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Soedjana H, Hasibuan LY, Riestiano BE, Andayani S, Nurfitriani A, Sundoro A, Putri AC, Prasetyo AT. Correlation of Sociodemographic Factors, Characteristics of Burns, and Neutrophil-to-Lymphocyte Ratio with the Level of Depression in Patients with Burn injuries. JPRAS Open 2024; 40:346-355. [PMID: 38756416 PMCID: PMC11096802 DOI: 10.1016/j.jpra.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
Background The most common psychological impact experienced by patients with burn injuries is depression. Several significant risk factors influence depression, including sociodemographic factors (gender, employment status, socioeconomic status, and marital status) and burn characteristics (burn depth, burn area, and total burn surface area). Neutrophil-to-lymphocyte ratio (NLR) was discovered as a new biomarker for depression detection. The purpose of this study was to investigate the correlation of sociodemographic factors, burn characteristics, and NLR with the severity of depression in patients with burn injuries. Methods This analytic descriptive study was conducted at Dr. Hasan Sadikin General Hospital from June 2022 to April 2023. Samples were assessed by a psychiatrist using the Hamilton Depression Rating Scale instrument, and a differential white blood count was calculated to obtain the NLR value. Results The study sample consisted of 32 patients, including 27 males and 6 females. There was no correlation of sociodemographic factors and burn wound characteristics with the level of depression. NLR in patients with burn injuries who had no depression, mild depression, and moderate depression was 5.78 ± 2.23, 7.4 ± 1.77, and 13.04 ± 6.25, respectively. NLR was statistically significantly associated with the level of depression in patients with burn injuries (p = 0.001). Conclusion There was no correlation of sociodemographic factors and burn characteristics with the level of depression. There was a significant correlation between NLR and the level of depression in patients with burn injuries at Dr. Hasan Sadikin General Hospital.
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Affiliation(s)
- Hardisiswo Soedjana
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Lisa Y. Hasibuan
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Betha Egih Riestiano
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Santi Andayani
- Department of Psychiatry, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Annisa Nurfitriani
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Ali Sundoro
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Almahitta Cintami Putri
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Arif Tri Prasetyo
- Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Grauberger JN, Joshi N, Joo A, Phelan AL, Lalikos JF. Xeroform Stick-Down Dressing: A Novel Treatment for Pediatric Partial-Thickness Burns. Ann Plast Surg 2024; 92:S123-S128. [PMID: 38319984 DOI: 10.1097/sap.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Burns traditionally require frequent, painful dressing changes to minimize infection risk and promote wound healing. To improve care for our pediatric population, our institution adapted a skin graft donor site dressing into a "stick-down" burn dressing consisting of a one-time application of bacitracin and 3% bismuth tribromophenate/vaseline impregnated gauze (Xeroform) that adheres to the burn and peels off as new epithelialized skin forms. The goal of which is to minimize dressing change frequency and patient discomfort in a cost-effective, widely available manner. This study aimed to compare clinical outcomes of the stick-down versus traditional topical dressings. METHODS A retrospective cohort study of pediatric patients (age <18 year) with partial-thickness burns treated at a level I pediatric trauma center for 4 years was conducted. One hundred eleven patients were included: 74 patients treated with daily silver sulfadiazene (Silvadene) dressings matched to 37 patients treated with the Xeroform stick-down dressing using 2:1 propensity score matching. Univariate analyses used Wilcoxon rank sum and Fisher exact tests. RESULTS The cohorts had similar demographics and burn characteristics. Both groups had similar hospitalization rates (31.1% Silvadene, 32.4% Xeroform), most commonly for pain control (54.5% Silvadene, 58.3% Xeroform), with similar average daily narcotic usage (7.7 ± 12.1 morphine milliequivalents Silvadene, 5.1 ± 9.5 Xeroform; P = 0.91). The Xeroform cohort had a shorter but statistically similar hospital stay (median, 1 vs 2 days). In addition, the Xeroform cohort required significantly less dressing changes with a median of 0.5 changes compared with 12 for the Silvadene cohort ( P < 0.0001). There was no difference in time to burn reepithelialization (median, 13.0 days for Silvadene and 12.0 days for Xeroform; P = 0.20) or wound healing complications (12.5% Silvadene, 2.7% Xeroform; P = 0.15). CONCLUSIONS The Xeroform stick-down dressing has equivalent clinical outcomes to that of standard Silvadene dressings for the treatment of pediatric partial-thickness burns with the major advantages of decreasing dressing change frequency, minimizing patient distress and pain, and streamlining clinical care.
