Towards Optimization of Hydroxychloroquine Dosing in Intensive Care Unit COVID-19 Patients.

Hydroxychloroquine (HCQ) appears to be a promising treatment for COVID-19. However, all ongoing clinical trials with HCQ use different dosing regimens, resulting in various concentrations. Pharmacokinetic studies are therefore needed to define the optimal dosing regimen.

Assertive Anger Mediates Effects of Dialectical Behaviour-informed Skills Training for Borderline Personality Disorder: A Randomized Controlled Trial.

UNLABELLED: Dialectical behaviour therapy (DBT)-informed skills training for borderline personality disorder (BPD) aims at the development of specific emotion regulation skills in patients, particularly with regard to the regulation of problematic anger. While the effects of dialectical behaviour skills training have been shown, their processes of change are rarely examined. Neacsiu, Rizvi and Linehan (2010) found that patient's self-reported use of emotion regulation skills was a mediator of therapeutic change in these treatments; however, they found no effect for problematic anger. From an integrative perspective on anger (Pascual-Leone & Greenberg, 2007; Pascual-Leone & Paivio, 2013), there are several forms of anger, varying in their degree of therapeutic productivity. The present add-on randomized controlled trial included n = 41 patients with BPD (n = 21 DBT-informed skills training versus n = 20 treatment as usual). The first study examined the outcome of the DBT-informed skills training encompassing basic components of training in mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. Results showed that symptom reduction was significantly greater in the DBT-informed skills training, compared with the treatment as usual. The second study used process assessment, for which all patient completers underwent a 50-min-long psychological interview both early and late in treatment, which was rated using the Classification of Affective Meaning States. DBT-informed skills training produced increased levels of primary 'assertive' anger, as compared with the treatment as usual, whereas no effect was found for 'rejecting' secondary anger. Most importantly, we showed that changes in assertive anger mediated the reported symptom reduction, in particular in patient's social roles. We discuss these results in the context of underlying mechanisms of change in DBT skills group treatments, in particular towards developing more productive forms of anger in this patient population. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting anger remains unchanged over the course of treatment. Short-term objectives for intervention might involve the specific increase of assertive anger in BPD, by using DBT-informed skills training; long-term objectives for intervention might involve a specific decrease of rejecting anger in BPD.

Long-term outcomes of COVID-19 intensive care unit survivors and their family members: a one year follow-up prospective study.

Purpose: To describe the long-term physical, functional and mental status of COVID-19 intensive care unit (ICU) patients and their family members 1 year after ICU discharge. Methods: We performed a prospective observational cohort study among patients admitted to the ICU for COVID-19-associated respiratory failure and their family members. Patients attended a one-year follow-up consultation with family members. Physical, functional and respiratory outcomes were collected. In addition, participants completed the Hospital Anxiety and Depression Scale and the Revised Impact of Event Scale. Qualitative components were collected during a 2-h face-to-face interview. Results: Fifty-four patients and 42 family members were included. Thirty-four (63%) patients reported chronic fatigue and 37 (68.5%) dyspnea. Computed tomography scans were abnormal in 34 patients (72.3%). Anxiety symptoms were present in 23 (48%) patients and 26 (66%) family members, depression in 11 (23%) and 13 (33%), and post-traumatic stress disorder in 12 (25%) and 23 (55%), respectively. Visit limitation was reported as the most painful experience for family members. Numerous patients recalled nightmares that contributed to the anxiety. Long-term reconstruction was difficult for both patients and family members. Conclusion: The vast majority of patients and their relatives reported long-term consequences on various physical and mental components, leading to a profound impact on their well-being.

Decision making and visibility in cats (Felis catus) in a progressive elimination task.

