Site of care and factors associated with mortality in unvaccinated Australian aged care residents during COVID-19 outbreaks.

BACKGROUND: Residential InReach presents an alternative to hospital admission for aged care residents swabbed for coronavirus disease 2019 (COVID-19), although relative outcomes remain unknown. AIMS: To compare rates and predictors of 28-day mortality for aged care residents seen by InReach with COVID-19, or 'suspected COVID-19' (sCOVID), including hospital versus InReach-based care. METHODS: Prospective observational study of consecutive patients referred to a Victorian InReach service meeting COVID-19 testing criteria between April and October 2020 (prevaccine availability). COVID-19 was determined by positive polymerase chain reaction testing on nasopharyngeal swab. sCOVID-19 was defined as meeting symptomatic Victorian Government testing criteria but persistently swab negative. RESULTS: There were no significant differences in age, sex, Clinical Frailty Score (CFS) or Charlson Comorbidity Index (CCI) between 152 patients with COVID-19 and 118 patients with sCOVID. Similar results were found for 28-day mortality between patients with COVID-19 (35/152, 23%) and sCOVID (32/118, 27%) (P = 0.4). For the combined cohort, 28-day mortality was associated with initial oxygen saturation (P < 0.001), delirium (P < 0.001), hospital transfer for acuity (P = 0.02; but not public health/facility reasons), CFS (P = 0.04), prior ischaemic heart disease (P = 0.01) and dementia (P = 0.02). For patients with COVID-19, 28-day mortality was associated with initial oxygen saturation (P = 0.02), delirium (P < 0.001) and hospital transfer for acuity (P = 0.01), but not public health/facility reasons. CONCLUSION: Unvaccinated aged care residents meeting COVID-19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within-facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility-based reasons, and lower than those transferred for clinical acuity.

Emotional sounds guide visual attention to emotional pictures: An eye-tracking study with audio-visual stimuli.

For the realm of visual cues, it has been well documented that attention is preferentially oriented toward emotionally relevant cues. Preliminary evidence suggests that emotional cues from other sensory modalities may also steer visual attention toward emotional pictures. However, more research is needed to elucidate the mechanisms that are involved. Therefore, a novel design was used to investigate whether emotional sounds promote attentional orientation toward emotional pictures. To this end, 48 participants viewed pairs of pictures with either neutral or unpleasant content in a free-viewing paradigm. In addition, neutral or unpleasant sounds were presented either on the left-hand or on the right-hand side of the monitor. Eye movements were recorded as an index of visual spatial attention toward the pictures. Most interestingly, position and valence of the sounds independently modulated visual orienting towards unpleasant pictures. For initial capture and sustained attention, orienting towards unpleasant pictures was significantly enhanced when any sound was heard on the same side as the unpleasant picture. In addition, unpleasant sounds (irrespective of the side) boosted leftward bias of initial attention toward emotionally congruent pictures. Taken together, this study clearly shows that emotional auditory cues guide visual spatial allocation of attention specifically to emotionally congruent pictures. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Resilience, frailty and outcomes in geriatric rehabilitation.

OBJECTIVE: To assess relationships between resilience, frailty and outcomes in geriatric rehabilitation inpatients. METHODS: Eighty-nine inpatients had Brief Resilience Scale (BRS) and frailty index (FI-CGA) completed. Pearson's or Spearman's correlation was used to determine correlation between BRS, FI-CGA and covariates. Multivariate logistic regression was used to determine associations between resilience, frailty and covariates with functional independence measure gain, length of stay (LOS) > 21 days, mortality and discharge care requirements. RESULTS: There was a negative correlation between BRS and premorbid FI-CGA (r = -0.31, P = 0.03) and admission FI-CGA (r = -0.26, P = 0.01) and between BRS and Mini-Mental State Examination score (rho = -0.26, P = 0.02). BRS was not associated with observed outcomes. Premorbid FI-CGA was associated with inpatient mortality, and greater increase in FI-CGA during acute stay was associated with greater LOS. All patients who died were frail (FI-CGA > 0.25). CONCLUSION: Resilience and frailty were inversely related. Frailty was an independent predictor of rehabilitation LOS and mortality.

