El desarrollo de independencia de personas que viven con demencia mientras participan en una actividad de pintura artística

This study explored the practice and spacing-of-practice effects in people living with dementia during an artistic painting activity. The video recordings of 23 participants were systematically observed during their first and fourth session of the activity. Improvements in independence, engagement, and well/ill-being expressions were analyzed from the first to the fourth session. Moreover, it was analyzed whether a group who had practiced three times a week (n = 12) improved more than a group who had practiced once a week (n = 13). Participants became more independent as they practiced, but the spacing of the sessions did not show any significant effect. Participants with severe dementia showed greater independence improvements than participants with mild to moderate dementia, although they required significantly more assistance throughout the entire study. The positive rates in active engagement and well/ill-being expressions suggest that artistic painting activities promote the motivation and well-being of participants, including those in the severe stage of dementia.Este estudio exploró los efectos de la práctica y el espaciamiento de la práctica en personas que viven con demencia durante una actividad de pintura artística. Vídeos de 23 participantes fueron sistemáticamente observados durante su primera y cuarta sesión de la actividad. Se analizaron las mejoras de los participantes desde la primera sesión a la cuarta sesión, en base a las expresiones de independencia, involucración con la actividad y bienestar/malestar. Además, se comparó si un grupo que había practicado tres veces por semana (n = 12) mejoraba más que un grupo que había practicado una vez por semana (n = 13). Los participantes se volvieron más independientes a medida que practicaban, pero el espaciamiento de las sesiones no mostró ningún efecto significativo. Los participantes con demencia severa mostraron mayores mejoras en la independencia que los participantes con demencia de leve a moderada, aunque requirieron mucha más asistencia durante todo el estudio. La observación de altas tasas de participación activa y expresiones de bienestar sugieren que las actividades de pintura artística promueven la motivación y el bienestar de los participantes, incluidos aquellos en la etapa severa de la demencia

Ventriculostomy related infection in intensive care unit: Diagnostic criteria and related conditions

Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions. Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P < 0.05. Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1000 days of drainage). This group was on overage older, had more severe systemic response syndrome and a significantly higher number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia, glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (interquartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and subarachnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with 55.7% area under curve (95% CI 0.43–0.70). Conclusions: CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia and the ratio of glycorrachia/glycemia

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease