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Complex trauma is still a relatively new field of psychology. Complex post-traumatic stress disorder (C-PTSD) results from enduring complex trauma.

Complex trauma is ongoing or repeated interpersonal trauma, where the victim is traumatized in captivity, and where there is no perceived way to escape. Ongoing child abuse is captivity abuse because the child cannot escape. Domestic violence is another example. Forced prostitution/sex trafficking is another.

Complex PTSD is a proposed disorder which is different to post-traumatic stress disorder. Many of the issues and symptoms endured by complex trauma survivors are outside of the list of symptoms within the (uncomplicated) PTSD diagnostic criterion. Complex PTSD does acknowledge and validate these added symptoms.

The impact of complex trauma is very different to a one time or short-lived trauma. The effect of repeated/ongoing trauma – caused by people – changes the brain, and also changes the survivor at a core level. It changes the way survivors view the world, other people and themselves in profound ways.

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The impact of complex trauma is very different to a one time or short-lived trauma. The effect of repeated/ongoing trauma – caused by people – changes the brain, and also changes the survivor at a core level. It changes the way survivors view the world, other people and themselves in profound ways.
This article provides some of the symptoms and impact most felt by complex trauma survivors.

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When the first cases of COVID-19 were first identified in Wuhan, China over nine months ago, medical experts were focused on the immediate symptoms of the virus—including shortness of breath, fever, lack of sense of smell or taste, and dry cough. However, several months into the pandemic, they began to notice that while the majority of those infected with the virus made a complete recovery, others were still suffering months later.
Joseph Berger, a neurologist at the Perelman School of Medicine at the University of Pennsylvania, and his colleagues at Penn Medicine have been following up with patients who struggle to return to full health—aka "long haulers"—through their Post-COVID Recovery Clinic, treating their prolonged symptoms and the damage the virus has wreaked on the body. In a paper published by the University, they detail 9 of the long-term symptoms. Read on to discover what symptoms to look out for. Read on, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.

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Post-intensive care syndrome (PICS), a condition found in survivors of critical illness, is characterized by persistent physical, cognitive, and psychological sequelae that impact the quality of life after discharge from an intensive care unit (ICU). At present, there are no International Classification of Disease (ICD) billing codes for this condition. Without financial alignment, clinicians cannot diagnose PICS, hindering tracking of its prevalence and impeding policy development for this condition. Clinicians should be screening for PICS in all survivors of critical illness, particularly those with acute respiratory distress syndrome (ARDS).
Results from single-center studies suggest over 75 percent of ARDS survivors develop PICS. With nearly 5 percent of patients with COVID-19 requiring ICU admission for ARDS, it is important for clinicians to be able to diagnose PICS in survivors, and researchers to be able to track it. Member states should impress upon the World Health Organization to create ICD-10 codes for PICS.

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This competence based framework was developed as part of the APCP's competence project by a working party from the APCP Neonatal Committee and updated in 2015 by Adare Brady and Peta Smith.  The essential competencies were developed by a panel of specialist neonatal and paediatric physiotherapists from clinical, research, and academic settings whose goal was to establish the basis by which to prepare the paediatric physiotherapy workforce to deliver safe, quality, standardised, competent, family-focused care to neonates within the Neonatal Intensive Care, High Dependency and Special Care setting and in follow-up in the Community after discharge.

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Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Alfentanil with propofol versus morphine with midazolam for the sedation of critically ill patients.

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Background: In the current meta-analysis, we focus on the exploration of percutaneous catheter drainage (PCD) in terms of its overall safety as well as efficacy in the treatment of infected pancreatitis necrosis based on qualified studies.

Methods: The following electronic databases were searched to identify eligible studies through the use of index words updated to May 2018: PubMed, Cochrane, and Embase. Relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI) were utilized for the main outcomes.

Results: A total of 622 patients in the PCD group and 650 patients in the control group from 13 studies were included in the present meta-analysis. The aggregated results indicated that the incidence of bleeding was decreased significantly (RR: 0.42, 95% CI: 0.25-0.70) in the PCD group as compared with the control group. In addition, PCD decreased the mortality (RR: 0.76, 95% CI: 0.41-1.42), hospital duration (SMD: -0.22, 95% CI: -0.77 to -0.33), duration in intensive care unit (ICU) (SMD: -0.13, 95% CI: -0.30 to -0.04), pancreatic fistula (RR: 0.73, 95% CI: 0.46-1.17), and organ failure (RR: 0.91, 95% CI: 0.45-1.82) in comparison with the control group, but without statistical significance.

