Interventions to Alleviate the Psychosocial Needs of Hospice Family Caregivers: A Systematic Review

Hospice care is a growing service to individuals with terminal and chronic illnesses to promote quality of life and comfort versus treatment at the end of their life. The support of hospice care extends to the family of hospice patients. Many patients who wish to receive hospice care at home have involvement from family to become their primary caregiver. This systematic review was designed to answer the question, what interventions are available to alleviate the psychosocial needs of hospice family caregivers. Based on the inclusion and exclusion criteria set for this study 11 articles met criteria to be analyzed. Two major themes emerged from the data, counseling services, and education opportunities that was further broken down into informal education and psychoeducation. Further research should continue to explore effective interventions for hospice family caregivers

Interventions to Alleviate the Psychosocial Needs of Hospice Family Caregivers: A Systematic Review

Hospice care is a growing service to individuals with terminal and chronic illnesses to promote quality of life and comfort versus treatment at the end of their life. The support of hospice care extends to the family of hospice patients. Many patients who wish to receive hospice care at home have involvement from family to become their primary caregiver. This systematic review was designed to answer the question, what interventions are available to alleviate the psychosocial needs of hospice family caregivers. Based on the inclusion and exclusion criteria set for this study 11 articles met criteria to be analyzed. Two major themes emerged from the data, counseling services, and education opportunities that was further broken down into informal education and psychoeducation. Further research should continue to explore effective interventions for hospice family caregivers

Efficacy and safety of two neutralising monoclonal antibody therapies, sotrovimab and BRII-196 plus BRII-198, for adults hospitalised with COVID-19 (TICO): a randomised controlled trial

BACKGROUND: We aimed to assess the efficacy and safety of two neutralising monoclonal antibody therapies (sotrovimab [Vir Biotechnology and GlaxoSmithKline] and BRII-196 plus BRII-198 [Brii Biosciences]) for adults admitted to hospital for COVID-19 (hereafter referred to as hospitalised) with COVID-19. METHODS: In this multinational, double-blind, randomised, placebo-controlled, clinical trial (Therapeutics for Inpatients with COVID-19 [TICO]), adults (aged ≥18 years) hospitalised with COVID-19 at 43 hospitals in the USA, Denmark, Switzerland, and Poland were recruited. Patients were eligible if they had laboratory-confirmed SARS-CoV-2 infection and COVID-19 symptoms for up to 12 days. Using a web-based application, participants were randomly assigned (2:1:2:1), stratified by trial site pharmacy, to sotrovimab 500 mg, matching placebo for sotrovimab, BRII-196 1000 mg plus BRII-198 1000 mg, or matching placebo for BRII-196 plus BRII-198, in addition to standard of care. Each study product was administered as a single dose given intravenously over 60 min. The concurrent placebo groups were pooled for analyses. The primary outcome was time to sustained clinical recovery, defined as discharge from the hospital to home and remaining at home for 14 consecutive days, up to day 90 after randomisation. Interim futility analyses were based on two seven-category ordinal outcome scales on day 5 that measured pulmonary status and extrapulmonary complications of COVID-19. The safety outcome was a composite of death, serious adverse events, incident organ failure, and serious coinfection up to day 90 after randomisation. Efficacy and safety outcomes were assessed in the modified intention-to-treat population, defined as all patients randomly assigned to treatment who started the study infusion. This study is registered with ClinicalTrials.gov, NCT04501978. FINDINGS: Between Dec 16, 2020, and March 1, 2021, 546 patients were enrolled and randomly assigned to sotrovimab (n=184), BRII-196 plus BRII-198 (n=183), or placebo (n=179), of whom 536 received part or all of their assigned study drug (sotrovimab n=182, BRII-196 plus BRII-198 n=176, or placebo n=178; median age of 60 years [IQR 50-72], 228 [43%] patients were female and 308 [57%] were male). At this point, enrolment was halted on the basis of the interim futility analysis. At day 5, neither the sotrovimab group nor the BRII-196 plus BRII-198 group had significantly higher odds of more favourable outcomes than the placebo group on either the pulmonary scale (adjusted odds ratio sotrovimab 1·07 [95% CI 0·74-1·56]; BRII-196 plus BRII-198 0·98 [95% CI 0·67-1·43]) or the pulmonary-plus complications scale (sotrovimab 1·08 [0·74-1·58]; BRII-196 plus BRII-198 1·00 [0·68-1·46]). By day 90, sustained clinical recovery was seen in 151 (85%) patients in the placebo group compared with 160 (88%) in the sotrovimab group (adjusted rate ratio 1·12 [95% CI 0·91-1·37]) and 155 (88%) in the BRII-196 plus BRII-198 group (1·08 [0·88-1·32]). The composite safety outcome up to day 90 was met by 48 (27%) patients in the placebo group, 42 (23%) in the sotrovimab group, and 45 (26%) in the BRII-196 plus BRII-198 group. 13 (7%) patients in the placebo group, 14 (8%) in the sotrovimab group, and 15 (9%) in the BRII-196 plus BRII-198 group died up to day 90. INTERPRETATION: Neither sotrovimab nor BRII-196 plus BRII-198 showed efficacy for improving clinical outcomes among adults hospitalised with COVID-19. FUNDING: US National Institutes of Health and Operation Warp Speed

