Publications by authors named "Tara Quasim"

57 Publications

Long term outcomes following critical care hospital admission: A prospective cohort study of UK biobank participants.

Lancet Reg Health Eur 2021 Jul;6:100121

School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom.

Background: : This study aimed to understand the impact of a critical care admission on long-term outcomes, compared to other hospitalised patients without a critical care encounter. A secondary aim was to examine the interrelationship between emotional, physical, and social problems during recovery.

Methods: : We utilised data from the UK Biobank, an on-going, prospective population-based cohort study. We employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital (first admission to hospital available) without critical care. Structural equation modelling was used to analyse emotional, physical and social outcomes following critical illness and the relationships between these health domains.

Findings: : Data from 1,618 patients were analysed. The median time to follow-up in the critical care cohort was 4427 days (IQR:788-6146) vs 4516 days (IQR: 811-6369) in the non-critical care, hospitalised cohort. Across the two time periods assessed (pre and post 2000), patients exposed to critical care were more likely to experience mental health issues such as depression ( < 0.01) and social isolation ( = 0.01) following discharge from hospital. The critical care cohort were also more likely to have social problems such as the requirement for government funded welfare support ( = 0.02). In the critical care cohort, social and emotional health were closely correlated ( < 0.001, 95% CI:0.33-0.54). The nature of physical problems changed over time; pre-2000 there was a significant difference between the critical and non-critical care in physical outcomes following discharge from hospital, however, there was no difference detected between the two cohorts post-2000.

Interpretation: This cohort study has demonstrated that survivors of critical illness have different psycho-social outcomes to matched patients, hospitalised without a critical care encounter.

Funding: JM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019-02-16). AHL is part of the Social and Public Health Sciences Unit, funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
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http://dx.doi.org/10.1016/j.lanepe.2021.100121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278491PMC
July 2021

Comparing performance on the Months of the Year Backwards test in hospitalised patients with delirium, dementia, and no cognitive impairment: an exploratory study.

Eur Geriatr Med 2021 Jun 22. Epub 2021 Jun 22.

Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.

Purpose: To investigate performance of the Months of the Year Backwards (MOTYB) test in older hospitalised patients with delirium, dementia, and no cognitive impairment.

Methods: Secondary analysis of data from a case-control study of 149 hospitalised patients aged ≥ 65 years with delirium [with or without dementia (N = 50)], dementia [without delirium (N = 46)], and no cognitive impairment (N = 53). Verbatim transcripts of MOTYB audio recordings were analysed to determine group differences in response patterns.

Results: In the total sample [median age 85y (IQR 80-88), 82% female], patients with delirium were more often unable to recite months backward to November (36/50 = 72%) than patients with dementia (21/46 = 46%; p < 0.01) and both differed significantly from patients without cognitive impairment (2/53 = 4%; p's < 0.001). 121/149 (81%) of patients were able to engage with the test. Patients with delirium were more often unable to engage with MOTYB (23/50 = 46%; e.g., due to reduced arousal) than patients with dementia (5/46 = 11%; p < 0.001); both groups differed significantly (p's < 0.001) from patients without cognitive impairment (0/53 = 0%). There was no statistically significant difference between patients with delirium (2/27 = 7%) and patients with dementia (8/41 = 20%) in completing MOTYB to January, but performance in both groups differed (p < 0.001 and p < 0.02, respectively) from patients without cognitive impairment (35/53 = 66%).

Conclusion: Delirium was associated with inability to engage with MOTYB and low rates of completion. In patients able to engage with the test, error-free completion rates were low in delirium and dementia. Recording of engagement and patterns of errors may add useful information to MOTYB scoring.
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http://dx.doi.org/10.1007/s41999-021-00521-4DOI Listing
June 2021

Multimorbidity and its relationship with long-term outcomes following critical care discharge: a prospective cohort study.

Chest 2021 Jun 18. Epub 2021 Jun 18.

Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK. Electronic address:

Background: Survivors of critical illness have poor long-term outcomes with subsequent increases in healthcare utilisation. Less is known about the interplay between multimorbidity and long-term outcomes.

Research Question: How do baseline patient demographics impact mortality and healthcare utilisation in the year following discharge from critical care?

Study Design And Methods: Using data from a prospectively collected cohort, we employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital without critical care. Long-term mortality was examined via nationally linked data as was hospital resource use in the year following hospital discharge. The cause of death was also examined.

Results: This analysis included 3112 participants. There was no difference in long-term mortality between the critical care and hospital cohorts (adjusted HR: 1.09 (95% CI: 0.90-1.32), p=0.39). Pre-hospitalisation emotional health issues such as a clinical diagnosis of depression, were associated with increased long-term mortality (HR:1.49 (95% CI: 1.14-1.96), p<0.004). Healthcare utilisation was different between the two cohorts in the year following discharge with the critical care cohort experiencing a 29% increased risk of hospital readmission (OR 1.29 (95% CI:1.11-1.50), p=0.001).

