PC-FACS

Valproic Acid for TBI Engagement in Meaningful Activities Interpreters’ Challenges EOL Discussions Goals and Preferences of Older Adults ACP Patients with Cirrhosis Children's Regrets After Sibling Death Psychiatric Symptomology COVID Rave Reviews Administration Cases Traumatic Brain Injury Background: brain injury (TBI) remains a major source morbidity mortality the US worldwide.1,2 Can valproic acid (VPA) attenuate post-TBI lesion size swelling? Clinically Approved Dose Improves Neurologic Recovery Decreases Lesion Size Swine Subjected to Hemorrhagic Shock Design Participants: This study investigated whether low VPA dose, versus previously validated higher could similarly tissue damage increase neurologic recovery model nonlethal hemorrhagic shock. were subjected 40% blood volume hemorrhage. Animals remained shock 2 hours before randomization saline resuscitation alone (control), saline-VPA-150 mg/kg, or saline-VPA-50 mg/kg. severity scores (range=0–32) assessed daily 14 days, postinjury day-3 was measured via MRI. Results: laboratory values similar across groups (n = 5/group). VPA-treated animals demonstrated less impairment returned baseline faster (postinjury day 1 mean score, control=22±3 vs. VPA-150=8±7 VPA-50=6±6; P=0.02 0.003, respectively), had smaller lesions (mean mm3, control=1,268±241 VPA-150=620±328 VPA-50=439±235; P 0.007 0.001, respectively). Pharmacologic Modulation Metabolism by Induce Neuroprotective Environment swine combined (12 mm cortical impact) (40% loss hypotension) randomized them two (n=5/group): (1) (3x hemorrhage volume) (2) saline-VPA (saline, 3x volume; VPA, 150 mg/kg). 6 hours, brains harvested 100 mg perilesional used metabolite extraction analysis using reversed-phase liquid chromatography-mass spectrometry positive negative ion modes. 3,750 1,955 total metabolites detected modes, respectively. There no between-group differences mode; however, 167 differentially expressed (P<0.05) mode, which included derivates. Pathway showed several pathways affected treatment group, including biosynthesis unsaturated fatty acids (P=0.001). Targeted amino on glycolysis/tricarboxylic cycle revealed that decreased excitotoxic serine levels Commentary: causes death disability. The incidence from 2006 2014 increased 53%.3 Survival initial trauma does not impede ongoing pathophysiologic processes initiated injury. Currently, there are therapies limit subsequent improve recovery. Medical management is mainly supportive. provided neuroprotection improved this TBI. resolved neuroinflammation, free radical production, ischemia, excitotoxicity responses tissue. upregulates important protecting recovering function lost TBI, acids, reduces serine. inhibits histone deacetylase, promotes gene transcription favoring neurogenesis, resolution neuroinflammation. promising role needs be explored clinical trials. Bottom Line: metabolic changes favor decreases cause Reviewer: Regina M. Mackey, MD, Center Palliative Medicine, Mayo Clinic, Rochester, MN Sources: Wakam GK, Biesterveld BE, Pai MP, et al. clinically approved dose improves traumatic J Trauma Acute Care Surg. 2021 Feb 1;90(2):346–352. doi:10.1097/TA.0000000000003036 Access article PubMed. Bhatti UF, Karnovsky A, Dennahy IS, modulation metabolism can induce neuroprotective environment. Mar 1;90(3):507–514. doi:10.1097/TA.0000000000003026 References:1.World Health Organization. Injuries Violence: Facts 2014. https://www.who.int/violence_injury_prevention/media/news/2015/Injury_violence_facts_2014/en/. Published Accessed June 1, 2020.2.Rhee P, Joseph B, Pandit V, Increasing deaths United States. Ann 2014;260(1):13–21. doi:10.1097/SLA.00000000000006003.Centers Disease Control Prevention. & concussion. https://www.cdc.gov/traumaticbraininjury/get_the_facts.html. Reviewed May 12, 2021. Among Disability, Dementia, Depression