Brief description of media:

While experts are still trying to figure out why and how this happens, the reality is that coronavirus survivors appear to be at an increased risk of developing mental health issues even long after recovery.

Brief description of media:

Aggressive reimbursement reform has been an imposing directive for care providers of ICU medicine. Timely knowledge of actual care routines obtained from a large sample of actively practicing physicians should be mandatory when developing any guidelines or practice standards. A questionnaire was therefore designed by the steering committee of the ACCP Council on Critical Care and sent to its members. The 1,294 responses were analyzed for demographics of the individual practitioner, local aspects of ICU staffing and policies, reimbursement, and a specific practice issue, nutrition. The typical respondent was aged 41 to 50 (41 percent), was a pulmonary subspecialist (68 percent), was not critical care certified (55 percent), worked 25 to 50 percent of his or her total time in the ICU (40 percent), and would continue ICU practice despite poor reimbursement (82 percent). Physicians practiced within a group (53 percent), in a 100- to 500-bed hospital (69 percent), with house staff available (60 percent), and predominantly cared for Medicare patients (55 percent). The following data may allow better judgments to be made pertaining to the implementation of care policies in the current ICU environment.

Brief description of media:

It was just a couple of months into the pandemic when patients in online support groups began describing the phenomenon. In some emergency departments, they said, their complaints were largely being dismissed—or at the very least diminished—by health care professionals. The patients felt they were not being heard, or perhaps even were outright disbelieved.

The common thread through these comments was a basic one. Each of the patients had already been infected with COVID-19 and presumably had recovered, yet each was still dealing with symptoms of the disease—sometimes vague, sometimes nonspecific—that simply would not go away. Physicians and nurses, already overloaded with emergent cases of the virus, were baffled, often searching for other, more benign explanations for what they were being told.

Brief description of media:

It was just a couple of months into the pandemic when patients in online support groups began describing the phenomenon. In some emergency departments, they said, their complaints were largely being dismissed—or at the very least diminished—by health care professionals. The patients felt they were not being heard, or perhaps even were outright disbelieved.

The common thread through these comments was a basic one. Each of the patients had already been infected with COVID-19 and presumably had recovered, yet each was still dealing with symptoms of the disease—sometimes vague, sometimes nonspecific—that simply would not go away. Physicians and nurses, already overloaded with emergent cases of the virus, were baffled, often searching for other, more benign explanations for what they were being told.

Brief description of media:

With multiple advances in critical care, more patients are given the chance to survive life-threatening illnesses such as sepsis. This growing cohort of patients, however, grapples with a new challenge – post-intensive care syndrome (PICS). As the condition is increasingly recognized, the number of clinics devoted to helping patients with PICS recover is also on the rise.

Brief description of media:

Evidence-based recommendations on The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters.
In May 2019, we updated this guidance because the Sherlock 3CG software is now also available in the Site Rite v8 ultrasound device. Details of the modifications are explained in the review decision. The update also includes revised cost-saving estimates. New evidence and updated costs identified during the guidance review are denoted as [2019].
Implementation
NICE has developed tools, in association with relevant stakeholders, to help organisations put this guidance into practice.

Adoption support resource

Brief description of media:

NICE has developed a Medtech Innovation Briefing (MIB) on the Space GlucoseControl system for managing blood-glucose in critically ill patients in intensive care.
The Space GlucoseControl system is intended to be used for controlling blood-glucose levels of critically ill patients in intensive care and could be used in place of manual protocols for planning the measurement of blood-glucose levels. The system includes nutrition infusion pumps, an insulin pump, and an algorithm to calculate insulin dosing and blood-glucose measurement intervals.
Medtech Innovation Briefings provide a description of the medical technology, including its likely place in therapy, the costs of using the technology and a critical review of the strengths and weaknesses of the relevant published evidence.
Their purpose is to provide objective information on device and diagnostic technologies to aid local decision-making by clinicians, managers and procurement professionals. By making this information available, NICE helps to avoid the need for NHS organisations to produce similar information for local use.
Medtech Innovation Briefings are not NICE guidance. They differ in format, contain no judgement on the value of the technology and do not constitute a guidance recommendation.
MIBs are commissioned by NHS England and produced in support of the NHS 5 Year Forward View, specifically as one of a number of steps which will accelerate innovation in new treatments and diagnostics.