Conclusion: Our findings provide evidence for the treatment effect of PCD in the decrease of bleeding, mortality, duration in hospital and ICU, pancreatic fistula, organ failure as compared with the surgical treatment. In conclusion, further studies based on high-quality RCTs with larger sample size and long-term follow-ups are warranted for the confirmation of PCD efficacy in treating infected pancreatitis necrosis.

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Nathan Maryn walks in the post-surgical intensive care unit at The Johns Hopkins Hospital with his wife, Barbara Maryn, and Jennifer Sahm, a physical therapist. A nurse followed with a chair in case he became unsteady. Exercise in the ICU is associated with better long term outcomes.
One woman left Johns Hopkins' intensive-care unit believing her husband and nurse had been plotting to kill her. Another ICU patient had flashbacks of hospital walls covered in blood. A third had visions of big spiders riding bicycles in her room. Suddenly, a favorite hobby, gardening, felt creepy.
Doctors used to think patients returned to normal after the delusions and hallucinations of ICU delirium stopped. They're learning instead that some leave the hospital with terrifying false memories, often of being assaulted or imprisoned. The horrible visions help explain why a recent Johns Hopkins study found that one in four patients had post-traumatic stress symptoms two years after going home.

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A crisis is silently brewing in hospitals around the world, and it may not be exactly what you think. While the numbers of COVID-19 cases and deaths continue to swell, the very treatments used to battle this deadly disease are triggering life-altering mental health effects.

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Post-hospital medical resource use among ICU
survivors is substantial, although similar to that after non-ICU
hospitalization. Although the fraction of survivors unable to
live independently was small, a larger fraction required home
care services. Identifying post-hospital supports needed by ICU
survivors can be useful for policy makers and others responsible
for healthcare planning.

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Rationale: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few intensive care units (ICUs).
Objectives: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs.
Methods: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a 9-year period, we assessed ICU, hospital, 30-day, and 180-day mortality rates; ICU and hospital lengths-of-stay; post-hospital use of hospital care, ICU care, outpatient physician care, medications, and home care; and post-hospital residence location. We explored data stratified by age, sex, and separate categories of geocoded income for urban and rural residents. For post-hospital use variables we compared ICU patients with those admitted to hospitals without the need for ICU care.
Measurements and Main Results: After ICU admission there was a high initial death rate, which declined between 30 and 180 days and thereafter remained at the lower value. Hospital mortality was 19.0%, with 21.7% dying within 6 months of ICU admission. Women had higher hospital mortality than men

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Objective: Wearable devices using new technology may be a cost-effective method to assess functional outcomes in survivors of critical illness. Our primary objective was to review the extent to which wearable devices such as smartphones, pedometers, accelerometers and global positioning systems have been used to evaluate outcomes in survivors of an intensive care unit admission.

Design: We included studies of patients surviving an ICU admission and which measured outcomes using wearable devices. We performed a scoping review of studies found by searching the CINAHL, Embase, MEDLINE and PubMed databases.

Results: The seven studies we identified were published in or after 2012 and were predominantly descriptive (n = 6) with one randomised controlled trial. All studies described outcomes in cohorts of relatively few participants (range, 11-51 participants). Duration to follow-up was mostly short, at a median time of 3 months after ICU discharge (range, in-hospital to 27 years). All studies used accelerometers to monitor patient movement: physical activity (n = 5), sleep quality (n = 1), and infant movement (n = 1). The accelerometers were bi-axial (n = 3), uni-axial (n = 2) combined uni-axial (n = 1) and tri-axial (n = 1). Common outcomes evaluated were the number of participants walking for < 30 min/day, mean daily step count and walking speed.

Conclusions: Wearable devices have infrequently been used to measure physical activity in survivors of critical illness and all identified studies were published recently, which suggests that the use of wearable devices for research may be increasing. To date, only accelerometry has been reported, and the wide variation in methodologies used and the outcomes measured limits synthesis of these data.