Interpretation: This national cohort study has demonstrated increased resource use for critical care survivors in the year following discharge but fails to replicate past findings of increased longer-term mortality. Multimorbidity, lifestyle factors and socio-economic status appear influence long term outcomes and should be the focus of future research.
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http://dx.doi.org/10.1016/j.chest.2021.05.069DOI Listing
June 2021

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

Crit Care Explor 2020 Nov 19;2(11):e0273. Epub 2020 Nov 19.

School of Nursing, Vanderbilt University, Nashville, TN.

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.
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http://dx.doi.org/10.1097/CCE.0000000000000273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191690PMC
November 2020

Transitions of Care After Critical Illness-Challenges to Recovery and Adaptive Problem Solving.

Crit Care Med 2021 Jun 5. Epub 2021 Jun 5.

Department of Physiotherapy, Western Health, Sunshine Hospital, Melbourne, VIC, Australia. Department of Critical Care, School of Medicine, The University of Melbourne, Melbourne, VIC, Australia. School of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia. Department of Physiotherapy, Western Health, Melbourne, VIC, Australia. School of Nursing, Vanderbilt University, Nashville, TN. Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunology, Wake Forest University School of Medicine, Winston Salem, NC. Department of Perioperative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. School of Nursing, University of Pittsburgh, Pittsburgh, PA. University College London Hospitals NHS Foundation Trust, London, United Kingdom. Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, New York, NY. Vanderbilt University Medical Center, Nashville, TN. Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. University Hospitals Cleveland Medical Center, Cleveland, OH. Pulmonary and Critical Care Medicine, Geisinger Medical Center, Mechanicsville, PA. Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom. Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY. School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom. Emory University Hospital (Emory Healthcare), Atlanta, GA. Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. Department of Medicine, Division of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT. Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT. Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT. Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI. Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI. Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA. Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.

Objectives: Investigate the challenges experienced by survivors of critical illness and their caregivers across the transitions of care from intensive care to community, and the potential problem-solving strategies used to navigate these challenges.

Design: Qualitative design-data generation via interviews and data analysis via the framework analysis method.

Setting: Patients and caregivers from three continents, identified through the Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups).

Subjects: Patients and caregivers following critical illness.

Interventions: Nil.

Measurements And Main Results: From 86 interviews (66 patients, 20 caregivers), we identified the following major themes: 1) Challenges for patients-interacting with the health system and gaps in care; managing others' expectations of illness and recovery. 2) Challenges for caregivers-health system shortfalls and inadequate communication; lack of support for caregivers. 3) Patient and caregiver-driven problem solving across the transitions of care-personal attributes, resources, and initiative; receiving support and helping others; and acceptance.

Conclusions: Survivors and caregivers experienced a range of challenges across the transitions of care. There were distinct and contrasting themes related to the caregiver experience. Survivors and caregivers used comparable problem-solving strategies to navigate the challenges encountered across the transitions of care.
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http://dx.doi.org/10.1097/CCM.0000000000005095DOI Listing
June 2021

Optimizing Critical Illness Recovery: Perspectives and Solutions From the Caregivers of ICU Survivors.

Crit Care Explor 2021 May 12;3(5):e0420. Epub 2021 May 12.

Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom.

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.
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http://dx.doi.org/10.1097/CCE.0000000000000420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162533PMC
May 2021

Comorbidity and survival after admission to the intensive care unit: A population-based study of 41,230 patients.

J Intensive Care Soc 2021 May 15;22(2):143-151. Epub 2020 Apr 15.

University of Glasgow, Institute of Health and Wellbeing, Glasgow, UK.

Purpose: To describe the relationship between comorbidities and survival following admission to the intensive care unit.

Methods: Retrospective observational study using several linked routinely collected databases from 16 general intensive care units between 2002 and 2011. Comorbidities identified from hospitalisation in the five years prior to intensive care unit admission. Odds ratios for survival in intensive care unit, hospital and at 30 days, 180 days and 12 months after intensive care unit admission derived from multiple logistic regression models.

Results: There were 41,230 admissions to intensive care units between 2002 and 2011. Forty-one percent had at least one comorbidity - 24% had one, 17% had more than one. Patients with comorbidities were significantly older, had higher Acute Physiology and Chronic Health Evaluation II scores and were more likely to have received elective rather than emergency surgery compared with those without comorbidities. After excluding elective hospitalisations, intensive care unit and hospital mortality for the cohort were 24% and 29%, respectively. Asthma (odds ratio 0.79, 95% confidence interval 0.63-0.99) and solid tumours (odds ratio 0.74, 0.67-0.83) were associated with lower odds of intensive care unit mortality than no comorbidity. Intensive care unit mortality was raised for liver disease (odds ratio 2.98, 2.43-3.65), cirrhosis (odds ratio 2.61, 1.9-3.61), haematological malignancy (odds ratio 2.29, 1.85-2.83), chronic ischaemic heart disease (odds ratio 1.53, 1.19-1.98), heart failure (odds ratio 1.79, 1.35-2.39) and rheumatological disease (odds ratio 1.53, 1.18-1.98).

Conclusions: Comorbidities affect two-fifths of intensive care unit admission and have highly variable effects on subsequent outcomes. Information on the differential effects of comorbidities will be helpful in making better decisions about intensive care unit support and understanding outcomes beyond surviving intensive care unit.
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http://dx.doi.org/10.1177/1751143720914229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120566PMC
May 2021

Post-intensive care syndrome following cardiothoracic critical care: Feasibility of a complex intervention.

J Rehabil Med 2021 Jun 3;53(6):jrm00206. Epub 2021 Jun 3.

Academic Unit of Anaesthesia, Pain and Critical Care Medicine, University of Glasgow, Glasgow, UK. E-mail:

Objectives: To describe the long-term outcomes of cardiac intensive care unit patients and their primary caregivers, and to explore the feasibility of implementing a complex intervention, designed to support problems associated with post-intensive care syndrome and post-intensive care syndrome-family, in the year following discharge from the cardiac intensive care unit.

Design: A complex multidisciplinary rehabilitation programme, delivered as a quality improvement initiative, in a single centre in the West of Scotland. Outcomes were measured using surveys of health related quality of life, self efficacy, anxiety, depression, pain, caregiver strain, and insomnia.

Participants: Patients and their caregivers were invited to participate 12 weeks after hospital discharge. Twenty-seven patients and 23 caregivers attended the programme.

Results: Over 90% of patients had problems in at least one quality of life domain at baseline, 41% of patients had symptoms of anxiety and 22% had symptoms of depression. During the baseline visit, caregiver strain was present in 20% of caregivers, 57% had symptoms of anxiety, and 35% had symptoms of depression. Improvements in outcomes were seen in both patients and caregivers at 1-year follow-up. The programme was implemented, and iterative learning obtained about the content and the operationalization of the service, in order to understand feasibility.

Conclusion: This small-scale quality improvement project has demonstrated that this complex multidisciplinary rehabilitation programme is feasible and has positive implications for patients following discharge from the cardiac intensive care unit, and their caregivers.
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http://dx.doi.org/10.2340/16501977-2825DOI Listing
June 2021

The wider implications of the COVID-19 pandemic: Assessing the impact of accident and emergency use for frequent attenders.

Int Emerg Nurs 2021 05 20;56:100984. Epub 2021 Feb 20.

NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, United Kingdom; School of Medicine, Dentistry and Nursing, University of Glasgow, United Kingdom; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, United Kingdom. Electronic address:

Introduction: Emergency departments have seen altered patterns of attendance since the beginning of the COVID-19 pandemic, with reductions in the number of attendances for non-COVID-19 - patients. We assessed the use of the emergency department by frequent attenders during the height of the COVID-19 pandemic and explored any changes in emergency department attendance by this group.

Methods: As part of ongoing improvement work, we utilised a cohort design to evaluate the difference in patterns of attendance for the frequent attender group in a single centre. We created a 2019 'top attender' cohort and a similar cohort for 2020. We compared admission patterns between the two time periods in order to understand the impact of the COVID-19 pandemic on this group.

Results: Both groups were predominately male. Mental health and substance misuse use problems were common across both cohorts. The majority of patients lived in a socio-economically deprived areas. The median number emergency department visits in 2019, for the top attender cohort was 6 (IQR: 4-9) vs 4 (IQR: 2-7) for the top attender cohort of 2020 (p < .0013).

Conclusion: This single centre evaluation has shown a significant reduction in emergency department attendances for a frequent attender cohort in a single centre. Future work should investigate the longer-term impact which the COVID-19 pandemic has had on this patient group.
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http://dx.doi.org/10.1016/j.ienj.2021.100984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896822PMC
May 2021

Benefits of Peer Support for Intensive Care Unit Survivors: Sharing Experiences, Care Debriefing, and Altruism.

Am J Crit Care 2021 03;30(2):145-149

Kimberley J. Haines is physiotherapy lead and senior ICU physiotherapist, Department of Physiotherapy, Western Health, Sunshine Hospital, St Albans, Australia and an associate professor, Centre for Integrated Critical Care, University of Melbourne, Australia.

Background: After critical illness, patients are often left with impairments in physical, social, emotional, and cognitive functioning. Peer support interventions have been implemented internationally to ameliorate these issues.

Objective: To explore what patients believed to be the key mechanisms of effectiveness of peer support programs implemented during critical care recovery.

Methods: In a secondary analysis of an international qualitative data set, 66 telephone interviews with patients were undertaken across 14 sites in Australia, the United Kingdom, and the United States to understand the effect of peer support during recovery from critical illness. Prevalent themes were documented with framework analysis.