Inability participate meaningful activities (MAs) increases older adults’ risk identity well-being.1,2 Are MAs achievable despite disability, dementia, depression? cross-sectional association between depression engagement nationally representative sample community-dwelling elders. Participants asked about their favorite activity (“What your activity?”; “In last month, did health/functioning ever keep you activity?”). MA self-reported participation enhanced cognitive (eg, reading), social connectedness, physical aptitude (walking/jogging). Lack engaging passive (watching television), inability do activity, lack activity. Multinomial logistic regressions survey-weighted Poisson regression used. (N=11,382) age mean=74 years (SD=7.2), 56% women, 81% white. Favorite walking/jogging (14%), outdoor maintenance (10%), reading (9%). Eighty-four percent (95% CI=83%–85%) participants without depression, dementia engaged MAs. In contrast, (52%–61%) disability alone, 74% (70%–79%) 68% (64%–71%) 35% (27%–42%) all three weighted, multivariable analyses adjusting age, sex, race/ethnicity, income, elders any condition combinations conditions (vs. none) likely engage combination least (disability alone: RR=0.66, 95% CI=0.61–0.72; dementia: RR=0.48, 0.42–0.56; depression: RR=0.46, 0.38–0.55; three: RR=0.35; 0.27–0.45). How define MAs? those possible setting frailty illness? authors’ definition include spiritual such as prayer finding time solitude, specifically excludes watching television. Many people find meaning joy activities. Regardless, based definitions, most participated biggest predictor participation. confounded use some A significantly greater portion patients would categorized participating if authors Participating central our sense well-being. Although and/or remain preferred activities, diagnoses make doing so (and thus maintaining identity/well-being) harder. Kate Lally, MD FAAHPM, Dana-Farber Cancer Institute Harvard School, Boston, Source: Oh Gan S, Boscardin WJ, among adults depression. JAMA Intern Med. Apr 1;181(4):560–562. doi:10.1001/jamainternmed.2020.7492 References:1.Morley JE, Philpot CD, Gill D, Berg-Weger nursing home. Am Med Dir Assoc. 2014;15(2):79–81. doi:10.1016/j.jamda.2013.11.0222.Katz P. Function, psychological Adv Psychosom 2004;25:41–62. doi:10.1159/000079057 Spanish Management End-of-Life Culture language impact patient understanding serious illness, prognosis, end-of-life care options.1–3 What challenges professional medical interpreters face during discussions? conducted semi-structured interviews interpreters, exploring faced provider-patient communication discussions. recruited emails distributed institutional interpreter listservs at Wisconsin academic centers. During face-to-face interviews, experiences mediating discussions decision making who English Language Learning (ELL, formerly termed “limited proficiency”). Analysis grounded theory constant comparative method, recruitment stopped “theoretical saturation.” Interpreters (N=17) mean=43 (SD=12) 82% female, mean=11 (SD=7.4) experience. described intensive attention accuracy discussions, even when caused emotional distress. emotion-laden multiple family members team members, impacted distress related discussion topic, provider-interpreter-patient relationships, provider empathy, constraints, tempo, member characteristics, experience level, self-care skills. routinely consciously chose alter maintain maximize others’ trust role. Professional strains rapid tempo contributed unintentional alterations content. Perceived nonempathic behaviors providers rare intentional flow content (aimed decreasing families while minimizing modification). Intentional also relieved dissociating unacceptable, providers. appreciated pre-encounter receive information preparation. Physicians always adept working interpreters.4 adds