Hunter-Gatherer Olfaction Is Special

People struggle to name odors [1-4]. This has been attributed to a diminution of olfaction in trade-off to vision [5-10]. This presumption has been challenged recently by data from the hunter-gatherer Jahai who, unlike English speakers, find odors as easy to name as colors [4]. Is the superior olfactory performance among the Jahai because of their ecology (tropical rainforest), their language family (Aslian), or because of their subsistence (they are hunter-gatherers)? We provide novel evidence from the hunter-gatherer Semaq Beri and the non-hunter-gatherer (swidden-horticulturalist) Semelai that subsistence is the critical factor. Semaq Beri and Semelai speakers-who speak closely related languages and live in the tropical rainforest of the Malay Peninsula-took part in a controlled odor- and color-naming experiment. The swidden-horticulturalist Semelai found odors much more difficult to name than colors, replicating the typical Western finding. But for the hunter-gatherer Semaq Beri odor naming was as easy as color naming, suggesting that hunter-gatherer olfactory cognition is special

Multidimensional signals and analytic flexibility: Estimating degrees of freedom in human speech analyses

Recent empirical studies have highlighted the large degree of analytic flexibility in data analysis which can lead to substantially different conclusions based on the same data set. Thus, researchers have expressed their concerns that these researcher degrees of freedom might facilitate bias and can lead to claims that do not stand the test of time. Even greater flexibility is to be expected in fields in which the primary data lend themselves to a variety of possible operationalizations. The multidimensional, temporally extended nature of speech constitutes an ideal testing ground for assessing the variability in analytic approaches, which derives not only from aspects of statistical modeling, but also from decisions regarding the quantification of the measured behavior. In the present study, we gave the same speech production data set to 46 teams of researchers and asked them to answer the same research question, resulting insubstantial variability in reported effect sizes and their interpretation. Using Bayesian meta-analytic tools, we further find little to no evidence that the observed variability can be explained by analysts’ prior beliefs, expertise or the perceived quality of their analyses. In light of this idiosyncratic variability, we recommend that researchers more transparently share details of their analysis, strengthen the link between theoretical construct and quantitative system and calibrate their (un)certainty in their conclusions

Improved quality of life with immediate versus deferred initiation of antiretroviral therapy in early asymptomatic HIV infection

Objective: To determine if immediate compared to deferred initiation of antiretroviral therapy (ART) in healthy persons living with HIV had a more favorable impact on health-related quality of life (QOL), or self-assessed physical, mental, and overall health status. Design: QOL was measured in the Strategic Timing of Antiretroviral Therapy study, which randomized healthy ART-naive persons living with HIV with CD4 cell counts above 500 cells/μl from 35 countries to immediate versus deferred ART. Methods: At baseline, months 4 and 12, then annually, participants completed a visual analog scale (VAS) for perceived current health and the Short-Form 12-Item Health Survey version 2 from which the following were computed: general health perception; physical component summary (PCS); and mental component summary (MCS); the VAS and general health were rated from 0 (lowest) to 100 (highest). Results: QOL at study entry was high (mean scores: VAS=80.9, general health=72.5, PCS53.7, MCS=48.2). Over a mean follow-up of 3 years, changes in all QOL measures favored the immediate group (P < 0.001); estimated differences were as follows: VAS=1.9, general health=3.6, PCS=0.8, MCS=0.9. When QOL changes were assessed across various demographic and clinical subgroups, treatment differences continued to favor the immediate group. QOL was poorer in those experiencing primary outcomes; however, when excluding those with primary events, results remained favorable for immediate ART recipients. Conclusion: In an international randomized trial in ART-naive participants with above 500 CD4 cells/μl, there were modest but significant improvements in self-assessed QOL among those initiating ART immediately compared to deferring treatment, supporting patient-perceived health benefits of initiating ART as soon as possible after an HIV diagnosis

Inflammation associates with impaired small arterial elasticity early in HIV disease

© The Author(s) 2018. We estimated small arterial elasticity and used linear regression to evaluate its association with inflammatory biomarkers among antiretroviral therapy-naïve, HIV-positive patients with high CD4+ counts. After adjustment, high-sensitivity C-reactive protein and interleukin-6 were inversely associated with small arterial elasticity. These data suggest that systemic inflammation may contribute to vascular dysfunction even in very early HIV disease

Recurrence of Symptoms Following Cryptococcal Meningitis: Characterizing a Diagnostic Conundrum With Multiple Etiologies.

