142 research outputs found
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 patientâs
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
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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 are the dominant features
giving a vortex kink or bend, while the is found to be the dominant
Kelvin wave associated with vortex twisting.Comment: 18 pages, 7 figures, 1 tabl
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
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
Association between inflammation and post-intensive care syndrome: a systematic review
Post-intensive care syndrome describes the physical, cognitive and emotional symptoms which persist following critical illness. At present there is limited understanding of the pathological mechanisms contributing to the development of post-intensive care syndrome. The aim of this systematic review was to synthesise current evidence exploring the association between inflammation and features of post-intensive care syndrome in survivors of critical illness. Relevant databases were systematically searched for studies of human participants exposed to critical illness. We sought studies that reported results for biomarkers with an identified role in the pathophysiology of inflammation obtained at any time-point in the patient journey and an outcome measure of any feature of post-intensive care syndrome at any point following hospital discharge. We included 32 studies, with 23 in the primary analysis and nine in a brain injury subgroup analysis. In the primary analysis, 47 different biomarkers were sampled and 44 different outcome measures were employed. Of the biomarkers which were sampled in five or more studies, interleukin-8, C-reactive protein and interleukin-10 most frequently showed associations with post-intensive care syndrome outcomes in 71%, 62% and 60% of studies, respectively. There was variability in terms of which biomarkers were sampled, time-points of sampling and outcome measures reported. Overall, there was mixed evidence of a potential association between an inflammatory process and long-term patient outcomes following critical illness. Further high-quality research is required to develop a longitudinal inflammatory profile of survivors of critical illness over the recovery period and evaluate the association with outcomes
Prevalence, characteristics and longer-term outcomes of patients with persistent critical illness due to COVID-19 in Scotland:a national cohort study.
Electronic training devices: discussion on the pros and cons of their use in dogs as a basis for the position statement of the European Society of Veterinary Clinical Ethology (ESVCE)
In recent years, the affirmation of a greater ethical sense and research generating a better knowledge of the mechanisms of animal learning, evidence of the existence of an animal mind), and studies on the dog-human attachment bond have led to changes in the dog-human relationship. These changes have caused a notable improvement in dog training techniques. Increased emphasis on dog welfare, overall, led to questioning of many training techniques and tools that used aversive means. Recent research on the use of aversive training devices has been performed and, on this basis it has been possible to create guidelines to inform the public about utility and the possible detriments related to the use of these devices as a tool in dog training. The European Society of Clinical Animal Ethology (ESVCE) has released a public position statement based on the current scientific information available on e-collars, punitive training techniques and canine welfare. This paper elaborates and discusses the arguments âpro and contra the use of e-collars and aversive training methodsâ leading to the statement in more detail. As a conclusion, ESVCE strongly opposes the use of e-collars in dog training, and urges all European countries to take an interest in and position on this welfare matter
Optimizing Critical Illness Recovery: Perspectives and Solutions from the Caregivers of ICU Survivors
Objectives: To understand the unmet needs of caregivers of ICU survivors, how they accessed support post ICU, and the key components of beneficial ICU recovery support systems as identified from a caregiver perspective.
Design: International, qualitative study.
Subjects: We conducted 20 semistructured interviews with a diverse group of caregivers in the United States, the United Kingdom, and Australia, 11 of whom had interacted with an ICU recovery program.
Setting: Seven hospitals in the United States, United Kingdom, and Australia.
Interventions: None.
Measurements and Main Results: Content analysis was used to explore prevalent themes related to unmet needs, as well as perceived strategies to improve ICU outcomes. Post-ICU care was perceived to be generally inadequate. Desired caregiver support fell into two main categories: practical support and emotional support. Successful care delivery initiatives included structured programs, such as post discharge telephone calls, home health programs, post-ICU clinics, and peer support groups, and standing information resources, such as written educational materials and online resources.
Conclusions: This qualitative, multicenter, international study of caregivers of critical illness survivors identified consistently unmet needs, means by which caregivers accessed support post ICU, and several care mechanisms identified by caregivers as supporting optimal ICU recovery
Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol.
Background: This study sought to establish the long-term effects of Covid-19 following hospitalisation. Methods: 327 hospitalised participants, with SARS-CoV-2 infection were recruited into a prospective multicentre cohort study at least 3 months post-discharge. The primary outcome was self-reported recovery at least ninety days after initial Covid-19 symptom onset. Secondary outcomes included new symptoms, disability (Washington group short scale), breathlessness (MRC Dyspnoea scale) and quality of life (EQ5D-5L). Findings: 55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age. Interpretation: Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females. Funding: National Institute for Health Research, UK Medical Research Council, Wellcome Trust, Department for International Development and the Bill and Melinda Gates Foundation
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