Programa de seguimiento al alta de la unidad de cuidados intensivos / Follow-up program after intensive care unit discharge

Introducción: El seguimiento de pacientes al alta de la unidad de cuidados intensivos (UCI) permite el reconocimiento precoz de las complicaciones asociadas al síndrome post terapia intensiva (SPTI). El objetivo de este estudio es la estandarización de medidas básicas de resultado incluidas en un programa de seguimiento de pacientes en riesgo de presentar SPTI. Métodos: El comité de Seguimiento y Rehabilitación luego de la Enfermedad Crítica de la Sociedad Argentina de Terapia Intensiva (SATI) convocó a diferentes comités para la redacción del presente documento. Se realizó una búsqueda bibliográfica, junto con reuniones y foros de discusión. Las recomendaciones incluidas en el programa de seguimiento según el sistema GRADE son: frecuencia de seguimiento, profesionales encargados del programa, dominios básicos a evaluar, herramientas recomendadas para su evaluación validadas al español y duración del programa. Conclusión: Las medidas recomendadas para el seguimiento de pacientes permiten establecer los lineamientos básicos para la identificación y tratamiento precoz de las complicaciones asociadas al SPTI

Introduction: Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize outcome variables in a follow-up program for patients at risk of suffering PICS. Methods: The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program. Conclusion: The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS

Follow-up program after intensive care unit discharge. / Programa de seguimiento al alta de la unidad de cuidados intensivos.

INTRODUCTION: Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize outcome variables in a follow-up program for patients at risk of suffering PICS. METHODS: The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program. CONCLUSION: The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS.

High-resolution SPECT study of regional cerebral blood flow in drug-free and drug-naive schizophrenic patients.

OBJECTIVE: The purpose of the study was to compare regional cerebral blood flow (CBF) in schizophrenic patients never treated with psychotropic drugs (drug-naive) and in schizophrenic patients free from drugs for various amounts of time. METHOD: Seventeen schizophrenic patients (nine who were drug naive and eight who had been drug free for at least 3 weeks) and 12 healthy volunteers were included in the study. Regional cerebral perfusion was studied with the use of a head-dedicated, high-resolution single photon emission computed tomography (SPECT) system. Cerebral SPECT scans were performed with technetium-99m-hexamethyl-propyleneamine oxime as a tracer. Regional CBF was measured as a ratio of regional tracer uptake to either cerebellar or whole brain tracer uptake. RESULTS: When the cerebellum was taken as the reference region, the drug-naive patients showed a significant bilateral reduction of perfusion in the mesial, dorsolateral, and basal prefrontal cortex, in the temporal cortex, and in the subcortical gray structures: thalamus, caudate nucleus, and putamen/pallidum complex. No significant differences emerged in the comparison between the drug-free patients and the healthy subjects. With correction for whole brain activity, some of the differences that had been found disappeared, but a significant hypoperfusion persisted in the basal ganglia and thalamus of the drug-naive, but not the drug-free, patients. Few correlations between symptom presentation and regional CBF perfusion were observed in the schizophrenic patients. CONCLUSIONS: These results suggest a pattern of cerebral hypoperfusion in schizophrenic patients never treated with neuroleptics that was not detectable in patients who had undergone various periods of pharmacological washout.

Language and thought disorder in schizophrenia: brain morphological correlates.

In this magnetic resonance imaging study, the authors analyzed the relationships between frontal and temporal lobe volumes, volumes of ventricular system subdivisions and clinical and neuropsychological aspects of language and thought disorder in a group of 19 young schizophrenic patients. Schizophrenics showed enlargement of lateral ventricles, especially of the central and occipital segments compared with 15 age and sex matched healthy controls but no differences were present in prefrontal, temporal lobe and superior temporal gyrus volumes. Prefrontal volume was inversely correlated with Thought, Language and Communication (TLC) scale total scores; left superior temporal gyral (STG) volume was positively correlated with verbal fluency test performance; higher total ventricular volume was significantly correlated with poor performance to a sentence generation test; STG laterality index was correlated with global TLC scores, the more severe the thought and language disorders, the relatively smaller the left and larger the right STG. These results suggest a complex neuroanatomical substrate for thought and language disorders in schizophrenia.