Results: Most patients who had been involved in peer support programs reported benefit. Patients described 3 primary mechanisms: (1) sharing experiences, (2) care debriefing, and (3) altruism.

Conclusion: Peer support is a relatively simple intervention that could be implemented to support patients during recovery from critical illness. However, more research is required into how these programs can be implemented in a safe and sustainable way in clinical practice.
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http://dx.doi.org/10.4037/ajcc2021702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182973PMC
March 2021

Provision of holistic care after severe COVID-19 pneumonia.

Lancet Respir Med 2021 03 5;9(3):e24. Epub 2021 Feb 5.

Intensive Care Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.

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http://dx.doi.org/10.1016/S2213-2600(21)00019-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906750PMC
March 2021

Long term outcomes of critically ill COVID-19 pneumonia patients: early learning.

Intensive Care Med 2021 Feb 9;47(2):240-241. Epub 2020 Nov 9.

Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.

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http://dx.doi.org/10.1007/s00134-020-06313-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652047PMC
February 2021

Timing of Onset, Burden, and Postdischarge Mortality of Persistent Critical Illness in Scotland, 2005-2014: A Retrospective, Population-Based, Observational Study.

Crit Care Explor 2020 Apr 29;2(4):e0102. Epub 2020 Apr 29.

NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom.

We aimed to understand the prevalence, timing of onset, resource use, and long-term outcomes of patients who developed persistent critical illness in a national dataset.

Design: Retrospective cohort. Using a physiologic risk adjustment model from ICU admission, we examined the relative ability of acute (related to reason for ICU presentation) and antecedent (demographics, comorbidities) characteristics to discriminate hospital mortality models. Persistent critical illness was defined as the point during an ICU stay when, at the population-level, patients' acute diagnoses and physiologic disturbance are no longer more accurate at discriminating who survives than are baseline demographics and comorbidity. We examined the change across ICU stay in the relative discrimination of those characteristics, and short-term (in-hospital and 30 d after admission) and medium-term (90 d after admission) survival. Finally, we analyzed the changes in the population definition of persistent critical illness over time.

Setting: Patients admitted as level 3 to Scottish ICUs between 2005 and 2014.

Patients: Seventy-two-thousand two-hundred fifty-three adult level 3 ICU admissions in 23 ICUs across Scotland.

Interventions: None.

Measurements And Main Results: The onset of persistent critical illness, occurs at an average of 5.0 days (95% CI, 3.9-6.4 d) across this dataset. The crossing point increased across the decade, by an average of 0.36 days (95% CI, 0.22-0.50 d) per year. In this dataset, 24,425 (33.8%) remained in the ICU long enough to meet this greater than 5-day definition of persistent critical illness. The care of such patients involved 72.3% ICU days used by any level 3 patient; 46.5% of all Scottish ICU bed-days were after day 5. Although rates of 30 days after admission survival rose dramatically during the decade under study, these rates were similar for those with shorter or longer ICU stays, as were the rates of 90-day survival among those who survived at least 30 days.

Conclusions: Persistent critical illness occurred in one in three ICU patients in Scotland. These minority of patients accounted for disproportionate hospital resources but did not have worse 30- or 90-day postadmission survival.
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http://dx.doi.org/10.1097/CCE.0000000000000102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188420PMC
April 2020

Key Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?

Crit Care Explor 2020 Apr 29;2(4):e0088. Epub 2020 Apr 29.

Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.

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.
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http://dx.doi.org/10.1097/CCE.0000000000000088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188426PMC
April 2020

Factors associated with intensive care admission in patients with lung cancer: a population-based observational study of 26, 731 patients.

BMC Pulm Med 2020 Feb 7;20(1):36. Epub 2020 Feb 7.

Department of Public Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.

Background: Lung cancer is the most common cause of cancer related death worldwide and survival is poor. Patients with lung cancer may develop a critical illness, but it is unclear what features are associated with an Intensive Care Unit (ICU) admission.

Methods: This retrospective, observational, population-based study of linked cancer registration, ICU, hospital discharge and mortality data described the factors associated with ICU admission in patients with lung cancer. The cohort comprised all incident cases of adult lung cancer diagnosed between 1st January 2000 and 31st December 2009 in the West of Scotland, UK, who were subsequently admitted to an ICU within 2 years of cancer diagnosis. Multiple logistic regression was used to determine factors associated with admission.

Results: 26,731 incident cases of lung cancer were diagnosed with 398 (1.5%) patients admitted to an ICU. Patients were most commonly admitted with respiratory conditions and there was a high rate of invasive mechanical ventilation. ICU, in-hospital and six-month survival were 58.5, 42.0 and 31.2%, respectively. Surgical treatment of lung cancer increased the odds of ICU admission (OR 7.23 (5.14-10.2)). Odds of admission to ICU were reduced with older age (75-80 years OR 0.69 (0.49-0.94), > 80 years OR 0.21 (0.12-0.37)), female gender (OR 0.73 (0.59-0.90)) and radiotherapy (OR 0.54 (0.39-0.73)) or chemotherapy treatment (OR 0.52 (0.38-0.70)).

Conclusion: 1.5% of patients diagnosed with lung cancer are admitted to an ICU but both short term and long term survival was poor. Factors associated with ICU admission included age < 75 years, male gender and surgical treatment of cancer.
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http://dx.doi.org/10.1186/s12890-020-1071-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007647PMC
February 2020

A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients.

PLoS One 2020 24;15(1):e0227471. Epub 2020 Jan 24.

Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, Scotland, United Kingdom.

Background: Delirium is a common and serious acute neuropsychiatric syndrome which is often missed in routine clinical care. Inattention is the core cognitive feature. Diagnostic test accuracy (including cut-points) of a smartphone Delirium App (DelApp) for assessing attention deficits was assessed in older hospital inpatients.

Methods: This was a case-control study of hospitalised patients aged ≥65 years with delirium (with or without pre-existing cognitive impairment), who were compared to patients with dementia without delirium, and patients without cognitive impairment. Reference standard delirium assessment, which included a neuropsychological test battery, was based on Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A separate blinded assessor administered the DelApp arousal assessment (score 0-4) and attention task (0-6) yielding an overall score of 0 to 10 (lower scores indicate poorer performance). Analyses included receiver operating characteristic curves and sensitivity and specificity. Optimal cut-points for delirium detection were determined using Youden's index.

Results: A total of 187 patients were recruited, mean age 83.8 (range 67-98) years, 152 (81%) women; n = 61 with delirium; n = 61 with dementia without delirium; and n = 65 without cognitive impairment. Patients with delirium performed poorly on the DelApp (median score = 4/10; inter-quartile range 3.0, 5.5) compared to patients with dementia (9.0; 5.5, 10.0) and those without cognitive impairment (10.0; 10.0, 10.0). Area under the curve for detecting delirium was 0.89 (95% Confidence Interval 0.84, 0.94). At an optimal cut-point of ≤8, sensitivity was 91.7% (84.7%, 98.7%) and specificity 74.2% (66.5%, 81.9%) for discriminating delirium from the other groups. Specificity was 68.3% (56.6%, 80.1%) for discriminating delirium from dementia (cut-point ≤6).

Conclusion: Patients with delirium (with or without pre-existing cognitive impairment) perform poorly on the DelApp compared to patients with dementia and those without cognitive impairment. A cut-point of ≤8/10 is suggested as having optimal sensitivity and specificity. The DelApp is a promising tool for assessment of attention deficits associated with delirium in older hospitalised adults, many of whom have prior cognitive impairment, and should be further validated in representative patient cohorts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227471PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980392PMC
April 2020

Impact of a pharmacist intervention at an intensive care rehabilitation clinic.

BMJ Open Qual 2019 27;8(3):e000580. Epub 2019 Sep 27.

Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.

Objective: While disruptions in medications are common among patients who survive critical illness, there is limited information about specific medication-related problems among survivors of critical care. This study sought to determine the prevalence of specific medication-related problems detected in patients, seen after critical care discharge.

Design: Consecutive patients attending an intensive care unit (ICU) follow-up programme were included in this single-centre service evaluation.

Setting: Tertiary care regional centre in Scotland (UK).

Participants: 47 patients reviewed after critical care discharge at an ICU follow-up programme.

Interventions: Pharmacists conducted a full medication review, including: medicines reconciliation, assessing the appropriateness of each prescribed medication, identification of any medication-related problems and checking adherence.

Measurements: Medication-related problems in patients following critical care discharge. Interventions and medication-related problems were systematically graded and risk factors were identified using an adapted version of the National Patient Safety Agency Risk Matrix.

Main Results: 69 medication-related problems were identified in 38 (81%) of the 47 patients. The most common documented problem was drug omission (29%). 64% of the medication-related problems identified were classified as either moderate or major. The number of pain medications prescribed at discharge from intensive care was predictive of medication-related problems (OR 2.02, 95% CI 1.14 to 4.26, p=0.03).

Conclusions: Medication problems are common following critical care. Better communication of medication changes both to patients and their ongoing care providers may be beneficial following a critical care admission. In the absence of highly effective communication, a pharmacy intervention may contribute substantially to an intensive care rehabilitation or recovery programme.
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http://dx.doi.org/10.1136/bmjoq-2018-000580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768365PMC
September 2019

Exploring Patients' Goals Within the Intensive Care Unit Rehabilitation Setting.

