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📃Scientific paper: Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19 Ref.: BioMed Central, 2024 Abstract: Objective To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Design Retrospective practice analysis from March 5, 2020, to April 15, 2021. Setting Intensive care units (ICU) at four medical institutions. Patients n = 3780 adults with ICU admission and diagnosis of COVID-19. Interventions We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). Measurements and main results The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m^2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484, p  < 0.001). Multivariate linear regression (model adjusted R^2 = 0.68, p  < 0.001) demonstrates mechanical ventilation (β = − 0.86, p  = 0.001), average mobility score in first three sessions (β = 2.6, p  < 0.001) and physical rehabilitation dosage (β ... Continued on ES/IODE ➡️ https://etcse.fr/283 ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19 Abstract: Objective To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Design Retrospective practice analysis from March 5, 2020, to April 15, 2021. Setting Intensive care units (ICU) at four medical institutions. Patients n = 3780 adults with ICU admission and diagnosis of COVID-19. Interventions We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). Measurements and main results The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m^2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484, p  < 0.001). Multivariate linear regression (model adjusted R^2 = 0.68, p  < 0.001) demonstrates mechanical ventilation (β = − 0.86, p  = 0.001), average mobility score in first three sessions (β = 2.6, p  < 0.001) and physical rehabilitation dosage (β ... Continued on ES/IODE ➡️ https://etcse.fr/283 ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19 Abstract: Objective To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Design Retrospective practice analysis from March 5, 2020, to April 15, 2021. Setting Intensive care units (ICU) at four medical institutions. Patients n = 3780 adults with ICU admission and diagnosis of COVID-19. Interventions We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). Measurements and main results The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m^2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484, p  < 0.001). Multivariate linear regression (model adjusted R^2 = 0.68, p  < 0.001) demonstrates mechanical ventilation (β = − 0.86, p  = 0.001), average mobility score in first three sessions (β = 2.6, p  < 0.001) and physical rehabilitation dosage (β ... Continued on ES/IODE ➡️ https://etcse.fr/283 ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

📃Scientific paper: Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19 Abstract: Objective To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19. Design Retrospective practice analysis from March 5, 2020, to April 15, 2021. Setting Intensive care units (ICU) at four medical institutions. Patients n = 3780 adults with ICU admission and diagnosis of COVID-19. Interventions We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) “6-Clicks” (6–24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital). Measurements and main results The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m^2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman’s rho [r] = 0.484, p  < 0.001). Multivariate linear regression (model adjusted R^2 = 0.68, p  < 0.001) demonstrates mechanical ventilation (β = − 0.86, p  = 0.001), average mobility score in first three sessions (β = 2.6, p  < 0.001) and physical rehabilitation dosage (β ... Continued on ES/IODE ➡️ https://etcse.fr/283 ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

Your weekly selection of #articles from the ICM Journal: From the topical collection "ICU Toolbox": 🔹Positive end-expiratory pressure optimization in ARDS: physiological evidence, bedside methods and clinical applications 👉 https://rdcu.be/dExlX 🔹High-flow nasal cannula: evolving practices and novel clinical and physiological insights 👉 https://rdcu.be/dEkQ8 From the topical collection "My green ICU": 🔹Less is more for greener intensive care 👉 https://rdcu.be/dEkPC And ICM's latest articles: 🔹A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients 👉 https://rdcu.be/dEkYK 🔹A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year 👉 https://rdcu.be/dEkQI 🔹What intensivists need to know on cardiac dysfunction in critically ill cancer patients 👉 https://rdcu.be/dEkYD 🔹OPEN ACCESS ~ Non-occlusive mesenteric ischemia and intra-arterial vasodilatory therapy in severe shock and multi-organ failure: treating the untreatable? 👉 https://rdcu.be/dEk20 🔹The new global definition of ARDS loses one of the first games: a chromatic advice 👉 https://rdcu.be/dEkPN 🔹Rapid syndromic multiplex PCR panels for the management of ventilator-associated lower respiratory tract infections: pondering important limitations. Author’s reply 👉 https://rdcu.be/dEkQN 🔹OPEN ACCESS ~ Correction: The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections 👉 https://rdcu.be/dEkPS Read more articles here! 👉 https://lnkd.in/eeBieiy