Brief description of media:

Purpose: Despite advances in medical science, patient death and family bereavement are commonly encountered in adult intensive care units (ICUs). This is the first review to investigate the state of ICU bereavement support globally, and the availability and effectiveness of bereavement support interventions.

Methods: A systematic review and narrative synthesis. Medline, CINAHL Plus, PsycINFO, Web of Science, EMBASE were searched and inclusion/exclusion criteria were applied. Included studies were appraised using relevant appraisal tools.

Results: Fourteen papers formed the review; five of which were international surveys reporting variable bereavement practices and levels of support. A lack of training and resources were identified barriers. Nine papers reported the effectiveness of primarily discrete bereavement support interventions including: a personal memento, a handwritten condolence letter, a post-death meeting; storytelling, research participation, use of an ICU diary. One study evaluated a bereavement follow-up program. Generally, all identified interventions were well accepted by bereaved families.

Conclusions: The reviewed evidence was weak, and findings were contextually bound. As such, it is difficult to make recommendations for the most acceptable and effective bereavement support intervention(s). Bereavement support in ICU needs further exploration and clinicians must be adequately trained and supported for the delivery of evidence-informed, culturally competent care.

Keywords: Bereavement; Intensive care units; Narrative synthesis; Systematic review.

Brief description of media:

Paul Henderson can’t remember the journey to Edinburgh’s Western General Hospital on March 24, 2020, but he knows that he arrived at two in the afternoon and nine hours later he was on a life support machine. His next recollection is waking up in the hospital’s intensive care unit in a frenzied state as doctors explained that his case of Covid-19 was so severe he had been placed in a medically induced coma for 30 days. Slowly, as the medication started to wear off, the full details of his illness were revealed to him by doctors and nurses on the ward.

Henderson came close to dying several times while on the intensive care unit. His colon was perforated, leaking toxins into his bloodstream and causing organ failure. His kidneys stopped working, leaving him strapped to a dialysis machine. Eight blood transfusions were required to replace the blood he lost. He struggled to breathe as his lungs filled with fluid due to acute pneumonia caused by the virus. To help him breathe doctors cut a hole in his throat, inserting a tube to compensate for his weakened respiratory muscles.

The ordeal left him gaunt and weak. He lost 12 kilograms. The muscles in his legs had diminished so much that he struggled to walk two paces. And yet it was the mental impact that troubled him most: the petrifying dreams he had experienced under sedation continued to haunt him. “The delirium was terrifying, I had very disturbing dreams and as far as I was aware they were real,” Henderson says. “[I thought] my wife had left me because she was having an affair. Then she shot herself in a wood. I could still hear the screams.”

The delusions were constant. At one point Henderson felt he was floating above a table in a white room with a friend who had died from cancer three years earlier. Another time he imagined he was drowning in the hull of a boat alongside his brother who had been killed by a drunk driver 14 years ago. Then he saw a close friend being kidnapped by the Ulster Volunteer Force and shot in the back of the head.

Brief description of media:

A 33-item Trauma Symptom Checklist (TSC-33) is presented, and the psychometric properties of this scale are summarized from four separate studies. Developed to assess the impact of childhood abuse on later (adult) functioning, the TSC-33 consists of five subscales (Dissociation, Anxiety, Depression, Post-Sexual Abuse Trauma-hypothesized [PSAT-h], and Sleep Disturbance) and a total scale score. Data suggest that the TSC-33 and its associated subscales are reasonably reliable measures that display some predictive and discriminative validity with regard to childhood sexual abuse. Other variables appear to elevate checklist scores as well, however, such as physical abuse history and mental health client status, although apparently not gender.

Brief description of media:

This report will examine the published scientific evidence regarding the safety and efficacy of inhaled nitric oxide in the management of hypoxemic respiratory failure in adult acute respiratory distress syndrome patients. The goal of this project is to produce new insights on the use of this experimental therapy.
Therefore, the information provided within this document may provide the impetus and support for optimizing the use of this therapy in other jurisdictions. 

Brief description of media:

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

Predictive logistic equation of risk of active treatment using an acute physiology and chronic health evaluation (APACHE II and III) prognostic system for allocation to an intermediate care unit as opposed to intensive care unit (ICU) by monitoring patients with low risk of requiring life supporting treatment.