Sleep and Postpartum Psychosis: A Narrative Review of the Existing Literature

Sleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP.

The effect of wound electrical stimulation in venous leg ulcer healing-a systematic review

OBJECTIVE

The benefit of using electric stimulation therapy (EST) to heal venous leg ulcers (VLUs) is not well established. The main aim of this systematic review was to evaluate the effects of ulcer EST in VLU healing.

METHODS

A systematic search of the literature was conducted using the databases PubMed, Scopus, and Web of Science and included original studies that reported VLU healing after EST. The inclusion criteria were at least two surface electrodes placed on or near the wound or a planar probe covering the ulcer area to be treated. The Cochrane risk of bias tool for randomized control trials (RCTs) and Joanna Briggs Institute critical appraisal checklist for case series were used to evaluate the risk of bias.

RESULTS

This review included eight RCTs and three case series involving a total of 724 limbs in 716 patients with VLUs. The mean patient age was 64.2 years (95% confidence interval, 62.3-66.2), and 46.2% (95% confidence interval, 41.2%-50.4%) were men. The active electrode was placed on the wound with the passive electrode placed on healthy skin (n = 6), the two electrodes were placed on either side of the wound edges (n = 4), or a planar probe was used (n = 1). The pulsed current was the most used waveform (n = 9). The change in the ulcer size was the main method used to determine ulcer healing (n = 8), followed by the ulcer healing rate (n = 6), exudate levels (n = 4), and the time to healing (n = 3). Five RCTs detected a statistically significant improvement in at least one VLU healing outcome, after EST compared with the control group. In two of these, EST was better than the control but only for patients who had not undergone surgical treatment of VLU.

CONCLUSIONS

The findings from the present systematic review support the use of EST to accelerate wound healing of VLUs, especially for patients who are not surgical candidates. However, the significant variation in electric stimulation protocols represents an important limitation to its use and should be addressed in future studies.

Exploring the Barriers to Discussing Unconscious Racial Bias in Psychiatry Trainees

Introduction

Racism is present in most aspects of our society, including healthcare. Differences in health outcomes, and in the quality of mental health treatment for people coming from ethnic minority groups have been demonstrated in the literature. Psychiatry trainees are required to understand the impact of structural inequalities and power differences within mental health services, and to be able to deliver clinical care that is equitable for all.

Objectives

To provide psychiatry trainees with a space to reflect on unconscious racial bias in clinical work and to explore potential barriers when talking about such topics.

Methods

A Race and Equality Reflective Group for psychiatry trainees was organised as an opportunity to discuss unconscious racial bias. Due to an insufficient number of registrations, the session was cancelled. An anonymous feedback questionnaire was sent to all trainees to understand reasons behind this, and to explore potential barriers to participation. The results were analysed and were brought back to a regular Balint group for further exploration.

Results

Twelve trainees filled in the questionnaire. The main themes identified included this topic being a sensitive issue (5; 41.7%), discomfort in trainees (5; 41.7%), insufficient time to participate (4; 33%) and timetable clash (3; 25.9%). Barriers to discussing unconscious racial bias and inequality were identified in further exploration with trainees. The tendency for groups to adopt a split position that was observed, mirrors the dynamics seen in institutional racism.

Conclusions

This work has highlighted the need for ongoing focused, facilitated educational spaces where these issues can be openly discussed and reflected upon.

Disclosure

No significant relationships.

P4735Preoperative frailty is a predictor of worse in-hospital outcomes after coronary artery bypass graft surgery and improves the predictive accuracy of EUROSCORE I and II

Introduction

Although coronary artery bypass grafting (CABG) is the most widely performed cardiovascular procedure in the world and is the standard treatment for complex coronary artery disease, the risk prediction for the procedure has major gaps. In this context, preoperative frailty may have a relevant role in the prediction of surgical risk.

Purpose

Our goal was to evaluate the impact of frailty on in-hospital outcomes after CABG and verify if any other comorbidity enhances the effects of fragility.