existing reports suggest undue stress because deficit. avoid inadvertently compelling compromise neutrality, should speak more slowly, review vocabulary advance, back-and-forth dialogue English-speaking provide brief discussion. suggests empathy part physician bigger threat interpretation than conflict interpreter's own values. Given key component effective communication, providing palliative training creating opportunities post-encounter feedback physicians an quality improvement strategy. Better incorporating into ELL patients. Reviewers: Keenan Correa, BS, Elizabeth Chuang, MPH Albert Einstein College Bronx, NY Rhodes MG, Fletcher KE, Blumenfeld-Kouchner F, Jacobs EA. interpreters’ end life Patient Educ Couns. Jan 21;S0738-3991(21)00045-8. doi:10.1016/j.pec.2021.01.018 References:1.Bhargava Wartak SA, Friderici J, Rothberg MB. Hispanic ethnicity knowledge behavior diabetes. Diabetes Educator. 2014;40(3):336–343. doi:10.1177/01457217145244502.Carrion IV, Cagle JG, Van Dussen DJ, Culler KL, Hong S. Knowledge hospice beliefs pain management: Hispanics non-Hispanics. Hosp Palliat Care. 2015;32(6):647–653. doi:10.1177/10499091145360233.Park NS, Jang YR, Ko Chiriboga DA. Factors affecting willingness racially/ethnically diverse men women. 2016;33(8):770–776. doi:10.1177/10499091155909764.Silva Genoff M, Zaballa Interpreting life: systematic delivery services cancer limited proficiency. Pain Symptom Manage. 2016;51(3):569–580. doi:10.1016/j.jpainsymman.2015.10.011 Outcome Healthcare Multiple Chronic Conditions growing support transition health treating single diseases isolation aligned patients’ priorities.1–3 goals preferences chronic (MCCs)? outcome healthcare ≥65 MCCs Priorities underwent priorities identification (2017–2018) primary practice. ≥3 conditions; addition, they ≥10 medications, saw ≥2 specialists, emergency department visits one hospitalization past year. facilitator trained elicit met (one 20- 30-minute session) practice site, home, telephone recorded results template. (N=163) mean=78 (SD=7.6), 97% white, 67% common encompassed meals other family/friends (24%), shopping (6.1%), exercising (4.6%). Twelve desired live independently specifying necessary barriers (41%), fatigue unsteadiness dyspnea (6.1%). Similar proportions identified ≥1 medication helpful (80%) bothersome (79%). Medications commonly cited medications (nonopioids [36/55 users] opioids [15/27]), sleep (27/51), respiratory inhalants (19/45). Most often mentioned statins (25/97) antidepressants (13/40). Twenty reported excess medications. Twenty-six helpful; (9.2%) too many. Twenty-three named procedures 15% unwanted procedures. Glucose monitoring doable 18/48 diabetes 9/48. highlights what geriatricians clinicians each day. If we don't understand motivates practical actionable way, will achieve true wellness. found varied unique, through facilitation process, able very specific goals. These serve goalpost decisions made potential treatments interventions. reality, these change over time, continuous assessment needed figure out how fit context individual's life. Importantly, includes person's surrounding community, literacy, influencers health, supports need additional larger, population. framework provides structured approach values, inform focus MCCs. Laura Patel, Transitions LifeCare, Raleigh, NC Tinetti ME, Costello DM, Naik AD, conditions. Netw Open. 1;4(3):e211271. doi:10.1001/jamanetworkopen.2021.1271 References:1.Boyd C, Smith Masoudi Decision-making conditions: executive summary AGS Guiding Principles Multimorbidity. Geriatr Soc. 2019;67(4):665–673. doi:10.1111/jgs.15809.2.Ferris R, Blaum Kiwak E, Perspectives patients, clinicians, system leaders outcomes condition. Aging Health. 