Nutrition care processes across hospitalisation in critically ill patients with COVID-19 in Australia: a multicentre prospective observational study

Background: The COVID-19 pandemic highlighted major challenges with usual nutrition care processes, leading to reports of malnutrition and nutrition-related issues in these patients. Objective: The objective of this study was to describe nutrition-related service delivery practices across hospitalisation in critically ill patients with COVID-19 admitted to Australian intensive care units (ICUs) in the initial pandemic phase. Methods: This was a multicentre (nine site) observational study in Australia, linked with a national registry of critically ill patients with COVID-19. Adult patients with COVID-19 who were discharged to an acute ward following ICU admission were included over a 12-month period. Data are presented as n (%), median (interquartile range [IQR]), and odds ratio (OR [95% confidence interval {CI}]). Results: A total of 103 patients were included. Oral nutrition was the most common mode of nutrition (93 [93%]). In the ICU, there were 53 (52%) patients seen by a dietitian (median 4 [2–8] occasions) and malnutrition screening occurred in 51 (50%) patients most commonly with the malnutrition screening tool (50 [98%]). The odds of receiving a higher malnutrition screening tool score increased by 36% for every screening in the ICU (1st to 4th, OR: 1.39 [95% CI: 1.05–1.77] p = 0.018) (indicating increasing risk of malnutrition). On the ward, 51 (50.5%) patients were seen by a dietitian (median time to consult: 44 [22.5–75] hours post ICU discharge). The odds of dietetic consult increased by 39% every week while on the ward (OR: 1.39 [1.03–1.89], p = 0.034). Patients who received mechanical ventilation (MV) were more likely to receive dietetic input than those who never received MV. Conclusions: During the initial phases of the COVID-19 pandemic in Australia, approximately half of the patients included were seen by a dietitian. An increased number of malnutrition screens were associated with a higher risk score in the ICU and likelihood of dietetic consult increased if patients received MV and as length of ward stay increased

Orientation Sensitivity at Different Stages of Object Processing: Evidence from Repetition Priming and Naming

An ongoing debate in the object recognition literature centers on whether the shape representations used in recognition are coded in an orientation-dependent or orientation-invariant manner. In this study, we asked whether the nature of the object representation (orientation-dependent vs orientation-invariant) depends on the information-processing stages tapped by the task

Priming from distractors in Rapid Serial Visual Presentation is modulated by image properties and attention

1. We investigated distractor processing in a dual-target rapid serial visual presentation (RSVP) task containing familiar objects, by measuring repetition priming from a priming distractor (PD) to Target 2 (T2). Priming from a visually identical PD was contrasted with priming from a PD in a different orientation from T2. We also tested the effect of attention on distractor processing, by placing the PD either within or outside the attentional blink (AB). PDs outside the AB induced positive priming when they were in a different orientation to T2 and no priming, or negative priming, when they were perceptually identical to T2. PDs within the AB induced positive priming regardless of orientation. These findings demonstrate (1) that distractors are processed at multiple levels of representation; (2) that the view-specific representations of distractors are actively suppressed during RSVP; and (3) that this suppression fails in the absence of attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved

Early information processing contributions to object individuation revealed by perception of illusory figures

To isolate multiple coherent objects from their surrounds, each object must be represented as a stable perceptual entity across both time and space. Recent theoretical and empirical work has proposed that this process of object individuation is a mid-level operation that emerges around 200–300 ms after stimulus onset. However, this hypothesis is based on paradigms that have potentially obscured earlier effects. Furthermore, no study to date has directly assessed whether object individuation occurs for task-irrelevant objects. In the present study we used electroencephalography (EEG) to measure the time course of individuation, for stimuli both within and outside the focus of attention, to assess the information processing stage at which object individuation arises for both types of objects. We developed a novel paradigm involving items defined by illusory contours, which allowed us to vary the number of to-be-individuated objects while holding the physical elements of the display constant (a design characteristic not present in earlier work). As early as 100 ms after stimulus onset, event-related potentials tracked the number of objects in the attended hemifield, but not those in the unattended hemifield. By contrast, both attended and unattended objects could be individuated at a later stage. Our findings challenge recent conceptualizations of the time course of object individuation and suggest that this process arises earlier for attended than unattended items, implying that voluntary spatial attention influences the time course of this operation

The neural basis of temporal individuation and its capacity limits in the human brain

