Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Our main objective is to assess the effectiveness of follow-up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aim to assess the effectiveness in relation to health-related quality of life, mortality, depression and anxiety, post-traumatic stress disorder, physical function, cognitive function, ability to return to work or education and adverse events. Our secondary objectives are, in general, to examine both the various ways that follow-up services are provided and any major influencing factors. Specifically, we aim to explore: the effectiveness of service organisation (physician versus nurse led, face to face versus remote, timing of follow-up service); possible differences in services related to country (developed versus developing country); and whether participants had delirium within the ICU setting

Gyroscopic motion of superfluid trapped atomic condensates

The gyroscopic motion of a trapped Bose gas containing a vortex is studied. We model the system as a classical top, as a superposition of coherent hydrodynamic states, by solution of the Bogoliubov equations, and by integration of the time-dependent Gross-Pitaevskii equation. The frequency spectrum of Bogoliubov excitations, including quantum frequency shifts, is calculated and the quantal precession frequency is found to be consistent with experimental results, though a small discrepancy exists. The superfluid precession is found to be well described by the classical and hydrodynamic models. However the frequency shifts and helical oscillations associated with vortex bending and twisting require a quantal treatment. In gyroscopic precession, the vortex excitation modes $m=\pm 1$ are the dominant features giving a vortex kink or bend, while the $m=+2$ is found to be the dominant Kelvin wave associated with vortex twisting.Comment: 18 pages, 7 figures, 1 tabl

Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors

Background: The intensive care unit (ICU) stay has been linked with a number of physical and psychological sequelae, known collectively as post‐intensive care syndrome (PICS). Specific ICU follow‐up services are relatively recent developments in health systems, and may have the potential to address PICS through targeting unmet health needs arising from the experience of the ICU stay. There is currently no single accepted model of follow‐up service and current aftercare programmes encompass a variety of interventions and materials. There is uncertain evidence about whether follow‐up services effectively address PICS, and this review assesses this. Objectives: Our main objective was to assess the effectiveness of follow‐up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aimed to assess effectiveness in relation to health‐related quality of life (HRQoL), mortality, depression and anxiety, post‐traumatic stress disorder (PTSD), physical function, cognitive function, ability to return to work or education and adverse effects. Our secondary objectives were to examine different models of follow‐up services. We aimed to explore: the effectiveness of service organisation (physician‐ versus nurse‐led, face‐to‐face versus remote, timing of follow‐up service); differences related to country (high‐income versus low‐ and middle‐income countries); and effect of delirium, which can subsequently affect cognitive function, and the effect of follow‐up services may differ for these participants. Search methods: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2017. We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles. Selection criteria: We included randomised and non‐randomised studies with adult participants, who had been discharged from hospital following an ICU stay. We included studies that compared an ICU follow‐up service using a structured programme and co‐ordinated by a healthcare professional versus no follow‐up service or standard care. Data collection and analysis: Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesised findings. We used the GRADE approach to assess the certainty of the evidence. Main results: We included five studies (four randomised studies; one non‐randomised study), for a total of 1707 participants who were ICU survivors with a range of illness severities and conditions. Follow‐up services were led by nurses in four studies or a multidisciplinary team in one study. They included face‐to‐face consultations at home or in a clinic, or telephone consultations or both. Each study included at least one consultation (weekly, monthly, or six‐monthly), and two studies had up to eight consultations. Although the design of follow‐up service consultations differed in each study, we noted that each service included assessment of participants' needs with referrals to specialist support if required. It was not feasible to blind healthcare professionals or participants to the intervention and we did not know whether this may have introduced performance bias. We noted baseline differences (two studies), and services included additional resources (two studies), which may have influenced results, and one non‐randomised study had high risk of selection bias. We did not combine data from randomised studies with data from one non‐randomised study. Follow‐up services for improving long‐term outcomes in ICU survivors may make little or no difference to HRQoL at 12 months (standardised mean difference (SMD) ‐0.0, 95% confidence interval (CI) ‐0.1 to 0.1; 1 study; 286 participants; low‐certainty evidence). We found moderate‐certainty evidence from five studies that they probably also make little or no difference to all‐cause mortality up to 12 months after ICU discharge (RR 0.96, 95% CI 0.76 to 1.22; 4 studies; 1289 participants; and in one non‐randomised study 79/259 deaths in the intervention group, and 46/151 in the control group) and low‐certainty evidence from four studies that they may make little or no difference to PTSD (SMD ‐0.05, 95% CI ‐0.19 to 0.10, 703 participants, 3 studies; and one non‐randomised study reported less chance of PTSD when a follow‐up service was used). It is uncertain whether using a follow‐up service reduces depression and anxiety (3 studies; 843 participants), physical function (4 studies; 1297 participants), cognitive function (4 studies; 1297 participants), or increases the ability to return to work or education (1 study; 386 participants), because the certainty of this evidence is very low. No studies measured adverse effects. We could not assess our secondary objectives because we found insufficient studies to justify subgroup analysis. Authors' conclusions: We found insufficient evidence, from a limited number of studies, to determine whether ICU follow‐up services are effective in identifying and addressing the unmet health needs of ICU survivors. We found five ongoing studies which are not included in this review; these ongoing studies may increase our certainty in the effect in future updates. Because of limited data, we were unable to explore whether one design of follow‐up service is preferable to another, or whether a service is more effective for some people than others, and we anticipate that future studies may also vary in design. We propose that future studies are designed with robust methods (for example randomised studies are preferable) and consider only one variable (the follow‐up service) compared to standard care; this would increase confidence that the effect is due to the follow‐up service rather than concomitant therapies

Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report.

OBJECTIVE: To comprehensively update and survey the current provision of recovery, rehabilitation and follow-up services for adult critical care patients across the UK. DESIGN: Cross-sectional, self-administered, predominantly closed-question, electronic, online survey. SETTING: Institutions providing adult critical care services identified from national databases. PARTICIPANTS: Multiprofessional critical care clinicians delivering services at each site. RESULTS: Responses from 176 UK hospital sites were included (176/242, 72.7%). Inpatient recovery and follow-up services were present at 127/176 (72.2%) sites, adopting multiple formats of delivery and primarily delivered by nurses (n=115/127, 90.6%). Outpatient services ran at 130 sites (73.9%), predominantly as outpatient clinics. Most services (n=108/130, 83.1%) were co-delivered by two or more healthcare professionals, typically nurse/intensive care unit (ICU) physician (n=29/130, 22.3%) or nurse/ICU physician/physiotherapist (n=19/130, 14.6%) teams. Clinical psychology was most frequently lacking from inpatient or outpatient services. Lack of funding was consistently the primary barrier to service provision, with other barriers including logistical and service prioritisation factors indicating that infrastructure and profile for services remain inadequate. Posthospital discharge physical rehabilitation programmes were relatively few (n=31/176, 17.6%), but peer support services were available in nearly half of responding institutions (n=85/176, 48.3%). The effects of the COVID-19 pandemic resulted in either increasing, decreasing or reformatting service provision. Future plans for long-term service transformation focus on expansion of current, and establishment of new, outpatient services. CONCLUSION: Overall, these data demonstrate a proliferation of recovery, follow-up and rehabilitation services for critically ill adults in the past decade across the UK, although service gaps remain suggesting further work is required for guideline implementation. Findings can be used to enhance survivorship for critically ill adults, inform policymakers and commissioners, and provide comparative data and experiential insights for clinicians designing models of care in international healthcare jurisdictions

Collective excitations of trapped Bose condensates in the energy and time domains

A time-dependent method for calculating the collective excitation frequencies and densities of a trapped, inhomogeneous Bose-Einstein condensate with circulation is presented. The results are compared with time-independent solutions of the Bogoliubov-deGennes equations. The method is based on time-dependent linear-response theory combined with spectral analysis of moments of the excitation modes of interest. The technique is straightforward to apply, is extremely efficient in our implementation with parallel FFT methods, and produces highly accurate results. The method is suitable for general trap geometries, condensate flows and condensates permeated with vortex structures.Comment: 6 pages, 3 figures small typos fixe

Foot pain and foot health in an educated population of adults: results from the Glasgow Caledonian University Alumni Foot Health Survey

