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Nikakis J, Tale E, Malkov D, Arora US, Keys J, Li TS, Yao SC, Cohen TJ. The effect of osteopathic manipulative treatment on quality of life in patients with cardiac implantable electronic devices. J Osteopath Med 2024; 124:365-368. [PMID: 38632892 DOI: 10.1515/jom-2023-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024]
Abstract
CONTEXT Osteopathic manipulative treatment (OMT) has been demonstrated to have an effect on the autonomic nervous system, which may have antiarrhythmic effects. The effects of OMT in patients with cardiac implantable electronic devices (CIEDs) have not previously been reported. This study investigated the impact of OMT on quality of life (QOL) in this patient population. OBJECTIVES The purpose of this study is to investigate the effects of OMT on QOL in CIED patients. METHODS Subjects with CIEDs were recruited into a double-blind randomized controlled institutional review board (IRB)-approved clinical trial (ClinicalTrials.gov ID: NCT04004741) and randomized to OMT or light touch (control) groups. Subjects received a one-time intervention, performed by board-certified neuromusculoskeletal medicine (NMM) and osteopathic manipulative medicine (OMM) physicians. The OMT protocol utilized techniques including myofascial release, rib raising, facilitated positional release (FPR), and osteopathic cranial manipulative medicine. Subjects' QOL was assessed immediately preceding intervention and one-month postintervention utilizing the Research ANd Development (RAND) 36-Item Short Form Health Survey (SF-36, eight parameters). Groups were compared utilizing unpaired t tests; α=0.05. RESULTS Forty-two subjects were enrolled, with four lost to follow-up, which resulted in 19 OMT and 19 control subjects for analysis. Of the eight QOL parameters, two showed significant improvement with OMT: role limitations due to physical health (p=0.001) and pain (p=0.003). CONCLUSIONS This study demonstrates the potential for QOL improvement in CIED patients. Specifically, subjects in the OMT group reported an improvement in activities of daily living as well as a decrease in overall pain, including pain interfering with work. Additional research is necessary to further understand the physiologic effects of OMT, including its effects on arrhythmias, in CIED patients.
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Affiliation(s)
- Jacqueline Nikakis
- 43984 New York Institute of Technology College of Osteopathic Medicine , Old Westbury, NY, USA
| | - Ermin Tale
- 43984 New York Institute of Technology College of Osteopathic Medicine , Old Westbury, NY, USA
| | - Denis Malkov
- 43984 New York Institute of Technology College of Osteopathic Medicine , Old Westbury, NY, USA
| | - Uddampreet S Arora
- 43984 New York Institute of Technology College of Osteopathic Medicine , Old Westbury, NY, USA
| | - Jordan Keys
- Department of Osteopathic Manipulative Medicine, 43984 NYIT-College of Osteopathic Medicine , Old Westbury, NY, USA
| | - To Shan Li
- Department of Osteopathic Manipulative Medicine, 43984 NYIT-College of Osteopathic Medicine , Old Westbury, NY, USA
| | - Sheldon C Yao
- Department of Osteopathic Manipulative Medicine, 43984 NYIT-College of Osteopathic Medicine , Old Westbury, NY, USA
| | - Todd J Cohen
- 43984 New York Institute of Technology College of Osteopathic Medicine , Old Westbury, NY, USA
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Wehrfritz A, Schmidt J, Bremer F, Lang A, Welzer J, Castellanos I. Ethical conflicts associated with COVID-19 pandemic, triage and frailty-unexpected positive disease progression in a 90-year-old patient: A case report. Clin Case Rep 2023; 11:e7710. [PMID: 37476601 PMCID: PMC10354352 DOI: 10.1002/ccr3.7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
During the COVID 19 pandemic, advanced age, scoring systems, and a shortage of ICU beds were used as cut-offs for ICU admission. This case report describes the epicrisis of an elderly patient who was almost mistakenly not treated in an ICU.
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Affiliation(s)
- Andreas Wehrfritz
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Joachim Schmidt
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Frank Bremer
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Anne‐Katharina Lang
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
| | - Jacob Welzer
- Department of AnaesthesiologyKlinikum FuerthFuerthGermany
| | - Ixchel Castellanos
- Department of AnaesthesiologyUniversity hospital of Erlangen, Faculty of Medicine, Friedrich‐Alexander‐University ErlangenErlangenGermany
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Hofhuis JGM, Schermer T, Spronk PE. Mental health-related quality of life is related to delirium in intensive care patients. Intensive Care Med 2022; 48:1197-1205. [PMID: 35984472 DOI: 10.1007/s00134-022-06841-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Delirium during intensive care unit (ICU) stay may be related to premorbid mental illness. In addition, delirium during ICU stay may also negatively affect long-term health-related quality of life. The aim of our study was to investigate if delirium in the ICU is related to premorbid mental quality of life and affects long-term mental quality of life after ICU stay. METHODS We performed a prospective cohort study in 1021 patients admitted for longer than 48 h in a medical-surgical ICU. We evaluated mental and physical quality of life using the Short-form-12 before ICU admission, at hospital discharge, and 3, 6 and 12 months after hospital discharge. Mixed model and logistic regression models were used to analyze the data. RESULTS Patients who experienced a delirium during ICU stay reported a worse pre-admission mental quality of life than those without delirium (p < 0.001). Furthermore, patients who suffered from delirium during their ICU stay exhibited a significant decrease in mental quality of life over time relative to patients without delirium (p = 0.035). CONCLUSION In this large follow-up study, we demonstrated that ICU survivors who experienced a delirium during ICU stay reported a significantly worse pre-admission mental health-related quality of life and a significant decrease in mental health-related quality of life in the year after hospital discharge compared with patients without delirium.
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Affiliation(s)
- José G M Hofhuis
- Department of Intensive Care, Gelre Hospitals, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands. .,Expertise Center for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.
| | - Tjard Schermer
- Department of Epidemiology, Gelre Hospitals, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands
| | - Peter E Spronk
- Department of Intensive Care, Gelre Hospitals, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.,Expertise Center for Intensive Care Rehabilitation Apeldoorn (ExpIRA), Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.,Department of Intensive Care, University Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Chugh Y, Katoch S, Sharma D, Bahuguna P, Duseja A, Kaur M, Dhiman RK, Prinja S. Health-Related Quality of Life Among Liver Disorder Patients in Northern India. Indian J Community Med 2022; 47:76-81. [PMID: 35368487 PMCID: PMC8971888 DOI: 10.4103/ijcm.ijcm_1033_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: The present study aims to determine the health-related quality of life (HRQoL) among liver disorder patients being treated in tertiary care hospital in north India and exploration of factors affecting HRQoL. Methodology: The HRQoL was assessed among 230 patients visiting either the outpatient department (OPD) or those admitted in high dependency unit (HDU) or liver intensive care unit (ICU) using direct measuring tools such as Euro QoL five-dimension questionnaire (EQ-5D) and EQ visual analog scale. Multivariate regression was used to explore the factors influencing HRQoL. Results: Mean EQ-5D scores among chronic hepatitis and compensated cirrhosis patients were 0.639 ± 0.062 and 0.562 ± 0.048, respectively. Among those who were admitted in the ICU or HDU, mean EQ-5D score was 0.295 ± 0.031. At discharge, this score improved significantly to 0.445 ± 0.055 (P < 0.001). The multivariate results implied that HRQoL was significantly better among patients with lower literacy level (P = 0.018) and those treated in OPD settings (P < 0.001). Conclusion: HRQoL is impaired among patients suffering from liver disorders specifically those admitted in ICU. Further, there is a need to generate more evidence to explore the impact of determinants and treatment-associated costs on the HRQoL.
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Affiliation(s)
- Yashika Chugh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Katoch
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radha Krishan Dhiman
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Munir H, Morais JA, Goldfarb M. Health-Related Quality of Life in Older Adults With Acute Cardiovascular Disease Undergoing Early Mobilization. CJC Open 2021; 3:888-895. [PMID: 34401695 PMCID: PMC8347843 DOI: 10.1016/j.cjco.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/22/2021] [Indexed: 10/25/2022] Open
Abstract
Background Early mobilization (EM) is safe and feasible in older adults with acute cardiovascular disease (CVD) and may improve posthospitalization patient-centred outcomes. Our objective was to assess posthospitalization health-related quality of life (HRQOL) in older adults with acute CVD undergoing EM. Methods Patients aged ≥ 60 years with acute CVD undergoing EM at an academic tertiary centre in Montreal, Quebec were prospectively enrolled from January 2018 to January 2020. Functional status was measured using the validated Level of Function Mobility Scale. HRQOL was measured using the Short-Form 36 questionnaire at 1 and 12 months posthospitalization. The primary outcome was the questionnaire's physical component summary (PCS) score at 1 month posthospitalization. Results There were 147 patients included in the analysis (aged 75.0 ± 8.7 years; 44.6% female; 48.6% with ischemic heart disease). The mean 1-month PCS score was 34.7 ± 9.7, which was 11.5 points and 8.4 points lower compared to age-matched Canadian normative data for people ages 65-74 years and ≥ 75 years, respectively. The mean PCS score at 12 months (36.5 ± 9.2) and the mean mental component summary scores at 1 and 12 months (36.9 ± 11.1; 40.5 ± 11.5) were lower than those of the age-matched population (all P < 0.0001). In the multivariable analysis, increased age and worse prehospitalization function were associated with lower PCS score at 1 month. Conclusions Older adults with acute CVD had lower HRQOL at 1 and 12 months posthospitalization than age-matched Canadian norms. Prehospitalization functional status was predictive of poor posthospitalization HRQOL. The EM program was safe and feasible in this patient population. Further studies are needed to determine whether EM can improve posthospitalization patient-centred outcomes in older adults, particularly those with poor prehospitalization functional status.
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Affiliation(s)
- Haroon Munir
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - José A Morais
- Division of Geriatric Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Abstract
OBJECTIVES Although patient's health status before ICU admission is the most important predictor for long-term outcomes, it is often not taken into account, potentially overestimating the attributable effects of critical illness. Studies that did assess the pre-ICU health status often included specific patient groups or assessed one specific health domain. Our aim was to explore patient's physical, mental, and cognitive functioning, as well as their quality of life before ICU admission. DESIGN Baseline data were used from the longitudinal prospective MONITOR-IC cohort study. SETTING ICUs of four Dutch hospitals. PATIENTS Adult ICU survivors (n = 2,467) admitted between July 2016 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients, or their proxy, rated their level of frailty (Clinical Frailty Scale), fatigue (Checklist Individual Strength-8), anxiety and depression (Hospital Anxiety and Depression Scale), cognitive functioning (Cognitive Failure Questionnaire-14), and quality of life (Short Form-36) before ICU admission. Unplanned patients rated their pre-ICU health status retrospectively after ICU admission. Before ICU admission, 13% of all patients was frail, 65% suffered from fatigue, 28% and 26% from symptoms of anxiety and depression, respectively, and 6% from cognitive problems. Unplanned patients were significantly more frail and depressed. Patients with a poor pre-ICU health status were more often likely to be female, older, lower educated, divorced or widowed, living in a healthcare facility, and suffering from a chronic condition. CONCLUSIONS In an era with increasing attention for health problems after ICU admission, the results of this study indicate that a part of the ICU survivors already experience serious impairments in their physical, mental, and cognitive functioning before ICU admission. Substantial differences were seen between patient subgroups. These findings underline the importance of accounting for pre-ICU health status when studying long-term outcomes.
