Intensive care 1980-1995: change in patient characteristics, nursing workload and outcome

Objective: To assess temporal changes in patient characteristics, nursing workload and outcome of the patients and to compare the actual amount of available nursing staff with the estimated needs in a medical-surgical ICU. Design: Retrospective analysis of prospectively collected data. Setting: A medical-surgical adult intensive care unit (ICU) in a Swiss university hospital. Patients: Data of all patients staying in the ICU between January 1980 and December 1995 were included. Interventions: None. Measurements and results: The estimated number of nurses needed was defined according to the Swiss Society of Intensive Care Medicine (SGI) grading system: category I=one nurse/patient/shift (=8 h), category II=one nurse/two patients/shift, category III=one nurse/three patients/shift. An intervention score (IS) was obtained, based on a number of specific activities in the ICU. There was a total of 35,327 patients (32 % medical and 68 % postoperative/trauma patients). Over time, the number of patients per year increased (1980/1995:1,825/2,305, p70 years (19 %/28 %,p<0.001), and a decrease in the number of patients<60 years (58 % /41 %, p<0.001). During the same time period, the IS increased two-fold. Measurement of nursing workload showed an increase over time. The number of nursing days per year increased (1980/1995: 7454/8681, p<0.019), as did the relative amount of patients in category I (49 %/71 %, p<0.001), whereas the portion of patients in category II (41 %/28 %,p< 0.019) and category III (10 %/0 %) decreased. During the same time period, mortality at ICU discharge decreased (9.0 %/ 7.0 %,p< 0.002). Conclusions: During the last 16 years, there has been a marked increase in workload at this medical-surgical ICU. Despite an increase in the number of severely sick patients (as defined by the nursing grading system) and patient age, ICU mortality and LOS declined from 1980 to 1995. This may be ascribed to improved patient treatment or care. Whether an increasingly liberal discharge policy (transfer to newly opened intermediate care units, transfer of patients expected to die to the ward) or a more rigorous triage (denying admission to patients with a very poor prognosis) are confounding factors cannot be answered by this investigation. The present data provide support for the tenet that there is a trend toward more complex therapies in increasingly older patients in tertiary care ICUs. Calculations for the number or nurses needed in an ICU should take into account the increased turnover of patients and the changing patient characteristic

Effects of substance use disorder on treatment process and outcome in a ten-session psychiatric treatment for borderline personality disorder.

Dual diagnosis is common in Borderline Personality Disorder (BPD), one of the most common being Substance Use Disorder (SUD). Previous studies have shown that general psychiatric management (GPM) was effective in reducing borderline symptoms. In the present study, we tested whether the short GPM was as effective in the BPD + SUD as in the BPD group. We analysed a group of 99 patients presenting a BPD. 51 of these patients presented a SUD. The BPD group and the BPD + SUD group received a manual-based short variant of the GPM treatment. Previous studies have shown that a 10-session version of GPM was effective in reducing borderline symptoms at the end of the treatment (Psychother Psychosom 83:176-86, 2014). We found no significant difference in the reduction of general symptoms, which diminished in both groups. The specific borderline symptoms were also reduced in both groups, but there was a slightly higher reduction of the borderline symptoms in the SUD group. The therapeutic alliance progressed positively in all groups. Moreover, the alliance increased more over time in the SUD group. The short variant of GPM seems to be effective in BPD treatment independently from the presence of SUD. Therefore, this treatment could be an effective entry-level treatment for patients with dual diagnosis as well as patients with BPD only. Further studies are needed to confirm efficacy and long-term outcome. The trial was registered at ClinicalTrial.gov (identifier NCT01896024 )

SY30-3THE USE OF SOPHISMS IN SUSTAINING DISULFIRAM

Disulfiram's use is not supported by scientific evidence but nevertheless largely advocated and used. This would be less odd in case of lacking or just preliminary evidence. What is peculiar in the case of disulfiram's prescription is its persistence against evidence. Hence arise the question how it is possible that its use can be supported, i.e. by what type of arguments. The goal of an argument is to persuade, the goal of logic and argumentation is additionally to persuade for good reasons. In this sense, a good argument would give good reasons to believe the conclusion. Fallacies are bad arguments, either because they have weak logic, or because they rely on a false premise. Sophisms are intentionally used fallacies, an attempt to persuade opponents that a specific conclusion is true, by means other than by proposing relevant evidence. Proponents of fallacious arguments may use them either because they are incapable or because they are unwilling to accept their arguments to be fallacious. We therefore formulate the hypothesis that the frequency use of fallacious arguments within our otherwise supposedly evidence based discipline may be indicative of (a) a scientifically immature discipline, and/or (b) a moralistically intermingled disciplin

The sensitivity and specificity of a diagnostic test of sequence-space synesthesia

People with sequence-space synaesthesia (SSS) report stable visuo-spatial forms corresponding to numbers, days and months (amongst others). This type of synaesthesia has intrigued scientists for over 130 years but the lack of an agreed upon tool for assessing it has held back research on this phenomenon. The present study builds on previous tests by measuring the consistency of spatial locations that is known to discriminate controls from synaesthetes. We document, for the first time, the sensitivity and specificity of such a test and suggest a diagnostic cut-off point for discriminating between the groups based on the area bounded by different placement attempts with the same item

