Virtual reality-based early neurocognitive stimulation in critically ill patients: A pilot randomized clinical trial

This study focuses on the application of a non-immersive virtual reality (VR)-based neurocognitive intervention in critically ill patients. Our aim was to assess the feasibility of direct outcome measures to detect the impact of this digital therapy on patients’ cognitive and emotional outcomes. Seventy-two mechanically ventilated adult patients were randomly assigned to the “treatment as usual” (TAU, n = 38) or the “early neurocognitive stimulation” (ENRIC, n = 34) groups. All patients received standard intensive care unit (ICU) care. Patients in the ENRIC group also received adjuvant neurocognitive stimulation during the ICU stay. Outcome measures were a full neuropsychological battery and two mental health questionnaires. A total of 42 patients (21 ENRIC) completed assessment one month after ICU discharge, and 24 (10 ENRIC) one year later. At onemonth follow-up, ENRIC patients had better working memory scores (p = 0.009, d = 0.363) and showed up to 50% less non-specific anxiety (11.8% vs. 21.1%) and depression (5.9% vs. 10.5%) than TAU patients. A general linear model of repeated measures reported a main effect of group, but not of time or group–time interaction, on working memory, with ENRIC patients outperforming TAU patients (p = 0.008, ¿p2 = 0.282). Our results suggest that non-immersive VR-based neurocognitive stimulation may help improve short-term working memory outcomes in survivors of critical illness. Moreover, this advantage could be maintained in the long term. An efficacy trial in a larger sample of participants is feasible and must be conducted. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Autonomic nervous system assessment in critically ill patients undergoing a cognitive rehabilitation therapy

Recent clinical and electrophysiological studies reveal a high incidence of autonomic nervous system (ANS) dysfunction in patients treated in Intensive Care Units (ICUs). Cognitive rehabilitation (CR) is a behavioral therapy that has proven to be effective improving cognitive deficits in clinical populations with abnormalities in brain activation patterns. A total of 17 critically ill patients received CR aimed to improve the ANS status, which was quantified in terms of HRV. The CR included cognitive exercises aimed to improve prefrontal activation. HRV was obtained during pre-CR, CR and post-CR. Power in the low (PLF) and high (PHF) frequency bands related to sympathetic and parasympathetic systems was computed. PHF was obtained within a band centered at respiratory rate. Comparing with baseline values, 7 patients showed an increased PHF in post-CR, suggesting an increase of parasympathetic activity

Walking family: Programme of parental skills during foster care and reunification. Summary of main findings of the Project I+D EDU2014-52921-C2. [Infographics]

Podeu consultar la versió castellana, francesa i portuguesa al recurs relacionat.Walking Family is a support programme for specific parenting skills in foster care and reunification. Its main aim is to promote the acceptance and involvement of the welfare measure and to foster and strengthen reunification. One of the most relevant aspects of the programme is its group methodology, as it can be used to convey effective coping strategies for everyday problems. Walking Family is characterised by three cornerstones of innovation: positive parenting and child welfare, child participation and family resilience. The programme is developed over 5 modules, each containing 3 sessions. Each session offers activities to do with the children, with the parents and with the family as a unit

Data Descriptor : A European Multi Lake Survey dataset of environmental variables, phytoplankton pigments and cyanotoxins

Under ongoing climate change and increasing anthropogenic activity, which continuously challenge ecosystem resilience, an in-depth understanding of ecological processes is urgently needed. Lakes, as providers of numerous ecosystem services, face multiple stressors that threaten their functioning. Harmful cyanobacterial blooms are a persistent problem resulting from nutrient pollution and climate-change induced stressors, like poor transparency, increased water temperature and enhanced stratification. Consistency in data collection and analysis methods is necessary to achieve fully comparable datasets and for statistical validity, avoiding issues linked to disparate data sources. The European Multi Lake Survey (EMLS) in summer 2015 was an initiative among scientists from 27 countries to collect and analyse lake physical, chemical and biological variables in a fully standardized manner. This database includes in-situ lake variables along with nutrient, pigment and cyanotoxin data of 369 lakes in Europe, which were centrally analysed in dedicated laboratories. Publishing the EMLS methods and dataset might inspire similar initiatives to study across large geographic areas that will contribute to better understanding lake responses in a changing environment.Peer reviewe

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19

Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.info:eu-repo/semantics/publishedVersio

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.Peer reviewe

Caminhar em família: Programa de competências parentais durante o acolhimento e a reunificação familiar. Resumo dos principais resultados do Projeto I+D EDU2014-52921-C2. [Infográficos]

Podeu consultar la versió castellana, anglesa i francesa al recurs relacionat.Caminhar em familia é um programa de apoio às competências parentais específicas aos processos de acolhimento e de reunificação familiar. O seu principal objetivo é promover a aceitação e o envolvimento com a medida de proteção, bem como o de favorecer e consolidar a reunificação familiar. Um dos aspetos mais relevantes do programa é a sua metodologia grupal, já que através da mesma se transmitem estratégias eficazes para dar resposta aos problemas quotidianos. O Caminhar em família carateriza-se por três linhas de inovação: Parentalidade positiva e proteção à infância, participação infantil e resiliência familiar. O Programa desenvolve-se em 5 módulos e cada um deles inclui 3 sessões. Cada sessão apresenta atividades para realizar com filhos e filhas, com pais e mães e com a família em conjunto

Marcher en famille: Programme de compétences parentales pendant l'accueil et la réunification familiale. Résumé des principaux résultats du Projet I+D EDU2014-52921-C2. [Infographie]

Podeu consultar la versió castellana, anglesa i portuguesa al recurs relacionat.Marcher en famille est un programme de soutien aux compétences parentales spécifiques dans un processus d’accueil et de réunification familiale. Son objectif principal est de promouvoir l’acceptation et l’implication de la mesure de protection, ainsi que de favoriser et de garantir la réunification familiale. L’un des aspects les plus importants du programme est sa méthodologie groupale, puisque l’on peut au travers d’elle transmettre des stratégies effectives d’affrontement des problèmes quotidiens. Le Marcher en famille se caractérise par trois axes d’innovation: Parentalité positive et protection de l’enfance, participation infantile et résilience familiale. Le programme se développe en 5 modules et chacun d’entre eux comprend 3 séances. Chaque séance présente des activités à réaliser avec les fils