Patient resilience in the fracture orthopaedic rehabilitation geriatric environment.

OBJECTIVE: To explore the relationship between resilience and rehabilitation outcomes in older orthopaedic patients. METHODS: Geriatric rehabilitation patients admitted to a general metropolitan hospital following a fracture were interviewed face-to-face. Their resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC), and rehabilitation outcomes were assessed according to functional independence measure (FIM) gain, length of stay, discharge destination and mortality rate. RESULTS: A total of 29 patient interviews were used in data analysis. Resilience scores varied from 49-92, with an average of 73, representing overall high resilience compared to general population samples. Resilience scores as measured by the CD-RISC did not correlate with functional improvements during rehabilitation postfracture. CONCLUSION: Further studies, including patients with a broader range of resilience scores, particularly at the lower end of the spectrum, are required to explore the relationship between resilience and rehabilitation outcomes in greater depth.

Mastoid cavity obliteration and Vibrant Soundbridge implantation for patients with mixed hearing loss.

OBJECTIVES/HYPOTHESIS: To review the results of obliteration of a preexisting mastoid cavity with abdominal fat and Vibrant Soundbridge implantation in patients with mixed hearing loss (MHL) and to compare the data with results of Vibrant Soundbridge implantation in patients with MHL without mastoid cavity and with pure sensorineural hearing loss (SNHL). STUDY DESIGN: Retrospective chart analysis of 10 patients (10 ears) with MHL and preexisting mastoid cavity, 18 patients (19 ears) with MHL alone and nine patients (10 ears) with SNHL treated in one tertiary referral center. METHODS: Vibrant Soundbridge implantation and obliteration in case a mastoid cavity existed previously. Pure tone audiometry (average air-bone gap, average functional gain), speech audiometry (Freiburg Monosyllabic Test) and complication rate were main outcome measures. RESULTS: Postoperative average air-bone gap was -15.1 ± 21.2 dB in patients with MHL with mastoid cavity obliteration, -7.2 ± 11.4 dB in patients with MHL without mastoid cavity, and -5.7 ± 11.2 dB in patients with SNHL. Average functional gain was 40.0 ± 23.5 dB, 39.7 ± 12.1 dB, and 9.5 ± 10.6 dB. Postoperative speech discrimination rate was 77.9 ± 20.8%, 83.3 ± 13.6%, and 83.6 ± 6.3%. No severe intraoperative or postoperative complications were noted. CONCLUSIONS: Mastoid cavity obliteration during Vibrant Soundbridge implantation in patients with MHL and preexisting mastoid cavity is a safe procedure. The audiometric results are satisfying and comparable to those of other patient groups implanted with the same device. LEVEL OF EVIDENCE: 4.

Botulinum toxin treatment of salivary fistulas following parotidectomy: follow-up results.

BACKGROUND: Salivary fistulas are a well-known sequel of parotidectomy, and successful treatment with botulinum toxin has been demonstrated in individual cases. Here, we report on 12 patients with fistulas treated following parotidectomy for various indications. METHODS AND RESULTS: Injection of botulinum toxin type A into the residual gland tissue was the initial treatment. After early intervention (within 6 weeks after development of the fistula), only one fistula remained (9 of 10 fistulas treated early only with botulinum toxin). One patient with early intervention did not want to wait for the botulinum toxin treatment to take effect and demanded early surgical revision, which was successful. In one patient with a permanent fistula, botulinum toxin treatment began 420 days after the operation and was unsuccessful. No side effects were evident after the treatment. CONCLUSION: In summary, botulinum toxin injections into the parotid tissue remaining after surgery appear to be an effective treatment for salivary fistulas following parotidectomy.