The VA-Cyberware lower limb prosthetics-orthotics optical laser digitizer.

Characterization of the residual limbs and limb segments of patients for prosthesis and orthosis design has principally been a subjective process, highly dependent upon the skill, level of training, and experience of the prosthetist/orthotist involved. Even with the application of computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies in prosthetics and orthotics, residual limb/limb segment characterization has remained substantially subjective and dependent upon prosthetist/orthotist skill, training, and experience. To eliminate the variations and errors that frequently occur because of this dependence, and to further quantify the patient measurement process, rehabilitation engineering researchers at the New York Department of Veterans Affairs Medical Center developed an optical laser digitizer for quantitative characterization of patients' residual limbs'/limb segments' spatial geometry and surface topography. The optical digitizer developed is described, and results of laboratory and clinical tests with the digitizer are presented. Examples showing the capability of the digitizer to accurately, rapidly, repeatably, and consistently capture the contours over the entire surfaces of the residual limbs of patients with below-knee (BK) and above-knee (AK) amputation, the lower limbs of orthotics patients, and the feet and ankles of pedorthics patients, are given. In addition, results of a comparative clinical study of optical digitization and standard prosthetics CAD plaster wrap cast electromechanical digitization of the residual limbs of subjects with BK and AK amputation are presented. The enhanced accuracy, repeatability, and consistency afforded by optical digitization are shown. Finally, areas for refinement of the optical digitizer's design, identified in the project's laboratory and clinical tests, are discussed.

A reconsideration of the relationship between cerebral structural abnormalities and family history of schizophrenia.

In a study of 229 schizophrenic patients for whom reliable family history information was available, ventricular size and incidence of ventricular enlargement were found to be greater in male cases without a family history of schizophrenia. A significant sex by family history interaction on cerebral ventricular dimension was detected. The age-corrected morbid risk for schizophrenia was lower among first degree relatives of male probands with ventricular enlargement vs. those with normal ventricles, but similar in relatives of females with and without ventricular enlargement. On the other hand, no association was found between family history and degree of cortical atrophy. A meta-analysis of published studies on the issue revealed 20% larger ventricles in patients without any known genetic predisposition for schizophrenia.

Automated fabrication of mobility aids (AFMA): below-knee CASD/CAM testing and evaluation program results.

In 1988 the Department of Veterans Affairs Rehabilitation Research and Development Service, under the directorship of Margaret J. Giannini, M.D., began a nationally directed computer-aided design and computer-aided manufacturing (CAD/CAM) research program for the Automated Fabrication of Mobility Aids (AFMA). Under this program CAD/CAM research and development centers were established at the Prosthetics Research Study in Seattle, WA; at Northwestern University and the VA Lakeside Medical Center in Chicago, IL; and at the VA Medical Center and New York University Medical Center in New York, NY. These three centers conducted a collaborative program: (a) to introduce CAD/CAM technologies to prosthetists, physicians, therapists, and rehabilitation health care professionals in the United States; (b) to evaluate the feasibility of using CAD/CAM systems in clinical prosthetics settings; (c) to test and evaluate the University College London-Bioengineering Center's and the University of British Columbia-Medical Engineering Resource Unit's respective systems for the computer-aided design and computer-aided manufacture of prosthetic sockets (CASD/CAM) for below-knee amputees; and, (d) to obtain quantitative data for refinement of the CASD/CAM systems tested, and for the development of new, enhanced, more efficacious, and expedient systems.

CT scan abnormalities and outcome of chronic schizophrenia.

The authors evaluated the relationship between brain morphological characteristics assessed by means of computerized tomography and the 2-year clinical and social outcomes of 18 patients with chronic schizophrenia. Cerebral structural abnormalities, especially cortical atrophy, were associated with a poorer outcome in several areas of clinical and social functioning.