Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Families of patients in ICU: A Scoping review of their needs and satisfaction with care Author(s): Scott, P., Thomson, P., & Shepherd, A Publisher or Source: Nursing Open Type of Media: Medical Journal Media Originally for: Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome for Families (PICS-F) COVID-19 Related: No Description: Aim To describe published literature on the needs and experiences of family members of adults admitted to intensive care and interventions to improve family satisfaction and psychological well‐being and health. Design Scoping review. Methods Several selective databases were searched. English‐language articles were retrieved, and data extracted on study design, sample size, sample characteristics and outcomes measured. Results From 469 references, 43 studies were identified for inclusion. Four key themes were identified: (a) Different perspectives on meeting family needs; (b) Family satisfaction with care in intensive care; (c) Factors having an impact on family health and well‐being and their capacity to cope; and (d) Psychosocial interventions. Unmet informational and assurance needs have an impact on family satisfaction and mental health. Structured written and oral information shows some effect in improving satisfaction and reducing psychological burden. Future research might include family in the design of interventions, provide details of the implementation process and have clearly identified outcomes. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Comparison of medical admissions to intensive care units in the United States and United Kingdom Author(s): Hannah Wunsch, MD, MSc; Derek C. Angus, MD, MPH; David A. Harrison, PhD; Walter T. Linde-Zwirble; and Kathryn M. Rowan, DPhil Publisher or Source: American Journal of Respiratory and Critical Care Medicine Type of Media: Medical Journal Media Originally for: Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Rationale: The US has seven times as many intensive care unit (ICU) beds per capita as the UK; the effect on care of critically ill patients is unknown. Objective: Compare medical ICU admission in the US and UK. Methods: Retrospective (2002-2004) cohort study of 172,785 admissions (137 US ICUs, Project IMPACT database; 160 UK ICUs, UK Case Mix Programme), with patients followed until initial hospital discharge. Results: UK (vs US) admissions were less likely to be admitted directly from the emergency room (ER), (33.4 vs 58.0%), had longer hospital stays before ICU admission (mean days 2.6±8.2 vs 1.0±3.6), and fewer were ≥85 years (3.2% vs 7.8%). UK patients were more frequently mechanically ventilated within 24h after ICU admission (68.0% vs 27.4%), were sicker (mean Acute Physiology Score 16.7±7.6 vs 10.6±6.8), and had higher primary hospital mortality (38.0% vs 15.9%; adjusted Odds Ratio (OR) 1.73, 95%CI 1.50-1.99). There was no mortality difference for mechanically ventilated patients admitted from the ER (adjusted OR 1.09, 0.89-1.33). Comparisons of hospital mortality were confounded by differences in casemix, hospital length of stay (UK median 10 days (IQR 3-24) vs US 6 (3-11)), and discharge practices: more US patients were discharged to skilled care facilities (29.0% of survivors vs 6.0% in the UK). Conclusions: Lower UK ICU bed availability is associated with fewer direct admissions from the ER, longer hospital stays before ICU admission, and higher severity of illness. Interpretation of between-country hospital outcomes is confounded by differences in casemix, processes of care and discharge practices. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – Results of an expert consensus and feasibility field test Author(s): Claudia D Spies, Henning Krampe, Nicolas Paul, Claudia Denke, Jo ̈ rn Kiselev, Sophie K Piper, Jochen Kruppa, Julius J Grunow, Karin Steinecke, Tuba Gu ̈lmez, Kathrin Scholtz, Simone Rosseau, Christiane Hartog, Reinhard Busse, Jo ̈ rg Caumanns, Ursula Marschall, Martin Gersch, Christian Apfelbacher, Steffen Weber-Carstens and Bjo ̈ rn Weiss Publisher or Source: Journal of the Intensive Care Society Type of Media: Medical Research Media Originally for: Critical Care Physicians, Nurses and/or Other Critical Care Medical Professionals Country of Origin: Germany Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Background: There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care. Methods: We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 1⁄4 5; n2 1⁄4 5; n3 1⁄4 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal. Results: We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)). Conclusions: We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: corona patients can follow a tailored multidisciplinary rehabilitation program at medifit rehabilitation centre after an icu admission Author(s): Staff Reporter Publisher or Source: Olive Press Type of Media: Newspaper Article Media Originally for: General Public Country of Origin: Spain Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: People after a stay in an Intensive Care Unit (ICU) often have Post Intensive Care Syndrome (PICS) this is a combination of physical disorders and limitations such as muscle weakness, reduce stamina, shortness of breath, pain and stiffness in the joints. The physical consequences after ICU are usually known, but there may also be psychological and cognitive problems. These residual symptoms lead to long term limitations in daily functioning and reduced quality of life. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: After COVID-19, patient’s long road to recovery includes physical therapy Author(s): Monica Riehl Publisher or Source: El Paso Herald-Post Type of Media: Newspaper Article Media Originally for: General Public Country of Origin: United States of America (the) Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: Fighting and overcoming Covid 19 is difficult for many. Even after winning the fight, so many still deal with lingering health complications. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: ICU Recovery Clinic Attendance, Attrition, and Patient Outcomes: The Impact of Severity of Illness, Gender, and Rurality Author(s): Mayer, K.P., Boustany, H., Cassity, E.P., Soper, M.K., Kalema, A.G. Kolpek, J.H., Montgomery-Yates, A.A. Publisher or Source: Critical Care Explorations Type of Media: Medical Journal Media Originally for: General Medical Professionals Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Attendance and attrition in ICU recovery clinic are related to patient factors (living in rural area) and ICU factors. Data suggest different recovery trajectories exist based on gender, severity of illness, and self-reported outcomes. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Physiotherapy & COVID-19: Rehabilitating on the front line Author(s): Savionne Francis, Dr . Publisher or Source: Jamaica Gleaner Type of Media: Newspaper Article Media Originally for: General Public Country of Origin: Jamaica Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: Yes Description: Each year, September 8 has been celebrated as World Physiotherapy Day since 1996. This is significant as it marks the date that the World Physiotherapy was founded in 1951. World Physiotherapy is the voice of the global physiotherapy community and we unite each year to raise awareness of our role in the medical fraternity. This year was celebrated under the theme ‘Rehabilitation after COVID-19’. Physiotherapists are a critical part of the management of COVID-19 patients worldwide. Here in Jamaica, we have been playing our role in managing our critically ill patients since March, when the first case was diagnosed. You may ask, how can a physiotherapist help to manage this condition? Well, there are two main phases that we fall into; first, there is the acute-subacute management, and second, rehabilitation after COVID-19. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Death, bereavement and randomised controlled trials (BRACELET): a methodological study of policy and practice in neonatal and paediatric intensive care trials Author(s): Claire Snowdon, Peter Brocklehurst, Robert Tasker, Martin Ward Platt, Sheila Harvey and Diana Elbourne Publisher or Source: NIHR Journals Library – Health Technology Assessment Type of Media: Medical Journal Media Originally for: Critical Care Physicians Country of Origin: United Kingdom of Great Britain and Northern Ireland (the) Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: Background: Researchers have seldom included bereaved parents in studies of participants’ views of randomised controlled trials (RCTs); hence our understanding of the impact of trials is based on skewed and incomplete samples. Little is known about parental experiences of the death of a child subsequent to their enrollment in a trial or of provision made for this experience by clinicians and trial teams. The Bereavement and RAndomised ControlLEd Trials (BRACELET) study was funded to consider bereavement in the context of paediatric intensive care (PIC) and neonatal intensive care (NIC) trials. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: ENABLERS AND BARRIERS TO IMPLEMENTING ICU FOLLOW-UP CLINICS AND PEER SUPPORT GROUPS FOLLOWING CRITICAL ILLNESS: THE THRIVE COLLABORATIVES Author(s): Kimberley J. Haines, PhD, BHSc; Joanne McPeake, PhD, MSc, BN (Hons), RGN; Elizabeth Hibbert, B.Physiotherapy; Leanne M. Boehm, PhD, RN, ACNS-BC; Krishna Aparanji, MD, CPE; Rita N Bakhru, MD, MS; Anthony J Bastin, MBBS PhD; Sarah J Beesley, MD, MSc; Lynne Beveridge, RGN; Brad W Butcher, MD; Kelly Drumright, MSN, RN, CNL; Tammy L Eaton, MSN, RN, FNP-BC, ACHPN; Thomas Farley, MS, ACNP; Penelope Firshman, BSc; Andrew Fritschle, PharmD; Clare Holdsworth, BPhys (Hons); Aluko A. Hope, MD, MSCE; Annie Johnson, APRN, ACNP-BC; Michael T. Kenes, PharmD, BCPS, BCCCP; Babar A. Khan, MD, MS; Janet A. Kloos, RN, PhD, APRN-CCNS, CCRN; Erin K. Kross, MD; Pamela Mactavish, BSc Pharm (Hons) MSc.; Joel Meyer, BM BCh DM; Ashley Montgomery-Yates, MD; Tara Quasim, MBChB, MD; Howard L. Saft, MD, MS; Andrew Slack, MBBS, MRCP, EDIC, MD (Res); Joanna Stollings, PharmD, FCCM, FCCP; Gerald Weinhouse, MD; Jessica Whitten, PharmD; Giora Netzer, MD, MSCE; Ramona O. Hopkins, PhD; Mark E. Mikkelsen, MD, MSCE; Theodore J Iwashyna, MD, PhD; and Carla M. Sevin, MD. Publisher or Source: Crit Care Med. Type of Media: Medical Journal Media Originally for: Critical Care Physicians, Nurses and/or Other Critical Care Medical Professionals Country of Origin: