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Experiencing critical illness and intensive care can be extremely stressful. Roughly 1 in 5 critical illness survivors have clinically significant post-traumatic stress disorder (PTSD) symptoms in the year after intensive care, according to an article in press in the journal Critical Care Clinics.

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The PTSD scoring system

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John Hopkins Medicine: The researchers found that 66 of the 186 patients (35 percent) had clinically significant symptoms of PTSD, with the greatest apparent onset occurring by the initial, three-month follow-up visit. Sixty-two percent of the survivors who developed PTSD still had symptoms at their two-year visit. Half of this same group was taking psychiatric medications, and 40 percent had seen a psychiatrist in the two years since being hospitalized with ALI.

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Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge.

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Introduction
Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge.

Methods
A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated.

Results
300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).

Conclusions
Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity, and the requirement for ongoing health care support.

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Aim: To describe a randomized controlled trial protocol designed to evaluate the effectiveness of mobile health based Preterm Home Care Program (mHealthPHCP) known as "NeoRaksha" mobile health application in improving parent-infant-interaction, growth, and development of preterms.

Design: A prospective, randomized controlled clinical trial. The protocol is approved and funded by Department of Biotechnology, Government of India on 2 August 2016.

Methods: A total of 300 preterm-mother dyads admitted to neonatal intensive care unit of a tertiary care hospital will be recruited and randomized to intervention and control group. The intervention group would receive mobile health based Preterm Home Care Program and the control group would receive standard preterm care. Intervention group will be followed up at home by community health workers known as Accredited Social Health Activist who will be trained in using the NeoRaksha mobile health application. Preterms outcomes will be assessed during follow-up at hospital.

Discussion: Supporting continuity of preterm care is vital as parents and preterms experience transition from Neonatal Intensive Care unit to their home. Empowering mothers and community health workers by integrating mobile technology into health care can help promote healthy preterms, enhance development outcomes and follow-up, which in turn can reduce the mortalities, morbidities, and disabilities associated with prematurity.

Impact: The results of this study could open up new horizons in integrating hospital and home-based preterm care through technology, which paves way to scale up the model across the countries.

Keywords: India; community health worker; development; growth; mHealth; mobile health application; mother-infant interaction; nursing; premature infants; preterm home care.

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Methods: We conducted a large survey among French ICUs to evaluate their visiting policies and how information was provided to patient’s family. A questionnaire was built up by intensivists and nurses. French ICUs were solicited, and the questionnaire was sent to all participating ICUs, for being filled in by the unit medical and/or nursing head. Data regarding the hospital and ICU characteristics, the visiting policy and procedures, and the management of family information were collected.

Results: Among the 289 French ICUs, 188 (65%) participated. Most ICUs have a waiting room 118/188 (62.8%) and a dedicated room for meeting the family 152/188 (80.8%). Of the 188 ICUs, 45 (23.9%) were opened on a 24‑h‑a‑day basis. In the remaining ICUs, the time period allowed for visits was 4.75±1.83h (median 5h). In ICUs where visiting restrictions were reported, open visiting was allowed for end‑of‑life situations in 107/143 (74.8%). Children are allowed to visit a patient in 164/188 (87.2%) regardless of their age in 97/164 (59.1%) of ICUs. Families received an information leaflet in 168/188 (89.3%). Information was provided to families through structured meetings in 149/188 (79.2%) of ICUs at patient admission with participation of nurses and nursing assistants in 133/188 (70.4%) and 55/188 (29.2%), respectively. Information delivered to the family was reported in the patient chart by only 111/188 ICUs (59%). Participation in care was infrequent.

Conclusions: Although French ICUs do not follow the consensus recommendations, slow progress exists com‑pared to previous reports. Implementation of these recommendations is largely needed to offer better welcome and information improvement. Further studies on that topic would enable evaluating remaining obstacles and increasing caregivers’ awareness, both critical for further progresses on that topic.

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Most major decisions in the intensive care unit (ICU) regarding goals of care are shared by clinicians and someone other than the patient. Multicenter clinical trials focusing on improved communication between clinicians and these surrogate decision makers have not reported consistently improved outcomes.

We suggest that acquired maladaptive reasoning may contribute importantly to failure of the intervention strategies tested to date. Surrogate decision makers often suffer significant psychological morbidity in the form of stress, anxiety, depression, and post-traumatic stress disorder. Family members in the ICU also suffer cognitive blunting and sleep deprivation. Their decision-making abilities are eroded by anticipatory grief and cognitive biases, while personal and family conflicts further impact their decision making.

We propose recognizing a family ICU syndrome to describe the morbidity and associated decision-making impairment experienced by many family members of patients with acute critical illness (in the ICU) and chronic critical illness (in the long-term, acute care hospital). Research rigorously using models of compromised decision making may help elucidate both mechanisms of impairment and targets for intervention. Better quantifying compromised decision making and its relationship to poor outcomes will allow us to formulate and advance useful techniques.

The use of decision aids and improving ICU design may provide benefit now and in the near future. In measuring interventions targeting cognitive barriers, clinically significant outcomes, such as time to decision, should be considered. Statistical approaches, such as survival models and rank statistic testing, will increase our power to detect differences in our interventions.

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Ill health affects people in different ways. As you have been unwell it may take some time to feel your normal self again. The length of time this takes will depend on the illness you have had; how long you have been ill for; how much weight you may have lost and other factors individual to you. Many people experience both physical and emotional changes, while others experience very little. Research shows that because of a lack of memory of the illness while in intensive care, patients find it difficult to understand why it takes so long to return to normal. This booklet aims to give you information about what to expect following a period of critical illness and some advice on how to help your recovery and rehabilitation both in hospital and when you go home.

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The Intensive Care Unit (ICU) is situated in the Ulster Hospital in Dundonald, Belfast. The hospital is the major acute hospital for the South Eastern Health and Social Care Trust and delivers a full range of acute services for the population. Staff had noticed that ICU patients and their relatives returning to the follow up clinic were describing concerning issues including nightmares, sleep deprivation, hallucinations and flashbacks. These contributed to them being unable to adjust to being home and leading a regular family life, creating stress for both the patient and their family. To build on the work of the follow up clinic and to further improve the psychological support for patients, staff thought that a possible solution was the introduction of patient diaries.

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Patients with COVID-19 are staying longer than the average three to four days in the intensive care unit (ICU), says Megan Hosey , a rehabilitation psychologist at The Johns Hopkins Hospital’s medical ICU. This puts them at greater risk for developing post-intensive care syndrome (PICS) — physical, cognitive, and psychological changes that occur after surviving an illness or injury that requires treatment in the ICU.

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Patients with COVID-19 are staying longer than the average three to four days in the intensive care unit (ICU), says Megan Hosey, a rehabilitation psychologist at The Johns Hopkins Hospital’s medical ICU. This puts them at greater risk for developing post-intensive care syndrome (PICS) — physical, cognitive, and psychological changes that occur after surviving an illness or injury that requires treatment in the ICU.