Am J Crit Care 2019 09;28(5):393-400

Joanne M. McPeake is a nurse consultant, clinical research in innovation, National Health Service (NHS) Greater Glasgow and Clyde, and honorary senior clinical lecturer, University of Glasgow School of Medicine, Dentistry and Nursing, Glasgow, Scotland. Michael O. Harhay is an instructor, Department of Biostatistics, Epidemiology and Informatics, and Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Helen Devine is a senior physiotherapist and Pamela MacTavish is a highly specialized pharmacist in the intensive care unit, Glasgow Royal Infirmary, Glasgow, Scotland. Theodore J. Iwashyna is a professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor and a research scientist, Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan. Mark Mikkelsen is an associate professor of medicine and chief of the Section of Medical Critical Care, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Health System, and director of the medical intensive care unit, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania. Martin Shaw is an honorary lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow and principal clinical physicist, NHS Greater Glasgow and Clyde. Tara Quasim is a senior clinical lecturer, University of Glasgow School of Medicine, Dentistry and Nursing and an intensive care unit consultant, NHS Greater Glasgow and Clyde.

Background: The number of patients surviving critical care is increasing. Quality of life after critical care is known to be poor for some patients. The evidence base for effective rehabilitation interventions in the period following a stay in an intensive care unit is limited.

Objectives: To understand what rehabilitation goals are important to patients after critical care discharge.

Methods: This prospective study, which was undertaken during an intensive care unit recovery program, explored the recovery goals of 43 patients. Framework analysis was used to extract prevalent themes and identify the important components of recovery from the patients' perspective.

Results: Participants described diverse goals for their post-intensive care unit recovery. Most goals were about health-related quality of life, including physical goals and rehabilitation. Although health was central to many of the participants' individual recovery aims, themes of family and social engagement and adopting appropriate goal trajectories also emerged within patient goals. Individual strategies for reaching these goals varied, and patients had different aspirations about what they could achieve.

Conclusions: Patients' aspirations for their intensive care unit recovery are diverse. Design of postdischarge care can be informed by this greater understanding of the heterogeneous starting points and goal trajectories of survivors of critical illness.
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http://dx.doi.org/10.4037/ajcc2019436DOI Listing
September 2019

The influence of alcohol abuse on agitation, delirium and sedative requirements of patients admitted to a general intensive care unit.

J Intensive Care Soc 2019 Aug 30;20(3):208-215. Epub 2018 Jul 30.

Glasgow Royal Infirmary, Glasgow, UK.

Purpose: Patients with alcohol-related disease constitute an increasing proportion of those admitted to intensive care unit. There is currently limited evidence regarding the impact of alcohol use on levels of agitation, delirium and sedative requirements in intensive care unit. This study aimed to determine whether intensive care unit-admitted alcohol-abuse patients have different sedative requirements, agitation and delirium levels compared to patients with no alcohol issues.

Methods: This retrospective analysis of a prospectively acquired database (June 2012-May 2013) included 257 patients. Subjects were stratified into three risk categories: alcohol dependency (n = 69), at risk (n = 60) and low risk (n = 128) according to Fast Alcohol Screening Test scores and World Health Organisation criteria for alcohol-related disease. Data on agitation and delirium were collected using validated retrospective chart-screening methods and sedation data were extracted and then log-transformed to fit the regression model.

Results: Incidence of agitation (p = 0.034) and delirium (p = 0.041) was significantly higher amongst alcohol-dependent patients compared to low-risk patients as was likelihood of adverse events (p = 0.007). In contrast, at-risk patients were at no higher risk of these outcomes compared to the low-risk group. Alcohol-dependent patients experienced suboptimal sedation levels more frequently and received a wider range of sedatives (p = 0.019) but did not receive higher daily doses of any sedatives.

Conclusions: Our analysis demonstrates that when admitted to intensive care unit, it is those who abuse alcohol most severely, alcohol-dependent patients, rather than at-risk drinkers who have a significantly increased risk of agitation, delirium and suboptimal sedation. These patients may require closer assessment and monitoring for these outcomes whilst admitted.
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http://dx.doi.org/10.1177/1751143718787748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693117PMC
August 2019

Understanding what matters to patients in critical care: An exploratory evaluation.

Nurs Crit Care 2020 07 15;25(4):214-220. Epub 2019 Jul 15.

Critical Care, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK.

Background: The delivery of person-centred care is a key priority for managers, policy makers, and clinicians in health care. The delivery person-centred care in critical care is challenging because of competing demands.

Aims And Objectives: The aim of this quality improvement project was to understand what mattered to patients on a daily basis within the critical care environment. It aimed to understand personal goals and what patients needed to improve their experience. This paper reports on the outputs from this quality improvement project.

Design And Data Analysis: During each daily ward round, patients were asked "what matters to you today?" Outputs from this were entered into the Daily Goals Sheet, which is utilized for every patient in our critical care unit or in the nursing notes. Using Framework Analysis, prevalent themes were extracted from the patient statements documented.

Results: A total of 196 unique patients were included in this analysis alongside 592 patient statements. Four broad themes were generated: medical outcomes and information, the critical care environment, personal care, and family and caregivers.