Australia Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Objective: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of post-intensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them. Design: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data. Setting: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 23 sites, across three continents. Subjects: Clinicians from 23 sites. Measurement and Main Results: Ten enablers and nine barriers to implementation of ICU follow-up clinics were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of peer support groups were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising. Conclusions: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Survival, Hospitalization Charges and Follow-up Results in Critically Ill Patients Author(s): David J. Cullen, M.D., Linda C. Ferrara, R.N., Burton A. Briggs, M.D., Peter F. Walker, M.D., and John Gilbert, Ph.D. Publisher or Source: The New England Journal of Medicine Type of Media: Medical Journal Media Originally for: Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals Country of Origin: United States Primary Focus of Media: Pre-Use of PICS Designation COVID-19 Related: No Description: In 226 consecutive critically ill primarily postoperative patients, we determined survival and quality of life, hospitalizaron charges, and consumption of blood and blood products. The patients were physiologically unstable and required intensive physician and nursing care. By one month, 123 patients had died (54 percent), 70 were still hospitalized, and 31 were home; only one of 103 survivors had fully recovered. By 12 months, 164 patients (73 per cent) had died, 10 were still hospitalized, and 51were home. Twenty-seven of 64 survivors had fully recovered. Hospitalization charges averaged $14,304 per patient. The total charge for blood and blood fractions was $617,710—21 per cent of the total hospitalization charge; $ 515, 71 (83 per cent) of the blood charge went to 164 nonsurvivors, whereas $101,939 (17 per cent) went to the 62 survivors. These data document the use of increasingly limited resources in the management of critically ill patients. The medical profession must make difficult decisions to allocate these resources effectively. (N Engl J Med 269:982-987,1976) To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Posttraumatic Stress Disorder in General Intensive Care Unit Survivors: A Systematic Review Author(s): Dimitry S. Davydow, M.D.,* Jeneen M. Gifford, M.D., Sanjay V. Desai, M.D., Dale M. Needham, M.D., Ph.D., and O. Joseph Bienvenu, M.D., Ph.D. Publisher or Source: General Hospital Psychiatry Type of Media: Medical Journal Media Originally for: Nurses and/or Other Critical Care Medical Professionals, Critical Care Physicians Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD, and the impact of post-ICU PTSD on health-related quality of life (HRQOL). To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.

Click to Return to Search Page VIEW SELECTED LIBRARY MEDIA Name of Media: Post-sepsis syndrome–an evolving entity that afflicts survivors of sepsis Author(s): Zachary Mostel, Abraham Perl, Matthew Marck, Syed F. Mehdi, Barbara Lowell, Sagar Bathija, Ramchandani Santosh, Valentin A. Pavlov, Sangeeta S. Chavan & Jesse Roth Publisher or Source: Molecular Medicine Type of Media: Medical Journal Media Originally for: Critical Care Physicians Country of Origin: United States Primary Focus of Media: Post Intensive Care Syndrome (PICS) COVID-19 Related: No Description: Background The sequelae of sepsis were once thought to be independent of sepsis itself and assumed to be either comorbid to sick patients or complications of critical illness. Recent studies have reported consistent patterns of functional disabilities in sepsis survivors that can last from months to years after symptoms of active sepsis had resolved. Body Post-sepsis syndrome is an emerging pathological entity that has garnered significant interest amongst clinicians and researchers over the last two decades. It is marked by a significantly increased risk of death and a poor health-related quality of life associated with a constellation of long-term effects that persist following the patient’s bout with sepsis. These include neurocognitive impairment, functional disability, psychological deficits, and worsening medical conditions. Conclusion This “post-sepsis syndrome” has been the subject of active preclinical and clinical research providing new mechanistic insights and approaches linked to survivor well-being. Here we review important aspects of these research efforts and goals of care for patients who survive sepsis. To view the PDF, Article, Photo, or Chart, Click Icon: To view the attached Video media file, Click Icon: PostICU, Inc's library staff reviewed this copyrighted material contained in the library and reasonably believes that its inclusion in our library complies with the "Fair Use Doctrine" because: (1) our library's is for nonprofit and educational purposes; (2) the nature of the copyrighted work is related to our mission; (3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole is fair and reasonable; and (4) the potential market for or value of the copyrighted work will if impacted, should be enhanced, by its presence in our library.