213 research outputs found
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 patientâs
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
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 âRehabilitation after critical illnessâ (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. Patientsâ 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
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
Organ failure, outcomes and deprivation status among critically ill cirrhosis patients â a one-year cohort study
No abstract available
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
Safety of extubating mechanically ventilated patients on vasoactive infusions: a retrospective cohort study
No abstract available
Superfluid toroidal currents in atomic condensates
The dynamics of toroidal condensates in the presence of condensate flow and
dipole perturbation have been investigated. The Bogoliubov spectrum of
condensate is calculated for an oblate torus using a discrete-variable
representation and a spectral method to high accuracy. The transition from
spheroidal to toroidal geometry of the trap displaces the energy levels into
narrow bands. The lowest-order acoustic modes are quantized with the dispersion
relation with . A condensate
with toroidal current splits the co-rotating and
counter-rotating pair by the amount: . Radial dipole excitations are the lowest energy dissipation modes.
For highly occupied condensates the nonlinearity creates an asymmetric mix of
dipole circulation and nonlinear shifts in the spectrum of excitations so that
the center of mass circulates around the axis of symmetry of the trap. We
outline an experimental method to study these excitations.Comment: 8 pages, 8 figure
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
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 postâintensive care syndrome (PICS). Specific ICU followâup 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 followâup service and current aftercare programmes encompass a variety of interventions and materials. There is uncertain evidence about whether followâup services effectively address PICS, and this review assesses this.
Objectives:
Our main objective was to assess the effectiveness of followâup 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 healthârelated quality of life (HRQoL), mortality, depression and anxiety, postâtraumatic 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 followâup services. We aimed to explore: the effectiveness of service organisation (physicianâ versus nurseâled, faceâtoâface versus remote, timing of followâup service); differences related to country (highâincome versus lowâ and middleâincome countries); and effect of delirium, which can subsequently affect cognitive function, and the effect of followâup 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 nonârandomised studies with adult participants, who had been discharged from hospital following an ICU stay. We included studies that compared an ICU followâup service using a structured programme and coâordinated by a healthcare professional versus no followâup 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 nonârandomised study), for a total of 1707 participants who were ICU survivors with a range of illness severities and conditions. Followâup services were led by nurses in four studies or a multidisciplinary team in one study. They included faceâtoâface consultations at home or in a clinic, or telephone consultations or both. Each study included at least one consultation (weekly, monthly, or sixâmonthly), and two studies had up to eight consultations. Although the design of followâup 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 nonârandomised study had high risk of selection bias.
We did not combine data from randomised studies with data from one nonârandomised study. Followâup services for improving longâterm outcomes in ICU survivors may make little or no difference to HRQoL at 12 months (standardised mean difference (SMD) â0.0, 95% confidence interval (CI) â0.1 to 0.1; 1 study; 286 participants; lowâcertainty evidence). We found moderateâcertainty evidence from five studies that they probably also make little or no difference to allâcause 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 nonârandomised study 79/259 deaths in the intervention group, and 46/151 in the control group) and lowâcertainty evidence from four studies that they may make little or no difference to PTSD (SMD â0.05, 95% CI â0.19 to 0.10, 703 participants, 3 studies; and one nonârandomised study reported less chance of PTSD when a followâup service was used).
It is uncertain whether using a followâup 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 followâup 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 followâup 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 followâup service) compared to standard care; this would increase confidence that the effect is due to the followâup service rather than concomitant therapies
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