Conclusion: The analysis of the data from this quality improvement project has demonstrated that, by asking a simple question within the context of a ward round, care can be enhanced and personalized and long-term outcomes potentially improved. More research is required to understand what the optimal methods are of implementing these requests.

Relevance To Clinical Practice: Two main recommendations from practice emerged from this quality improvement project: asking patients "what matters to you?" on a daily basis may help support the humanization of the critical care environment, and visiting and access by families must be discussed with patients to ensure this is appropriate for their needs.
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http://dx.doi.org/10.1111/nicc.12461DOI Listing
July 2020

Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives.

Crit Care Med 2019 09;47(9):1194-1200

Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA.

Objectives: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.

Design: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.

Setting: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents.

Subjects: Clinicians from 21 sites.

Measurement And Main Results: Ten enablers and nine barriers to implementation of "ICU follow-up clinics" were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of "peer support groups" were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.

Conclusions: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.
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http://dx.doi.org/10.1097/CCM.0000000000003818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699486PMC
September 2019

Return to Employment after Critical Illness and Its Association with Psychosocial Outcomes. A Systematic Review and Meta-Analysis.

Ann Am Thorac Soc 2019 10;16(10):1304-1311

Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia.

Patients who survive critical illness have well-defined physical, cognitive, emotional, and familial problems. However, the impact of these problems on survivors' ability to return to work and other financial outcomes is less clear. To determine the financial and employment consequences of an intensive care stay, we performed a systematic review and meta-analysis. We searched the MEDLINE, Embase, and CINAHL databases (1970-2018). All publication types except narrative reviews, case reports, case-control studies, and editorials were included. Included studies assessed financial outcomes in patients admitted to critical care and their caregivers. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcome reported was return to employment among those previously employed. We also examined financial stress and the impact financial outcomes had on quality of life and psychosocial health. Of 5,765 eligible abstracts, 51 studies were included, which provided data on 858 caregivers/family members and 7,267 patients. Forty-two papers reported patient outcomes, and 11 papers described caregivers/family members. Two papers included data from both patients and caregivers/family members. Return to employment was the most commonly reported financial outcome for critical care survivors. The pooled estimates for return to employment among those who were employed before critical illness were 33% (95% confidence interval [CI], 21-48%), 55% (95% CI, 45-64%), and 56% (95% CI, 45-66%) at 3, 6, and 12 months, respectively. Across the studies included in this review, there was a positive association with psychosocial health if patients returned to employment. This included improved health-related quality of life and fewer depressive symptoms. Regarding caregivers/family members, six studies reported changes in employment such as reduced hours and lost earnings. After critical illness, many patients who were previously employed do not return to work, even one year later. This new job loss is associated with worse health-related quality of life among survivors and worse psychological function among survivors and caregivers/family members. More interventional research is required to understand how best to support employability after critical illness.Registered with PROSPERO (CRD42018102360).
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http://dx.doi.org/10.1513/AnnalsATS.201903-248OCDOI Listing
October 2019

Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives.

Intensive Care Med 2019 07 4;45(7):939-947. Epub 2019 Jun 4.

Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Objective: To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs.

Methods: Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine's THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data.

Results: Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs-new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU-former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them-clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician's own understanding of patient experience-there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work-this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes.

Conclusions: The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area.
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http://dx.doi.org/10.1007/s00134-019-05647-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611738PMC
July 2019

Chronic pain in intensive care unit survivors: incidence, characteristics and side-effects up to one-year post-discharge.

J Rehabil Med 2019 Jun;51(6):451-455

Physiotherapy, Glasgow Royal Infirmary, G4OSF Glasgow, United Kingdom.

Background: Intensive care unit survivors experience significant physical and psychological problems, including chronic pain following discharge. The aim of this study was to observe the incidence, anatomical sites, intensity, and interference of chronic pain in intensive care unit survivors over a 1-year period. In addition, potential predictors of chronic pain were analysed.

Methods: Data were collected during an intensive care unit follow-up programme as part of a quality improvement initiative. Data from the Brief Pain Inventory and from musculoskeletal assessment were examined, alongside demographic data from the patient. Data were collected from patients at baseline and at a 1-year follow-up appointment.

Results: Data from 47 intensive care unit survivors were included in this study. In 66% (n = 31) of the patients a "new" chronic pain that did not exist before their stay in the intensive care, was reported. Pain intensity in this patient group was "moderate"' and did not improve significantly over the 1-year period. Although pain interference with life decreased over the study period, it was still the most common cause of reduced enjoyment of life and reduced employment at 1-year follow-up.

Conclusion: Chronic pain is associated with morbidity in intensive care unit survivors. Pain interference, but not pain intensity, improved significantly in the first year after discharge. Further multi-centre research is required to elucidate the chronic pain experience.
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http://dx.doi.org/10.2340/16501977-2558DOI Listing
June 2019

Understanding the patient journey: a mechanism to reduce staff burnout?