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Souron R, Morel J, Gergelé L, Infantino P, Brownstein CG, Lapole T, Millet GY. Relationship between intensive care unit-acquired weakness, fatigability and fatigue: What role for the central nervous system? J Crit Care 2020; 62:101-110. [PMID: 33316555 DOI: 10.1016/j.jcrc.2020.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To provide a comprehensive review of studies that have investigated fatigue in intensive care unit (ICU) survivors and questions the potential link between intensive care unit-acquired weakness (ICUAW), fatigability and fatigue. We also question whether the central nervous system (CNS) may be the link between these entities. MATERIAL AND METHODS A narrative review of the literature that investigated fatigue in ICU survivors and review of clinical trials enabling understanding of CNS alterations in response to ICU stays. RESULTS Fatigue is a pervasive and debilitating symptom in ICU survivors that can interfere with rehabilitation. Due to the complex pathophysiology of fatigue, more work is required to understand the roles of ICUAW and/or fatigability in fatigue to provide a more holistic understanding of this symptom. While muscle alterations have been well documented in ICU survivors, we believe that CNS alterations developing early during the ICU stay may play a role in fatigue. CONCLUSIONS Fatigue should be considered and treated in ICU survivors. The causes of fatigue are likely to be specific to the individual. Understanding the role that ICUAW and fatigability may have in fatigue would allow to tailor individual treatment to prevent this persistent symptom and improve quality of life.
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Affiliation(s)
- Robin Souron
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France; Laboratory of Impact of Physical Activity on Health (IAPS), UR n°201723207F, University of Toulon, France
| | - Jérôme Morel
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France; Département d'anesthésie et réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.
| | - Laurent Gergelé
- Ramsay Générale de Santé, Hôpital privé de la Loire, Saint Etienne, France
| | - Pascal Infantino
- Département d'anesthésie et réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Callum G Brownstein
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France.
| | - Thomas Lapole
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France
| | - Guillaume Y Millet
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France.
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Zeggwagh Z, Abidi K, Kettani MN, Iraqi A, Dendane T, Zeggwagh AA. Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge. Indian J Crit Care Med 2020; 24:531-538. [PMID: 32963435 PMCID: PMC7482352 DOI: 10.5005/jp-journals-10071-23489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The aims of this study were to evaluate changes in health-related quality of life (HRQoL) before ICU admission and after ICU discharge in elderly patients and to determine predictors of this HRQoL. Materials and methods This prospective study has been realized in the medical ICU (August 2012-March 2013). All patients 65 years of age or older who were hospitalized for ≥48 hours in our medical ICU have been included. The HRQoL was assessed 1 month prior to ICU admission in all the patients at admission and 3 months after ICU discharge for survivors using the Arabic version of MOS SF-36 questionnaire. Results We enrolled 118 patients (66 M: 55.9% and 52 F: 44.1%). The mean age was 72 ± 6 years. ICU mortality rate was 47.5% and three-month mortality rate was 55.1%. The reliability and validity of MOS SF-36 were satisfactory. Among the 53 survivors at follow-up, the subscales of MOS SF-36 decreased significantly at 3 months after ICU stay except the “Bodily Pain”. The physical component score (PCS) and mental component score (MCS) decreased also significantly. The independent factors strongly associated with PCS and its variations were: age (β = −1.56, p = 0.001), prior functional status (β = −22.10, p = 0.002) and SAPSII (β = −0.16, p = 0.04). For MCS, these factors were: live alone (β = 16.50, p = 0.006), previous functional status (β = −9.09, p = 0.008) and existence of education level (β = 2.98, p = 0.037). Conclusion We demonstrated a fall in the physical and psychical aspects of HRQoL 3 months after ICU discharge in the elderly patients. In addition to factors such as age, prior functional status and severity of illness, family status and educational level seem decisive in the post-ICU HRQoL. How to cite this article Zeggwagh Z, Abidi K, Kettani MNZ, Iraqi A, Dendane T, Zeggwagh AA. Health-related Quality of Life Evaluated by MOS SF-36 in the Elderly Patients 1 Month before ICU Admission and 3 Months after ICU Discharge. Indian J Crit Care Med 2020;24(7):531–538.
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Affiliation(s)
- Zineb Zeggwagh
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Khalid Abidi
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Nz Kettani
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Amina Iraqi
- King Fahd Highschool, Abdelmalek Essaadi University of Tanger, Morocco
| | - Tarek Dendane
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Amine Ali Zeggwagh
- Medical Intensive Care Unit, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
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Guzelhan Y, Oztas DM, Conkbayir C, Rodoplu O, Erdinc I, Canbay C, Ugurlucan M, Alpagut U, Bozbuga N. Assessment of anxiety and health-related quality of life in patients with lower extremity peripheral arterial occlusive disease. Arch Med Sci Atheroscler Dis 2020; 5:e212-e218. [PMID: 32832723 PMCID: PMC7433785 DOI: 10.5114/amsad.2020.97728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the effect of chronic occlusive vascular disease on anxiety with adverse outcome with health-related quality of life (HRQoL). MATERIAL AND METHODS Three hundred and thirty-five patients who were treated for peripheral arterial occlusive disease were enrolled in this study. 187 patients who had undergone percutaneous transluminal angioplasty and 148 patients who had one or more surgical revascularizations enrolled in the study. Mean age of the patients was 62.6 ±10 years. Two hundred and eighty-nine patients were male, 46 patients were female. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 335 patients filled out the SF-36 and STAI, and 304 patients (90.7 % of the series) filled them out at 6-month follow-up. RESULTS There was no mortality and no significant morbidity after vascular interventions in the series. Significant improvement was found in two of eight health domains. The score of social functioning increased to 60.4 from 52.6 (p < 0.03) and general health perception increased to 75.1 from 60.5 (p < 0.04) at 6-month follow-up. The two STAI sub-scores, the State Anxiety Inventory (STAI-S) and the Trait Anxiety Inventory (STAI-T) were found high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was no significant decrease of the levels of anxiety. CONCLUSIONS This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status in patients suffering from lower extremity peripheral arterial occlusive disease.
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Affiliation(s)
- Yalcin Guzelhan
- Department of Psychiatry, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Didem Melis Oztas
- Cardiovascular Surgery Clinic, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Cenk Conkbayir
- Department of Cardiology, Near East University, Nicosia, Cyprus
| | - Orhan Rodoplu
- Cardiovascular Surgery Clinic, Kadikoy Medicana Hospital, Istanbul, Turkey
| | - Ibrahim Erdinc
- Cardiovascular Surgery Clinic, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Cagla Canbay
- Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nilgun Bozbuga
- Department of Cardiovascular Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Anxiety and health-related quality of life after cardiac surgery. ACTA ACUST UNITED AC 2020; 5:e27-e35. [PMID: 33585722 PMCID: PMC7863552 DOI: 10.5114/amsad.2020.94376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/03/2019] [Indexed: 12/19/2022]
Abstract
Introduction The aim of this study was to investigate the effect of elective cardiac surgery on health-related quality of life (HRQoL). Material and methods One hundred and eight (35 women and 73 men, mean age 62.3 ±12.7 years) patients undergoing open heart surgery were enrolled in the study. Physical and mental domains of quality of life were measured using the 36-item Medical Outcomes Short-Form Health Survey (SF-36) self-administered questionnaire, and anxiety symptoms were assessed using the Spielberger State-Trait Anxiety Inventory (STAI). At baseline 108 patients filled out the SF-36 and STAI, and 102 patients at 6-month follow-up. Results It was found that there was significant improvement in three out of eight health domains: physical functioning (p < 0.02), role physical (p < 0.01), and social functioning (p < 0.04), at 6-month follow-up. The two STAI sub-scores: the State Anxiety Inventory and the Trait Anxiety Inventory were found to be high (≥ 40) both preoperatively and 6 months postoperatively. Postoperatively there was not any statistically significant decrease in the levels of anxiety. Conclusions This study suggests that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and prediction of functional status and HRQoL in patients after cardiovascular surgery. Furthermore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety.
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Bauer PR. The Sicker Are Sicker: A Tale of Late Outcome After Sepsis. Crit Care Med 2020; 47:610-611. [PMID: 30882433 DOI: 10.1097/ccm.0000000000003676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Health related quality of life and predictive factors six months after intensive care unit discharge. Anaesth Crit Care Pain Med 2019; 38:137-141. [DOI: 10.1016/j.accpm.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
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Houlihan S, Fernandez N, Magnant C, Levin A, Murphy S. Evaluating a Nurse-Driven Mobility Algorithm for Hospitalized General Medicine Patients: A Pilot Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fontela PC, Abdala FANB, Forgiarini SGI, Luiz Jr. AF. Quality of life in survivors after a period of hospitalization in the intensive care unit: a systematic review. Rev Bras Ter Intensiva 2018; 30:496-507. [PMID: 30672974 PMCID: PMC6334481 DOI: 10.5935/0103-507x.20180071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 07/10/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the long-term, health-related quality of life of intensive care unit survivors by systematic review. METHODS The search for, and selection and analysis of, observational studies that assessed the health-related quality of life of intensive care unit survivors in the electronic databases LILACS and MEDLINE® (accessed through PubMed) was performed using the indexed MESH terms "quality of life [MeSH Terms]" AND "critically illness [MeSH Terms]". Studies on adult patients without specific prior diseases published in English in the last 5 years were included in this systematic review. The citations were independently selected by three reviewers. Data were standardly and independently retrieved by two reviewers, and the quality of the studies was assessed using the Newcastle-Ottawa scale. RESULTS In total, 19 observational cohort and 2 case-control studies of 57,712 critically ill patients were included. The follow-up time of the studies ranged from 6 months to 6 years, and most studies had a 6-month or 1-year follow up. The health-related quality of life was assessed using two generic tools, the EuroQol and the Short Form Health Survey. The overall quality of the studies was low. CONCLUSIONS Long-term, health-related quality of life is compromised among intensive care unit survivors compared with the corresponding general population. However, it is not significantly affected by the occurrence of sepsis, delirium, and acute kidney injury during intensive care unit admission when compared with that of critically ill patient control groups. High-quality studies are necessary to quantify the health-related quality of life among intensive care unit survivors.
