Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?

Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties

The Italian registry of pulmonary non-tuberculous mycobacteria - IRENE:The study protocol

Background: A substantial increase in pulmonary and extra-pulmonary diseases due to non-tuberculous mycobacteria (NTM) has been documented worldwide, especially among subjects suffering from chronic respiratory diseases and immunocompromised patients. Many questions remain regarding the epidemiology of pulmonary disease due to NTM (NTM-PD) mainly because reporting of NTM-PD to health authorities is not mandated in several countries, including Italy. This manuscript describes the protocol of the first Italian registry of adult patients with respiratory infections caused by NTM (IRENE). Methods: IRENE is an observational, multicenter, prospective, cohort study enrolling consecutive adult patients with either a NTM respiratory isolate or those with NTM-PD. A total of 41 centers, including mainly pulmonary and infectious disease departments, joined the registry so far. Adult patients with all of the following are included in the registry: 1) at least one positive culture for any NTM species from any respiratory sample; 2) at least one positive culture for NTM isolated in the year prior the enrolment and/or prescribed NTM treatment in the year prior the enrolment; 3) given consent to inclusion in the study. No exclusion criteria are applied to the study. Patients are managed according to standard operating procedures implemented in each IRENE clinical center. An online case report form has been developed to collect patients' demographics, comorbidities, microbiological, laboratory, functional, radiological, clinical, treatment and outcome data at baseline and on an annual basis. An IRENE biobank has also been developed within the network and linked to the clinical data of the registry. Conclusions: IRENE has been developed to inform the clinical and scientific community on the current management of adult patients with NTM respiratory infections in Italy and acts as a national network to increase the disease's awareness

Trueness of intraoral scanners in implant-supported rehabilitations: An in vitro analysis on the effect of operators’ experience and implant number

Background: Intraoral scanners (IOS) are widely used in prosthodontics. However, a good trueness is mandatory to achieve optimal clinical results. The aim of the present in vitro study was to compare two IOS considering the operator’s experience and different implant clinical scenarios. (2) Methods: Two IOS (IT—Itero, Align Technology; and OS—Opera MC, Opera System, Monaco) were compared simulating three different clinical scenarios: Single implant, two implants, and full-arch rehabilitation. Ten scans were taken for each configuration by two different operators (one expert, one inexperienced); influence of operator experience and the type of scanner used was investigated. (3) Results: Trueness of the scans differed between the experienced and nonexperienced operator and this difference was statistically significant in all the three scenarios (p = 0.000–0.001, 0.037). A significant difference was present between the scanners (p = 0.000), in the two-implant and full-arch scenarios (p = 0.00). (4) Conclusions: Experience of the operator significantly affect trueness of IT and OP scanners. A statistically significant difference was present among IOS in the two-implant and full-arch scenarios

Mapping adult literacy performance — support document

In 2010, the National Centre for Vocational Education Research (NCVER) conducted a preliminary study to determine the feasibility of mapping the performance levels of the international Adult Literacy and Life Skill Survey (ALLS) to those of the Australian Core Skills Framework (ACSF) using a Delphi technique (Circelli, Curtis, Perkins, 20111 ). In that study, a small number of adult literacy and numeracy experts used their professional judgement to qualitatively align a sample of ALLS items to the ACSF levels. At the completion of the study, there was general consensus among the participants that: • the mapping process was feasible for the: o Reading domain of the ACSF to the ALLS prose and document literacy domains; as well as the o Numeracy domains of the two frameworks. • a larger-scale research study should be undertaken to empirically align the two frameworks onto a single scale for each of the two domains (i.e., Reading and Numeracy). The National Centre for Vocational Education Research (NCVER) commissioned Victoria University (Shelley Gillis) in conjunction with Educational Measurement Solutions (Margaret Wu and Mar k Dulhunty) to undertake the larger-scale research study

Auto-efficacia e qualit\ue0 di vita in pazienti con BPCO: risultati preliminari

La capacit\ue0 dell\u2019individuo di gestire efficacemente i comportamenti in ambito di salute \ue8 una variabile importante nei programmi di riabilitazione polmonare. La comprensione dei meccanismi di compromissione della Qualit\ue0 di Vita dovrebbe aiutare ad identificare gli obiettivi di riabilitazione polmonare. La ricerca ha mostrato correlazioni positive tra auto-efficacia e l'outcome riabilitativo in pazienti con BPCO. Questo studio ha cercato di valutare il ruolo relativo dell\u2019 auto-efficacia e delle variabili socio-demografiche nel predire la QdV in pazienti con BPCO. SOGGETTI: 103 ( 62 M, 41F, Et\ue0 media 70) con BPCO. STRUMENTI: Perceived Health Competence Scale (PHCS, 8 item, Smith, 1995); Airways Questionnaire 20 (AQ 20, Quick & Jones, 1994). RISULTATI: Autoefficacvia e et\ue0 predicono la qualit\ue0 di vita (R quadro corretto=0,27). I risultti incorggiano la riabilitazione polmonare (Moullec, 2011) con varie componenti, tra cui incontri psico-educativi e di self-management volti al potenziamento delle risorse positive dell\u2019individuo per favorire una migliore gestione della malattia e qualit\ue0 di vita

Survival after pulmonary rehabilitation in patients with COPD: impact of functional exercise capacity and its changes

Carlos A Camillo,1,2 Daniel Langer,1,2 Christian R Osadnik,1,3–5 Lisa Pancini,2 Heleen Demeyer,1,2 Chris Burtin,1,6 Rik Gosselink,1,2 Marc Decramer,2 Wim Janssens,2 Thierry Troosters1,2 1KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; 2University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium; 3Monash University, Department of Physiotherapy, Melbourne, VIC, Australia; 4Institute for Breathing and Sleep, Melbourne, VIC, Australia; 5Monash Health, Monash Lung and Sleep, Melbourne, VIC, Australia; 6Hasselt University, Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium Abstract: The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan–Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV1] 43±16% predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81%; Group 2, 69%; Group 3, 47%; Group 4, 27%; log rank test, P<0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95% confidence interval {CI} 0.30–0.50]) and Δ6MWD ≥30 m (HR 0.66 [95% CI 0.51–0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95% CI 0.92–2.00]; not significant), Group 3 (HR 1.90 [95% CI 1.28–2.84]; P=0.001), and Group 4 (HR 3.28 [95% CI 2.02–5.33]; P,0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD. Keywords: pulmonary disease, chronic obstructive, exercise training, mortality, 6-minute walk test, minimally important differenc