Br J Nurs 2019 Mar;28(6):396-397

Nurse Consultant (Clinical Research and Innovation), NHS Greater Glasgow and Clyde.

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http://dx.doi.org/10.12968/bjon.2019.28.6.396DOI Listing
March 2019

Models of Peer Support to Remediate Post-Intensive Care Syndrome: A Report Developed by the Society of Critical Care Medicine Thrive International Peer Support Collaborative.

Crit Care Med 2019 01;47(1):e21-e27

Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.

Objectives: Patients and caregivers can experience a range of physical, psychologic, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism.

Design: We sought to identify technical, safety, and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation.

Subjects And Setting: Seventeen Thrive sites from the United States, United Kingdom, and Australia were represented by a range of healthcare professionals.

Measurements And Main Results: Via an iterative process of in-person and email/conference calls, members of the Collaborative defined the key areas on which peer support models could be defined and compared, collected detailed self-reports from all sites, reviewed the information, and identified clusters of models. Barriers and challenges to implementation of peer support models were also documented. Within the Thrive Collaborative, six general models of peer support were identified: community based, psychologist-led outpatient, models-based within ICU follow-up clinics, online, groups based within ICU, and peer mentor models. The most common barriers to implementation were recruitment to groups, personnel input and training, sustainability and funding, risk management, and measuring success.

Conclusions: A number of different models of peer support are currently being developed to help patients and families recover and grow in the postcritical care setting.
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http://dx.doi.org/10.1097/CCM.0000000000003497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719778PMC
January 2019

Family and Support Networks Following Critical Illness.

Crit Care Clin 2018 Oct 11;34(4):609-623. Epub 2018 Aug 11.

Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland.

Research highlights the psychosocial impact of critical illness on family who typically adopt a caregiver role to the survivor. We review evidence on informal caregiver psychosocial outcomes and interventional studies designed to improve them. We argue informal caregivers have distinct and complex needs that differ from patients. Interventional studies ought to be designed for this cohort with careful attention paid to the timing of interventions. We consider the influence of social isolation on recovery and discuss service improvement approaches to build social support networks to enhance recovery, where caregivers and survivors are involved in the design of aftercare programs.
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http://dx.doi.org/10.1016/j.ccc.2018.06.008DOI Listing
October 2018

Diagnostic test accuracy of a novel smartphone application for the assessment of attention deficits in delirium in older hospitalised patients: a prospective cohort study protocol.

BMC Geriatr 2018 09 17;18(1):217. Epub 2018 Sep 17.

Edinburgh Delirium Research Group, University of Edinburgh, Edinburgh, UK.

Background: Delirium is a common and serious clinical syndrome which is often missed in routine clinical care. The core cognitive feature is inattention. We developed a novel bedside neuropsychological test for assessing inattention in delirium implemented on a smartphone platform (DelApp). We aim to evaluate the diagnostic performance of the DelApp in a representative cohort of older hospitalised patients.

Methods: This is a prospective study of older non-scheduled hospitalised patients (target n = 500, age ≥ 65), recruited from elderly care and acute orthopaedic wards. Exclusion criteria are: non-English speakers; severe vision or hearing impairment; photosensitive epilepsy. A structured reference standard delirium assessment based on DSM-5 criteria will be used, which includes a cognitive test battery administered by a trained assessor (Orientation-Memory-Concentration Test, Abbreviated Mental Test-10, Delirium Rating Severity Scale-Revised-98, digit span, months and days backwards, Vigilance A' test) and assessment of arousal (Observational Scale of Level of Arousal, Richmond Agitation Sedation Scale). Prior change in cognition will be documented using the Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be categorized as delirium (with/without dementia), possible delirium, dementia, no cognitive impairment, or undetermined. A separate assessor (blinded to diagnosis and assessments) will administer the DelApp index test within 3 h of the reference standard assessment. The DelApp comprises assessment of arousal (score 0-4) and sustained attention (score 0-6), yielding a total score between 0 and 10 (higher score = better performance). Outcomes (length of stay, mortality and discharge location) will be collected at 12 weeks. We will evaluate a priori cutpoints derived from a previous case-control study. Measures of the accuracy of DelApp will include sensitivity, specificity, positive and negative predictive values, and area under the ROC curve. We plan repeat assessments on up to 4 occasions in a purposive subsample of 30 patients (15 delirium, 15 no delirium) to examine changes over time.

Discussion: This study evaluates the diagnostic test accuracy of a novel smartphone test for delirium in a representative cohort of older hospitalised patients, including those with dementia. DelApp has the potential to be a convenient, objective method of improving delirium assessment for older people in acute care.

Trial Registration: Clinical trials.gov, NCT02590796 . Registered on 29 Oct 2015. Protocol version 5, dated 25 July 2016.
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http://dx.doi.org/10.1186/s12877-018-0901-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142423PMC
September 2018
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