375 research outputs found
Physical outcome measure for critical care patients following intensive care discharge
Introduction: The aim of this study was to evaluate the most suitable
physical outcome measures to be used with critical care patients following
discharge. ICU survivors experience physical problems
such as reduced exercise capacity and intensive care acquired
weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends
the use of outcome measures however does not provide
any specific guidance. A recent Cochrane review noted wide variability
in measures used following ICU discharge (2).
Methods: Discharged ICU patients attended a five week multidisciplinary
programme. Patients’ physical function was assessed during
the programme, at 6 months and 12 months post discharge. Three
outcome measures were included in the initial two cohorts. The Six
Minute Walk Test (6MWT) and the Incremental Shuttle Walk test
(ISWT) were chosen as they have been used within the critical care
follow up setting (2). The Chester Step Test (CST) is widely thought
to be a good indicator of ability to return to work (one of the programmes
primary aims). Ethics approval was waived as the
programme was part of a quality improvement initiative.
Results: Data was collected for the initial patients attending the
programme (n = 13), median age was 52 (IQR = 38-72), median ICU
LOS was 19 days (IQR = 4-91), median APACHE II was 23 (IQR = 19-41)
and 11 were men. One patient was so physically debilitated that the
CST or ISWT could not be completed however a score was achieved
using the 6MWT. Another patient almost failed to achieve level 1 of
the ISWT. Subsequent patients for this project (total n = 47) have all
therefore been tested using the 6MWT. Good inter-rater and intrarater
reliability and validity have been reported for the 6MWT (3).
Conclusions: Exercise capacity measurement is not achievable for
some patients with either the ISWT or the CST due to the severity of
their physical debilitation. Anxiety, post-traumatic stress disorder and
depression are common psychological problems post discharge (4),
therefore using a test with a bleep is not appropriate. Therefore, the 6MWT is the most appropriate physical outcome measure to be used
with critical care patients post discharge
Classification of pain and its treatment at an intensive care rehabilitation clinic
Introduction
Treatment in an Intensive Care Unit (ICU) often necessitates uncomfortable
and painful procedures for patients throughout their admission.
There is growing evidence to suggest that chronic pain is
becoming increasingly recognised as a long term problem for patients
following an ICU admission [1]. Intensive Care Syndrome: Promoting
Independence and Return to Employment (InS:PIRE) is a five
week rehabilitation programme for patients and their caregivers after
ICU discharge at Glasgow Royal Infirmary. This study investigated the
incidence and location of chronic pain in patients discharged from ICU
and classified the analgesics prescribed according to the World Health
Organization analgesic
Methods
The InS:PIRE programme involved individual sessions for patients and
their caregivers with a physiotherapist and a pharmacist along with
interventions from medical, nursing, psychology and community services.
The physiotherapist documented the incidence and pain location
during the assessment. The pharmacist recorded all analgesic medications
prescribed prior to admission and at their clinic visit. The patient’s
analgesic medication was classified according to the WHO pain ladder
from zero to three, zero being no pain medication and three being
treatment with a strong opioid. Data collected was part of an evaluation
of a quality improvement initiative, therefore ethics approval was
waived.
Results
Data was collected from 47 of the 48 patients who attended the rehabilitation
clinic (median age was 52 (IQR, 44-57) median ICU LOS
was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of
the patients were men (67 %)). Prior to admission to ICU 43 % of patients
were taking analgesics and this increased to 81 % at the time
of their clinic visit. The number of patients at step two and above on
the WHO pain ladder also increased from 34 % to 56 %.
Conclusions
Of the patients seen at the InS:PIRE clinic two-thirds stated that they
had new pain since their ICU admission. Despite the increase in the
number and strength of analgesics prescribed, almost a quarter of
patients still complained of pain at their clinic visit. These results confirm
that pain continues to be a significant problem in this patient
group. Raising awareness in primary care of the incidence of chronic
pain and improving its management is essential to the recovery
process following an ICU admission
Pharmacy intervention at an intensive care rehabilitation clinic
Introduction: During an intensive care stay, patients often have their
chronic medications withheld for a variety of reasons and new drugs
commenced [1]. As patients are often under the care of a number of
different medical teams during their admission there is potential for
these changes to be inadvertently continued [2]. Intensive Care Syndrome:
Promoting Independence and Return to Employment (InS:PIRE)
is a five week rehabilitation programme for patients and their
caregivers after ICU (Intensive Care Unit) discharge at Glasgow Royal
Infirmary. Within this programme a medication review by the critical
care pharmacist provided an opportunity to identify and resolve any
pharmaceutical care issues and also an opportunity to educate patients
and their caregivers about changes to their medication.
Methods: During the medication review we identified ongoing
pharmaceutical care issues which were communicated to the patient’s
primary care physician (GP) by letter or a telephone call. The patients
were also encouraged to discuss any issues raised with their GP. The
significance of the interventions was classified from those not likely to
be of clinical benefit to the patient, to those which prevented serious
therapeutic failure.
