A family intervention to reduce delirium in hospitalzed ICU patients: a feasibility randomized controlled trial

Background: Family members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and accept ability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients. Method: A single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation, or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and 5 therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of implementing the intervention from their perspective. Results: Recruitment rate was 28% of eligible patients (recruited n=90, attrition n=1). Following instruction by the research nurse the family member delivered the intervention which was assessed to be feasible and acceptable by family members and nurses. Protocol adherence could be improved with alternative data collection methods. Nurses considered the activities acceptable. Conclusion: The study was able to recruit, randomise, and retain family member participants. Further strategies are required to assess intervention fidelity and improve data collection

What is the relationship between elements of ICU treatment and memories after discharge in adult ICU survivors?

Objectives: Patients admitted to an intensive care unit (ICU) often experience distressing memories during recovery that have been associated with poor psychological and cognitive outcomes. The aim of this literature review was to synthesise the literature reporting on relationships between elements of ICU treatment and memories after discharge in adult ICU survivors. Review method used: Integrative review methods were used to systematically search, select, extract, appraise and summarise current knowledge from the available research and identify gaps in the literature. Data sources: The following electronic databases were systematically searched: PubMed, Ovid EMBASE, EBSCOhost CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials. Additional studies were identified through searches of bibliographies. Original quantitative research articles written in English that were published in peer-review journals were included. Review methods: Data extracted from studies included authors, study aims, population, sample size and characteristics, methods, ICU treatments, ICU memory definitions, data collection strategies and findings. Study quality assessment was based on elements of the Critical Appraisal Skills Programme using the checklists developed for randomised controlled trials and cohort studies. Results: Fourteen articles containing data from 13 studies met the inclusion criteria and were included in the final analysis. The relatively limited evidence about the association between elements of ICU treatment and memories after ICU discharge suggest that deep sedation, corticoids and administration of glucose 50% due to hypoglycaemia contribute to the development of delusional memories and amnesia of ICU stay. Conclusions: The body of literature on the relationship between elements of ICU treatment and memories after ICU discharge is small and at its early stages. Larger studies using rigorous study design are needed in order to evaluate the effects of different elements of ICU treatment on the development of memories of the ICU during recovery

Annealing schedule from population dynamics

We introduce a dynamical annealing schedule for population-based optimization algorithms with mutation. On the basis of a statistical mechanics formulation of the population dynamics, the mutation rate adapts to a value maximizing expected rewards at each time step. Thereby, the mutation rate is eliminated as a free parameter from the algorithm.Comment: 6 pages RevTeX, 4 figures PostScript; to be published in Phys. Rev.

Crossing the Communication Chasm: Challenges and Opportunities in Transitions of Care from the Hospital to the Primary Care Clinic

Background Transitions of care from specialty and acute settings to primary care abound. Compared to the continuity in end-of-shift handoffs, care transitions involve provider communication between practices and facilities with their own cultures and bureaucracies. Using the transition from acute care to outpatient primary care for stroke/transient ischemic attack (TIA) patients as a case study, this qualitative research explored communication practices and institutional arrangements among clinical providers responsible for longitudinal management of hypertension. In this study, researchers investigated the barriers and facilitators of effective communication between acute stroke/TIA inpatient and primary care providers at a Veterans Affairs Medical Center. Methods A multidisciplinary team conducted consensus-based coding and thematic analysis of semistructured interviews with 21 clinical providers (9 with primary responsibilities for inpatient care and 12 with primary responsibilities in outpatient, primary care). Results Thematic analysis of responses identified three factors that influenced communication between clinical providers: (1) consistent, concise but complete medication and treatment plans; (2) reliable, standardized discharge documentation; (3) use of multiple modes of communication. Participants identified cultural barriers, including challenges with rotating providers at a teaching hospital and local discharge practices. Conclusion Ambiguity about who is being handed off to and time pressures in the acute setting may lead inpatient providers to give lower priority to discharge communication, leaving outpatient providers with low-quality information. While electronic templates have standardized key components of discharge documentation, improvement opportunities remain. Increased awareness of the challenges and opportunities on each side of the care transfer could foster communication practices that systematically account for the information needs of inpatient and outpatient providers

