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Adult ICU patients routinely experience pain, both at rest and with routine ICU care such as procedures or wound care. Lack of treatment of pain can result in many complications including delirium. The PADIS Guidelines suggest that pain be routinely monitored in all adult ICU patients. Self- reporting is the gold standard for assessment of pain. Vital signs should not be used alone for assessment of pain in patients that are unable to communicate. The Behavioral Pain Scale (BPS) and the Critical‐Care Pain Observation Tool (CPOT) are the most valid and reliable behavioral pain scales for assessing pain in adult, ICU patients unable to communicate pain.

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The Confusion Assessment Method (CAM) was created in 1990, and it was intended to be a bedside assessment tool usable by non-psychiatrists by Dr. Sharon Inouye to assess for delirium.6 The CAM-ICU is an adaptation of this tool for use in ICU patients (e.g., critically ill patients on or off the ventilator). Delirium is defined in terms of four diagnostic features and is deemed positive when Feature 1 and Feature 2 and either Feature 3 or 4 are present (see CAM-ICU schematic on next page). The CAM-ICU is one of the recommended ICU delirium screening tools.

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We tend to make sense of sickness by ascribing levels to it, like medals in Olympic boxing: There’s featherweight “I’m under the weather,” a welterweight “ghastly ill.” And then there’s the super heavyweight, an opponent that actually scares you. Few people have to face off with this kind of illness. I have. Which may be why, as I scan through the daily news about the coronavirus, I tend to skip the stats on how many have died, the ventilators we don’t have, the politics, the quarantines, the jobs lost, even the bread-baking. Instead, I find myself drifting into the minds of those souls strapped to gurneys in the hallway, encased in a macramé of tubes and wires, fighting for each breath. These are the ones facing the super heavyweight. Some of them will die. But the ones I think about are the ones who will survive. Because I’ve been there. I know that getting off the ventilator won’t be the end of the story. And I know that not being sick doesn’t mean you’re well.

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This short article is written “from the inside”: from the perspective of someone who has spent weeks in an intensive care unit (ICU) with acute respiratory distress syndrome, severe sepsis, and multiple organ failure. My life was saved by highly skilled and compassionate physicians and nurses. I am also an academic philosopher and I was struck by how certain assumptions made by these physicians and nurses might be improved. I offer the following suggestions about patient autonomy and about the transition out of the ICU against a background of profound gratitude and respect for those who work in critical care.

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The CPOT includes evaluation of four different behaviors (facial expressions, body movements, muscle tension, and compliance with the ventilator for mechanically ventilated patients or vocalization for nonincubated patients) rated on a scale of zero to two with a total score ranging from 0 to 8. The CPOT is feasible, easy to complete, and simple to understand.

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Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (UPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large-scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.

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A guide to using and understanding the Family and Medical Leave Act.

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A comprehensive functional assessment requires thorough and careful inquiry, which is difficult to accomplish in most busy clinical practices. This paper examines the reliability and validity of the Functional Status Questionnaire (FSQ), a brief, standardized, self-administered questionnaire designed to provide a comprehensive and feasible assessment of physical, psychological, social and role function in ambulatory patients. The FSQ can be completed and computer-scored in minutes to produce a one-page report which includes six summated-rating scale scores and six single-item scores. The clinician can use this report both to screen for and to monitor patients" functional status. In this study, the FSQ was administered to 49? regular users of Boston's Beth Israel Hospital's Healthcare Associates and 656 regular users of 76 internal medicine practices in Los Angeles. The data demonstrate that the FSQ produces reliable sub-scales with construct validity. The authors believe the FSQ addresses many of the problems behind the slow diffusion into primary care of systematic functional assessment.

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Many patients who are discharged from the Intensive Care Unit (ICU) frequently suffer health problems long after they've left the hospital. The patient and their loved ones are often puzzled as to why, having survived a critical illness, that the former ICU patient is unable to work, enjoy activities, gain weight, and/or regain happiness after leaving the hospital. In researching this topic, I was alarmed at the number of individuals who are plagued by a profound range of serious mental health issues coupled with prolonged physical weakness.

The purpose of this piece is to bring attention to the widespread incidence of post-ICU depression and mental health and to encourage education and networking of professionals interested in assisting post-ICU patients and their caregivers. Hopefully, information contained in the article will provide caregivers and loved ones of former ICU patients with practical suggestions on how to initiate a successful dialog with a variety of health care professionals and mental health providers to ensure that the post-ICU care received results in the best possible outcome.

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Over the last 15 years the management of patients admitted in the ICU has changed dramatically. A growing number of well-designed randomized controlled studies have been published, resulting in improved medical care and reduction of short-term morbidity and mortality. Despite these important achievements, little attention has been placed on the long-term complications of subjects discharged from the ICU. This review will focus on the most common long-term outcomes post-ICU admission and will emphasize the importance of developing ICU clinics to provide comprehensive care to ICU survivors. We also describe our experience regarding the organization, functioning, and limitations for the development of our post-ICU clinic.

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This study aimed to assess whether interventions targeted at improving sleep in the ICU were associated with reductions in ICU delirium. Secondary outcomes include duration of delirium and ICU length of stay.

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Despite reduced mortality and increasing survival rate of ICU treatment, a large group of patients surviving the ICU have a variety of complaints. Survivors of critical illness can undergo dramatic changes in their lives as a result of their experience, with many having some form of deficit in one or more domains of physical, psychological or cognitive functioning. There is still much to learn about the magnitude of the so-called Post ICU Syndrome (PICS) in patients surviving in the ICU.