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A case study regarding a patient with Fibromyalga and Post-traumatic Stress Disorder.

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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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“Wake Up and Breathe” Protocol
Spontaneous Awakening Trials (SATs) + Spontaneous Breathing Trials (SBTs)

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Background: Delirium affects nearly 70% of older adults hospitalized in the intensive care unit (ICU), and many of those will be left with persistent cognitive impairment or dementia. There are no effective and scalable recovery models to remediate ICU-acquired cognitive impairment and its attendant elevated risk for dementia or Alzheimer disease (AD). The Improving Recovery and Outcomes Every Day after the ICU (IMPROVE) trial is an ongoing clinical trial which evaluates the efficacy of a combined physical exercise and cognitive training on cognitive function among ICU survivors 50 years and older who experienced delirium during an ICU stay. This article describes the study protocol for IMPROVE.

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MY FAMILY AND I have needed counseling for psychological trauma stemming from my ICU experience. It wasn’t the car accident itself (which I don’t remember) that caused my post-intensive care syndrome (PICS). It wasn’t even the risk of death, which I overcame. It was the fear I felt in the ICU that created the horrible memories I’ve had such trouble dealing with.

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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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The follow-up of patients who are discharged from intensive care units follows distinct flows in different parts of the world. Outpatient clinics or post intensive care clinics represent one of the forms of follow-up, with more than 20 years of experience in some countries. Qualitative studies that followed up patients in these outpatient clinics suggest more encouraging results than quantitative studies, demonstrating improvements in intermediate outcomes, such as patient and family satisfaction. More important results, such as mortality and improvement in the quality of life of patients and their families, have not yet been demonstrated. In addition, which patients should be indicated for these outpatient clinics? How long should they be followed up? Can we expect an improvement of clinical outcomes in these followed-up patients? Are outpatient clinics cost-effective? These are only some of the questions that arise from this form of follow-up of the survivors of intensive care units. This article aims to review all aspects relating to the organization and performance of post-intensive care outpatient clinics and to provide an overview of studies that evaluated clinical outcomes related to this practice.

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Hundreds of thousands of seriously ill coronavirus patients who survive and leave the hospital are facing a new and difficult challenge:
recovery. Many are struggling to overcome a range of troubling residual symptoms, and some problems may persist for months, years or even the rest of their lives.
Patients who are returning home after being hospitalized for severe respiratory failure from the virus are confronting physical, neurological, cognitive and emotional issues.
And they must navigate their recovery process as the pandemic continues, with all of the stresses and stretched resources that it has brought.
“It’s not just, ʻOh, I had a terrible time in hospital, but thank goodness I’m home and everything’s back to normal,’” said Dr. David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City. “It’s, ʻI just had a terrible time in hospital and guess what? The world is still burning. I need to address that while also trying to sort of catch up to what my old life used to be.’”
It is still too early to say how recovery will play out for these patients. But here is a look at what they are experiencing so far, what we can learn from former patients with similar medical experiences, and the challenges that most likely lie ahead.

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Background. In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage.
Methods. Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R.
Results. The scale demonstrated good test–retest reliability (r ̄0±86), internal consistency (r ̄0±99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects.
Conclusions. The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.

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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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The objectives of the Power point are:
• Compare valid & reliable pain assessment tools
• Identify special challenges to effective pain assessment, prevention, & management
• Integrate effective strategies to prevent & manage pain into everyday clinical practice
• Incorporate evidence from the PAD Guidelines, including Quality of Evidence and Strength of Recommendations

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Drew Patten, who was in the same intensive care unit as Derek Draper tells of the twilight world between life and death where he was convinced doctors were trying to kill him