Hip fractures are common and their impact can be substantial, but researchers have found adherence to hip fracture care standards reduces risk of death and improved patient outcomes.   A report led by NeuRA Senior Research Fellow, Lara Harvey, and published in the Medical Journal of Australia showed the Hip Fracture Care Clinical Standard is improving outcomes for patients, with some factors substantially lowering risk of death for patients.   “Hip fracture is common and unfortunately associated with substantial morbidity, mortality, reduced quality of life and independence,” Dr Harvey said. “What this research found was that if hip fracture patients received high quality clinical care, there is a significant decrease in short- and longer-term mortality.”    The study found where patients received care that met five or six out of six key quality indicators there was a 60% lower short-term mortality risk, while those meeting four indicators saw a 40% reduction. This pattern was sustained at one year. The Hip Fracture Clinical Care Standard was introduced by the Australian Commission on Safety and Quality in Health Care in 2016 to improve care for around 19,000 people who fracture their hip each year, usually after a fall. “These findings emphasise the significant cumulative impact of adhering to multiple care processes and underscore the importance of a multidisciplinary approach to delivering high-quality hip fracture care,” Dr Harvey said.   The report tied into NeuRA’s ongoing work with the Australian & New Zealand Hip Fracture Registry, which continues to grow and has data on more than 110,000 hip fractures. Its Annual Report, released this month, had a focus on performance against the clinical care standard and noted a number of achievements, but also room for improvement.    You can read more here: https://lnkd.in/gEZm5sFD

Should We Not Be Recommending Small Adult BVMs in OHCA? Background: - Optimal outcome in OHCA (Out of Hospital Cardiac Arrest) is survival with good neurologic function. - Proven effective interventions: high-quality CPR and defibrillation. - Importance of controlled ventilation: Excessive ventilation can hinder hemodynamics and cerebral blood flow. Context: - Standard recommendation: Tidal volumes of 500-600 mL/breath. - Issue: Large adult BVMs (Bag-Valve Masks) often exceed this volume, risking over-ventilation. - Suggested solution: Smaller adult BVMs to align delivered volumes with guidelines. Study Overview: - Retrospective, observational cohort study by Snyder BD et al. - Data from a single urban EMS system from 2015-2021. - Change from large to small adult BVMs in mid-2017. - Primary outcome: Return of Spontaneous Circulation (ROSC). Results: - 1994 patients analyzed (67% with small BVM, 33% with large BVM). - ROSC rates: Small BVM (33%) vs. Large BVM (40%). - Adjusted analysis confirmed lower ROSC with small BVM (aOR 0.74). - Ventilation rates were similar; higher ETCO2 observed with small BVM. Strengths: - Rigorous data integration and verification. - Consideration of COVID-19 impact and long-term trends. Limitations: - Applicability limited to patients with advanced airway management. - Confounding baseline differences. - Retrospective nature only shows association, not causation. - Unknown exact tidal volumes delivered. Discussion: - Baseline differences could skew results. - Small BVM group had more favorable conditions (e.g., bystander CPR, fewer public arrests). - Despite adjusting for these factors, lower ROSC persisted in the small BVM group. - The study raises concerns about potential physiological harm from smaller tidal volumes. Conclusion: - Small BVMs were associated with lower ROSC. - Additional research needed to clarify impacts on ventilation and outcomes. - Current recommendation: Stick with large BVMs, but ensure controlled ventilation rate (10 BPM). Takeaway: - The trial's methodological issues highlight the need for robust evidence before changing clinical practices. - Until more definitive evidence is available, using large BVMs with proper technique remains advisable. Reference: - Snyder BD et al., Resuscitation 2023, PMID: 37805062.

