Tag Archives: care

International research team publishes a set of guidelines to care for ICU COVID-19 patients

An international team of researchers led by members at McMaster University has published a set of guidelines for healthcare workers to help them better treat intensive care unit (ICU) patients with COVID-19.

Image via Pixabay.

The Surviving Sepsis Campaign COVID-19 panel has released a set of 54 recommendations on several topics related to the treatment of the disease such as infection control, laboratory diagnosis and specimens, the dynamics of blood flow support, ventilation support, and therapy.

How to

“Previously there was limited guidance on acute management of critically ill patients with COVID-19, although the World Health Organization and the United States Centers for Disease Control and Prevention have issued preliminary guidance on infection control, screening and diagnosis in the general population,” said first author Waleed Alhazzani, assistant professor of medicine at McMaster.

The team explains that such “large clinical practice guidelines” typically take one or two years to develop but that, given the urgency of the situation, the team assembled this body of recommendations within 18 days. The guidelines should be useful to health care workers on the frontline, allied health professionals, and policymakers involved in the care of patients with COVID-19. Its authors included members from Australia, Canada, China, Denmark, Italy, Korea, the Netherlands, United Arab Emirates, United Kingdom, United States, and Saudi Arabia.

“Everyone worked hard to make this guideline available to the end user rapidly while maintaining methodological rigour.”

The 54 recommendations put together by the team include four best practice statements, nine ‘strong recommendations’, and 35 ‘weak recommendations’. The four best-practice statements are as follows:

  • Healthcare workers performing procedures that have the potential of generating aerosols — intubation, bronchoscopy, and open suctioning among others — on patients with COVID-19 should wear fitter respirator masks such as N95, FFP2 or equivalent, not surgical masks, in addition to other personal protective equipment.
  • Such procedures should only be performed in a negative pressure room if such installations are available. Negative pressure rooms are designed to prevent the spread of pathogens from room to room.
  • Intubation of such patients should be performed by personnel with experience in airway management to minimize the number of attempts and thus, the risk of transmission.
  • Adults with COVID-19 who are being treated with non-invasive, positive pressure ventilation or high flow nasal cannula should be closely monitored for worsening respiratory status and intubated early if needed.

The panel says they will issue further guidelines and update the existing ones in the future as the situation evolves.

The paper “Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)” has been published in the journal Critical Care Medicine.

Better diets could save billions in U.S. health care costs

Healthier diets could save the US around $50 billion in healthcare costs annually, according to a new study.

Image credits Ylanite Koppens.

Unhealthy diets are a leading cause of poor health, as they promote the development of cardiometabolic diseases (CMDs) such as heart disease, stroke, and type 2 diabetes. A new study led by Brigham and Women’s Hospital researchers estimates that unhealthy diets can account for 45% of all CMD-related deaths in the US, leading to a national healthcare burden of around $50 billion nationally.

Fooding the bill

“There is a lot to be gained in terms of reducing risk and cost associated with heart disease, stroke, and diabetes by making relatively simple changes to one’s diet,” said corresponding author Thomas Gaziano, MD, MSc, of the Division of Cardiovascular Medicine at the Brigham. “Our study indicates that the foods we purchase at the grocery store can have a big impact. I was surprised to see a reduction of as much as 20 percent of the costs associated with these cardiometabolic diseases.”

In collaboration with researchers at the Friedman School of Nutrition Science and Policy at Tufts University, the team looked at the impact of 10 dietary factors — fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats, and sodium — on one’s diet on annual CMD-related health costs.

Towards this end, they used data from the National Health and Nutrition Examination Survey (NHANES), to create a representative U.S. population sample of individuals aged between 35 and 85 years old. Then, using a model they developed, the team analyzed how the individual risk of CMDs shift based on the dietary patterns of respondents to the NHANES study. Finally, they calculated what the overall CMD-related costs would be if everyone followed an optimal diet in relation to the 10 factors.

They conclude that suboptimal diets cost around $301 per person per year, for a total of over $50 billion nationally. The team explains that this sum represents 18% of all heart disease, stroke and type 2 diabetes costs in the United States. Costs were highest for those with Medicare ($481/person) and those who were eligible for both Medicare and Medicaid ($536/person).

The consumption of processed meats and low consumption of nuts, seeds, and omega-3 fat foodstuffs (such as seafood) were the highest drivers of CMD risks and additional costs, the team explains.

