Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records.

BACKGROUND: There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. AIMS: This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery-Åsberg Depression Rating Scale (MADRS-6). METHOD: A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. RESULTS: The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. CONCLUSIONS: The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.

Phase angle and rectus femoris cross-sectional area as predictors of severe malnutrition and their relationship with complications in outpatients with post-critical SARS-CoV2 disease.

Background and aims: The diagnosis of malnutrition in post-critical COVID-19 patients is challenging as a result of the high prevalence of obesity, as well as the variability and previously reported inconsistencies across currently available assessment methods. Bioelectrical impedance vector analysis (BIVA) with phase angle (PhA) and nutritional ultrasound (NU®) are emerging techniques that have been proven successful in assessing body composition with high precision in previous studies. Our study aims to determine the performance and usefulness of PhA and rectus femoris cross-sectional area (RF-CSA) measurements in assessing body composition as part of the full routine morphofunctional assessment used in the clinical setting, as well as their capacity to predict severe malnutrition and to assess complications and aggressive therapy requirements during recent intensive care unit (ICU) admission, in a cohort of post-critically ill COVID-19 outpatients. Methods: This prospective observational study included 75 post-critical outpatients who recovered from severe COVID-19 pneumonia after requiring ICU admission. Correlations between all the morphofunctional parameters, complications, and aggressive therapy requirements during admission were analyzed. Multivariate logistic regression analysis and ROC curves were provided to determine the performance of NU® and PhA to predict severe malnutrition. Differences in complications and aggressive therapy requirements using the cutoff points obtained were analyzed. Results: In total, 54.7% of patients were classified by Subjective Global Assessment (SGA) as SGA-B and 45.3% as SGA-C, while 78.7% met the Global Leadership Initiative of Malnutrition (GLIM) criteria. PhA correlates positively with body cell mass/height (BCM/h) (r = 0.74), skeletal muscle index (SMI) (r = 0.29), RF-CSA (r = 0.22), RF-Y axis (r = 0.42), and handgrip strength (HGS) assessed using dynamometry (r = 0.42) and the Barthel scale (r = 0.29) and negatively with ICU stay (r = -0.48), total hospital stay (r = -0.57), need for invasive mechanical ventilation (IMV) (r = -0.39), days of IMV (r = -0.41), need for tracheostomy (r = -0.51), and number of prone maneuvers (r = -0.20). RF-CSA correlates positively with BCM/h (r = 0.41), SMI (r = 0.58), RF-Y axis (r = 0.69), and HGS assessed using dynamometry (r = 0.50) and the Barthel scale (r = 0.15) and negatively with total hospital stay (r = -0.22) and need for IMV (r = -0.28). Cutoff points of PhA < 5.4° and standardized phase angle (SPhA) < -0.79 showed good capacity to predict severe malnutrition according to SGA and revealed differences in ICU stay, total hospital stay, number of prone maneuvers, need for IMV, and need for rehabilitation, with statistical significance (p < 0.05). An RF-CSA/h < 2.52 cm2/m (for men) and <2.21 cm2/m (for women) also showed good performance in predicting severe malnutrition and revealed differences with statistical significance (p < 0.05) in ICU stay and total hospital stay. Conclusion: More than 75% of the post-critical COVID-19 survivors had malnutrition, and approximately half were obese. PhA, SPhA, RF-CSA, and RF-CSA/h, when applied to the assessment of body composition in post-critical COVID-19 patients, showed moderate-to-high correlation with other morphofunctional parameters and good performance to predict severe malnutrition and to assess complications and aggressive therapy requirements during ICU admission. Besides being readily available methods, BIVA and NU® can help improve the morphofunctional assessment of malnutrition in post-critical COVID-19 survivors; however, more studies are needed to assess the performance of these methods in other populations.

Post-Intensive Care Unit Multidisciplinary Approach in Patients with Severe Bilateral SARS-CoV-2 Pneumonia.

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Design: Prospective cohort study. Environment: Multidisciplinary outpatient clinic. Population: Patients with severe COVID-19 pneumonia, post- ICU admission. Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Conclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

Patología psicógena en la planta de neurología. Revisión de los últimos 10 años de hospitalización en un servicio de tercer nivel / Psychogenic pathology in the neurology unit. A review of the hospital admissions over the last 10 years in a third-level service

