Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE)

No abstract available

An International Study Exploring the Experience of Survivors of Critical Illness as Volunteers within ICU Recovery Services

Objectives: Many clinicians have implemented follow-up and aftercare to support patients following ICU. Some of this care is supported and facilitated by peer volunteers. There is limited contemporary work that has explicitly explored volunteer roles within ICU recovery services or the experience of volunteers undertaking these roles. We sought to explore the experience of survivors of critical illness, as volunteers, involved in ICU recovery services and understand their motivation for undertaking these roles. Design: Qualitative exploration using in-depth semistructured interviews. The study design used an inductive content analysis process. We also documented the roles that were adopted by volunteers in each site involved in the study. Setting: Patients and caregivers were sampled from seven sites across three continents. Patients and Subjects: Patients and caregivers who had adopted peer-volunteering roles were undertaken. Interventions: None. Measurements and Main Results: Twelve patient and caregiver peer volunteers were interviewed. Four key themes were identified. These themes related to the experience of volunteers within ICU recovery services and their motivation for undertaking these roles: 1) self-belief and acceptance, 2) developing peer support, 3) social roles and a sense of purpose, and 4) giving back. Overwhelmingly, participants were positive about the role of the volunteer in the critical care setting. Conclusions: Peer volunteers undertake a variety of roles in ICU recovery services and during recovery more generally. These roles appear to be of direct benefit to those in these roles. Future research is needed to develop these roles and fully understand the potential impact on the service, including the impact on other patients

Investigating the Impact of Hypoxia on Reactive Oxygen Species Generation within Murine Breast Cancer Cells

When cancer metastasizes from a primary tumor site to secondary site through the bloodstream or lymph, the cancer becomes more difficult to treat. For this reason, it is vital to study what indicates the metastatic potential of a tumor. Current research has shown that cell lines with high metastatic potential display increased levels of metabolic adaptability over their nonmetastatic counterparts after undergoing hypoxic conditions. One method of assessing this adaptability is to measure the concentration of reactive oxygen species (ROS) produced by the cells while undergoing oxidative stress. In highly adaptable metastatic cells, an increase of ROS buildup within the cells will lead to expression of hypoxia-inducible factor (HIF-1), which could be affected differently by both chronic and intermittent hypoxia. Although some studies analyze the effect of reoxygenation post-hypoxia, not much is known about ROS generation during hypoxia. Over the course of this study, it was found that ROS are generated in higher quantities within the metastatic 4T1 cells compared to nonmetastatic 67NR cells under chronic hypoxia. Results of this study also indicated that 4T1 cells produce ROS in higher quantities under low nutrient conditions, and 67NR cells produce slightly higher quantities of ROS under intermittent hypoxia. These results suggest that, in addition to metabolic plasticity, 4T1 cells can modulate ROS levels to encourage metastasis through the HIF-1α pathway

Key components of ICU recovery programmes: what did patients report provided benefit?

Objectives: To understand from the perspective of patients who did, and did not attend ICU recovery programs, what were the most important components of successful programs and how should they be organized. Design: International, qualitative study. Setting: Fourteen hospitals in the United States, United Kingdom, and Australia. Patients: We conducted 66 semi-structured interviews with a diverse group of patients, 52 of whom had used an ICU recovery program and 14 whom had not. Interventions: None. Measurements and Main Results: Using content analysis, prevalent themes were documented to understand what improved their outcomes. Contrasting quotes from patients who had not received certain aspects of care were used to identify perceived differential effectiveness. Successful ICU recovery programs had five key components: 1) Continuity of care; 2) Improving symptom status; 3) Normalization and expectation management; 4) Internal and external validation of progress; and 5) Reducing feelings of guilt and helplessness. The delivery of care which achieved these goals was facilitated by early involvement (even before hospital discharge), direct involvement of ICU staff, and a focus on integration across traditional disease, symptom, and social welfare needs. Conclusions: In this multicenter study, conducted across three continents, patients identified specific and reproducible modes of benefit derived from ICU recovery programs, which could be the target of future intervention refinement

The health and social consequences of an alcohol related admission to critical care: a qualitative study

Objective: To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design: In-depth, semistructured interviews with participants ( patients) 3–7 months post intensive care discharge. Setting: The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. Participants: 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. Interventions: None. Measurements and main results: Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. Conclusions: There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated

The Principalship: A Study of the Principal\u27s Time on Task From 1960 to the Twenty-First Century

