Family Caregivers Identify Their Needs from the Inpatient Team during a Loved One’s Inpatient Psychiatric Hospitalization

Introduction: According to existing literature, family-caregiver needs during a loved one’s inpatient psychiatric hospitalization are not fully understood or addressed in practice. We aimed to identify specific, practical family caregiver needs from the inpatient team during a loved one’s psychiatric hospitalization. Methods: Semi-structured interviews were designed and tested through a phenomenological analytical approach. Interviews were conducted with family caregivers (n = 16, one caregiver per loved one) who participated in caring for a loved one (age 18-30 years) during an inpatient psychiatric hospitalization. Results: Four main themes arose: the need to be listened to and collaborated with regarding treatment planning, the need for education and guidance about mental illness, the need for emotional support and validation by the inpatient team, and that family caregivers associate their experience with their perception of their loved one’s experience. Discussion: Interactions with the inpatient team are meaningful to family caregivers, who have needs that are or are not met. Study participants indicated that they feel better supported when they are fully included in their loved one’s care, it matters how information and education are delivered and by whom, and they appreciate dedicated support for themselves. Furthermore, their feelings are influenced by their understanding of their loved one’s experience. Conclusions: Understanding what family caregivers value in their interactions with the inpatient team illuminates areas to design support for family caregivers with a loved one in a psychiatric hospital. Families want support from the whole team for different needs at different times throughout hospitalization and after discharge

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Assessing Investment Advice Provided to Participants in Defined Contribution Retirement Plans

Investment advice is increasingly important as more Americans enroll in defined contribution retirement plans and assume more responsibility for ensuring sufficient retirement income. This report offers the U.S. Government Accountability Office a review of the legal restraints and practical shortfalls of investment advice given to defined contribution plan participants. The authors provide targeted recommendations for research to document sources of investment advice; the effects of advice on participant behaviors; how to improve communication of investment fees; and changes in the provision of investment advice resulting from federal regulations to be approved in 2010