P-73AN INVESTIGATION OF ADDICTIONS (SUBSTANCES AND BEHAVIORS) IN A COMMUNITY SAMPLE

Chemical and behavioral addictions are highly prevalent in our societies. Nevertheless, studies investigating a large panel of addictive behaviors in a community sample are lacking from the current literature on the topic. The aim of the current study is to explore addictive behaviors prevalence, characteristics, and interrelations in a sample of French speaking adults from the general population. Both substances (alcohol, tobacco, cannabis, drugs) and behaviors (gambling, Internet, buying, sport, work, mobile phone, eating) were considered. Several features of these addictive behaviors (involved in the triggering of the behaviors) were considered, namely, frequency, loss of control, hedonic aspects, craving, impact upon the daily living, and emotional contexts. 770 subjects answered to the online survey. Descriptive results will be presented for each conducts and their related features (prevalence, comorbidities, specific characteristics associated with each addictive behaviors). Our study thus provides a detailed overview of the current conducts' prevalence along with their co-occurrences. It also sheds some lights on how these behaviors may have an impact upon the daily living, and eventually turn into problematic behaviors. A particular emphasis is set on some behavioral conducts, like Internet gaming which is particularly salien

Psychometric properties of the transaddiction craving triggers questionnaire in alcohol use disorder.

We aimed to develop the transaddiction craving triggers questionnaire (TCTQ), which assesses the propensity of specific situations and contexts to trigger craving and to test its psychometric properties in alcohol use disorder (AUD). This study included a sample of 111 AUD outpatients. We performed exploratory factor analysis (EFA) and calculated item-dimension correlations. Internal consistency was measured with Cronbach's alpha coefficient. Construct validity was assessed through Spearman correlations with craving, emotional symptoms, impulsivity, mindfulness, and drinking characteristics. The EFA suggested a 3-factor solution: unpleasant affect, pleasant affect, and cues and related thoughts. Cronbach's coefficient alpha ranged from .80 to .95 for the three factors and the total score. Weak positive correlations were identified between the TCTQ and drinking outcomes, and moderate correlation were found between the TCTQ and craving strength, impulsivity, anxiety, depression, and impact of alcohol on quality of life. The 3-factor structure is congruent with the well-established propensity of emotions and cues to trigger craving. Construct validity is supported by close relations between the TCTQ and psychological well-being rather than between the TCTQ and drinking behaviors. Longitudinal validation is warranted to assess sensitivity to change of the TCTQ and to explore its psychometric properties in other addictive disorders

Diversificación de la producción de alimentos: cultivo de hongos comestibles utilizando residuos locales (Valle Fértil, San Juan)

Desde hace más de 15 años el programa PROHUERTA, a través de la Estación Experimental Agropecuaria San Juan del INTA, viene promoviendo la autoproducción de alimentos y su diversificación en familias con Necesidades Básicas Insatisfechas (NBI) del departamento Valle Fértil. Tomando la experiencia que tiene el Laboratorio de Micología Aplicada del CRILAR – CONICET en la provinciade La Rioja, se propone continuar con la diversificación de la producción agrícola a escala familiar, acercando la tecnología desarrollada por este laboratorio para la producción de hongos comestibles tipo gírgolas (Pleurotus sp). Estos hongos son cultivados por su agradable y característico sabor y apreciados debido a sus propiedades nutricionales y medicinales. Pueden crecer y degradar gran diversidad de residuos lignocelulósicos, tienen tiempos cortos de desarrollo y fructificación, se cultivan de manera sencilla y económica y además tienen como ventaja la posibilidad de poder producirse sin suelo.EEA San JuanFil: Vitale Guardia, Pablo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Juan; ArgentinaFil: Fracchia, S. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Regional de Investigaciones Científicas y Transferencia Tecnológica de La Rioja (CRILAR); ArgentinaFil: Rothen, C. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Regional de Investigaciones Científicas y Transferencia Tecnológica de La Rioja (CRILAR); Argentin

SY09-3HARM REDUCTION IN NON-SUBSTANCE RELATED ADDICTIONS

Behavioral addictions (gambling, gaming, internet use) are new challenges for policy makers, and the question arises if harm reduction is an applicable concept. Gambling addiction policies are trying to include harm reduction models (limitation of the amount of money you can bet, limitation in access to gambling venues). We will discuss if these models are valid in gaming addiction. I.E. If we only consider the classical policy models applied for reducing substances harm: supply reduction, demand reduction and harm reduction, limitations arise: for example: applying these concepts to gaming addiction is impossible. If heroin is an identified substance, games are heterogeneous in nature and are described from cognitive enhancers to highly addictive. The concept of supply should include the complex nature of video games. Reducing demand could be considered as a censure directly in conflict with human nature to produce the best and most attractive games (should unattractive cars be produced to reduce global warming). And finally harm reduction concepts in gaming will be discusse

Morphology of the ferritin iron core by aberration corrected scanning transmission electron microscopy

As the major iron storage protein, ferritin stores and releases iron for maintaining the balance of iron in fauna, flora, and bacteria. We present an investigation of the morphology and iron loading of ferritin (from equine spleen) using aberration-corrected high angle annular dark field scanning transmission electron microscopy. Atom counting method, with size selected Au clusters as mass standards, was employed to determine the number of iron atoms in the nanoparticle core of each ferritin protein. Quantitative analysis shows that the nuclearity of iron atoms in the mineral core varies from a few hundred iron atoms to around 5000 atoms. Moreover, a relationship between the iron loading and iron core morphology is established, in which mineral core nucleates from a single nanoparticle, then grows along the protein shell before finally forming either a solid or hollow core structure