UK TMS NEWS ANNOUNCEMENT   Magstim Horizon Inspire Transcranial Magnetic Stimulation Device Approved By UKCA for NHS & Private UK Clinics UK System for Patient Treatment of MDD, OCD and Decreasing Anxiety*   Magstim has been awarded UKCA clearance for the Horizon Inspire System, continuing to provide NHS physicians and researchers with next-generation transcranial magnetic stimulation technology to treat patients with MDD, OCD and Decreasing Anxiety*.   “As the first to introduce clinical TMS into the NHS, our team continues delivering innovative treatments to help treat depression and anxiety,” said Professor Alex O’Neill Kerr, MBChB, Medical Director of Transforming Mind Solutions. “This new system takes trusted Magstim TMS technology to the next level, improving patient outcomes.”   Magstim has supplied the NHS with TMS technology for more than 30 years. The Inspire enables both experienced TMS providers as well as those who are new to TMS to get up a running fast to provide patient treatments.”   The Inspire provides high-power air-cooling, ability to deliver back-to-back customizable treatments, all while being easy to use, cost-effective and offering portability between clinic rooms. Magstim TMS technology is cited in more than 20,000 peer reviewed research papers and used in hospitals, clinics and research centers worldwide.   The use of Transcranial Magnetic Stimulation for treating MDD and OCD is increasing worldwide, driven by new studies demonstrating its effectiveness over other treatments (**).   The Horizon Inspire system leverages intuitive preset clinical workflows to simplify the treatment process, delivering precise results with no pulse decay, ensuring the correct dosage. Magstim’s air-cooled coil reduces downtime and eliminates additional cooling expenses. Advanced data analytics tools improve treatment efficacy. * Horizon 3.0 Inspire is indicated for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode, as well as an adjunct for the treatment of adult patients suffering from Obsessive-Compulsive Disorder (OCD).   ** https://lnkd.in/eK94AXEH Learn more at: https://lnkd.in/gytY6t9w   #TMS #depression #UKCA #NHS

A primary care physician (PCP) serves as the first point of contact for medical concerns, provides routine check-ups, manages chronic conditions, and refers patients to specialists when needed. You should prioritize regular health screenings as recommended by your primary care physician (PCP). These screenings help in early detection and prevention of various medical conditions, potentially saving lives and improving overall health outcomes. 5 common basic screenings: 1.    High blood pressure (hypertension) often has no symptoms but can lead to serious health problems like heart disease, stroke, and kidney disease if left untreated. 2.    High levels of cholesterol in the blood can increase the risk of heart disease and stroke. Screening helps in identifying elevated cholesterol levels early so that lifestyle changes or medication can be initiated to manage it effectively. 3.    Mental health screenings, including depression screenings, are important for individuals of all ages. Early detection and intervention for depression can lead to improved quality of life and prevent complications. 4.    Diabetes is a chronic condition characterized by high blood sugar levels. Screening for diabetes is crucial as early diagnosis and management can prevent or delay complications such as heart disease, kidney disease, nerve damage, and vision problems. 5.    Cancer screenings are tailored based on factors such as gender, age, and personal/family medical history. Common cancer screenings include; Colorectal for both men and women, Breast cancer, cervical cancer, prostate cancer, skin cancer and testicular cancer. When you skip or postpone these screenings, you are delaying the detection of diseases, which leads to potentially more severe health problems down the line. Therefore, it's essential to follow the screening recommendations provided by your PCP and to prioritize your health by attending routine check-ups and screenings. Reach out to Agility Health Connect for more information and support. info@agilityhealthconnect.com

New paper: Communicating treatment options to older patients with advanced kidney disease: a conversation analysis study. https://lnkd.in/eSp355WE We identified two approaches used by clinicians when presenting treatment options for older people with advanced kidney disease. The first approach, less commonly used, frames conservative kidney management (CKM) as a main treatment option alongside dialysis. The clinician refers to the evidence & frames CKM as an active treatment. In the second, more common approach, CKM is framed as subordinate. It is not presented as having potential benefit for the patient: the disadvantages of dialysis are not explicated, and neither are CKM’s potential advantages. When CKM is presented as a main treatment option alongside dialysis more opportunities are provided for the patient to ask questions about CKM/not having dialysis, provide their perspective about CKM, and therefore consider it a relevant option. This approach was also associated with significantly higher patient-reported shared decision-making scores compared with the ‘CKM as subordinate’ approach. These novel findings have important implications for understanding how clinicians' communication influences patient engagement with a treatment decision - and why high rates of decisional regret have been reported among older patients receiving dialysis. On the basis of this and other evidence from the OSCAR study, we have developed a communication training intervention for kidney doctors and nurses to optimise how they communicate with patients about treatment decisions. Watch this space! With thanks to everyone who participated in the OSCAR study, the patient and public advisory group, project advisory group and NIHR (National Institute for Health and Care Research) for funding. Research team of stars includes Dr Chloe Shaw, Dr Ryann Sowden, Prof James Tulsky, Prof Fliss Murtagh, Prof Fergus Caskey, Prof Ruth Parry, Assoc Prof Rebecca Barnes.