2018;30(5):778–799. doi:10.1177/08982643176911663.Tinetti Green AR, Ouellet Rich MW, Boyd C. Caring 2019;170(3):199–200. doi:10.7326/M18-3269 Deficits Advance Planning Decompensated Liver Transplant Centers leading US, annual number individuals cirrhosis 65% 1999 2016.1 advance planning (ACP) experienced decompensated liver transplant centers? qualitative adult high-volume California centers describe ACP. diagnosis cirrhosis, portal hypertension-related complication, current/previous Model End-Stage sodium (MELD-Na) score ≥15. Clinicians professionals illness trajectory. context, behaviors, thoughts, concerning ACP, preferences, goals, surrogate making, documentation. Transcripts coded themes generated separately clinicians. (n=42) mean=58 (SD=11), male, Hispanic/Latino 38% white MELD-Na mean=16 (SD=7.3). (n=46) 28% hepatologists, 24% coordinators, 20% hepatobiliary surgeons, 13% workers, 11% hepatology nurse practitioners, 4% critical physicians. Thematic saturation occurred after 18 21 clinician identifying five themes: 1) consideration outside outpatient visits; 2) optimistic attitudes teams hindered disease progression dying; 3) primarily discussed strategy encouraging health-related behavioral change; 4) avoided discussing alternative options patients; 5) makers unprepared making. (PWCs) have utilization rates high morbidity, mortality, costs.2–5 PWCs unique organ candidates bridge transplant. Yet, eligible transplant, prognosis until terminal hospitalization.6 Patel's demonstrates structural issue. false dichotomy choosing imposed upon caregivers well-meaning fails capture nuances hoping best preparing what's next happen. It incongruent preferences. Their “focus hope” actually restricts “hope” only outcome. insufficient infrequent. Kyle Neale, DO, Cleveland OH Patel AA, Ryan GW, Tisnado 2021;181(5):652–660. doi:10.1001/jamainternmed.2021.0152 References:1.Tapper EB, Parikh ND. Mortality due States, 1999–2016: observational study. BMJ. 2018;362:k2817. doi:10.1136/bmj.k28172.Wang CW, Lebsack Sudore RL, Lai JC. Low readiness candidates. Dig Dis Sci. May;66(5):1446–1451. doi:10.1007/s10620-020-06369-13.Kelly EM, James PD, Murthy S costs end-stage compared decedents. Clin Gastroenterol Hepatol. 2019 Oct;17(11):2339–2346. doi:10.1016/j.cgh.2019.01.0464.D'Amico G, Garcia-Tsao G Natural history prognostic indicators survival cirrhosis: 118 studies. Jan;44(1):217–231. doi:10.1016/j.jhep.2005.10.0135.Patel Walling AM, Ricks-Oddie FP, Saab 2017;15(10):1612–1619.e4. doi:10.1016/j.cgh.2017.01.0306.Najafian N, Sack JS, DeLisle Jakab inpatient/outpatient program. Nov;22(11):1445–1448. doi:10.1089/jpm.2018.0261 Children Wished They Had/Had Not Done Coping First 13 Months Sibling's Neonatal/Pediatric Intensive Unit/Emergency Department Studies document parents regret child's death.1,2 children sibling's death? data longitudinal mixed-methods, multisite where 6- 18-year-olds responded open-ended questions wished had/had done coping 2, 4, 6, months death. Content (N=132) 72% school-age (6–9 years) preteen adolescent (10–18 (58% female; 30% Hispanic, 50% Black). Siblings 62% male (26 infants, four preschoolers, 15 school-age, 26 adolescent) died pediatric/neonatal ICU/emergency (n=45/17/9). wishing something different timepoint differ gender, race/ethnicity. spent (33%), talked/played sibling (26%), saved (13%), taken (12%), been see grow up (≤9%). Regarding things wish done, 26% (no difference gender; preteens adolescents likelier 2- [P=0.03] [P=0.02]; months, siblings Black/white [P=0.01]); surviving mean/yelled ill (60%), complained/argued mother sibling, kept feelings inside. coped talking (26%) deceased; playing (20%); TV (15%); avoiding thinking/talking (11%); remembering (10%); crying, laughing, praying (7%–8%); living sibling; resuming usual (3%). importance open, context-appropriate child-communication has long championed pediatric care3 echoed thread continues manuscript same:4 children, just like adults, say "I love you," "Please forgive me," you,” "Thank and, course, “Goodbye.” shows involving care; siblings, talk team. However, given many guilt death, thinking involved may ensure suffer Anticipatory guidance, participation, debriefing aspects bereavement care. Okhuysen-Cawley, Texas Hospital, Baylor Houston, TX Youngblut JM, Brooten D. first thirteen neonatal/pediatric unit/emergency Feb;24(2):226–232. doi:10.1089/jpm.2019.0538. References:1.Brooten Caicedo Parents: I child NICU/PICU Assoc Nurse Pract. 