Abstract Background Foot pain is common amongst the general population and impacts negatively on physical function and quality of life. Associations between personal health characteristics, lifestyle/behaviour factors and foot pain have been studied; however, the role of wider determinants of health on foot pain have received relatively little attention. Objectives of this study are i) to describe foot pain and foot health characteristics in an educated population of adults; ii) to explore associations between moderate-to-severe foot pain and a variety of factors including gender, age, medical conditions/co-morbidity/multi-morbidity, key indicators of general health, foot pathologies, and social determinants of health; and iii) to evaluate associations between moderate-to-severe foot pain and foot function, foot health and health-related quality-of-life. Methods Between February and March 2018, Glasgow Caledonian University Alumni with a working email address were invited to participate in the cross-sectional electronic survey (anonymously) by email via the Glasgow Caledonian University Alumni Office. The survey was constructed using the REDCap secure web online survey application and sought information on presence/absence of moderate-to-severe foot pain, patient characteristics (age, body mass index, socioeconomic status, occupation class, comorbidities, and foot pathologies). Prevalence data were expressed as absolute frequencies and percentages. Multivariate logistic and linear regressions were undertaken to identify associations 1) between independent variables and moderate-to-severe foot pain, and 2) between moderate-to-severe foot pain and foot function, foot health and health-related quality of life. Results Of 50,228 invitations distributed, there were 7707 unique views and 593 valid completions (median age [inter-quartile range] 42 [31–52], 67.3% female) of the survey (7.7% response rate). The sample was comprised predominantly of white Scottish/British (89.4%) working age adults (95%), the majority of whom were overweight or obese (57.9%), and in either full-time or part-time employment (82.5%) as professionals (72.5%). Over two-thirds (68.5%) of the sample were classified in the highest 6 deciles (most affluent) of social deprivation. Moderate-to-severe foot pain affected 236/593 respondents (39.8%). High body mass index, presence of bunions, back pain, rheumatoid arthritis, hip pain and lower occupation class were included in the final multivariate model and all were significantly and independently associated with moderate-to-severe foot pain (p < 0.05), except for rheumatoid arthritis (p = 0.057). Moderate-to-severe foot pain was significantly and independently associated lower foot function, foot health and health-related quality of life scores following adjustment for age, gender and body mass index (p < 0.05). Conclusions Moderate-to-severe foot pain was highly prevalent in a university-educated population and was independently associated with female gender, high body mass index, bunions, back pain, hip pain and lower occupational class. Presence of moderate-to-severe foot pain was associated with worse scores for foot function, foot health and health-related quality-of-life. Education attainment does not appear to be protective against moderate-to-severe foot pain

De-excitation of the strongly coupled band in 177Au and implications for core intruder configurations in the light Hg isotopes

Excited states in the proton-unbound nuclide 177Au were populated in the 92Mo(88Sr, p2n) reaction and identified using the Jurogam-II and GREAT spectrometers in conjunction with the RITU gas-filled separator at the University of Jyväskylä Accelerator Laboratory. A strongly coupled band and its decay path to the 11/2− α-decaying isomer have been identified using recoil-decay tagging. Comparisons with cranked HartreeFock-Bogoliubov (HFB) calculations based on Skyrme energy functionals suggest that the band has a prolate deformation and is based upon coupling the odd 1h11/2 proton hole to the excited 0+ 2 configuration in the 178Hg core. Although these configurations might be expected to follow the parabolic trend of core Hg(0+2 ) states as a function of neutron number, the electromagnetic decay paths from the strongly coupled band in 177Au are markedly different from those observed in the heavier isotopes above the midshell. This indicates that a significant change in the structure of the underlying A+1Hg core occurs below the neutron midshell

The use of imepitoin (Pexion™) on fear and anxiety related problems in dogs – a case series

Fear and anxiety based problems are common in dogs. Alongside behaviour modification programmes, a range of psychopharmacological agents may be recommended to treat such problems, but few are licensed for use in dogs and the onset of action of some can be delayed. The low affinity partial benzodiazepine receptor agonist imepitoin (Pexion™, Boehringer Ingelheim) is licensed for treating canine epilepsy, has a fast onset of action in dogs and has demonstrated anxiolytic properties in rodent models. This case series reports on the use of imepitoin in a group of dogs identified as having fear/anxiety based problems. Twenty dogs were enrolled into the study, attended a behaviour consultation and underwent routine laboratory evaluation. Nineteen dogs proceeded to be treated with imepitoin orally twice daily (starting dose approximately 10 mg/kg, with alterations as required to a maximum 30 mg/kg) alongside a patient-specific behaviour modification plan for a period of 11–19 weeks. Progress was monitored via owner report through daily diary entries and telephone follow-up every two weeks. A Positive and Negative Activation Scale (PANAS) of temperament was also completed by owners during baseline and at the end of the study