Addressing the Psychological Symptoms of Critical Illness: The Importance of "Negative" Trials in Guiding Next Steps

Validación del cuestionario básico de síntomas M. D. Anderson (MDASI) para pacientes con cáncer en población mexicana

Introducción: Los diferentes síntomas en el paciente con cáncer pueden afectar las actividades en la vida cotidiana, las decisiones terapéuticas, así como la calidad de vida. Por lo que identificar la sintomatología en este grupo de pacientes es de suma importancia. Objetivo: Validar el cuestionario básico de síntomas M. D. Anderson (MDASI) para pacientes con cáncer en población mexicana. Método: Se incluyeron 309 pacientes del Instituto Nacional de Cancerología con edad entre 18 a 85 años, el tipo de estudio fue transversal, no experimental. Instrumentos: Cuestionario básico de síntomas MDASI, Cuestionario de Calidad de Vida de la Organización Europea para el tratamiento e Investigación del cáncer (EORTC-QLQ-C30) y Termómetro de Distrés. Resultados: Un análisis factorial ajustado a dos factores presentó un instrumento con 12 reactivos, similar a la versión original. La consistencia interna de la escala global mostró un índice satisfactorio (0,86). Las alfas de Cronbach de cada subescala tuvieron un valor de 0,79 y 0,80 que explicaron el 48,04% de la varianza global. La validez, por medio de correlación con las medidas concurrentes, mostró resultados significativos (r de Pearson de 0,954 a -0,267, p<0,01). Conclusiones: El instrumento MDASI mostro propiedades psicométricas adecuadas, similar a la versión original. Es útil para la práctica clínica e investigación. Se recomienda realizar estudios complementarios para determinar su sensibilidad en efectos de intervenciones médicas y psicológicas.

Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

Objectives

To determine acceptability of medical cannabis research in critically ill patients.

Design

Q-methodology survey.

Setting

Convenience sample of healthcare providers and the general public were recruited at an acute care community hospital in Ontario, Canada.

Participants

In the first phase, 63 respondents provided 197 unique viewpoints in response to a topic statement about medical cannabis use in critically ill patients. Twenty-five viewpoints were selected for the q-sample. In the second phase, 99 respondents ranked these viewpoints according to an a priori quasi normal distribution ranging from +4 (most agree) to -4 (least agree). Factor analysis was combined with comments provided by survey respondents to label and describe the extracted factors.

Results

The factor labels were hoping and caring (factor 1), pragmatic progress (factor 2), and cautious/conservative and protectionist (factor 3). Factor 1 describes a viewpoint of unequivocal support for medical cannabis research in this population with few caveats. Factor 2 describes a viewpoint of cautious support with a need to monitor for unintended adverse effects. Factor 3 describes a viewpoint of ensuring that current analgosedation techniques are optimized before exposing patients to another potentially harmful drug.

Conclusions

Using a q-methodology design, we were able to sample and describe the viewpoints that exist about medical cannabis research in critically ill patients. Three factors emerged that seemed to adequately describe the relative ranking of q-statements by the majority of respondents. Combining the distinguishing statements along with respondent comments allowed us to determine that the majority support medical cannabis research in critically ill patients.

Pre-existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta-analysis of prevalence

AIMS

To determine the reported prevalence rate of pre-existing mental health disorders in patients admitted to adult ICUs and identify the most commonly occurring types of these disorders.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Five electronic databases were searched from 1 January 2000 -15 April 2020. Google Scholar was used to perform forwards citation searching.

METHODS

This review was conducted in line with the PRISMA guidelines and protocol registered with PROSPERO CRD42020181818. Meta-analyses were performed using the quality effects model to calculate weighted pooled prevalence estimates and heterogeneity was tested using the I² statistic.

RESULTS

Seven articles were included in the final review and meta-analysis (143,179 participants). Identified prevalence rates varied considerably, ranging from 6.2-28.0%, reflecting variation in each study's clinical context, as well as different patient selection and identification methodologies. The pooled prevalence rate of all pre-existing mental health disorders was 19.4% (95% CI 8.9-32.6%). Depression was the most common subtype, accounting for an estimated 60.5% (95% CI 54.4-66.5%) of identified mental health disorders. All analyses showed significant heterogeneity with I²  > 95%.

CONCLUSION

Approximately 19% of adult ICU patients have a history of a mental health disorder, most commonly depression. Further research is needed to improve the accuracy of this estimate as well as determine the best identification method.

IMPACT

This study has demonstrated that patients with pre-existing mental health disorders, particularly depression, constitute a significant subgroup in ICU. Given that the presence of a pre-existing mental health disorder appears to confer an increased mortality risk following ICU discharge, clinicians need to be made aware of this group of patients to provide additional support. Further research is needed to more accurately quantify this vulnerable group and establish methods to enable clinicians to readily identify and refer these patients for appropriate follow-up treatment.