Diaries For Intensive Care Unit Survivors (discuss): Perspectives Of Patients And Family Members Regarding Psychological Support

Rationale Diaries summarising care in the intensive care unit (ICU) have been incorporated into routine practice in some countries, although diary format, content, timing and method of delivery vary. The evidence and underpinning theory to support diary use is limited and uptake by patients and family members is infrequent raising questions of acceptance and generalisability. The purpose of this study was to elicit preferences of ICU survivors and their family members regarding diaries and other psychological support mechanisms, specifically if they wish to receive a diary or alternative psychological support material, what content they would like and preferred process and timing for receiving this information. Methods Patients in a general ICU for ≥3 days and their family members were invited to participate in this prospective exploratory study. Semi-structured interviews were conducted 3-5 months after ICU discharge via phone or in person. Interviews were transcribed verbatim and thematic analysis was conducted, with codes developed inductively using an iterative process and agreement on themes negotiated by team members. Results Forty-one survivors of critical illness and 26 family members consented to participation. Patients were usually male (63%), aged 50±18 years and stayed in ICU for median 8.5 (IQR 5.3-12.6) days. Patients and family members raised similar themes, although with a diverse range of opinion related to each aspect of ICU diary use. Considerations included: 1) memory and recall with some respondents wanting to know detail while others were either not curious or had no desire to be reminded of their ICU stay; 2) level of detail ranging from a comprehensive summary of clinical activities to a predominantly personal record of the experience; 3) the desire to develop shared memory of ICU and for the patient to understand what the family had been through; 4) timing of provision of diary from soon after the patient woke to months later; 5) concerns regarding the workload of staff to contribute to the diary; 6) potential to exacerbate or alternatively relieve stress; 7) uncertainty in regard to writing in diary as the patient may not survive; 8) ownership of the diary resting with the patient. Conclusions Common themes have been expressed by participants, although views regarding these themes were extremely diverse. Development of future interventions to aid psychological recovery must take into account these variable views to minimise the potential for causing distress to some survivors of critical illness and/or their family members whilst helping others

Development of an acute and chronic ecotoxicity assay using lux -marked Rhizobium leguminosarum biovar trifolii

A soil isolate of Rhizobium leguminosarum bv. trifolii was marked with a lux CDABE gene cassette to enable the expression of bioluminescence. The suitability of the bacterium as a soil pollution biosensor was assessed using acute and chronic assays. Bacterial bioluminescence responded sensitively to the metals studied, The order of sensitivity was found to be Cd > Ni = Zn > Cu for the acute test and Cd > Ni = Zn = Cu for the chronic test. The sensitive response of the biosensor highlighted its potential for use as an indicator of soil pollution

OscoNet: Inferring oscillatory gene networks

Background: Oscillatory genes, with periodic expression at the mRNA and/or protein level, have been shown to play a pivotal role in many biological contexts. However, with the exception of the circadian clock and cell cycle, only a few such genes are known. Detecting oscillatory genes from snapshot single-cell experiments is a challenging task due to the lack of time information. Oscope is a recently proposed method to identify co-oscillatory gene pairs using single-cell RNA-seq data. Although promising, the current implementation of Oscope does not provide a principled statistical criterion for selecting oscillatory genes. Results: We improve the optimisation scheme underlying Oscope and provide a wellcalibrated non-parametric hypothesis test to select oscillatory genes at a given FDR threshold. We evaluate performance on synthetic data and three real datasets and show that our approach is more sensitive than the original Oscope formulation, discovering larger sets of known oscillators while avoiding the need for less interpretable thresholds. We also describe how our proposed pseudo-time estimation method is more accurate in recovering the true cell order for each gene cluster while requiring substantially less computation time than the extended nearest insertion approach. Conclusions: OscoNet is a robust and versatile approach to detect oscillatory gene networks from snapshot single-cell data addressing many of the limitations of the original Oscope method

Globally optimal parameters for on-line learning in multilayer neural networks

We present a framework for calculating globally optimal parameters, within a given time frame, for on-line learning in multilayer neural networks. We demonstrate the capability of this method by computing optimal learning rates in typical learning scenarios. A similar treatment allows one to determine the relevance of related training algorithms based on modifications to the basic gradient descent rule as well as to compare different training methods