Abstract
Background
Family members of critically ill patients face considerable uncertainty and distress during their close others’ intensive care unit (ICU) stay. About 20–60% of family members ...experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation.
Methods
To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members’ satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members’ mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference.
Discussion
This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being.
Trial registration
ClinicalTrials.gov
NCT05280691
. Prospectively registered on 20 February 2022.
Purpose of Review
We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize ...community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions.
Recent Findings
There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health.
Summary
There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
OBJECTIVE: To investigate the serum antioxidant capacity and status of liver function parameters in Hepatitis B virus (HBV) and Hepatitis C Virus (HCV) infected patients. METHODS: In this ...case-control study, fifty patients with HBV (28 male & 22 females), fifty HCV patients (28 male & 22 females) and age and gender matched fifty healthy controls were enrolled from May to August 2016. The antioxidant status was determined by measuring trolox equivalent oxidant capacity (TEAC) through the Ferric Reducing Ability of Plasma assay. Serum levels of alkaline phosphates (ALP), Alanine amino transferase (ALT) and Albumin were estimated. Results: Serum ALT levels (U/L) were 119.69±5.03 & 24.3±3.01 in male HBV patients and controls; 176.34±75.48 and 25±3.01 in female HBV patients & Controls; 114.71±5.03 and 22.61±2.33 in male HCV patients and controls and 165±5.03 & 25±3.01 in female HCV patients & Controls respectively. Serum ALP levels (U/L) were 317.69±5.13, 240.17±23.9 in male HBV & controls, 159.34±5.03 & 138.4±3 in female HBV & Controls; 129.28±4.57, 230.47±33.5 in male HCV & controls and 169±3.65 and 165.10±5.70 in female HCV & Controls respectively (p<0.01). Serum TEAC (μg/mL) were 266.1±13.71, 413±18.21, 214.42±11.1, 395.71±16.33 in male HBV & control and female HBV & control respectively as compared to 264.6±14.55, 409.8±17.54, 273.4±13.84 and 395.5±14.23 in male HCV & control and female HCV & control respectively (p<0.01). CONCLUSION: A significantly high HBV & HCV induced oxidative stress and deranged liver parameters were observed in male and female patients, suggesting a possible association between viral pathogenesis and level of oxidative stress.
The moving mesh PDE (MMPDE) method for variational mesh generation and adaptation is studied theoretically at the discrete level, in particular the nonsingularity of the obtained meshes. Meshing ...functionals are discretized geometrically and the MMPDE is formulated as a modified gradient system of the corresponding discrete functionals for the location of mesh vertices. It is shown that if the meshing functional satisfies a coercivity condition, then the mesh of the semi-discrete MMPDE is nonsingular for all time if it is nonsingular initially. Moreover, the altitudes and volumes of its elements are bounded below by positive numbers depending only on the number of elements, the metric tensor, and the initial mesh. Furthermore, the value of the discrete meshing functional is convergent as time increases, which can be used as a stopping criterion in computation. Finally, the mesh trajectory has limiting meshes which are critical points of the discrete functional. The convergence of the mesh trajectory can be guaranteed when a stronger condition is placed on the meshing functional. Two meshing functionals based on alignment and equidistribution are known to satisfy the coercivity condition. The results also hold for fully discrete systems of the MMPDE provided that the time step is sufficiently small and a numerical scheme preserving the property of monotonically decreasing energy is used for the temporal discretization of the semi-discrete MMPDE. Numerical examples are presented.
The so‐called motorcycle graph has been employed in recent years for various purposes in the context of structured and aligned block decomposition of 2D shapes and 2‐manifold surfaces. Applications ...are in the fields of surface parametrization, spline space construction, semi‐structured quad mesh generation, or geometry data compression. We describe a generalization of this motorcycle graph concept to the three‐dimensional volumetric setting. Through careful extensions aware of topological intricacies of this higher‐dimensional setting, we are able to guarantee important block decomposition properties also in this case. We describe algorithms for the construction of this 3D motorcycle complex on the basis of either hexahedral meshes or seamless volumetric parametrizations. Its utility is illustrated on examples in hexahedral mesh generation and volumetric T‐spline construction.
Background:
SARS-CoV-2 infection affects the vascular endothelium, which mediates the inflammatory and thrombotic cascade. Moreover, alterations in the endothelium are related to arterial stiffness, ...which has been established as a marker of cardiovascular disease. The objective of this study is to analyse how the structure, vascular function, vascular ageing and endothelial damage are related to the biopsychological situation in adults diagnosed with persistent COVID and the differences by gender.
Methods:
This cross-sectional, descriptive, observational study will be carried out in the Primary Care Research Unit of Salamanca (APISAL) and in the BioSepsis laboratory of the University of Salamanca. The sample will be selected from the persistent COVID monographic office at the Internal Medicine Service of the University Hospital of Salamanca, and from the population of subjects diagnosed with persistent COVID in the clinical history of Primary Care. Through consecutive sampling, the study will include 300 individuals diagnosed with persistent COVID who meet the diagnosis criteria established by the WHO, after they sign the informed consent. Endothelial damage biomarkers will be measured using ELLA-SimplePlexTM technology (Biotechne). Their vascular structure and function will be analysed by measuring the carotid intima-media thickness (Sonosite Micromax); the pulse wave and carotid-femoral pulse wave velocity (cfPWV) will be recorded with Sphygmocor System
®
. Cardio Ankle Vascular Index (CAVI), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index will be analysed with Vasera VS-2000
®
. The integral assessment of the subjects with persistent COVID will be conducted with different scales that evaluate fatigue, sleep, dyspnea, quality of life, attention, nutrition state, and fragility. We will also evaluate their lifestyles (diet, physical activity, smoking habits and alcohol consumption), psychological factors, and cognitive deterioration, which will be gathered through validated questionnaires; moreover, physical activity will be objectively measured using a pedometer for 7 days. Body composition will be measured through impedance using an Inbody 230. Vascular ageing will be calculated with 10 and 90 percentiles of cfPWV and baPWV. Furthermore, we will analyse the presence of vascular injury in the retina, heart, kidneys and brain, as well as cardiovascular risk. Demographic and analytical variables will also be gathered.
Discussion:
Arterial stiffness reflects the mechanic and functional properties of the arterial wall, showing the changes in arterial pressure, blood flow, and vascular diameter that occur with each heartbeat. SARS-CoV-2 affects the endothelial cells that are infected with this virus, increasing the production of pro-inflammatory cytokines and pro-thrombotic factors, which can cause early vascular ageing and an increase of arterial stiffness. Persistent COVID is a complex heterogeneous disorder that affects the lives of millions of people worldwide. The identifications of potential risk factors to better understand who is at risk of developing persistent COVID is important, since this would enable early and appropriate clinical support. It is unknown whether vascular alterations caused by COVID-19 resolve after acute infection or remain over time, favouring the increase of arterial stiffness and early vascular ageing. Therefore, it is necessary to propose studies that analyse the evolution of persistent COVID in this group of patients, as well as the possible variables that influence it.
Clinical Trial registration:
ClinicalTrials.gov
, identifier NCT05819840
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