When making decisions animals can rely on information stored in memory and/or on information available through perceptual processes. Under some circumstances, perceptual access to a relevant piece of information can be lost as when a prey hides under a cover. If this piece of information is critical, the animal must be able to keep it active in the working memory until the final decision is made. Species endowed with object permanence can to a certain extent overcome such a lack of perceptual access. Numerous studies have investigated object permanence in animals, but no study systematically examined the interaction when making a decision between an information directly available through perception and an information that can no longer be perceived. In the present study, domestic cats (Felis catus) were administered a progressive elimination task in which they had to visit and deplete either two visible and one hidden target (e.g., Experiments 1 and 2) or one visible and two hidden targets (e.g., Experiments 3 and 4). The cats were brought back to the starting point after each visit to any target whether that target had been previously visited or not. The results revealed that the cats searched at the visible target(s) first and at the hidden target(s) last, which was referred to as the visibility rule. The results also revealed that the position of the bowl that was distinct (e.g., the visible bowl when the two other ones were hidden and the opposite) influenced the way this cognitive rule was implemented. More specifically, when the intermediate bowl was distinct the visibility rule was readily implemented but when either the right of the left bowl was distinct the visibility was violated. That is the cats did no longer choose the visible target(s) first. The visibility rule was interpreted in terms of optimization principles, the external distinct target effect was interpreted in terms of divided attention and lateralization.

Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing.

OBJECTIVE: Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial. DESIGN AND SETTING: This was a prospective, non-randomized study in two French intensive care units. PATIENTS AND PARTICIPANTS: One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated. INTERVENTIONS: All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated. MEASUREMENTS AND RESULTS: The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003). CONCLUSIONS: Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.

Strategy planning in dogs (Canis familiaris) in a progressive elimination task.

Domestic dogs (Canis familiaris) were administered a progressive elimination task in which they had to visit and deplete three baited sites. Dogs were brought back to the starting point after each visit to any site whether they had made a correct or an incorrect choice. In Experiment 1 (n=10) the results revealed that the dogs randomly selected among the sites when they were equidistant from the starting point whereas they relied on the least distance rule when one of sites was closer to the starting point than were the other sites. In Experiment 2 (n=12), the dogs first chose the left target when angular deviation between adjacent targets varied whether the least angular deviation was on the right of the left. Results are interpreted in terms of Gibson's hypothesis about cooperative hunters. The discussion also emphasizes comparisons with cats (i.e., solitary hunters).

Prognostic factors in acute respiratory distress syndrome: a retrospective multivariate analysis including prone positioning in management strategy.

OBJECTIVE: To investigate the prognostic factors in acute respiratory distress syndrome (ARDS) patients focusing on the use of prone positioning (PP). DESIGN AND SETTING: Retrospective study conducted in an intensive care unit of a university hospital. PATIENTS: All consecutive mechanically ventilated ARDS patients surviving on day 7 after the diagnosis of ARDS. METHODS: The study included all ARDS patients who survived more than 7 days after ARDS diagnosis between January 1995 and December 2002. Demographic and respiratory variables were collected on day 1, and the management of ARDS was analyzed during the first 7 days ( n=125). We performed a univariate analysis and a stepwise logistic regression analysis comparing survivors and nonsurvivors on day 28 and at 2 and 6 months. RESULTS: Mortality rates on day 28 and at 2 and 6 months were 21.6%, 32%, and 44% respectively. A SAPS II score less than 49, McCabe score, and the use of PP introduced in the first 7 days of ARDS management appeared to be independently correlated with a decrease in mortality. CONCLUSIONS: The SAPS II score, the McCabe score, and use of PP are independently correlated with the outcome in ARDS patients.

Strategy planning in cats (Felis catus) in a progressive elimination task.

Domestic cats (Felis cans) were administered a progressive elimination task in which they had to visit and deplete 3 baited sites. Cats were brought back to the starting point after each visit to any site whether the visit represented a correct or an incorrect choice. The results revealed that cats organized search as a function of the least distance principle whether they had to assess starting point to target distances (Experiment 1, n = 12) or adjacent bowl distances (Experiment 2, n = 12). The results also revealed that the starting point to target distance factor was the most influential in determining the initial choice (Experiment 3, n = 6) and in producing errors. Errors were also linked to the antero-posterior bodily axis of the cat. Results are discussed in terms of the predatory behavior of the cat.