BACKGROUND: Cryptococcal meningitis is a common cause of AIDS-related mortality. Although symptom recurrence after initial treatment is common, the etiology is often difficult to decipher. We sought to summarize characteristics, etiologies, and outcomes among persons with second-episode symptomatic recurrence. METHODS: We prospectively enrolled Ugandans with cryptococcal meningitis and obtained patient characteristics, antiretroviral therapy (ART) and cryptococcosis histories, clinical outcomes, and cerebrospinal fluid (CSF) analysis results. We independently adjudicated cases of second-episode meningitis to categorize patients as (1) microbiological relapse, (2) paradoxical immune reconstitution inflammatory syndrome (IRIS), (3) persistent elevated intracranial pressure (ICP) only, or (4) persistent symptoms only, along with controls of primary cryptococcal meningitis. We compared groups with chi-square or Kruskal-Wallis tests as appropriate. RESULTS: 724 participants were included (n = 607 primary episode, 81 relapse, 28 paradoxical IRIS, 2 persistently elevated ICP, 6 persistent symptoms). Participants with culture-positive relapse had lower CD4 (25 cells/μL; IQR: 9-76) and lower CSF white blood cell (WBC; 4 cells/μL; IQR: 4-85) counts than paradoxical IRIS (CD4: 78 cells/μL; IQR: 47-142; WBC: 45 cells/μL; IQR: 8-128). Among those with CSF WBC &lt;5 cells/μL, 86% (43/50) had relapse. Among those with CD4 counts &lt;50 cells/μL, 91% (39/43) had relapse. Eighteen-week mortality (from current symptom onset) was 47% among first episodes of cryptococcal meningitis, 31% in culture-positive relapses, and 14% in paradoxical IRIS. CONCLUSIONS: Poor immune reconstitution was noted more often in relapse than IRIS as evidenced by lower CSF WBC and blood CD4 counts. These easily obtained laboratory values should prompt initiation of antifungal treatment while awaiting culture results. CLINICAL TRIALS REGISTRATION: NCT01802385

Early Antiretroviral Therapy at High CD4 Counts Does Not Improve Arterial Elasticity: A Substudy of the Strategic Timing of AntiRetroviral Treatment (START) Trial

Background. Both human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Vascular function assessments can be used to study CVD pathogenesis. We compared the effect of immediate versus deferred ART initiation at CD4 counts >500 cells/mm on small arterial elasticity (SAE) and large artery elasticity (LAE). Methods. Radial artery blood pressure waveforms were recorded noninvasively. Small arterial elasticity and LAE were derived from analysis of the diastolic pulse waveform. Randomized treatment groups were compared with linear models at each visit and longitudinal mixed models. Results. Study visits involved 332 participants in 8 countries: mean (standard deviation [SD]) age 35 (10), 70% male, 66% nonwhite, 30% smokers, and median CD4 count 625 cells/mm and 10-year Framingham risk score for CVD 1.7%. Mean (SD) SAE and LAE values at baseline were 7.3 (2.9) mL/mmHg × 100 and 16.6 (4.1) mL/mmHg × 10, respectively. Median time on ART was 47 and 12 months in the immediate and deferred ART groups, respectively. The treatment groups did not demonstrate significant within- person changes in SAE or LAE during the follow-up period, and there was no difference in mean change from baseline between treatment groups. The lack of significant differences persisted after adjustment, when restricted to early or late changes, after censoring participants in deferred group who started ART, and among subgroups defined by CVD and HIV risk factors. Conclusions. Among a diverse global population of HIV-positive persons with high CD4 counts, these randomized data suggest that ART treatment does not have a substantial influence on vascular function among younger HIV-positive individuals with preserved immunity

A technique optimization protocol and the potential for dose reduction in digital mammography

Digital mammography requires revisiting techniques that have been optimized for prior screen∕film mammography systems. The objective of the study was to determine optimized radiographic technique for a digital mammography system and demonstrate the potential for dose reduction in comparison to the clinically established techniques based on screen- film. An objective figure of merit (FOM) was employed to evaluate a direct-conversion amorphous selenium (a-Se) FFDM system (Siemens Mammomat NovationDR, Siemens AG Medical Solutions, Erlangen, Germany) and was derived from the quotient of the squared signal-difference-to-noise ratio to mean glandular dose, for various combinations of technique factors and breast phantom configurations including kilovoltage settings (23–35 kVp), target∕filter combinations (Mo–Mo and W–Rh), breast-equivalent plastic in various thicknesses (2–8 cm) and densities (100% adipose, 50% adipose∕50% glandular, and 100% glandular), and simulated mass and calcification lesions. When using a W–Rh spectrum, the optimized FOM results for the simulated mass and calcification lesions showed highly consistent trends with kVp for each combination of breast density and thickness. The optimized kVp ranged from 26 kVp for 2 cm 100% adipose breasts to 30 kVp for 8 cm 100% glandular breasts. The use of the optimized W–Rh technique compared to standard Mo–Mo techniques provided dose savings ranging from 9% for 2 cm thick, 100% adipose breasts, to 63% for 6 cm thick, 100% glandular breasts, and for breasts with a 50% adipose∕50% glandular composition, from 12% for 2 cm thick breasts up to 57% for 8 cm thick breasts