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Affiliation(s)
- Paula Caitano Fontela
- Programa de Pós-Graduação em
Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul -
Porto Alegre (RS), Brasil
| | | | | | - Alberto Forgiarini Luiz Jr.
- Programa de Pós-Graduação em
Biociências e Reabilitação e Reabilitação e
Inclusão, Centro Universitário Metodista IPA - Porto Alegre (RS),
Brasil
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15
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Orwelius L, Nilsson M, Nilsson E, Wenemark M, Walfridsson U, Lundström M, Taft C, Palaszewski B, Kristenson M. The Swedish RAND-36 Health Survey - reliability and responsiveness assessed in patient populations using Svensson's method for paired ordinal data. J Patient Rep Outcomes 2018; 2:4. [PMID: 29757320 PMCID: PMC5934928 DOI: 10.1186/s41687-018-0030-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background The Short Form 36-Item Survey is one of the most commonly used instruments for assessing health-related quality of life. Two identical versions of the original instrument are currently available: the public domain, license free RAND-36 and the commercial SF-36. RAND-36 is not available in Swedish. The purpose of this study was threefold: to translate and culturally adapt the RAND-36 into Swedish; to evaluate its reliability and responsiveness using Svensson’s method for paired ordered categorical data; and to assess the usability of an electronic version of the questionnaire. The translation process included forward and backward translations and reconciliation. Test-retest reliability was examined during a period of two-weeks in 84 patients undergoing dialysis for chronic kidney disease. Responsiveness was examined in 97 patients before and 2 months after a cardiac rehabilitation program. Usability tests and cognitive debriefing of the electronic questionnaire were carried out with 18 patients. Results The Swedish translation of the RAND-36 was conceptually equivalent to the English version. Test-retest reliability was supported by non-significant relative position (RP) values among dialysis patients for all RAND-36 subscales (range − 0.02 to 0.10; all confidence intervals (CI) included zero). Responsiveness was demonstrated by significant improvements in RP values among cardiac rehabilitation patients for all subscales (range 0.22–0.36; lower limits of all CI > 0.1) except two subscales (General health, RP -0.02; CI -0.13 to 0.10; and Role functioning/emotional, RP 0.03; CI -0.09 to 0.16). In cardiac rehabilitation patients, sizable individual variation (RV > 0.2) was also shown for the Pain, Energy/fatigue and Social functioning subscales. The electronic version of RAND-36 was found easy and intuitive to use. Conclusions Our results provide evidence supporting the reliability and responsiveness of the newly translated Swedish RAND-36 and the user-friendliness of the electronic version. Svensson’s method for paired ordinal data was able to characterize not only the direction and size of differences among the patients’ responses at different time points but also variations in response patterns within groups. The method is therefore, besides being suitable for ordinal data, also an important and novel tool for gaining insights into patients’ response patterns to treatment or interventions, thus informing individualized care.
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Affiliation(s)
- Lotti Orwelius
- 1Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,10Intensive Care Unit, University Hospital, Linkoping, Sweden
| | - Mats Nilsson
- Futurum, - Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Evalill Nilsson
- 3QRC Stockholm Research Unit, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Marika Wenemark
- 4Department of Medical and Health Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.,Centre for Organisational support and Development, Region Östergötland, Linköping, Sweden
| | - Ulla Walfridsson
- 6Department of Cardiology, and Department of Medical and Health Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Mats Lundström
- 7Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Charles Taft
- Centre of registers, Västra Götaland, Göteborg, Sweden
| | - Bo Palaszewski
- Data Management and Analysis, Region Västra Götaland, Göteborg, Sweden
| | - Margareta Kristenson
- 4Department of Medical and Health Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.,Centre for Organisational support and Development, Region Östergötland, Linköping, Sweden
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Levinson M, Mills A, Oldroyd J, Gellie A, Barrett J, Staples M, Stephenson G. The impact of intensive care in a private hospital on patients aged 80 and over: health-related quality of life, functional status and burden versus benefit. Intern Med J 2017; 46:694-702. [PMID: 27009846 DOI: 10.1111/imj.13079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 03/01/2016] [Accepted: 03/09/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Greater numbers of persons aged over 80 years are admitted to intensive care units (ICU) compared with 15 years ago. Outcomes other than death such as physical dependence and cognitive impairment and treatment burden are important to older people. AIMS The aims of this study were to determine the long-term outcomes of functional impairment, health-related quality of life (HRQoL) and the self-reported burden of treatment in a sample of patients aged 80 years and above admitted to ICU. Half of the cohort were admitted for elective cardiac surgery, the rest for non-cardiac surgery and medical conditions. METHODS In this longitudinal cohort study, in a tertiary level ICU, we measured HRQoL using the SF-36 and functional status using the modified Barthel Index at several time points over a 2-year follow-up period. We also assessed treatment burden by asking participants whether they thought the episode of care was worthwhile. RESULTS A total of 348 patients was recruited into the study. One-fifth of the cohort had died by the 2-year follow-up data collection point. There was an improvement in physical functioning in the cardiac surgery group at 6 months which was not sustained. There was no change in HRQoL at 2 years in either group. The majority valued the episode of care. CONCLUSION We demonstrated that HRQoL and previous lifestyle is preserved in the majority following ICU admission, associated with a high level of patient valuation of the episode of care.
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Affiliation(s)
- M Levinson
- Department of Medicine, Cabrini-Monash University, Cabrini Institute for Research and Education, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - A Mills
- Department of Medicine, Cabrini-Monash University, Cabrini Institute for Research and Education, Melbourne, Victoria, Australia
| | - J Oldroyd
- Monash Centre for Health Research and Implementation, Melbourne, Victoria, Australia
| | - A Gellie
- Department of Medicine, Cabrini-Monash University, Cabrini Institute for Research and Education, Melbourne, Victoria, Australia
| | - J Barrett
- Intensive Care Unit, Cabrini Health, Melbourne, Victoria, Australia
| | - M Staples
- Cabrini Institute for Research and Education, Melbourne, Victoria, Australia
| | - G Stephenson
- Department of Medicine, Cabrini-Monash University, Cabrini Institute for Research and Education, Melbourne, Victoria, Australia
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17
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Tools for assessing quality of life in cardiology and cardiac surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 13:78-82. [PMID: 27212988 PMCID: PMC4860444 DOI: 10.5114/kitp.2016.58974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 11/29/2022]
Abstract
The holistic concept of health, popularization of knowledge, as well as social and economic factors have contributed to the growing interest in research concerning quality of life in cardiovascular diseases. The value of direct measurements of the patient's well-being and the extent of their functioning in everyday life (i.e., health-related quality of life; HRQoL) has gained appreciation. Questionnaires are the most popular method of measuring quality of life. On the basis of the literature, we can conclude that the Short-Form Health Survey (SF-36) questionnaire is one of the most widely used tools measuring the quality of life of patients undergoing cardiological treatment and cardiac surgery.
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18
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Busico M, Intile D, Sívori M, Irastorza N, Alvarez AL, Quintana J, Vazquez L, Plotnikow G, Villarejo F, Desmery P. Risk factors for worsened quality of life in patients on mechanical ventilation. A prospective multicenter study. Med Intensiva 2016; 40:422-30. [PMID: 26976118 DOI: 10.1016/j.medin.2016.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify risk factors for worsened quality of life (QoL) and activities of daily living (ADL) at 3 and 12 months after discharge from the Intensive Care Unit (ICU) in patients on mechanical ventilation (MV). DESIGN A prospective, multicentric observational study was made. SETTING Three ICUs in Argentina. PATIENTS The study included a total of 84 out of 129 mainly clinical patients admitted between 2011-2012 and requiring over 24hours of MV. INTERVENTIONS No interventions were carried out. VARIABLES Quality of life was assessed with the EQ-5D (version for Argentina), and ADL with the Barthel index. RESULTS The EQ-5D and Barthel scores were assessed upon admission to the ICU (baseline) and after three months and one year of follow-up. Comorbidities, delirium, ICU acquired weakness (ICUAW), and medication received were daily assessed during ICU stay. The baseline QoL of the global sample showed a median index of [0.831 (IQR25-75% 0.527-0.931)], versus [0.513 (IQR0.245-0.838)] after three months and [0.850 (IQR0.573-1.00)] after one year. Significant differences were observed compared with QoL in the Argentinean general population [mean 0.880 (CI 0.872-0.888), p<0.001; p<0.001; p0.002]. Individual analysis showed that 67% of the patients had worsened their QoL at three months, while 33% had recovered their QoL. In the multivariate analysis, the variables found to be independent predictors of worsened QoL were a hospital stay ≥21 days [OR 12.57 (2.75-57.47)], age ≥50 years [OR 5.61 (1.27-24.83)], previous poor QoL [OR 0.11 (0.02-0.54)] and persistent ICUAW [OR 8.32 (1.22-56.74)]. Similar results were found for the worsening of ADL. CONCLUSIONS Quality of life is altered after critical illness, and its recovery is gradual over time. Age, length of hospital stay, previous QoL and persistent ICUAW seem to be risk factors for worsened QoL.