Individuation refers to individuals' use of spatial and temporal properties to register objects as distinct perceptual events relative to other stimuli. Although behavioral studies have examined both spatial and temporal individuation, neuroimaging investigations have been restricted to the spatial domain and at relatively late stages of information processing. Here, we used univariate and multivoxel pattern analyses of functional MRI data to identify brain regions involved in individuating temporally distinct visual items and the neural consequences that arise when this process reaches its capacity limit (repetition blindness, RB). First, we found that regional patterns of blood-oxygen-level-dependent activity across the cortex discriminated between instances where repeated and non-repeated stimuli were successfully individuated-conditions that placed differential demands on temporal individuation. These results could not be attributed to repetition suppression or other stimulusrelated factors, task difficulty, regional activation differences, other capacity-limited processes, or artifacts in the data or analyses. Contrary to current theoretical models, this finding suggests that temporal individuation is supported by a distributed set of brain regions, rather than a single neural correlate. Second, conditions that reflect the capacity limit of individuation-instances of RB-lead to changes in the spatial patterns within this network, as well as amplitude changes in the left hemisphere premotor cortex, superior medial frontal cortex, anterior cingulate cortex, and bilateral parahippocampal place area. These findings could not be attributed to response conflict/ambiguity and likely reflect the core brain regions and mechanisms that underlie the capacity-limited process that gives rise to RB

Caffeine consumption and withdrawal among patients in the intensive care unit

BACKGROUND: There is a lack of data surrounding the use of therapeutic caffeine among adults admitted to intensive care units (ICUs).OBJECTIVES: The objective of this study was to determine reported caffeine use and withdrawal symptoms among patients admitted to the ICU to inform future prospective interventional trials.METHODS: This study used a cross-sectional survey design, where a survey was conducted by a registered dietitian among 100 adult patients admitted to an ICU in Brisbane, Australia.RESULTS: The median age of patients was 59.8 y (interquartile range: 44.0-70.0), and 68% were male. Ninety-nine percent of patients had daily consumption of caffeine with a median 338 mg (interquartile range: 162-504). Caffeine consumption was self-reported in 89% of patients and was uncovered by detailed identification in 10%. Almost one-third (29%) reported caffeine withdrawal symptoms while admitted to intensive care. Common withdrawal symptoms reported were headaches, irritability, fatigue, anxiety, and constipation. Eighty-eight percent of patients reported willingness to participate in future studies of therapeutic caffeine if they were admitted to the ICU. Preferred methods of parenteral and enteral routes of administration varied by patient and illness characteristics.CONCLUSIONS: Patients admitted to this ICU were ubiquitous consumers of caffeine before admission, and one-tenth were unaware. Patients viewed trials of therapeutic caffeine as highly acceptable. The results provide important baseline information for future prospective studies.</p

Distributed and opposing effects of incidental learning in the human brain

Incidental learning affords a behavioural advantage when sensory information matches regularities that have previously been encountered. Previous studies have taken a focused approach by probing the involvement of specific candidate brain regions underlying incidentally acquired memory representations, as well as expectation effects on early sensory representations. Here, we investigated the broader extent of the brain's sensitivity to violations and fulfilments of expectations, using an incidental learning paradigm in which the contingencies between target locations and target identities were manipulated without participants' overt knowledge. Multivariate analysis of functional magnetic resonance imaging data was applied to compare the consistency of neural activity for visual events that the contingency manipulation rendered likely versus unlikely. We observed widespread sensitivity to expectations across frontal, temporal, occipital, and sub-cortical areas. These activation clusters showed distinct response profiles, such that some regions displayed more reliable activation patterns under fulfilled expectations, whereas others showed more reliable patterns when expectations were violated. These findings reveal that expectations affect multiple stages of information processing during visual decision making, rather than early sensory processing stages alone

Improving nutrition care for neurosurgery patients through a nurse-led transition feeding protocol

Aim: Neurosurgical patients often transition from enteral nutrition (EN) to oral nutrition (ON) as they recover. Implementing a nurse-led feeding protocol to guide this transition may improve consistency of nutrition care and dietitian workload efficiency. This pragmatic study aimed to evaluate the effect of such a protocol on these outcomes and on nurses’ nutrition care attitudes, practices and knowledge. Methods: Data were collected retrospectively for 1 year pre- and prospectively for 1 year post-implementation of the transition feeding protocol (TFP). Participants who transitioned from EN to ON were included in the study. Post-implementation nurses in the neurosurgery ward were invited to complete a self-administered questionnaire to investigate attitudes, practices and knowledge. Results: One hundred and thirteen participants, 55 pre- and 58 post-implementation, took part in the study. Significantly more patients received transition feeding (TF) post-implementation (58% vs 93%, P < 0.001), there was a statistically significant improvement in the commencement of TF (0 vs 1 day after ON clearance; P = 0.029), and all patients consumed adequate oral intake 1-week post-EN cessation (92.3% vs 100%, P = 0.078). There was no difference in dietetic occasions of service post-implementation (2 vs 1.5; P = 0.204). A 38% survey response rate from nursing staff (n = 15) was achieved. More nurses were found to be initiating TF (P < 0.001) and a majority reported a perceived increase in knowledge and confidence in providing nutrition support. Conclusions: A TFP can optimise the transition from EN to ON by improving consistency and commencement of TF and nurses’ confidence and knowledge in overall nutrition care