Methods

Prospective cohort of patients submitted consecutively to isolated CABG between Jan/2013 and Dec/2017. Frailty was defined as any deficiency in the Katz Index. Of the 1508 patients, 126 (8.4%) were classified as frail. Baseline characteristics and outcomes were compared by univariate analysis. Multivariate regression models were applied for the adjusted analysis of outcomes. The predictive accuracy of the regression models were analyzed using ROC curves. The additional predictive accuracy of the frailty and other risk variables were evaluated by comparing the ROC curves with the DeLong test.

Results

The frail patients presented more advanced age, more comorbidities and the majority were female. Frailty was an independent predictor for in-hospital mortality (OR 5.55, p=0.002) and MACCE (OR 5.60, p=0.001). In addition, by means of an adjusted analysis, we identified that the frailty was associated with a longer time of hospitalization (B 4.61, 95% CI 2.12–7.10, p<0.001). We also identified that preoperative anemia was classified as an independent predictor for hospital mortality and MACCE and improved the effect of frailty on outcomes. In this way, we could verify that when associated with surgical risk scores, frailty and anemia significantly improved the predictive accuracy of EuroScore 1 and EuroScore 2 for in-hospital mortality.

Predictive accuracies

Conclusions

Frailty and preoperative anemia are independent predictors of hospital mortality and MACCE after CABG. Frailty was also a predictor of longer hospitalization time. The association of frailty and anemia with surgical risk scores resulted in a significant improvement in the predictive accuracy of the scores. Frailty screening by Katz Index improved the risk assessment for isolated CABG and, when associated with anemia, demonstrated that frail and anemic patients had worse surgical outcomes.

Acknowledgement/Funding

The development of the present study was funded entirely by the Institution itself.

Regret Anticipation Failures Scale (RAFS): Validation of the Portuguese version

Introduction

Failures in regret anticipation undermine regret avoidance, increasing regret frequency and ultimately the risk of regret-related problems. The Regret Anticipation Failures Scale (RAFS; Schmidt and Linden, 2011) was developed to evaluate interindividual differences in regret anticipation.

Objective

To investigate the psychometric properties of the RAFS Portuguese version.

Methods

A community sample composed of 108 university students and 79 employees (78.1% females; mean age = 33.16 ± 13.175; range: 17–62) answered the Portuguese preliminary version of the RAFS. To study the temporal stability, 31 participants (83.9% females; mean age = 26.54 ± 18.761) answered the RAFS again after approximately 6 weeks.

Results

The RAFS Cronbach alpha was “very good” (a = 0.81). All the items presented significant correlations with the total (excluding the item; > 0.20); only item 2 (Even when I’m stressed, I can foresee the regrets that certain behaviors could evoke in me) had the effect of lowering the internal consistency if deleted. The test-retest correlation coefficient was high, positive and significant (0.61; P < 0.001); there was not significant difference between test and re-test scores [14.26 ± 5.170 vs. 13.06 ± 4.761, t (30) = 1.532, P = 0.136]. Following Kaiser and Cattel Scree Plot criteria, only one factor was extracted, meaning that the scale is unidimensional.

Conclusions

The Portuguese version of RAFS has good reliability and construct validity. It could be very useful both in clinical and research contexts, namely in an ongoing project on the relationship between regret, personality and psychological distress.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The liver is the main organ to clear plasma and tissue kallikreins from rat plasma, in vivo

We report observations regarding the in vivo distribution of labelled kallikreins in plasma, liver and some other organs, twenty minutes following their intravenous injection in the rat. The kallikreins used were: tritiated homogeneous human plasma (HuPK) and horse urinary (HoUK) as well as highly purified iodinated rat plasma kallikrein (RPK). The main findings were: the liver cleared 15% of HuPK, 38% of RPK and 69% HoUK; with both types (plasma and tissue) of native kallikreins the liver was the main clearing organ.