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Affiliation(s)
- M Busico
- Unidad de Terapia Intensiva, Clínica Olivos SMG, Buenos Aires, Argentina.
| | - D Intile
- Unidad de Terapia Intensiva, Sanatorio Anchorena, CABA, Argentina
| | - M Sívori
- Servicio de Neumonologia, Hospital Ramos Mejía, CABA, Argentina
| | - N Irastorza
- Unidad de Terapia Intensiva, Sanatorio Anchorena, CABA, Argentina
| | - A L Alvarez
- Unidad de Terapia Intensiva, Clínica Bazterrica, CABA, Argentina
| | - J Quintana
- Unidad de Terapia Intensiva, Clínica Olivos SMG, Buenos Aires, Argentina
| | - L Vazquez
- Unidad de Terapia Intensiva, Clínica Bazterrica, CABA, Argentina
| | - G Plotnikow
- Unidad de Terapia Intensiva, Sanatorio Anchorena, CABA, Argentina
| | - F Villarejo
- Unidad de Terapia Intensiva, Clínica Olivos SMG, Buenos Aires, Argentina
| | - P Desmery
- Unidad de Terapia Intensiva, Sanatorio Anchorena, CABA, Argentina
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19
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The influence of hospitalization or intensive care unit admission on declines in health-related quality of life. Ann Am Thorac Soc 2015; 12:35-45. [PMID: 25493656 DOI: 10.1513/annalsats.201404-172oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Survivors of critical illness report impaired health-related quality of life (HRQoL) after hospital discharge, but the degree to which these impairments are attributable to critical illness is unknown. OBJECTIVES We sought to examine changes in HRQoL associated with an intensive care unit (ICU) stay and the differential association of type of hospitalization (critical illness versus noncritical illness) on changes in HRQoL. METHODS We identified 11,243 participants in the Ambulatory Care Quality Improvement Project (a multicenter randomized trial of Veterans conducted March 1997 to August 2000) completing at least two Medical Outcomes Study Short-Form 36 questionnaires over 2 years, and categorized patients by hospitalization status during the interval between measures. We used multiple linear regression with generalized estimating equations for analysis. MEASUREMENTS AND MAIN RESULTS Our primary outcome was change in the Physical Component Summary score. Participants requiring hospitalization or ICU admission had significantly worse baseline HRQoL than those not hospitalized (P < 0.001). Compared with patients who were not hospitalized, follow-up Physical Component Summary scores were lower among non-ICU hospitalized patients and ICU patients (adjusted β-coefficient = -1.40 [95% confidence interval, -1.81, -0.99] and adjusted β-coefficient = -1.53 [95% confidence interval, -2.11, -0.95], respectively), with no difference between the two groups (P value = 0.80). Similar results were seen for the Mental Component Summary score and each of the Medical Outcomes Study Short-Form 36 subdomains. CONCLUSIONS Prehospital HRQoL is a significant determinant of HRQoL after hospitalization or ICU admission. Hospitalization is associated with increased risk of impairment in HRQoL after discharge, yet the overall magnitude of this reduction is small and similar between non-ICU hospitalized and critically ill patients.
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20
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Biehl M, Kashyap R, Ahmed AH, Reriani MK, Ofoma UR, Wilson GA, Li G, Malinchoc M, Sloan JA, Gajic O. Six-month quality-of-life and functional status of acute respiratory distress syndrome survivors compared to patients at risk: a population-based study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:356. [PMID: 26428615 PMCID: PMC4591714 DOI: 10.1186/s13054-015-1062-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/09/2015] [Indexed: 12/29/2022]
Abstract
Introduction The long-term attributable burden related to acute respiratory distress syndrome (ARDS) is not fully investigated. The aim of this study is to evaluate the quality of life (QOL) and functional status at 6 months after hospitalization in patients at risk for ARDS who did and did not develop the syndrome. Method This is a population-based prospective cohort study of adult patients from Olmsted County, Minnesota, with or at risk for ARDS hospitalized from October 2008 to July 2011. The primary outcomes were changes in QOL and functional status, measured through 12-Item Short Form Survey (SF-12) and Barthel Index (BI) respectively, from baseline to 6 months, compared between survivors who did and did not develop ARDS. Results Of 410 patients with or at risk for ARDS, 98 had baseline surveys collected and 67 responded to a 6-month survey (26 ARDS, 41 non-ARDS). Both ARDS and non-ARDS groups had lower physical component of SF-12 at baseline compared to general population (P < 0.001 for both). ARDS patients had poorer baseline functional status compared to non-ARDS (mean BI 80 ± 25 vs. 88 ± 22, P = 0.03). No significant differences were observed for the change between 6 months and baseline BI (delta 2.3 for ARDS vs. 2.0 for non-ARDS, P = 0.5), or mental (delta 2.7 vs. 2.4, P = 0.9) or physical (delta –3 vs. –3.3, P = 0.9) component of SF-12 between survivors with and without ARDS. Conclusion In this population-based study, decreased QOL and functional status 6 months after hospitalization were largely explained by baseline condition, with similar recovery in survivors who did and did not develop ARDS. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1062-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Biehl
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA. .,Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. .,Sanford USD Medical Center, 1205 S. Grange Avenue, Suite 407, Sioux Falls, SD, USA.
| | - Rahul Kashyap
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA.
| | - Adil H Ahmed
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA. .,Wichita Falls Family Practice Residency Program (WFFRP), North Central Texas Medical Foundation, Wichita Falls, TX, USA.
| | - Martin K Reriani
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA. .,Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Uchenna R Ofoma
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA. .,Department of Critical Care Medicine, Geisinger Medical Center, Danville, PA, USA.
| | - Gregory A Wilson
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA.
| | - Guangxi Li
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA. .,Department of Medicine, Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing, China.
| | - Michael Malinchoc
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA. .,Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Jeff A Sloan
- Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Ognjen Gajic
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN, USA. .,Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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21
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Simultaneous Prediction of New Morbidity, Mortality, and Survival Without New Morbidity From Pediatric Intensive Care: A New Paradigm for Outcomes Assessment. Crit Care Med 2015; 43:1699-709. [PMID: 25985385 DOI: 10.1097/ccm.0000000000001081] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. DESIGN Prospective cohort study from December 4, 2011, to April 7, 2013. SETTING General and cardiac/cardiovascular PICUs at seven sites. PATIENTS Randomly selected PICU patients from their first PICU admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale and defined as an increase of ≥ 3 from preillness to hospital discharge) were 4.6% (site range, 2.6-7.7%) and unadjusted mortality rates were 2.7% (site range, 1.3-5.0%). Morbidity and mortality were significantly (p < 0.001) associated with physiological instability (measured with the Pediatric Risk of Mortality III score) in dichotomous (survival and death) and trichotomous (survival without new morbidity, survival with new morbidity, and death) models without covariate adjustments. Morbidity risk increased with increasing Pediatric Risk of Mortality III scores and then decreased at the highest Pediatric Risk of Mortality III values as potential morbidities became mortalities. The trichotomous model with covariate adjustments included age, admission source, diagnostic factors, baseline Functional Status Scale, and the Pediatric Risk of Mortality III score. The three-level goodness-of-fit test indicated satisfactory performance for the derivation and validation sets (p > 0.20). Predictive ability assessed with the volume under the surface was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (vs chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. CONCLUSIONS New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including both morbidity and mortality based on physiological status are suitable for research studies and quality and other outcome assessments. This approach may be applicable to other assessments presently based only on mortality.
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22
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Jeitziner MM, Zwakhalen SM, Bürgin R, Hantikainen V, Hamers JP. Changes in health-related quality of life in older patients one year after an intensive care unit stay. J Clin Nurs 2015; 24:3107-17. [PMID: 26248729 DOI: 10.1111/jocn.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study investigates health-related quality of life in older patients, over one year following an intensive care unit stay. BACKGROUND Health-related quality of life is an important outcome when assessing long-term effectiveness of intensive care treatment, and to assist patients, their relatives and healthcare professionals in making treatment decisions. DESIGN Prospective non-randomised longitudinal study. METHODS The Short Form Health Survey 36 was administered 1 week after an intensive care stay (retrospective baseline), and after six months and 12 months to the study population and to an age-matched comparison group at recruitment (baseline), and after six months and 12 months. Demographic data, admission diagnosis, length of stay, severity of illness, pain, anxiety, agitation, and intratracheal suctioning, turning and intubation were recorded. Recruitment period: December 2008 to April 2011. RESULTS Health-related quality of life of the older patients was significantly lower than the comparison group, both before and after the intensive care unit stay, and showed great individual variability. Within group scores, however, were stable over the year. Both physical and mental health scores were lower for the older patients. Renal failure, cardiac surgery and illness severity were associated with lower physical health scores. Cardiovascular illness, intratracheal suctioning and turning were associated with lower mental health scores. CONCLUSIONS Health-related quality of life was lower in older patients than in the age-matched group but remained stable over one year. RELEVANCE TO CLINICAL PRACTICE Older patients with severe illnesses, acute renal failure or who have had cardiac surgery, need additional support after hospital discharge due to functional restrictions. Discharge planning should ensure that this support would be provided. Special attention should be given to develop and use methods to reduce distress during routine intensive care interventions such as intratracheal suctioning or turning.
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Affiliation(s)
- Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital (Inselspital), Bern, Switzerland.,Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Sandra Mg Zwakhalen
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Reto Bürgin
- National Centre of Competence in Research, University of Geneva, Geneva, Switzerland
| | - Virpi Hantikainen
- Institute of Applied Nursing Science, University of Applied Sciences, St. Gallen, Switzerland
| | - Jan Ph Hamers
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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23
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Timmers TK, van Herwaarden JA, de Borst GJ, Moll FL, Leenen LPH. Long-term survival and quality of life after open abdominal aortic aneurysm repair. World J Surg 2015; 37:2957-64. [PMID: 24132818 DOI: 10.1007/s00268-013-2206-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Open repair of abdominal aortic aneurysm (AAA) generally involves postsurgery admission to the intensive care unit (ICU). Few studies have evaluated the impact of surgery for either ruptured or nonruptured AAA (with postoperative ICU treatment) on long-term survival and quality of life. The primary aim of this study was to quantify long-term survival and health-related quality of life (HrQpL) of a cohort of patients undergoing open AAA repair after hospital discharge. METHODS Consecutive patients undergoing open elective or acute AAA reconstruction with postoperative admission to the ICU and discharged alive from the hospital during 2009 were identified. Primary outcome measures were 1-year and long-term mortality. The secondary outcome was the HrQoL using the EuroQol-6D (EQ-6D) questionnaire at the end of the follow-up period. RESULTS A total of 263 patients were treated and postoperatively discharged alive: 56 had a ruptured AAA (rAAA), 35 a symptomatic AAA, and 172 an asymptomatic AAA. The 1-year mortality after open AAA repair was 8 %. Overall, 39 % of patients died within 10 postoperative years (mean 6.0 ± 2.8 years). Long-term survival of patients with a ruptured or symptomatic aneurysm was similar to that of patients undergoing elective aneurysm repair. Long-term HrQoL of the total study population was worse than that of an age-matched general Dutch population on the EQ-us (range 0-1, difference 0.12). This decrease in HrQoL was mainly seen in mobility, self-care, usual activities, and cognition. CONCLUSIONS Ten years after open AAA repair, the overall survival rate was 59 %. Long-term survival and HrQoL were similar for patients with a repaired ruptured or symptomatic aneurysm and those who underwent elective aneurysm repair. There were also no differences in patients with infrarenal versus juxtarenal/suprarenal aneurysms. Surviving patients had a lower HrQoL than the age-matched general Dutch population, especially regarding mobility, self-care, usual activities, and cognition.
