using BriefCope, depressive symptoms using Beck Depression Inventory, anxious symptoms using STAI. The APIM was used to test the dyadic effects of EI and coping strategies on anxious and depressive symptoms, using structural equation modelling.
Patients and caregivers reported both anxious and depressive symptoms. Coping strategies, such as problem solving, positive thinking and avoidance, exhibited evidence of actor (degree to which the individual's coping strategies are associated with their own anxiety or depression level) and partner effect (degree to which the individual's coping strategies are associated with the anxiety or depression level of the other member of the dyad). The caregivers’ EI was associated with a decrease of their own depression level contrary to patients for which the results were not significant. The patients’ and caregivers’ EI was associated with a decrease of their own level of anxiety.
EI and coping strategies were moderately associated with anxious and depressive symptomatology among MDD patient-caregiver dyads. These results suggest that targeted interventions could be proposed to both patients and caregivers.
•In MDD patients and caregivers report anxious and depressive symptoms.•Dyads’ symptoms are related to emotional intelligence with actor effects.•Actor and partner effects related coping strategies to dyads’ symptoms.•Interventions on emotional intelligence and coping strategies could be proposed.
Background
Since March 2020, health care systems were importantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, with some patients presenting severe acute ...respiratory distress syndrome (ARDS), requiring extra-corporeal membrane oxygenation (ECMO). We designed an ambispective observational cohort study including all consecutive adult patients admitted to 5 different ICUs from a university hospital. The main objective was to identify the risk factors of severe COVID-19 ARDS patients supported by ECMO associated with 90-day survival.
Results
Between March 1st and November 30th 2020, 76 patients with severe COVID-19 ARDS were supported by ECMO. Median (interquartile range IQR) duration of mechanical ventilation (MV) prior to ECMO was of 6 (3–10) days. At ECMO initiation, patients had a median PaO
2
:FiO
2
of 71 mmHg (IQR 62–81), median PaCO
2
of 58 mmHg (IQR 51–66) and a median arterial pH of 7.33 (IQR 7.25–7.38). Forty-five patients (59%) were weaned from ECMO. Twenty-eight day, 60-day and 90-day survival rates were, respectively, 92, 62 and 51%. In multivariate logistic regression analysis, with 2 models, one with the RESP score and one with the PRESERVE score, we found that higher BMI was associated with higher 90-day survival odds ratio (OR): 0.775 (0.644–0.934),
p
= 0.007) and 0.631 (0.462–0.862), respectively. Younger age was also associated with 90-day survival in both models OR: 1.1354 (1.004–1.285),
p
= 0.044 and 1.187 (1.035–1.362),
p
= 0.014 respectively. Obese patients were ventilated with higher PEEP than non-obese patients and presented slightly higher respiratory system compliance.
Conclusion
In this ambispective observational cohort of COVID-19 severe ARDS supported by ECMO, obesity was an independent factor associated with improved survival at 90-day.
Introduction and hypothesis
Wearing high heels may not only produce deleterious effects on the musculoskeletal system and on the general posture, but also on the activity of pelvic floor muscles. ...However, no data are currently available concerning the link between fecal incontinence and wearing high heels. Our aim was to determine whether wearing high-heeled shoes could influence anal canal pressure values in patients suffering from fecal incontinence.
Methods
In this retrospective monocentric study, 338 female patients were included. Clinical data, including the Wexner score, and manometric data were recorded (using 3D high-resolution anorectal manometry). Wearing high heels was defined by the use of high-heeled shoes at least four times a week for 4 consecutive hours with at least 1 year of usage time and heels ≥3 cm. Two sub-groups were defined: “high heels” vs “no high heels.”
Results
The two subgroups were comparable for clinical data, including Wexner score, except for a higher age, menopause and hormone replacement therapy, and urinary incontinence in the group with “high heels.” No statistical difference was observed concerning the anal canal pressure. Using analysis by logistic regression, only age was related to a significantly lower resting pressure.
Conclusions
In this retrospective cohort of women with fecal incontinence, no clinical or manometric differences were observed between women who wore high heels versus those who did not. Because there is limited knowledge on this potential link and because the pelvic tilt may vary according to age and the habit of walking with high heels, further studies are necessary.
Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care ...compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014–2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6 years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 1.03;1.56;
p
= 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 0.41;0.70;
p
< 0.0001; surgery 0.73 0.59;0.90;
p
< 0.01) than controls. Although the use and/or continuation of high-intensity end-of-life care is less important in schizophrenia patients with lung cancer, some findings suggest a loss of chance. Future studies should explore the expectations of patients with schizophrenia and lung cancer to define the optimal end-of-life care.
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