Introducción. Los trastornos psicógenos son frecuentes en la práctica neurológica, y, en ocasiones, obligan a hospitalizar al paciente para descartar una patología orgánica potencialmente grave. Objetivo. Conocer el perfil de los pacientes con diagnóstico al alta de trastorno psicógeno que ingresan en la planta de neurología de un hospital español. Pacientes y métodos. Se revisaron los informes de alta de neurología de los últimos 10 años, se seleccionaron los pacientes que tenían un diagnóstico de ‘no organicidad’ y se recogieron hasta un total de 28 variables demográficas, epidemiológicas y clínicas. Resultados. Sesenta y cuatro pacientes (el 1% de los hospitalizados) tenían diagnóstico de psicogenicidad, con una edad media de 40 años. La proporción de sexos era de 1 a 1, y la estancia media, de 10 días. Los síntomas mixtos eran los más habituales (50%), seguidos de los motores aislados (22%). Los posibles diagnósticos neurológicos de ictus isquémico y enfermedad desmielinizante fueron la mayoría de los casos. Sólo se consultó un 25% a psiquiatría durante el ingreso. En un 11% de los casos hubo historia posterior de intento de autolisis y en ocho casos (12,5%) se llegó a un diagnóstico ambulatorio de organicidad gracias al seguimiento evolutivo (‘error’ en el diagnóstico provisional al alta). Conclusión. Este trabajo dibuja por vez primera en nuestro medio el perfil del paciente psicógeno que ingresa en la planta de neurología, y examina su manejo hospitalario y su seguimiento ambulatorio. Se recuerda la necesidad de no menospreciaresta patología y de generar una vía ordenada para su manejo, siempre multidisciplinar y con el protagonismo del neurólogo y el psiquiatra

Introduction. Psychogenic disorders are frequently seen in neurological practice and sometimes make it necessary to hospitalise the patient in order to rule out a potentially severe organic pathology. Aim. To determine the profile of patients with a discharge diagnosis of psychogenic disorder that are admitted to the neurology unit of a Spanish hospital. Patients and methods. The neurology unit discharge abstracts from the last 10 years were reviewed and the patients who were diagnosed with ‘non-organicity’ were selected; a total of 28 demographic, epidemiological and clinical variables were also collected. Results. A total of 64 patients (1% of those admitted to hospital), with a mean age of 40 years, had a diagnosis of psychogenicity. The proportion between sexes was one to one and the mean length of stay in hospital was 10 days. Mixed symptoms were the most usual (50%), followed by isolated motor symptoms (22%). Most cases consisted of possible neurological diagnoses of ischaemic stroke and demyelinating disease. Only 25% of cases consulted psychiatry during hospitalisation. In 11% of cases there was a later history of suicide attempts and in eight cases (12.5%) an ambulatory diagnosis of organicity was reached thanks to the developmental follow-up (‘error’ in the provisional diagnosis on discharge). Conclusions. This study traces, for the first time in our setting, the profile of the psychogenic patient who is admitted to the neurology unit and examines their hospital management and their outpatient follow-up. We highlight the need not to underestimate this pathological condition and to generate an ordered way of managing it, which should always be multidisciplinary with the leading roles played by the neurologist and the psychiatrist

[Psychogenic pathology in the neurology unit. A review of the hospital admissions over the last 10 years in a third-level service]. / Patología psicógena en la planta de neurología. Revisión de los últimos 10 años de hospitalización en un servicio de tercer nivel.

INTRODUCTION: Psychogenic disorders are frequently seen in neurological practice and sometimes make it necessary to hospitalise the patient in order to rule out a potentially severe organic pathology. AIM: To determine the profile of patients with a discharge diagnosis of psychogenic disorder that are admitted to the neurology unit of a Spanish hospital. PATIENTS AND METHODS: The neurology unit discharge abstracts from the last 10 years were reviewed and the patients who were diagnosed with 'non-organicity' were selected; a total of 28 demographic, epidemiological and clinical variables were also collected. RESULTS: A total of 64 patients (1% of those admitted to hospital), with a mean age of 40 years, had a diagnosis of psychogenicity. The proportion between sexes was one to one and the mean length of stay in hospital was 10 days. Mixed symptoms were the most usual (50%), followed by isolated motor symptoms (22%). Most cases consisted of possible neurological diagnoses of ischaemic stroke and demyelinating disease. Only 25% of cases consulted psychiatry during hospitalisation. In 11% of cases there was a later history of suicide attempts and in eight cases (12.5%) an ambulatory diagnosis of organicity was reached thanks to the developmental follow-up ('error' in the provisional diagnosis on discharge). CONCLUSIONS: This study traces, for the first time in our setting, the profile of the psychogenic patient who is admitted to the neurology unit and examines their hospital management and their outpatient follow-up. We highlight the need not to underestimate this pathological condition and to generate an ordered way of managing it, which should always be multidisciplinary with the leading roles played by the neurologist and the psychiatrist.