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Affiliation(s)
- Tim K Timmers
- Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands,
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24
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Honselmann KC, Buthut F, Heuwer B, Karadag S, Sayk F, Kurowski V, Thiele H, Droemann D, Wolfrum S. Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis: Predictors of mortality and quality of life in patients with sepsis/pneumonia. J Crit Care 2015; 30:721-6. [PMID: 25818842 DOI: 10.1016/j.jcrc.2015.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/16/2015] [Accepted: 03/06/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study is to evaluate long-term mortality and quality of life (QoL) of intensive care patients with pneumonia and/or sepsis 1 year after discharge and to identify potential predictors for these outcome measures. METHODS This retrospective cohort study analyzed all patients admitted to the intensive care unit (ICU) of a German university hospital with diagnosis of pneumonia and/or sepsis between 2008 and 2009. Quality of life was assessed by telephone interview or mail using the standardized EuroQol 5-dimension questionaire. RESULTS Of 1406 patients treated in the ICU within the observational period, 217 met the inclusion criteria. Whereas in-hospital mortality differed significantly between pneumonia (17%) and sepsis (46%) (P < .001), 1-year mortality was not statistically significant (51% and 65%, P = .057). A high Simplified Acute Physiology Score (SAPS) II value was associated with high in-hospital mortality but failed to predict 1-year mortality. Quality of life, measured 1 year after discharge by visual analog scale (VAS), was 50% ± 25%, which was significantly lower than in a matched control group (70% ± 20%; P < .001). A high SAPS II score on admission did not correlate with VAS but was an independent predictor of a low EuroQol 5-dimension index. CONCLUSIONS The high post-ICU mortality of patients with pneumonia and sepsis emphasizes the need to focus on long-term follow-up in ICU studies and demonstrates that even when sepsis signs are missing, critically ill patients due to pneumonia have high 1-year mortality. Simplified Acute Physiology Score II does not predict long-term mortality, but a low SAPS II on admission might be useful to identify patients with good physical status after 1 year. TAKE HOME MESSAGE Hospital mortality of patients treated for pneumonia and/or sepsis is high and increases significantly within the first year after discharge. The SAPS II predicts in-hospital mortality and the physical components of QoL but not long-term mortality. TWEET One-year mortality of ICU pneumonia patients is equally high as in sepsis patients. Simplified Acute Physiology Score II cannot predict long-term mortality but can predict QoL.
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Affiliation(s)
- Kim C Honselmann
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Franziska Buthut
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Bjoern Heuwer
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Sevin Karadag
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Friedhelm Sayk
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Volkhardt Kurowski
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Holger Thiele
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Daniel Droemann
- Medical Clinic III, Pulmonology/Infectious Diseases, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Sebastian Wolfrum
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany; Department of Emergency Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany.
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Rodríguez-Villar S, Fernández-Méndez R, Adams G, Rodríguez-García JL, Arévalo-Serrano J, Sánchez-Casado M, Kilgour PM. Basal functional status predicts functional recovery in critically ill patients with multiple-organ failure. J Crit Care 2015; 30:511-7. [PMID: 25817326 DOI: 10.1016/j.jcrc.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/15/2015] [Accepted: 02/08/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to investigate the effect of baseline demographic, clinical, and functional characteristics of intensive care unit (ICU) patients with multiple-organ failure (MOF) on their functional recovery at 6 and 12 months posthospitalization. MATERIALS AND METHODS A total of 545 consecutively admitted adult patients with MOF during on admission were included in the study. Patients' functional status was prospectively assessed and compared with the baseline status and at 6 and 12 months postdischarge, using the Modified Rankin Scale and the Glasgow Outcome Scale Extended. Severity of disease on admission was assessed using the Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II. RESULTS A total of 266 patients were followed up. Functional status among MOF survivors improved between the 6th and 12th month postdischarge from the ICU. Higher functional status before admission, lower severity scores on admission, and younger age positively affected the improvement in functional status after ICU discharge. CONCLUSIONS The level of functional status befre ICU admission should be considered not only in research studies looking a long-term outcomes from ICU but also in the clinical care planning of critically ill patients during and after their ICU admission.
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Affiliation(s)
| | | | - Gary Adams
- Insulin and Diabetes Experimental Group, University Nottingham, Nottingham, UK
| | | | - Juan Arévalo-Serrano
- Internal Medicine Department, Príncipe de Asturias Hospital, Alcalá de Henares, Madrid, Spain
| | | | - Peter M Kilgour
- School of Medicine, University of St Andrews, North Haugh, UK
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Hofhuis JGM, van Stel HF, Schrijvers AJP, Rommes JH, Spronk PE. ICU survivors show no decline in health-related quality of life after 5 years. Intensive Care Med 2015; 41:495-504. [PMID: 25672277 DOI: 10.1007/s00134-015-3669-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/15/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Severe critical illness requiring treatment in the intensive care unit (ICU) may have a serious impact on patients and their families. However, optimal follow-up periods are not defined and data on health-related quality of life (HRQOL) before ICU admission as well as those beyond 2 years follow-up are limited. The aim of our study was to assess the impact of ICU stay up to 5 years after ICU discharge. METHODS We performed a long-term prospective cohort study in patients admitted for longer than 48 h in a medical-surgical ICU. The Short-Form 36 was used to evaluate HRQOL before admission (by proxy within 48 h after admission of the patient), at ICU discharge, and at 1, 2, and 5 years following ICU discharge (all by patients). Changes in HRQOL were assessed using linear mixed modeling. RESULTS We included a total of 749 patients (from 2000 to 2007). At 5 years after ICU discharge 234 patients could be evaluated. After correction for natural decline in HRQOL, the mean scores of four dimensions-physical functioning (p < 0.001), role-physical (p < 0.001), general health (p < 0.001), and social functioning (p = 0.003)-were still significantly lower 5 years after ICU discharge compared with their pre-admission levels, although effect sizes were small (<0.5). CONCLUSIONS After correction for natural decline, the effect sizes of decreases in HRQOL were small, suggesting that patients regain their age-specific HRQOL 5 years after their ICU stay.
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Affiliation(s)
- José G M Hofhuis
- Department of Intensive Care, Gelre Ziekenhuizen Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands,
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Our paper 20 years later: 1-year survival and 6-month quality of life after intensive care. Intensive Care Med 2015; 41:605-14. [PMID: 25605472 DOI: 10.1007/s00134-015-3654-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In the early 1990s, the in-hospital mortality rate of intensive care unit (ICU) patients dropped, and interest in the quality of life (QOL) of ICU survivors increased. In 1996, we published a study to investigate 1-year survival after hospital discharge and 6-month QOL after intensive care. Now, we compare our previous results with those reported in the recent literature to appraise any changes, and new knowledge in the area. RESULTS The 1-year survival of ICU patients after hospital discharge is substantial, lower than in the general population, and different among subgroups. Some studies showed a reduction in QOL at 6 months, as in our study, while others showed an improvement. Different results seem to be related mainly to the case mix. Studies on different types of patients found long-term cognitive impairment in ICU survivors, possibly not disease specific. The proportions of patients with neuropsychological morbidities such as posttraumatic stress disorder, anxiety, and depression, described after our study, did not show any change over time. CONCLUSIONS Differences between studies on long-term survival and QOL do not allow conclusions to be drawn about change over time. No change was found in neuropsychological morbidities. However, a lack of change may not be viewed negatively, because critically ill patients who survive ICU today may be at higher risk for poor long-term outcome than in the past due to the higher severity of their illness and the more aggressive treatments received. Future studies may provide understanding of the relationships between psychiatric symptoms, cognitive impairment, functional disability, and QOL.
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Walker W, Wright J, Danjoux G, Howell SJ, Martin D, Bonner S. Project Post Intensive Care eXercise (PIX): A qualitative exploration of intensive care unit survivors' perceptions of quality of life post-discharge and experience of exercise rehabilitation. J Intensive Care Soc 2014; 16:37-44. [PMID: 28979373 DOI: 10.1177/1751143714554896] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients who survive critical illness often report deterioration in health related quality of life. This has not been shown to improve following post-intensive care unit (ICU) self-directed exercise. The Post Intensive Care eXercise (PIX) study demonstrated improved objectively measured fitness following a supervised exercise programme following critical illness and also suggested beneficial effects on physical and mental health. The qualitative arm of the PIX study reported here utilised focus groups to explore in more detail recovery from critical illness, quality of life following hospital discharge, perceptions of the exercise programme and it's impact on perceived well-being. Sixteen participants (eight of whom underwent the supervised exercise programme) were allocated to four psychologist lead focus groups. Themes identified after hospital discharge centred on social isolation, abandonment, vulnerability and reduced physical activity. However, patients in the exercise group described exercise training as motivating, increasing energy levels and sense of achievement, social interaction and confidence. This study adds to the sparse literature on the patient experience post critical illness. It supports the improvements in physical and mental health suggested with exercise in the PIX study and would support further research in relation to the effects of supervised exercise and rehabilitation programmes post critical illness. It recommends that future comparative outcome studies in this patient population also include interview-based assessment as part of assessment of quality of life and an individual's functional status.
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Affiliation(s)
| | - Judith Wright
- Critical Care Department, The James Cook University Hospital, Middlesbrough, UK
| | - Gerard Danjoux
- Department of Anaesthesia, The James Cook University Hospital, Middlesbrough, UK
| | - Simon J Howell
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Denis Martin
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Stephen Bonner
- Critical Care Department, The James Cook University Hospital, Middlesbrough, UK
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Low health-related quality of life is a predictor of major adverse cardiovascular events in patients with chronic nonischemic heart failure. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 11:283-8. [PMID: 26336436 PMCID: PMC4283881 DOI: 10.5114/kitp.2014.45678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/04/2014] [Accepted: 03/12/2014] [Indexed: 11/17/2022]
Abstract
Introduction The need to indentify patients with chronic heart failure (CHF) at a higher risk of major adverse cardiovascular events (MACEs) has become increasingly important; therefore, new parameters, such as health-related quality of life (HRQoL), are gaining ground. The aim of this study The aim of this study was to determine the risk factors for MACEs, with a special emphasis on HRQoL in chronic non-ischemic heart failure (NIHF) patients. Material and methods This prospective study enrolled 271 hospitalized patients with heart failure symptoms (NYHA II and III), without neoplastic disease, diabetes, hepatic cirrhosis or chronic kidney disease, who had been receiving optimal medical treatment. In all the patients, laboratory examinations, electrocardiography, echocardiography, a 6-minute walking test, invasive right heart pressure measurements and coronary angiography were performed. HRQoL assessment was conducted with the Short-Form Health Survey (SF-36). Clinical observation commenced on admission to the hospital and lasted 3 years. Data concerning MACE incidence (death, transplantation, circulatory support, hospitalization) were obtained during outpatient visits. Results The final analysis enrolled 202 patients, while 17 patients were lost to follow up. The MACE incidence was 42.1%. Major adverse cardiovascular events risk factors in multiple factor analysis were: alkaline phosphatase (hazard ratio [HR] = 1.01; p < 0.05); right ventricular end-diastolic diameter (HR = 1.08; p < 0.001); hsCRP (HR = 1.04; p < 0.05); and the following HRQoL indices: Bodily Pain (HR = 0.98; p < 0.05) and Mental Health (HR = 0.97; p < 0.01). Conclusions Low values for HRQoL parameters (Bodily Pain and Mental Health), right ventricular end-diastolic diameter, serum concentration of hsCRP and alkaline phosphatase are prognostic factors in NIHF patients.
