Characteristics of the participant ICU settings.

Aims and objectivesThe study aim was to explore the use of an Intensive Care Unit (ICU) diary within four different ICUs units in Sweden and thereby contribute to practice guidelines regarding the structure, content and use of an ICU diary.BackgroundICU diaries are used to aid psychological recovery among critical care patients, but differences remain in diary writing both within and across countries. Few studies have focused on the combined views and experiences of ICU patients, family members and nursing staff about the use of ICU diaries.DesignAn instrumental multiple case study design was employed.MethodsThree focus groups interviews were carried out with 8 former patients and their family members (n = 5) from the research settings. Individual interviews were carried out with 2 patients, a family member and a nurse respectively. Observations, field notes, documentary analysis and conversations with nursing staff were also conducted. Consolidated criteria for reporting qualitative research (COREQ) was followed.ResultsThe qualitative findings firstly consisted of a matrix and descriptive text of the four ICU contexts and current practices. This highlighted that there were similarities regarding the aims and objectives of the diaries. However, differences existed across the case study sites about how the ICU diary was developed and implemented. Namely, the use of photographs and when to commence a diary. Second, a thematic analysis of the qualitative data regarding patients’ and family members’ use of the ICU diary, resulted in four themes: i) the diary was used to take in and fully understand the situation; ii) the diary was an opportunity to assimilate warm, personalised and human care; iii) the diary was used to manage existential issues; and iv) the diary was a tool in daily activities.ConclusionsAnalysis of the instrumental case study data led to the identification of core areas for inclusion in ICU diary practice guidelines.</div

Core themes from the qualitative analysis of interview findings and text message of participant patients and their family members.

Core themes from the qualitative analysis of interview findings and text message of participant patients and their family members.</p

Description of focus group interview participants.

Description of focus group interview participants.</p

Study protocol for instrumental multiple case study.

Study protocol for instrumental multiple case study.</p

Matrix of current ICU diary practices in the four study settings.

Matrix of current ICU diary practices in the four study settings.</p

Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups.

Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups.</p

Annotation clusters of genes up-regulated at Day 5 identified by DAVID.

<p>Annotation clusters of genes up-regulated at Day 5 identified by DAVID.</p

List of selected genes in the synapse category differentially expressed at Day 5 of motor skill learning.

<p>List of selected genes in the synapse category differentially expressed at Day 5 of motor skill learning.</p

Differentially expressed genes were grouped into functional clusters related to the synapse, the fibroblast growth factor family, and other processes.

<p><i>A,</i> The genes up-regulated at 5 days were grouped into 13 significantly enriched annotation clusters (p<0.01) using the DAVID bioinformatics resources. These clusters were then further condensed into 5 categories depending on the biological relationships between the clusters' annotation terms. Each of the five circles shown here represents one gene category. The area of the circle is directly proportional to the number of genes in that category. The thickness of the line connecting any two circles is proportional to the degree of overlap between the connected categories, indicated by the percentage of genes in the smaller of the two that are also present in the other. <i>B</i>, To estimate the effect of tightening the criterion for selecting differentially expressed genes on the rate of false positives, we successively increased our fold-change threshold from 1.5, to 1.75, and then 2.0 fold, and examined, at each threshold, the proportion of genes categorized into functionally enriched clusters. The percentages of genes remaining in any clusters (dark grey bars) and in the synapse category (black bars) were relatively unchanged as the fold-change threshold was increased. Assuming that the “true” proportion of "clusterable" genes is itself independent of the fold-change threshold, this observation implies that the false positive rate would probably not be much lower even with a more stringent fold-change threshold. DEG, differentially expressed genes.</p

A nontrivial forelimb reach-and-grasp task for the rat.

<p>Adult rats were trained to perform either a forelimb reach-and-grasp task (<i>Reach</i> groups) or a sham version of the task (<i>Sham</i> groups) for either 5 days (<i>Reach</i>, N = 4; <i>Sham</i>, N = 4) or 12 days (<i>Reach</i>, N = 4; <i>Sham</i>, N = 4) before tissue harvest. <i>A</i>, Behavioral setup for the <i>Reach</i> groups. In each trial a food pellet was placed at one of six possible slots arranged in three rows at different distances from the animal (near, mid, and far slots) and two columns that were ipsilateral and contralateral to the animal's preferred limb, respectively. The task goal was to reach and grasp the pellet using the preferred limb with single or multiple reaches. A reach was defined to be any hand trajectory from the box to the shelf area that crossed the border between the box and shelf (indicated by the thick black horizontal line), and then back to the box by crossing the same line. <i>B</i>, Behavioral setup for the <i>Sham</i> groups. In each trial the pellet was placed in the slit. Because the pellet was easily accessible, the rat naturally retrieved the reward with its tongue without using its forelimb. In all groups, the animal was conditioned to initiate a new trial by turning down either the left (left-handed rats, dotted-line arrows) or right (right-handed rats, solid-line arrows) aisle from the central aisle.</p