2019;31:175–183. doi:10.1097/JXX.00000000000001102.Caicedo Parents’ wishes infant's neonatal unit/pediatric Hospice Nurs. 2019;21(4):333–343. doi:10.1097/NJH.00000000000005593.Lövgren Sveen Steineck Wallin AE, Eilertsen M-E Kreicbergs U. Spirituality religious cancer-bereaved siblings' long-term grief [published online ahead print December 20, 2017]. Support doi:10.1017/S14789515170011464.Byock I. Dying Well. New York, NY: Riverhead Books; 1998. Symptomatology Associated Depression, Anxiety, Distress, Insomnia Professionals Working Affected COVID-19: Systematic Review Meta-Analysis mental (HPs) become vulnerable COVID-19 outbreak.1,2 psychiatric symptoms HPs pandemic? pandemic's impacts HPs. Four databases searched April 2020 (when studies populations contamination virulent disease). Egger Begg tests determined bias. Eight Chinese papers publication bias), sensitivity posttraumatic concentration (indicating robust results). correlation development disorders (linear relation 0.72 [95% CI=0.66–0.78]; P<0.01). study, doctors (n=927) prevalence insomnia (38 31%), anxiety (13 8.5%), 9.5%), somatization (1.6 0.4%), obsessive-compulsive (5.3 2.2%) nondoctor (n=1,255) (P<0.05). another, subjects (50%), (45%), (34%), (72%). work hours/week, main factors nurses’ 1,306 HPs, >50% presented disorders. (especially workers) disorder occupations. Greater outbreak (≥3 hours/day, <1 hours/day 1–2 hours/day), (<35 years), focused hours/day) associated anxiety. 4,600 questionnaires, respondents’ worries infecting coworkers (73%), (64%), protection measures (52%), violence (49%); 39% suffering. well-designed impressive pandemic frontline workers. Some stressors, availability protective equipment concerns childcare, prevented better stronger support. younger interesting perspective prompt counseling pre-emptive choice searching articles published fact eight relevant China pose substantial limitations study's findings. Long-term consequences assessed, findings apply cultures systems. stressors challenging address real time. learning implementation preventive train counsel Giovanni Elia, FAAPM, UCSF Health, San Francisco, CA da Silva FCT, Neto MLR. symptomatology anxiety, distress, meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 10;104:110057. doi:10.1016/j.pnpbp.2020.110057 1.Huang Y, Zhao N. Generalized disorder, depressive China: web-based survey. Psychiatry Res. 2020;288;112954. doi:10.1016/j.psychres.2020.1129542.Dai Hu Xiong H, Qiu Yuan X. Psychological coronavirus (COVID-19) workers China. MedRxiv. 2020. doi:10.1101/2020.03.03.20030874. Armstrong Kupeli Flemming K, Stone Wilkinson Candy B. Complementary therapy care: synthesis quantitative reviews. 2020;34(10):1332–1339. doi:10.1177/0269216320942450 sought elucidate reviews investigating efficacy complementary Previous same highly value treatments, though it synthesize conclusions efficacy. explores reason behind correlate quality-of-life scales. To truly assess efficacy, new medicine. Nimmons Hatter L, Davies Sampson EL, Walters Schrag A. Experiences Parkinson's atypical parkinsonian disorders: mixed methods review. Eur Neurol. 2020;27(10):1971–1987. doi:10.1111/ene.14424 examined introduced looked starting conversations, timing conversations. theme specialist providers, access Early involvement lead patient/family satisfaction extensive every open this.