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Fragala G, Fragala M. Improving the safety of patient turning and repositioning tasks for caregivers. Workplace Health Saf 2014; 62:268-73. [PMID: 25000545 DOI: 10.1177/216507991406200701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2014] [Indexed: 11/16/2022]
Abstract
Current evidence demonstrates why turning and positioning patients in bed presents a serious occupational risk of musculoskeletal disorders for caregivers. Results of the laboratory study investigating a new method of turning and positioning patients in bed are presented. The study was designed to evaluate how this new method reduced the risk of occupational musculoskeletal disorders to caregivers and may improve outcomes for patients.
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Schmidt K, Thiel P, Mueller F, Schmuecker K, Worrack S, Mehlhorn J, Engel C, Brenk-Franz K, Kausche S, Jakobi U, Bindara-Klippel A, Schneider N, Freytag A, Davydow D, Wensing M, Brunkhorst FM, Gensichen J. Sepsis survivors monitoring and coordination in outpatient health care (SMOOTH): study protocol for a randomized controlled trial. Trials 2014; 15:283. [PMID: 25015838 PMCID: PMC4226940 DOI: 10.1186/1745-6215-15-283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 06/02/2014] [Indexed: 01/04/2023] Open
Abstract
Background Sepsis sequelae include critical illness polyneuropathy, myopathy, wasting, neurocognitive deficits, post-traumatic stress disorder, depression and chronic pain. Little is known howlong-term sequelae following hospital discharge are treated. The aim of our study is to determine the effect of a primary care-based, long-term program on health-related quality of life in sepsis survivors. Methods/Design In a two-armed randomized multicenter interventional study, patients after sepsis (n = 290) will be assessed at 6, 12 and 24 months. Patients are eligible if severe sepsis or septic shock (ICD-10), at least two criteria of systemic inflammatory response syndrome (SIRS), at least one organ dysfunction and sufficient cognitive capacity are present. The intervention comprises 1) discharge management, 2) training of general practitioners and patients in evidence-based care for sepsis sequelae and 3) telephone monitoring of patients. At six months, we expect an improved primary outcome (health-related quality of life/SF-36) and improved secondary outcomes such as costs, mortality, clinical-, psycho-social- and process-of-care measures in the intervention group compared to the control group. Discussion This study evaluates a primary care-based, long-term program for patients after severe sepsis. Study results may add evidence for improved sepsis care management. General practitioners may contribute efficiently to sepsis aftercare. Trial registration U1111-1119-6345. DRKS00000741, CCT-NAPN-20875 (25 February 2011).
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Affiliation(s)
- Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany.
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Fragala G, Fragala M. Improving the Safety of Patient Turning and Repositioning Tasks for Caregivers. Workplace Health Saf 2014. [DOI: 10.3928/21650799-20140617-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tereran NP, Zanei SSV, Whitaker IY. Quality of life before admission to the intensive care unit. Rev Bras Ter Intensiva 2013; 24:341-6. [PMID: 23917930 PMCID: PMC4031806 DOI: 10.1590/s0103-507x2012000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022] Open
Abstract
Objective To examine the reliability of the SF-36 general health questionnaire when used to
evaluate the health status of critically ill patients before admission to
intensive care and to measure their health-related quality of life prior to
admission and its relation to severity of illness and length of stay in the
intensive care unit. Methods Prospective cohort study conducted in the intensive care unit of a public teaching
hospital. Over three months, communicative and oriented patients were interviewed
within the first 72 hours of intensive care unit admission; 91 individuals
participated. The APACHE II score was used to assess severity of illness, and the
SF-36 questionnaire was used to measure health-related quality of life. Results The reliability of SF-36 was verified in all dimensions using Cronbach's alpha
coefficient. In six dimensions of eight domains the value exceeded 0.70. The
average SF-36 scores of the health-related quality of life dimensions for the
patients before admission to intensive care unit were 57.8 for physical
functioning, 32.4 for role-physical, 53.0 for bodily pain, 63.2 for general
health, 50.6 for vitality, 56.2 for social functioning, 54.6 for role-emotional
and 60.3 for mental health. The correlations between severity of illness and
length of stay and the health-related quality of life scores were very low,
ranging from -0.152 to 0.175 and -0.158 to 0.152, respectively, which were not
statistically significant. Conclusion In the sample studied, the SF-36 demonstrated good reliability when used to
measure health-related quality of life in critically ill patients before admission
to the intensive care unit. The worst score was role-physical and the best was
general health. Health-related quality of life of patients before admission was
not correlated with severity of illness or length of stay in the intensive care
unit.
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Orwelius L, Fredrikson M, Kristenson M, Walther S, Sjöberg F. Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R236. [PMID: 24119915 PMCID: PMC4056627 DOI: 10.1186/cc13059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/11/2013] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age- and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterize the ICU patients with the lowest HRQoL within these strata. METHODS We did a cross-sectional comparison of scores of the short-form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6,093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each stratum, patients with low scores (below -2 SD of the control group) were identified and characterized. RESULTS After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (-2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived a shorter time after being in ICU. CONCLUSIONS After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had, however, a poor quality of life as compared with the controls (-2 SD). This group, which more often consisted of single men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support.
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Svenningsen H, Tønnesen EK, Videbech P, Frydenberg M, Christensen D, Egerod I. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study. J Clin Nurs 2013; 23:634-44. [PMID: 23647511 DOI: 10.1111/jocn.12250] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 01/07/2023]
Abstract
AIMS AND OBJECTIVES To investigate the effects of delirium in the intensive care unit on health-related quality of life, healthcare dependency and memory after discharge and to explore the association between health-related quality of life and memories, patient diaries and intensive care unit follow-up. BACKGROUND Up to 83% of intensive care unit patients experience delirium. In addition to increased risk of mortality, morbidity and cognitive impairment, the experience itself is unpleasant. A number of studies have focused on memories associated with delirium, but the association between delirium, memories and health-related quality needs further investigation. DESIGN We used an observational multicentre design with telephone interviews. METHODS Adult intensive care unit patients (n = 360) were consecutively recruited and interviewed using the intensive care unit-Memory Tool one week after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index. RESULTS Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious. CONCLUSIONS More than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine the long-term consequences of intensive care unit delirium. RELEVANCE TO CLINICAL PRACTICE We recommend regular assessment to prevent, detect and treat delirium. We also recommend an intensive care unit follow-up programme providing an opportunity for postintensive care unit patients, particularly previously delirious patients, to discuss their memories and experiences with intensive care unit professionals.
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Affiliation(s)
- Helle Svenningsen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus C, Denmark
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Nesseler N, Defontaine A, Launey Y, Morcet J, Mallédant Y, Seguin P. Long-term mortality and quality of life after septic shock: a follow-up observational study. Intensive Care Med 2013; 39:881-8. [PMID: 23358541 DOI: 10.1007/s00134-013-2815-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/29/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE In septic shock, short-term outcomes are frequently reported, while long-term outcomes are not. The aim of this study was to evaluate mortality and health-related quality of life (HRQOL) in survivors 6 months after an episode of septic shock. METHODS This single-centre observational study was conducted in an intensive care unit in a university hospital. All patients with septic shock were included. Mortality was assessed 6 months after the onset of septic shock, and a comparison between patients who survived and those who died was performed. HRQOL was assessed using the MOS SF-36 questionnaire prior to hospital admission (baseline) and at 6 months in survivors. HRQOL at baseline and at 6 months were compared to the general French population, and HRQOL at baseline was compared to 6-month HRQOL. RESULTS Ninety-six patients were included. Six-month mortality was 45%. Survivors were significantly younger, had significantly lower lactate levels and SAPS II scores, required less renal support, received less frequent administration of corticosteroids, and had a longer length of hospital stay. At baseline (n = 39) and 6 months (n = 46), all of the components of the SF-36 questionnaire were significantly lower than those in the general population. Compared to baseline (n = 23), the Physical Component Score (CS) improved significantly at 6 months, the Mental CS did not differ. CONCLUSIONS Mortality 6 months after septic shock was high. HRQOL at baseline was impaired when compared to that of the general population. Although improvements were noted at 6 months, HRQOL remained lower than that in the general population.
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Affiliation(s)
- Nicolas Nesseler
- Département d'Anesthésie-Réanimation 1, Inserm U991, Service de Réanimation Chirurgicale, Hôpital Pontchaillou, Université Rennes 1, Rennes, France.
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Hofhuis JGM, van Stel HF, Schrijvers AJP, Rommes JH, Spronk PE. The effect of acute kidney injury on long-term health-related quality of life: a prospective follow-up study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R17. [PMID: 23356544 PMCID: PMC4057105 DOI: 10.1186/cc12491] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 01/22/2013] [Indexed: 01/22/2023]
Abstract
Introduction Acute kidney injury (AKI) is a serious complication in critically ill patients admitted to the Intensive Care Unit (ICU). We hypothesized that ICU survivors with AKI would have a worse health-related quality of life (HRQOL) outcome than ICU survivors without AKI. Methods We performed a long-term prospective observational study. Patients admitted for > 48 hours in a medical-surgical ICU were included and divided in two groups: patients who fulfilled RIFLE criteria for AKI and patients without AKI. We used the Short-Form 36 to evaluate HRQOL before admission (by proxy within 48 hours after admission of the patient), at ICU discharge, hospital discharge, 3 and 6 months following ICU discharge (all by patients). Recovery in HRQOL from ICU-admission onwards was assessed using linear mixed modelling. Results Between September 2000 and January 2007 all admissions were screened for study participation. We included a total of 749 patients. At six months after ICU discharge 73 patients with AKI and 325 patients without AKI could be evaluated. In survivors with and without AKI, the pre-admission HRQOL (by proxy) and at six months after ICU discharge was significantly lower compared with an age matched general population. Most SF-36 dimensions changed significantly over time from ICU discharge. Change over time of HRQOL between the different AKI Rifle classes (Risk, Injury, Failure) showed no significant differences. At ICU discharge, scores were lowest in the group with AKI compared with the group without AKI for the physical functioning, role-physical and general health dimensions. However, there were almost no differences in HRQOL between both groups at six months. Conclusions The pre-admission HRQOL (by proxy) of AKI survivors was significantly lower in two dimensions compared with the age matched general population. Six months after ICU discharge survivors with and without AKI showed an almost similar HRQOL. However, compared with the general population with a similar age, HRQOL was poorer in both groups.
