Systematic Review: Controlled Trials of Interventions to Improve Communication in Intensive Care

Background: Communication between families and providers in the intensive care unit (ICU) affects patient and family outcomes, and healthcare utilization. Recent research has tested interventions designed to improve communication quality and outcomes between providers and families of ICU patients. We conducted a systematic review of these studies. Methods: We searched MEDLINE, PsychInfo, Cochrane, and CINAHL from 1995 to July 2010. Included studies reported controlled clinical interventions designed to improve communication between providers and families of ICU patients aged 18 years or older. Investigators abstracted all selected studies to a standardized data collection instrument and completed a quality checklist based on recommendations from the CONSORT investigators. Results: 2841 titles were identified. 180 met criteria for full review and 21 articles of 16 distinct interventions met full inclusion criteria, of which 5 were randomized. Interventions studied included printed information, or structured family conferences with or without additional family support. Conferences aimed to communicate diagnosis and prognosis, elicit patient values, assess family understanding, and clarify goals of treatment. Printed information, palliative care or ethics consultation, or regular, structured communication by the usual ICU team reduced family distress, improved comprehension, and decreased use of intensive treatments. Conclusions: Moderate quality evidence supports printed information and structured communication by the usual ICU team, ethics consultation, or palliative care consultation to improve family emotional outcomes, and reduce ICU lengths of stay and treatment intensity. Evidence that these interventions reduce total costs is inconclusive. A comprehensive research agenda should ensure future study of a full range of patient-centered outcomes.Master of Public Healt

AKAPS act in a two-step mechanism of memory acquisition

Defining the molecular and neuronal basis of associative memories is based upon behavioral preparations that yield high performance due to selection of salient stimuli, strong reinforcement, and repeated conditioning trials. One of those preparations is the Drosophila aversive olfactory conditioning procedure where animals initiate multiple memory components after experience of a single cycle training procedure. Here, we explored the analysis of acquisition dynamics as a means to define memory components and revealed strong correlations between particular chronologies of shock impact and number experienced during the associative training situation and subsequent performance of conditioned avoidance. Analyzing acquisition dynamics in Drosophila memory mutants revealed that rutabaga (rut)-dependent cAMP signals couple in a divergent fashion for support of different memory components. In case of anesthesia-sensitive memory (ASM) we identified a characteristic two-step mechanism that links rut-AC1 to A-kinase anchoring proteins (AKAP)-sequestered protein kinase A at the level of Kenyon cells, a recognized center of olfactory learning within the fly brain. We propose that integration of rut-derived cAMP signals at level of AKAPs might serve as counting register that accounts for the two-step mechanism of ASM acquisition

Delayed Hemolytic Transfusion Reaction in Sickle Cell Disease

Delayed hemolytic transfusion reactions (DHTR) are potentially life-threatening complications observed in patients with sickle cell disease. We review the clinical features, pathophysiology, laboratory evaluation, and management of this complication. It is important that DHTR be included in the differential diagnosis of acute pain episodes following a red blood cell transfusion in a patient with sickle cell disease

Aging and Post-Intensive Care Syndrome–Family (PICS-F): A Critical Need for Geriatric Psychiatry

Postintensive care syndrome–family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment compared with older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared with other geriatric populations. Second, as caregivers themselves age, caring for this unique burden can be more challenging compared with other geriatric populations. Third, evidence for models of care centered on patients with multimorbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multimorbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers

Prolonged rather than hasty decision-making in schizophrenia using the box task. Must we rethink the jumping to conclusions account of paranoia?

Accepted manuscript version, licensed CC BY-NC-ND 4.0. Jumping to conclusions (JTC) is the best established cognitive bias in schizophrenia and is increasingly targeted in interventions aimed to improve positive symptoms. To address shortcomings of the standard measure to capture JTC, the beads task, we developed a new variant—the box task—which was subsequently validated in people with elevated psychotic-like experiences. For the first time, the box task was administered in a sample of individuals with manifest schizophrenia. We hypothesized that patients with schizophrenia would display an elevated JTC bias relative to controls. Method - We recruited a large sample of 101 patients with schizophrenia and matched them to an online sample recruited from the general population. In the box task, participants must decide which of two kinds of colored balls are presented more often. Participants are told that the task may end prematurely, and that task performance will be counted as an error if no decision had been made before that point. The primary measure was the number of draws to decision (DTD), where fewer DTD corresponds to greater JTC. Results - In contrast to expectations, participants with schizophrenia showed significantly higher DTD (i.e., reduced JTC). Consistent with our previous findings, patients also displayed a lowered decision threshold compared to controls. Response confidence for the final decision was lower in patients and correlated with self-esteem and positive symptoms. While there was evidence that previous knowledge of the box task lowered DTD, exclusion of participants with experience on the box task did not substantially change results. Discussion - The study fits a growing body of experiments casting doubt on the generalizability of the JTC effect in schizophrenia across different tasks. While the study tentatively supports a liberal acceptance account of psychosis, caution is warranted and we recommend that research should explore and control for potentially important mediators (e.g., task difficulty, stress, test-taking attitudes)

The Facilitated Values History: Helping Surrogates Make Authentic Decisions for Incapacitated Patients with Advanced Illness

Many patients who develop incapacitating illness have not expressed clear treatment preferences. Therefore, surrogate decision makers are asked to make judgments about what treatment pathway is most consistent with the patient’s values. Surrogates often struggle with such decisions. The difficulty arises because answering the seemingly straightforward question, “What do you think the patient would choose?” is emotionally, cognitively, and morally complex. There is little guidance for clinicians to assist families in constructing an authentic picture of the patient’s values and applying them to medical decisions, in part because current models of medical decision making treat the surrogate as the expert on the patient’s values and the physician as the expert on technical medical considerations. However, many surrogates need assistance in identifying and working through the sometimes conflicting values relevant to medical decisions near the end of life. We present a framework for clinicians to help surrogates overcome the emotional, cognitive, and moral barriers to high-quality surrogate decision making for incapacitated patients

Spin Motion in Electron Transmission through Ultrathin Ferromagnetic Films Accessed by Photoelectron Spectroscopy

Ab initio and model calculations demonstrate that the spin motion of electrons transmitted through ferromagnetic films can be analyzed in detail by means of angle- and spin-resolved core-level photoelectron spectroscopy. The spin motion appears as precession of the photoelectron spin polarization around and as relaxation towards the magnetization direction. In a systematic study for ultrathin Fe films on Pd(001) we elucidate its dependence on the Fe film thickness and on the Fe electronic structure. In addition to elastic and inelastic scattering, the effect of band gaps on the spin motion is addressed in particular.Comment: 4 pages, 5 figure