Results: Data was collected from 47 of the 48 patients who attended
the clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15
(IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients
were men (67%). The pharmacist made 69 recommendations;
including 20 relating to drugs which had been withheld and not
restarted, dose adjustments were suggested on 13 occasions and
new drug recommendations were made for 10 patients. Duration of treatment for new medications started during hospital admission
was clarified on 12 occasions. Lastly adverse drug effects were reported
on 4 occasions and the incorrect drug was prescribed on 2
occasions. Of the interventions made 58% were considered to be of
moderate to high impact.
Conclusions: The pharmacist identified pharmaceutical care issues
with 18.6% of the prescribed medications. Just over half of the patients
reported that they were not made aware of any alterations to
their prescribed medication on discharge. Therefore a pharmacy
intervention is an essential part of an intensive care rehabilitation
programme to address any medication related problems, provide
education and to ensure patients gain optimal benefit from their
medication
Neutrino mass constraint from CMB and its degeneracy with other cosmological parameters
We show that the cosmic microwave background (CMB) data of WMAP can give
subelectronvolt limit on the neutrino mass: m_nu < 0.63 eV (95% CL). We also
investigate its degeneracy with other cosmological parameters. In particular,
we show the Hubble constant derived from the WMAP data decreases considerably
when the neutrino mass is a few times 0.1 eV.Comment: 3 pages, 2 figures, prepared for the TAUP2007 Proceeding
Deposit-feeding sea cucumbers enhance mineralization and nutrient cycling in organically-enriched coastal sediments
Bioturbators affect multiple biogeochemical interactions and have been suggested as suitable candidates to mitigate organic matter loading in marine sediments. However, predicting the effects of bioturbators at an ecosystem level can be difficult due to their complex positive and negative interactions with the microbial community
Conceptual model of sport-specific classification for para-athletes with intellectual impairment
The present paper describes the conceptual basis of evidence-based classification of para-athletes with intellectual impairment (II). An extensive description of the theoretical and conceptual foundation of the system as currently conceived is provided, as are examples of its applications in the three sports included in the Paralympic programme for II-athletes in 2020 (i.e., athletics, swimming and table tennis). Evidence based classification for II-athletes is driven by two central questions: i. How can intellectual impairment be substantiated in a valid and reliable way, and ii. Does intellectual impairment limit optimal sport proficiency? Evolution of the system and current best practice for addressing these questions are described, and suggestions for future research and development are provided. Challenges of understanding and assessing a complex (multifaceted and intersectional) impairment in the context of sport also are considered
EChOSim: The Exoplanet Characterisation Observatory software simulator
EChOSim is the end-to-end time-domain simulator of the Exoplanet
Characterisation Observatory (EChO) space mission. EChOSim has been developed
to assess the capability EChO has to detect and characterize the atmospheres of
transiting exoplanets, and through this revolutionize the knowledge we have of
the Milky Way and of our place in the Galaxy. Here we discuss the details of
the EChOSim implementation and describe the models used to represent the
instrument and to simulate the detection. Software simulators have assumed a
central role in the design of new instrumentation and in assessing the level of
systematics affecting the measurements of existing experiments. Thanks to its
high modularity, EChOSim can simulate basic aspects of several existing and
proposed spectrometers for exoplanet transits, including instruments on the
Hubble Space Telescope and Spitzer, or ground-based and balloon borne
experiments. A discussion of different uses of EChOSim is given, including
examples of simulations performed to assess the EChO mission
Cosmic Microwave Background Polarization
Cosmic microwave background (CMB) anisotropy is our richest source of
cosmological information; the standard cosmological model was largely
established thanks to study of the temperature anisotropies. By the end of the
decade, the Planck satellite will close this important chapter and move us
deeper into the new frontier of polarization measurements. Numerous
ground--based and balloon--borne experiments are already forging into this new
territory. Besides providing new and independent information on the primordial
density perturbations and cosmological parameters, polarization measurements
offer the potential to detect primordial gravity waves, constrain dark energy
and measure the neutrino mass scale. A vigorous experimental program is
underway worldwide and heading towards a new satellite mission dedicated to CMB
polarization.Comment: Review given at TAUP 2005; References added; Additional reference
Enhancement of vaccinia virus based oncolysis with histone deacetylase inhibitors
Histone deacetylase inhibitors (HDI) dampen cellular innate immune response by decreasing interferon production and have been shown to increase the growth of vesicular stomatitis virus and HSV. As attenuated tumour-selective oncolytic vaccinia viruses (VV) are already undergoing clinical evaluation, the goal of this study is to determine whether HDI can also enhance the potency of these poxviruses in infection-resistant cancer cell lines. Multiple HDIs were tested and Trichostatin A (TSA) was found to potently enhance the spread and replication of a tumour selective vaccinia virus in several infection-resistant cancer cell lines. TSA significantly decreased the number of lung metastases in a syngeneic B16F10LacZ lung metastasis model yet did not increase the replication of vaccinia in normal tissues. The combination of TSA and VV increased survival of mice harbouring human HCT116 colon tumour xenografts as compared to mice treated with either agent alone. We conclude that TSA can selectively and effectively enhance the replication and spread of oncolytic vaccinia virus in cancer cells. © 2010 MacTavish et al
Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention
Background:
Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors.
Methods:
Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008–2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID.
Results:
40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07–0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15).
Conclusions and relevance:
This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further
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