Cohort study of the APACHE II score and mortality for different types of intensive care unit patients.

OBJECTIVES: Find the discriminant and calibration of APACHE II (Acute Physiology And Chronic Health Evaluation) score to predict mortality for different type of intensive care unit (ICU) patients. METHODS: This is a cohort retrospective study using secondary data of ICU patients admitted to Siloam Hospital of Lippo Village from 2014 to 2018 with minimum age ≥17 years. The analysis uses the receiver operating characteristic curve, student t-test and logistic regression to find significant variables needed to predict mortality. RESULTS: A total of 2181 ICU patients: men (55.52%) and women (44.48%) with an average age of 53.8 years old and length of stay 3.92 days were included in this study. Patients were admitted from medical emergency (30.5%), neurosurgical (52.1%) and surgical (17.4%) departments, with 10% of mortality proportion. Patients admitted from the medical emergency had the highest average APACHE score, 23.14±8.5, compared with patients admitted from neurosurgery 15.3±6.6 and surgical 15.8±6.8. The mortality rate of patients from medical emergency (24.5%) was higher than patients from neurosurgery (3.5%) or surgical (5.3%) departments. Area under curve of APACHE II score showed 0.8536 (95% CI 0.827 to 0.879). The goodness of fit Hosmer-Lemeshow show p=0.000 with all ICU patients' mortality; p=0.641 with medical emergency, p=0.0001 with neurosurgical and p=0.000 with surgical patients. CONCLUSION: APACHE II has a good discriminant for predicting mortality among ICU patients in Siloam Hospital but poor calibration score. However, it demonstrates poor calibration in neurosurgical and surgical patients while demonstrating adequate calibration in medical emergency patients.

Effectiveness of online interprofessional education-communication course during the COVID-19 pandemic.

A developed IPE (Interprofessional Education)-communication course was first implemented at Universitas Pelita Harapan/UPH via online learning due to the COVID-19 pandemic. This study aimed to analyze the effectiveness of a newly developed IPE-online communication course offered to medical (MS) and nursing (NS) students. This study was a quantitative study using a pre-post design without control. The IPAS (Interprofessional Attitude Scale) assessed students' attitudes toward IPE. Satisfaction with the program was also measured following its completion. The questionnaire was administered via Survey Monkey to 535 respondents (MS = 250; NS = 285). Univariate and bivariate statistical analyses were employed. Before and after the IPE program, 161 MS and 146 NS completed the IPAS questionnaire (n = 307). The attitude of MS and NS were not improved significantly (p-value >0.05). Moreover, several subscales of attitudes decreased significantly, including "Diversity and Ethics" with a low-size effect for medical students and "Teamwork, Roles, and Responsibilities" and "Patient-Centeredness" with a low-size effect for nursing students. Both students (n = 307) were also satisfied with the IPE course (Mean MS: 4.28 and NS: 4.34). This study suggests that online IPE communication course may not be effective in fostering student attitudes. The IPE communication course should be accomplished through in-person class instead of online learning. Further IPE course evaluations are required to improve the acceptability, applicability, and effectiveness of IPE in health education.

The Impact of Post-COVID-19 Conditions on Sleep and Quality of Life in Indonesia: A Nationwide Cross-Sectional Study.

Background: Sleep disturbances are included in the six most commonly cited complaints in post-COVID-19 conditions. In order to find the optimal management approach and enhance Quality of Life (QoL), we intend to explore sleep disturbances that occur in post-COVID-19 conditions. Methods: This was a cross-sectional study conducted with interviews and questionnaires using the Pittsburgh Sleep Quality Index (PSQI) for assessing sleep quality, Insomnia Severity Index (ISI) for assessing insomnia, Epworth Sleepiness Scale (ESS) for assessing Excessive Daytime Sleepiness (EDS), STOP-BANG questionnaire for assessing Obstructive Sleep Apnea (OSA), and Short Form 36 (SF-36) for assessing QoL. We recruited respondents from several cities in Indonesia and performed an analysis to find the relationship between sleep disturbance and its association with QoL. Results: This study involved 757 respondents. They were predominantly female, with a median age of 39 years, no comorbidities, and had exhibited mild COVID-19 severity. Subjects with post-COVID-19 conditions experienced insomnia, poor sleep quality, normal sleepiness, and low risk of OSA. Sleep quality caused role limitations due to decreased physical and mental health. Insomnia caused role limitations due to emotional and social functioning problems. Meanwhile, OSA only affected physical functioning. Conclusion: Numerous aspects of patients' QoL are affected by sleep disturbance in post-COVID-19 conditions. A comprehensive approach and coordinated care pathways must be effectively managed to improve QoL among individuals experiencing sleep disturbance.

COVID-19-Associated Encephalopathy: Systematic Review of Case Reports.

BACKGROUND AND PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system, but there are also several reports of the involvement of the central nervous system, with one of the manifestations being encephalopathy. The relatively new emergence of COVID-19 means that few studies have investigated the clinical profile of encephalopathy associated with this disease. This study aimed to determine the clinical profile, laboratory, and imaging results of encephalopathy associated with COVID-19. METHODS: Three databases, namely PubMed/MEDLINE, Embase, and Scopus, were systematically searched for case reports and case series related to COVID-19-associated encephalopathy published from January 1, 2019 to July 20, 2020. RESULTS: This review included 24 studies involving 33 cases. The most-reported neurological symptoms were disorientation/confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). Laboratory examinations revealed increases in the C-reactive protein level (48.48%), the lactate dehydrogenase level (30.30%), and lymphopenia (27.27%). Brain imaging did not produce any pathological findings in 51.51% of the cases. Electroencephalography showed generalized slowing in 45.45% of the cases. Elevated protein (42.42%) and lymphocytosis (24.24%) were found in the cerebrospinal fluid. Fifteen patients were reportedly discharged from the hospital in a stable condition, while four cases of mortality were recorded. CONCLUSIONS: The clinical, laboratory, and imaging findings in this review support the hypothesis that cerebral damage in COVID-19-associated encephalopathy is caused by cytokine-immune-mediated inflammation rather than by direct invasion.

Glial Fibrillary Acidic Protein Serum Level as a Predictor of Clinical Outcome in Ischemic Stroke.

BACKGROUND: Glial Fibrillary Acidic Protein (GFAP) is a protein produced by astrocytes in response to brain injury, which then penetrates the cerebrospinal fluid and the blood stream. AIM: We sought to determine whether GFAP serum level in acute ischemic stroke could predict clinical outcome. METHODS: As much as 64 patients with first-ever ischemic stroke had their GFAP serum level measured at 72 hours after onset. The National Institute of Health Stroke Scale (NIHSS) was assessed during the 72 hours of onset, the seventh day, and followed up 1 month after. RESULTS: There were 46 men and 18 women included in the study. Mean age was 58.3 years old, and nearly half of them (46.9%) were between 50-59 years old. More than half (58.7%) presented with moderate to a severe stroke and mean GFAP serum level was 0.113 ± 0.029 ng/mL. GFAP serum levels had a significant correlation with NIHSS after 1 month (p = 0.04, r = 0.259). CONCLUSION: There is a significant correlation between GFAP serum levels with stroke severity scale after 1 month of stroke onset.