“We have accumulating evidence […] to support policy changes focused on improving health at a population level. One driver for those changes is identifying the exorbitant economic burden associated with chronic disease caused by our poor diets,” said co-senior author Renata Micha of the Friedman School of Nutrition Science and Policy at Tufts.

“This study provides additional evidence that those costs are unacceptable. While individuals can and do make changes, we need innovative new solutions — incorporating policy makers, the agricultural and food industry, healthcare organizations, and advocacy/non-profit organizations — to implement changes to improve the health of all Americans.”

The results of this study may underestimate the total cost of unhealthy diets, the team explains, as it can contribute to other health complications aside from CMDs. Additionally, other factors beyond the 10 used in this study could drive health risks and costs, they add. Finally, the NHANES study relied on self-reported data — participants were asked to recall what they ate in the past 24 hours — which isn’t very reliable.

The paper “Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model” has been published in the journal PLOS Medicine.

This is Reo sitting up by grasping ropes after lying on his back for 14 months following the onset of acute tetraparesis. Credit: Primate Research Institute, Kyoto University

How a touch screen helped a disabled chimpanzee walk again

This is Reo sitting up by grasping ropes after lying on his back for 14 months following the onset of acute tetraparesis. Credit: Primate Research Institute, Kyoto University

This is Reo sitting up by grasping ropes after lying on his back for 14 months following the onset of acute tetraparesis. Credit: Primate Research Institute, Kyoto University

In 2006, Reo the chimp became paralyzed from the neck down due to a spinal chord inflammation. But the chimp fought back and was able to recover enough to stand up and, later, pull himself upright using suspended ropes. There was still a matter of regaining the function of his legs, though. Gently and with a lot of patience, researchers of the Primate Research Institute at Kyoto University devised a novel physiotherapy that enabled Reo to walk using his feet ten years later.

Like most chimps from the Institute, Reo is well versed in using a touch screen to solve cognitive tasks. As a reward, he would receive a tasty treat. Although Reo had not used touch screens following his disability, Yoko Sakuraba of Kyoto University and colleagues tried using computerized tasks to help the chimp regain the function of his legs.

The setup was very simple. A tablet computer was placed on the surface of a wall in the lab where Reo had to perform some cognitive tasks, just like the old days. But instead of having the reward readily served after the task was ever, the food was placed on a tray in the opposite end of the room.

Final layout of the rehabilitation room. White represents the area used by humans, and grey represents the area used by the chimpanzee. a Thin lines represent walls made of acrylic board and iron frames, bold lines represent walls made of concrete, and dotted lines represent wire grid walls or partitions. Credit: Journal Primates

Final layout of the rehabilitation room. White represents the area used by humans, and grey represents the area used by the chimpanzee. a Thin lines represent walls made of acrylic board and iron frames, bold lines represent walls made of concrete, and dotted lines represent wire grid walls or partitions. Credit: Journal Primates

At first, the chimp would not cooperate, but the researchers were just as stubborn. They changed the setup seven times until Reo was comfortable enough to attempt to solve the puzzles on the computer screen. And so Reo ended up completing multiple tasks, then moved two meters to pick his food, only to move two meters more to return to his station.

During his first travel, the chimp moved by clinging to a stationary rope, but gradually Reo learned to move in an upright seated position which resembled the side-to-side manner of a penguin walking on land. After many, many rehabilitation sessions Reo was eventually able to walk for up to 500 meters during two-hour long sessions.

“Cognitive tasks may be a useful way to rehabilitate physically disabled chimpanzees, and thus improve their welfare in captivity,” says Sakuraba.

The story is indeed touching because it shows our primate cousins have at least just as much determination to regain bodily functions as humans do. This is important because it shifts the animal care paradigm, which in such situations advises euthanasia. Dr. Sakuraba says many disabled primates, and perhaps non-primates too, could use this treatment aided by humans to regain movement. She cautions, however, that just like for humans, this operation needs to be custom tailored to the needs and personalities of the patient.

“This study successfully applied a new method of walking rehabilitation using cognitive tasks to a chimpanzee with hind-limb disabilities. In particular, total distance walked increased, and the chimpanzee voluntarily participated in the process. Though Reo initially appeared fearful of the touch monitor and stopped several times during the walking rehabilitation sessions, careful adjustments resolved this problem, leading to the conclusion that personality and physical condition need to be considered when designing and adjusting a rehabilitation program. In addition, this was the first successful rehabilitation method to encourage walking and customized for a chimpanzee, Reo. In the future, we will need to continue rehabilitation exercises, and discuss goals for his continued improvement and well-being,” the authors wrote in the Journal Primates.