Health related quality of life in Critically ill Patients A study of health related quality of life in critically ill patients admitted on the Intensive Care

Health related quality of life (HRQOL) is a relevant outcome measure for patients admitted to the intensive care unit (ICU). Long term outcome for physical and psychological factors, functional status and social interactions are becoming more and more important both for doctors and nurses as well as for patients and their relatives (1;2). Therefore doctors and nurses want to know what a “reasonable” quality of life means to their patients. The main reason for HRQOL research described in this thesis is the lack of knowledge about the outcome of HRQOL in critically ill patients admitted to an ICU. Especially, the time course of changes in HRQOL following discharge from the ICU and during a general ward stay has not been studied. In HRQOL studies in general as well ass in critically ill patients, there is a lack of a clear framework for defining and describing HRQOL. One of the difficulties in HRQOL research is defining what one means by health related quality of life: there is no universally accepted definition. QOL, health status, functional status, and HRQOL are often used interchangeable in the literature (3). Yet each of these terms may reflect different aspects of an individual’s well-being (4). This also may lead to different measurement approaches which may lead to different results. Quality of life is described as a “unique personal perception” (5), influenced by social, psychological, cultural, familial, relational and individual factors. The World Health Organization defines “health” as not only the absence of infirmity and disease but also as a state of physical, mental and social well-being (6). Accordingly, an assessment of health related quality of life should reflect the patients’ physiological and psychological status, social functioning and perception of health. The quality of life applied to health, or HRQOL, takes into account not all dimensions

Quality of life before intensive care unit admission is a predictor of survival

Introduction: Predicting whether a critically ill patient will survive intensive care treatment remains difficult. The advantages of a validated strategy to identify those patients who will not benefit from intensive care unit (ICU) treatment are evident. Providing critical care treatment to patients who will ultimately die in the ICU is accompanied by an enormous emotional and physical burden for both patients and their relatives. The purpose of the present study was to examine whether health-related quality of life (HRQOL) before admission to the ICU can be used as a predictor of mortality. Methods: We conducted a prospective cohort study in a university-affiliated teaching hospital. Patients admitted to the ICU for longer than 48 hours were included. Close relatives completed the Short-form 36 (SF-36) within the first 48 hours o

Применение метода матричной прогонки для моделирования процесса пневматической обработки угольного пласта

Розглянуто чисельне рішення системи рівнянь математичної фізики, покладених в основу математичної моделі пневматичної дії на вугільний пласт, за допомогою методу матричної прогонки.The numerical solution of system of mathematical physics equations, formed the base of mathematical model of process of pneumatic action on coal stratum, using the method of matrix drive is considered

Comparing quality of dying and death perceived by family members and nurses for patients dying in US and Dutch ICUs

BACKGROUND: The Quality of Dying and Death (QODD) questionnaire is used as a selfreported measure to allow families and clinicians to assess patients' quality of dying and death. We evaluated end-of-life (EOL) experiences as measured by the QODD completed by families and nurses in the United States and the Netherlands to explore similarities and differences in these experiences and identify opportunities for improving EOL care. METHODS: Questionnaire data were gathered from family members of patients dying in the ICU and nurses caring for these patients. In The Netherlands, data were gathered in three teaching hospitals, and data was gathered from 12 sites participating in a randomized trial in the United States. The QODD consists of 25 items and has been validated in the United States. RESULTS: Data from 446 patients were analyzed (346 in the United States and 100 in the Netherlands). Dutch patients were older than those in the United States (72 + 10.2 years vs 65 + 16.0 years; P <.0025). The family-assessed overall QODD score was the same in both countries: the Netherlands = median, 9; interquartile range (IQR), 8-10 and the United States = median, 8; IQR, 5-10. US family members rated the quality of two items higher than did the Netherlands families: "time spent with loved ones" and "time spent alone." Nurseassessed QODD ratings varied: the single-item QODD summary score was significantly higher in the Netherlands (the Netherlands: median, 9; IQR, 8-10 vs the United States: median, 7; IQR, 5-8; P <.0025), whereas the QODD total score was higher in the United States (the Netherlands: median, 6.9; IQR, 5.5-7.6 vs the United States: median, 7.1; IQR, 5.88.4; P = .014), although it did not meet our criteria for statistical significance. Of the 22 nurse-assessed items, 10 were significantly different between the Netherlands and the United States, with eight having higher scores in the United States and 2 having higher scores in the Netherlands. CONCLUSIONS: The QODD was rated similarly by family members in the United States and the Netherlands but varied when assessed by nurses. These differences may be due to organizational or cultural differences between the two countries or to expectations of respondents

Occurrence of delirium is severely underestimated in the ICU during daily care

Delirium is associated with prolonged intensive care unit (ICU) stay and higher mortality. Therefore, the recognition of delirium is important. We investigated whether intensivists and ICU nurses could clinically identify the presence of delirium in ICU patients during daily care. All ICU patients in a 3-month period who stayed for more than 48 h were screened daily for delirium by attending intensivists and ICU nurses. Patients were screened independently for delirium by a trained group of ICU nurses who were not involved in the daily care of the patients under study. The Confusion Assessment Method for the ICU (CAM-ICU) was used as a validated screening instrument for delirium. Values are expressed as median and interquartile range (IQR; P25-P75). During the study period, 46 patients (30 male, 16 female), median age 73 years (IQR = 64-80), with an ICU stay of 6 days (range 4-11) were evaluated. CAM-ICU scores were obtained during 425 patient days. Considering the CAM-ICU as the reference standard, delirium occurred in 50% of the patients with a duration of 3 days (range 1-9). Days with delirium were poorly recognized by doctors (sensitivity 28.0%; specificity 100%) and ICU nurses (sensitivity 34.8%; specificity 98.3%). Recognition did not differ between hypoactive or active status of the patients involved. Delirium is severely under recognized in the ICU by intensivists and ICU nurses in daily care. More attention should be paid to the implementation of a validated delirium-screening instrument during daily ICU car

Physical impairment and perceived general health preceding critical illness is predictive of survival

Purpose: We hypothesized that item response based assessment of physical reserve preceding ICU admission is a predictor of survival. Methods: We evaluated physical functioning using the Academic Medical Center Linear Disability Score (ALDS) and quality of life using the first question (SF-1) and the physical component score (PCS-12) from the Short-form 12 (SF-12) before admission by patients or by close proxies within 72 h after ICU admission during 1 year. Results: We developed four logistic regression models to predict 1 year mortality using the predictors age, gender, ALDS, SF-1, PCS-12. A total of 510 patients participated. Twelve months after ICU discharge, 110 patients (22%) had died. Pre-admission ALDS (p =.004), and SF-1 (p =.012) improved the prediction models with age and gender PCS-12 showed no association with mortality (p =.062). Adding the ALDS (p =.049) and the SF-1 (p =.048) to a model with age, gender and the APACHE II score (improved the model. Adding PCS-12 showed no association with mortality (p =.355). Conclusions: Physical reserve as assessed by ALDS and perceived general health, preceding ICU admission is predictive of mortality. Obtaining patient's physical reserve or pre-existing perceived general health should be part of routine assessment whether a patient may benefit from ICU admission