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Schenk P, Warszawska J, Fuhrmann V, König F, Madl C, Ratheiser K. Health-related quality of life of long-term survivors of intensive care: changes after intensive care treatment. Experience of an Austrian intensive care unit. Wien Klin Wochenschr 2012; 124:624-32. [PMID: 22875391 DOI: 10.1007/s00508-012-0224-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/09/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to determine if health-related quality of life of long-term survivors changes 24 months after intensive care treatment compared to the quality of life before admission. METHODS From 281 patients treated at the ICU in 2001, 132 survivors were contacted by phone on average 24 months after discharge. Fernandez questionnaire was used to assess preadmission quality of life prospectively and postdischarge quality of life, retrospectively. In addition, age, sex, admission diagnosis, ICU length of stay, presence of organ failure, and necessity of mechanical ventilation were determined. RESULTS In the 101 ICU survivors who responded to the questionnaire, the total score of quality of life did not change significantly over time (5.48 ± 5.3 before admission vs. 5.6 ± 5.8 at follow-up; p = 0.9). Similarly, the performance of normal daily activities did not alter (3.0 ± 3.5 vs. 3.39 ± 3.6; p = 0,3). In contrast, the ability to perform basic physiological activities worsened significantly (0.39 ± 0.76 vs. 0.76 ± 1.52; p = 0.037), whereas the emotional state improved significantly after intensive care treatment (2.08 ± 1.78 vs. 1.46 ± 1.56, p = 0.003). In a stepwise multiple regression analysis the total score of quality of life before admission was the only variable which influenced the quality of life 2 years after ICU-stay. CONCLUSIONS In the interviewed population the total score of health-related quality of life did not change after intensive care treatment. Surprisingly, emotional state improved significantly although physical performance decreased. Quality of life after ICU discharge was predominantly influenced by preadmission quality of life. However, these results are not reflective of all ICU survivors.
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Affiliation(s)
- Peter Schenk
- Department of Pulmonology, Landesklinikum Thermenregion Hochegg, Hocheggerstrasse 88, 2840, Grimmenstein, Austria.
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Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, Layon AJ, Mocco J. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg 2012; 116:1379-88. [DOI: 10.3171/2012.2.jns111881] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients.
Methods
All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus.
Results
Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p < 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p < 0.004), hospital LOS (p < 0.004), hospital-acquired infections (p < 0.05), and ventilator-associated pneumonias (p < 0.001), and decreased the number of patient days in restraints (p < 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections.
Conclusions
Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.
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Affiliation(s)
| | | | | | | | | | - Lennox Archibald
- 3Infection Prevention and Control, Shands Hospital at the University of Florida, Gainesville, Florida; and
| | - A. Joseph Layon
- 4System Director, Critical Care Medicine, Geisinger Health System, Danville, Pennsylvania
| | - J Mocco
- 1Departments of Neurosurgery,
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Physical effects of trauma and the psychological consequences of preexisting diseases account for a significant portion of the health-related quality of life patterns of former trauma patients. J Trauma Acute Care Surg 2012; 72:504-12. [PMID: 22439224 DOI: 10.1097/ta.0b013e31821a416a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is known to be significantly affected in former trauma patients. However, the underlying factors that lead to this outcome are largely unknown. In former intensive care unit (ICU) patients, it has been recognized that preexisting disease is the most important factor for the long-term HRQoL. The aim of this study was to investigate HRQoL up to2 years after trauma and to examine the contribution of the trauma-specific, ICU-related, sociodemographic factors together with the effects of preexisting disease, and further to make a comparison with a large general population. METHODS A prospective 2-year multicenter study in Sweden of 108 injured patients. By mailed questionnaires, HRQoL was assessed at 6 months,12 months, and 24 months after the stay in ICU by Short Form (SF)-36, and information of preexisting disease was collected from the national hospital database. ICU-related factors were obtained from the local ICU database. Comorbidity and HRQoL (SF-36) was also examined in the reference group, a random sample of 10,000 inhabitants in the uptake area of the hospitals. RESULTS For the trauma patients, there was a marked and early decrease in the physical dimensions of the SF-36 (role limitations due to physical problems and bodily pain). This decrease improved rapidly and was almost normalized after 24 months. In parallel, there were extensive decreases in the psychologic dimensions (vitality, social functioning, role limitations due to emotional problems,and mental health) of the SF-36 when comparisons were made with the general reference population. CONCLUSIONS The new and important finding in this study is that the trauma population seems to have a trauma-specific HRQoL outcome pattern.First, there is a large and significant decrease in the physical dimensions of the SF-36, which is due to musculoskeletal effects and pain secondary to the trauma. This normalizes within 2 years, whereas the overall decrease in HRQoL remains and most importantly it is seen mainly in the psychologic dimensions and it is due to preexisting diseases.
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Khoudri I, Belayachi J, Dendane T, Abidi K, Madani N, Zekraoui A, Zeggwagh AA, Abouqal R. Measuring quality of life after intensive care using the Arabic version for Morocco of the EuroQol 5 Dimensions. BMC Res Notes 2012; 5:56. [PMID: 22264312 PMCID: PMC3293002 DOI: 10.1186/1756-0500-5-56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 01/22/2012] [Indexed: 11/16/2022] Open
Abstract
Background Health-related quality of life (HRQL) is a relevant outcome measures in intensive care unit (ICU). The aim of this study was to evaluate HRQL of ICU patients 3 months after discharge using the Arabic version for Morocco of the EuroQol-5-Dimension (EQ-5D), and to examine the psychometric properties of the questionnaire. Results The Arabic version for Morocco of the EQ-5D was approved by the EuroQol group. A prospective cohort study was conducted after medical ICU discharge. At 3-month follow up, the EQ-5D (self classifier and EQ-VAS) was administered in consultation or by telephone. EQ-VAS varies from 0 (better HRQL) to 100 (worst HRQL). An unweighted scoring for EQ5D-index was calculated. EQ5D-index ranges from -0.59 to 1. Test-retest reliability of the EQ-5D was tested using Kappa coefficient and intraclass correlation coefficient (ICC). Criterion validity was assessed by correlating EQ-VAS and EQ5D-index with the Short Form 36 (SF-36). Construct validity was tested using simple and multiple liner regression to assess factors influencing patients'HRQL. 145 survivors answered the EQ-5D. Median EQ5D-index was 0.52 [0.20-1]. Mean EQ-VAS was 62 ± 20. Test-retest reliability was conducted in 83 patients. ICCs of EQ5D-index and EQ-VAS were 0.95 and 0.92 respectively. For EQ-5D self classifier, agreement by kappa was above 0.40. Significant correlations were noted between EQ5D-index, EQ-VAS and SF-36 (p < 0.001). In multivariate analysis, factors associated with poorer HRQL for EQ5D-index were longer ICU length of stay (β = -0.01; p = 0.017) and higher educational level (β = -0.2; p = 0.001). For EQ-VAS men were associated with better HRQL (β = 6.5; p = 0.048). Conclusions The Arabic version for Morocco of the EQ-5D is reliable and valid. Women, high educational level and longer ICU length of stay were associated with poorer HRQL.
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Affiliation(s)
- Ibtissam Khoudri
- Faculty of Medicine, Laboratory of Biostatistics Clinical and Epidemiological Research, Rabat, Morocco.
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Hofhuis JGM, van Stel HF, Schrijvers AJP, Rommes JH, Spronk PE. Changes of health-related quality of life in critically ill octogenarians: a follow-up study. Chest 2011; 140:1473-1483. [PMID: 21960698 DOI: 10.1378/chest.10-0803] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Intensivists frequently are concerned about whether octogenarians actually will benefit from ICU admission. We studied changes in health-related quality of life (HRQOL) 6 months following ICU discharge in those patients. METHODS We performed a long-term prospective study in a medical-surgical ICU. Patients aged ≥ 80 years (n = 129) and < 80 years (n = 620) admitted for > 48 h were included. We used the Medical Outcomes Study 36-item short form (SF-36) to evaluate HRQOL before ICU admission (using proxies), at ICU discharge, at hospital discharge, and at 3 and 6 months following ICU discharge, using a linear mixed model. RESULTS At 6 months after ICU discharge, 49 patients aged ≥ 80 years and 352 patients aged < 80 years could be evaluated. At ICU discharge, physical functioning was far lower than mental functioning (physical component score, 24.9; mental component score, 46.1) in the octogenerians. Most SF-36 dimensions showed significant improvement over time (all P < .01, except role-emotional [P = .038] and bodily pain [P = .77]). In the octogenarians, mean SF-36 scores 6 months after ICU discharge were comparable to baseline in all dimensions. Most dimensions of the SF-36 were not significantly lower in surviving octogenarians at 6 months after ICU discharge compared with the normal population. CONCLUSIONS We demonstrated a good recovery of HRQOL in octogenarians surviving critical illness. The findings suggest that denying admission to the ICU should not just rely on old age.
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Affiliation(s)
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht
| | | | | | - Peter E Spronk
- Department of Intensive Care, Gelre Hospital, Apeldoorn; Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
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Skinner EH, Warrillow S, Denehy L. Health-related quality of life in Australian survivors of critical illness. Crit Care Med 2011; 39:1896-1905. [PMID: 21532478 DOI: 10.1097/ccm.0b013e31821b8421] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To document health-related quality of life of an Australian sample of intensive care unit survivors 6 months after intensive care unit discharge and compare this with preadmission health-related quality of life, health-related quality of life of national population norms, and international samples of intensive care unit survivors. DESIGN Prospective observational single-center study. SETTING Eighteen-bed medical-surgical tertiary intensive care unit of an Australian metropolitan hospital. PATIENTS Of the 122 eligible patients, 100 were recruited (intensive care unit length of stay >48 hrs, age >18 yrs, not imminently at risk of death) and the final sample comprised 67 patients, age (median [interquartile range], 61 yrs [49-73 yrs]), 60% male admitted to the intensive care unit for a median [interquartile range] 101 hrs (68-149 hrs). Normative age- and sex-matched Australian Short-Form 36 data from the Australian Bureau of Statistics, selected international cohorts of intensive care unit survivors, and their respective national age-matched normative data were included for comparison. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sixty-seven participants provided responses to questions rating health-related quality of life (Australian Short-Form 36) at preadmission (on admission to the intensive care unit or through retrospective recall as soon as able) and 6 months after intensive care unit discharge. Ten additional participants were unable to provide study data without proxy input and were excluded from analysis. Participants reported clinically meaningful improvements in bodily pain (p = .001), social functioning (p = .03), role-emotional domains of the Short-Form 36 (p = .04), and mental component summary score (p = .01) at 6 months after intensive care unit discharge, mostly attributable to the patients undergoing cardiac surgery, whereas remaining Short-Form 36 domains showed no difference between preadmission and 6 months (p > .05). Participants reported clinically meaningful decrements in preadmission Short-Form 36 data compared with the Australian normative population with role-physical (p < .001) and physical functioning (p < .001) most affected at follow-up. Health-related quality of life in this sample was comparable with international samples of intensive care unit survivors. CONCLUSIONS Although the majority of health-related quality of life domains did not differ between preadmission and 6-month follow-up, participants reported significant and clinically meaningful improvements in pain and mental health at follow-up. Critical illness survivors' health-related quality of life remained within 1 sd of Australian norms at follow-up and physical function health-related quality of life was most affected. Health-related quality of life in these Australian survivors of the intensive care unit was comparable with international survivors 6 months after intensive care unit admission.