The purpose of this study was to examine legislative and societal developments in the United States in relation to changes in educational administration and determine the existence of bifurcation points of change. The effects of legislative and societal changes on the tasks on which administrators focus their time were evaluated. The administrators were surveyed to determine if changes in time on task have occurred to meet the demands of current legislative priorities and if any demographic relationships existed. The study’s population consisted of 1950 (N=1950) administrators in public elementary, middle and high schools in the Southern Regional Educational Board 16 states. A systematic stratified random sample (n=480) was used with a researcher developed survey, for a return rate of 51.05%. In this study, 60.6% of the elementary respondents were females, while 60% of the 85 middle level principals and 69.2% of the 91 secondary principals were male. The analysis of the literature from the 1960s to the 21st century revealed bifurcation points in the time allocated to administrative tasks. One of the most pronounced findings was the consistent increase in the total amount of time that principals spend per week from the 1960s to 2007. Bifurcation points in educational administration were identified as occurring in the 1970s, 1980s, and early 2000s. The literature review demonstrated the mean time dedicated to the job was 49.31 hours in the 1960s and had risen to 61.1 hours in the early 2000s. The current study found the mean time worked by principals to be 60.3 hours per week. Positive correlations were discovered in six of the seven demographic characteristics in relation to the nine task areas: gender, grade level, student population, type of community, level of education, and principals’ experience. The percent of increase in time for the last three year period was: School Management - 57.5%, Personnel - 64.8%, Program Development - 64%, Student Activities - 38.4%, Student Behavior - 30.6%, Planning – 60.8%, Community Relations- 42.5%, District Office – 38.8%, and Professional Development - 52.9%. Fifty percent of the respondents pointed to the mandates of No Child Left Behind as a cause for the increase in time on task

Attitudes of purchasers of performance tested bulls at Ames Plantation

The purpose of this study was to collect data which would indicate the attitudes of purchasers toward bulls purchased in the Ames Plantation sales from 1966 through 1972. The study was designed also to determine what relationship certain personal and experience factors had to the degree of satisfaction. A questionnaire that contained general, sale, and individual bull questions was sent to persons who had purchased bulls at Ames Plantation during this seven-year period. Survey forms were completed by mail and usable forms were returned from 118 purchasers of 189 bulls. The individuals who had purchased bulls in this seven-year period were mailed a survey packet. The purchasers were asked to fill out the questionnaire and return. No other requirement was made of the people who were interviewed. In the sale information division, 56 percent of the respondents attended their first sale within the last five years. The remaining 44 percent ranged from six to 33 years since attending their first sale at Ames Plantation. Sixty-three percent received information on their first sale from the Extension Service, while 37 percent were divided among breed publications, mass media, and previous buyers. Of the bull purchasers 57 percent were full-time farmers. Sixty-seven percent reported as having always raised beef, 32 percent had not always, but for more than five years; and only one percent had raised beef cattle for less than five years. The contrast of farm size upon satisfaction showed that purchasers with larger farms were better satisfied with their bulls. Percentages for degree of satisfaction for different major farm enterprises reveal that purchasers with beef and swine as their major enterprises were less satisfied with their purchases than the people with other kinds of major enterprises. Percentages in the three categories of satisfaction based upon years training in a college of agriculture showed that purchasers who had from one to four years of training were more highly satisfied and fewer that were not satisfied than purchasers with no training or over five years training. Future Farmers of America training had very little effect upon satisfaction. Similarly, 4-H training had very little effect upon satisfaction. Satisfaction based upon purchaser age showed the age group from 36 through 55 to be most satisfied. The relationship of years in school and satisfaction tended to agree with the years of college of agriculture training in that purchasers with one through four years of college were more highly satisfied and fewer in numbers than those who were not satisfied. A smaller percentage of the people with less than nine years total education were highly satisfied and a larger percentage were not satisfied. Eighty-two percent of the purchasers attended their first sale as a potential buyer, and 76 percent purchased a bull at their first sale. Of the people in this study, 55 percent had purchased only one bull, 34 percent had purchased two through four bulls, and 11 percent five through eight bulls. Regarding the number of sales attended since the first sale, 49 percent had attended less than one-half and the rest were divided into three other categories: all of them, more than one-half, and half of them. To conclude the sale information segment, the purchasers were asked where they would go to find sale information. Sixty percent pointed to the Extension Service, 30 percent to Ames Plantation and 10 percent to other sources. The average farmer operated 1119 acres. Of these acres, 429 were in crops and 432 in pasture. The average purchaser had 1.4 years of College of Agriculture training and 2.0, 2.1 years for Future Farmers of America and 4-H training, respectively. The purchaser averaged 50.2 years of age and had 13.7 years of education. The average purchaser owned 110 brood cows and a total of 193 beef animals. Fifty-nine percent of the purchasers farmed alone, 24 percent farmed with a close relative, and 16 percent had other types of farm arrangments. Fifty-seven percent of the bull purchasers had never worked off the farm. The remaining 43 percent ranged from one to 50 years off the farm. A purchaser who operates on a partnership basis tended to be more highly satisfied than the purchaser that operated by himself. The relationship of effect of purchase price upon satisfaction illustrated that a greater percentage of purchasers who paid $1000 or more were better satisfied while a smaller percentage were not satisfied. Relationship percentages of effect of type farmer upon satisfaction showed that full-time farmers are better satisfied but not as highly satisfied as the part-time farmer. A greater percentage of part-time farmers are not satisfied. The contrast of experience in raising beef upon satisfaction showed that people who had always raised beef were better satisfied. The effect of number of contacts with Extension personnel upon satisfaction revealed that purchasers with from one through ten contacts a year were better satisfied. The effect of Extension material upon satisfaction indicated that purchasers who utilize Extension material frequently are more highly satisfied