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Affiliation(s)
- Elizabeth H Skinner
- Department of Physiotherapy and Department of Intensive Care, Monash Medical Centre, Southern Health, Clayton, Victoria, Australia.
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Dinglas VD, Gellar J, Colantuoni E, Stan VA, Mendez-Tellez PA, Pronovost PJ, Needham DM. Does intensive care unit severity of illness influence recall of baseline physical function? J Crit Care 2011; 26:634.e1-7. [PMID: 21737233 DOI: 10.1016/j.jcrc.2011.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study is to evaluate if severity of illness in the intensive care unit influences patients' retrospective recall of their baseline physical function from before hospital admission. MATERIALS AND METHODS This is a prospective cohort study of 193 acute lung injury survivors who, before hospital discharge, retrospectively reported their prehospitalization physical function using the Short Form 36 quality of life survey. RESULTS Four measures were used to evaluate intensive care unit (ICU) severity of illness: (1) Acute Physiology and Chronic Health Evaluation II Acute Physiologic Score at ICU admission, (2) Lung Injury Score at acute lung injury diagnosis, (3) Sequential Organ Failure Assessment score at study enrollment, and (4) maximum daily Sequential Organ Failure Assessment score during the entire ICU stay. In multivariable linear regression analysis, no measure of severity of illness was associated with prehospitalization physical function. Education level significantly modified the relationship between ICU severity of illness and baseline physical function with lower educational attainment having a stronger association with baseline physical function. CONCLUSION Intensive care unit severity of illness was not associated with patients' retrospectively recalled baseline physical function. Patients with a lower level of education may be more influenced by ICU severity of illness, but the magnitude of this effect may not be clinically meaningful.
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Affiliation(s)
- Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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Abstract
Sleep disturbances and fatigue are significant problems for critically ill patients. Existing sleep disorders, underlying medical/surgical conditions, environmental factors, stress, medications, and other treatments all contribute to a patient's inability to sleep. Sleep disturbance and debilitating fatigue that originate during acute illness may continue months after discharge from intensive care units (ICUs). If these issues are unrecognized, lack of treatment may contribute to chronic sleep problems, impaired quality of life, and incomplete rehabilitation. A multidisciplinary approach that incorporates assessment of sleep disturbances and fatigue, environmental controls, appropriate pharmacologic management, and educational and behavioral interventions is necessary to reduce the impact of sleep disturbances and fatigue in ICU patients. Nurses are well positioned to identify issues in their own units that prevent effective patient sleep. This article will discuss the literature related to the occurrence, etiology, and risk factors of sleep disturbance and fatigue and describe assessment and management options in critically ill adults.
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Affiliation(s)
- Ellyn E Matthews
- College of Nursing, University of Colorado Denver, 13120 E 19th Ave, Aurora, CO 80045, USA.
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Williams TA, Leslie GD. Challenges and possible solutions for long-term follow-up of patients surviving critical illness. Aust Crit Care 2011; 24:175-85. [PMID: 21514838 DOI: 10.1016/j.aucc.2011.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Surviving critical illness can be life-changing and present new healthcare challenges for patients after discharge from hospital. Optimisation of recovery, rather than mere survival, is an important goal of intensive care. Observational studies have identified decreased quality of life and increased healthcare needs for survivors but loss to follow-up can be high with possible selection bias. Patients in need of support may therefore not be included in study results or allocated appropriate follow up support. AIM To examine the frequency and reasons patients admitted to general ICUs who survive critical illness are excluded from study participation or lost to follow-up and consider the possible implications and solutions. METHOD The literature review included searches of the MEDLINE, EMBASE, and CINAHL databases. Studies (2006-2010) were included if they described follow-up of survivors from general ICUs. RESULTS Ten studies were reviewed. Of the 3269 eligible patients, 14% died after hospital discharge, 27% declined, and 22% were lost to follow-up. Reasons for loss to follow-up included no response, inability to contact the patient, too ill or admitted to another facility. CONCLUSION The most appropriate method of care follow-up has yet to be established but is likely to involve an eclectic model that tailors service provision to support individual patient needs. Identifying methods to minimise loss to follow-up may enhance interpretation of patients' recovery, lead to improvements in clinical practice and inform healthcare service decisions and policy.
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Affiliation(s)
- Teresa A Williams
- School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia.
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Conti M, Friolet R, Eckert P, Merlani P. Home return 6 months after an intensive care unit admission for elderly patients. Acta Anaesthesiol Scand 2011; 55:387-93. [PMID: 21348865 DOI: 10.1111/j.1399-6576.2011.02397.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Home return after critical care is very important not only to patients and families. To move back home, patients have to fulfill two conditions: survive, and have a relatively good functional status. In addition, home return could be considered a low-cost outcome because of the reduced permanent healthcare costs. METHODS To determine the factors influencing the home-return probability of critically ill elderly patients 6 months after an intensive care unit (ICU) admission, we analyzed a cohort of patients aged 65 years or older admitted to an ICU. Demographic and social parameters, as well as admission diagnosis, underlying diseases, severity scores, ICU stay parameters, and complications were recorded. The final outcome was the place of stay (or death) 180 days after ICU admission. RESULTS Of 526 patients, 72% of the cohort and 93% of hospital survivors were able to return to their homes. Among the variables used in the multivariate logistic regression, advanced age, length of hospital stay before ICU admission, severity of acute illness, diagnosis category, and complications, as well as certain comorbidities, such as chronic heart failure or a neoplasia, were independently negatively associated with a home return. CONCLUSION Some interesting factors were identified in this single-center study. They could be considered for a multicenter study to build a universal prediction model for home return. Home return could be used for elderly patients as a surrogate for outcomes that are very important to the elderly but also to health politics.
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Affiliation(s)
- M Conti
- Service of Intensive Care, Department of Anesthesiology, Pharmacology, and Intensive Care, Geneva University Hospital, University of Geneva, Genève, Switzerland.
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Health-related quality of life of trauma patients after intensive care: a 2-year follow-up study. Eur J Trauma Emerg Surg 2011; 37:629-33. [DOI: 10.1007/s00068-011-0084-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
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Orwelius L, Bäckman C, Fredrikson M, Simonsson E, Nordlund P, Samuelsson A, Sjöberg F. Social integration: an important factor for health-related quality of life after critical illness. Intensive Care Med 2011; 37:831-8. [PMID: 21318438 DOI: 10.1007/s00134-011-2137-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine to what extent availability of social integration affects health-related quality of life (HRQoL) in former intensive care unit (ICU) patients and how it relates to corresponding findings in a general reference group. DESIGN Controlled, multicenter, prospective, explorative study. SETTING AND PATIENTS HRQoL data (SF-36) were collected from three combined medical and surgical ICUs in the south-east of Sweden. Social integration was assessed by the Availability of Social Integration (AVSI) instrument (seven questions related to the social interaction of the patient). As reference group, a random sample (n = 6,093) of people from the uptake area of the hospitals was used. Social integration (AVSI), HRQoL (SF-36), and comorbidity were examined also in the reference group. INTERVENTIONS None. MEASUREMENTS AND RESULTS The level of social integration significantly affected HRQoL for the former ICU patients, whereas no such effect was seen for the general reference group. For the ICU patients, social integration affected HRQoL to a larger extent than age, sex, and the ICU-related factors examined, but to a lower extent than the pre-existing diseases. CONCLUSIONS For a comprehensive assessment of HRQoL in former ICU patients, it is mandatory to include the effect of social integration.
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Affiliation(s)
- Lotti Orwelius
- Department of Intensive Care, Linköping University/University Hospital of Linköping, Linköping, Sweden.
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Capuzzo M, Bertacchini S, Davanzo E, Felisatti G, Paparella L, Tadini L, Alvisi R. Health-related quality of life before planned admission to intensive care: memory over three and six months. Health Qual Life Outcomes 2010; 8:103. [PMID: 20846435 PMCID: PMC2949820 DOI: 10.1186/1477-7525-8-103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 09/16/2010] [Indexed: 11/10/2022] Open
Abstract
Background The validity of Health-Related Quality of Life (HRQOL) recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at 3 and 6 months in a population of patients with planned ICU admission after surgery. Methods This prospective study was performed in three Italian centres on patients who had undergone General, Orthopaedic or Urologic surgery. All adult patients with planned ICU admission between October 2007 and July 2008 were considered for enrolment. At hospital admission, the Mini Mental Status Examination and EuroQoL (EQ) questionnaire (referring to the last two weeks) were administered to the patients who consented. Three and six months after ICU admission, the researchers administered by phone the EQ questionnaire and Post-Traumatic Stress Syndrome 14 questions Inventory, asking the patients to rate their HRQOL before surgery and ICU admission. Past medical history demographic and clinical ICU-related variables were collected. Statistical analysis Chi-square test and non parametric statistics were used to compare groups of patients. The EQ-5D was transformed in the time trade-off (TTO) to obtain a continuous variable, subsequently analysed using the Intraclass Correlation Coefficient (ICC). Results Of the 104 patients assessed at baseline and discharged from the hospital, 93 had the EQ administered at 3 months, and 89 at 6 months. The ICC for TTO recalled at 3 months vs pre-ICU TTO was 0.851, and that for TTO recalled at 6 months vs pre-ICU TTO was 0.833. The ICC for the EQ-VAS recalled at 3 months vs pre-ICU EQ-VAS was 0.648, and that for the EQ-VAS recalled at 6 months vs pre-ICU EQ-VAS was 0.580. Forty-two (45%) patients assessed at 3 months gave the same score in all EQ-5D items as at baseline. They underwent mainly orthopaedic surgery (p 0.011), and perceived the severity of their illness as lower (p 0.009) than patients scoring differently at 3 months in comparison with baseline. Conclusions The patients with planned ICU admission have a good memory of their health status as measured by EQ-5D in the period preceding surgery and ICU admission, especially at three months.
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Affiliation(s)
- Maurizia Capuzzo
- University Section of Anaesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S, Anna, Ferrara, Italy.
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