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Affiliation(s)
- Jennifer N Grauberger
- From the Division of Plastic and Reconstructive Surgery, University of Massachusetts Chan Medical School, Worcester, MA
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Panayi AC, Heyland DK, Stoppe C, Jeschke MG, Didzun O, Matar D, Tapking C, Palackic A, Bliesener B, Harhaus L, Knoedler S, Haug V, Bigdeli AK, Kneser U, Orgill DP, Hundeshagen G. The long-term intercorrelation between post-burn pain, anxiety, and depression: a post hoc analysis of the "RE-ENERGIZE" double-blind, randomized, multicenter placebo-controlled trial. Crit Care 2024; 28:95. [PMID: 38519972 PMCID: PMC10958907 DOI: 10.1186/s13054-024-04873-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Despite the growing prevalence of burn survivors, a gap persists in our understanding of the correlation between acute burn trauma and the long-term impact on psychosocial health. This study set out to investigate the prevalence of long-term pain and symptoms of anxiety and depression in survivors of extensive burns, comparing this to the general population, and identify injury and demographic-related factors predisposing individuals to psychosocial compromise. METHODS RE-ENERGIZE was an international, double-blinded, randomized-controlled trial that enrolled 1200 patients with partial- or full-thickness burns that required surgical treatment. For the post hoc analysis, we excluded participants who did not complete the Short Form Health Survey (SF-36) questionnaire. Normative data were taken from the 2021 National Health Interview Survey dataset. Propensity score matching was performed using the nearest-neighbor 1-to-1 method, and the two cohorts were compared in terms of chronic pain, and symptoms of anxiety and depression. A multivariable analysis was performed on the burns cohort to identify factors predicting post-discharge pain and symptoms of anxiety and depression. RESULTS A total of 600 burn patients and 26,666 general population adults were included in this study. Following propensity score matching, both groups comprised 478 participants each, who were predominately male, white, overweight and between 20 and 60 years old. Compared to the general population, burn patients were significantly more likely to report the presence of moderate and a lot of pain (p = 0.002). Symptoms of anxiety were significantly higher in the burn population in two of four levels (most of the time; some of the time; p < 0.0001 for both). Responders in the burn population were significantly less likely to report the absence of depressive symptoms (p < 0.0001). Burn patients were also significantly more likely to report that their mental health affects their social life. TBSA, history of depression, and female sex were identified as independently associated factors for pain, anxiety, and depressive symptoms. The presence of chronic pain and anxiety symptoms independently predicted for symptoms of depression. CONCLUSIONS Analyzing the largest multicenter cohort of patients with extensive burns, we find that burn injury is associated with chronic pain, and symptoms of anxiety and depression. In addition, TBSA-burned and history of depression directly correlate with the prevalence of chronic pain, and symptoms of anxiety and depression. Finally, pain, and symptoms of anxiety and depression are interrelated and may have interactive effects on the process of recovery following burn injury. Burn patients would, therefore, benefit from a multidisciplinary team approach with early mobilization of pain and mental health experts, in order to promptly prevent the development of psychosocial challenges and their consequences.
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Affiliation(s)
- Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Marc G Jeschke
- Hamilton Health Sciences Research, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Oliver Didzun
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Dany Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women'S Hospital, Harvard Medical School, Boston, MA, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian Tapking
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Alen Palackic
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Björn Bliesener
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Leila Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women'S Hospital, Harvard Medical School, Boston, MA, USA
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Amir K Bigdeli
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women'S Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany.
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Neufeld MY, Plaitano E, Janeway MG, Munzert T, Scantling D, Allee L, Sanchez SE. History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence. J Trauma Acute Care Surg 2023; 95:143-150. [PMID: 37068014 PMCID: PMC10407825 DOI: 10.1097/ta.0000000000003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized. Our objective was to determine if risk of hospital reencounter-violent reinjury and all-cause-was associated with preexisting MI at time of index injury among female victims of violence. METHODS All females (15-100 + years) presenting to a level I trauma center with violent injury (2002-2019) surviving to discharge were included (N = 1,056). Exposure was presence of preexisting MI. The primary outcome was hospital reencounters for violent reinjury and all-cause within one year (through 2020). The secondary outcome was the development of a new MI within one year of index injury. Odds of reencounter and development of new MI for those with and without preexisting MI were compared with multivariable logistic regression, stratified for interaction when appropriate. RESULTS There were 404 women (38%) with preexisting MI at time of index injury. Approximately 11% of patients with preexisting MI experienced violent reinjury compared to 5% of those without within 1 year ( p < 0.001). Specifically, those with MI in the absence of concomitant substance use had more than three times the odds of violent reinjury (adjusted Odds Ratio, 3.52 (1.57, 7.93); p = 0.002). Of those with preexisting MI, 64% had at least one reencounter for any reason compared to 46% of those without ( p < 0.001 ) . Odds of all-cause reencounter for those with preexisting MI were nearly twice of those without (adjusted Odds Ratio, 1.81 [1.36, 2.42]; p < 0.0001). CONCLUSION Among female victims of violence, preexisting MI is associated with a significantly increased risk of hospital reencounter and violent reinjury within the first year after index injury. Recognition of this vulnerable population and improved efforts at addressing MI in trauma patients is critical to ongoing prevention efforts to reduce violent reinjury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Miriam Y Neufeld
- From the Department of Surgery (M.Y.N., T.M., D.S., L.A., S.E.S.), Boston Medical Center; Department of Surgery (M.Y.N., D.S., L.A., S.E.S.), Boston University School of Medicine; Undergraduate Program in Neuroscience (E.P.), Boston University College of Arts and Sciences, Boston, Massachusetts; and Department of Surgery (M.G.J.), University of Michigan, Ann Arbor, Michigan
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Ameratunga S, Samaranayaka A, Wyeth EH, Davie G, Lilley R, Wilson S, Kokaua J, Derrett S. Prevalence and predictors of post-traumatic stress symptoms in 2200 hospitalised and non-hospitalised injured New Zealanders. Aust N Z J Psychiatry 2022; 56:1344-1356. [PMID: 34823376 DOI: 10.1177/00048674211060747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand's Accident Compensation Corporation. This government-funded universal no-fault insurance scheme replaced tort-based compensation for injuries in 1974 since when civil litigation (which can bias post-traumatic stress disorder estimates) has been rare. METHODS A total of 2220 Accident Compensation Corporation claimants aged 18-64 years recruited to the Prospective Outcomes of Injury Study were interviewed at 12 months post-injury to identify symptoms suggestive of post-traumatic stress disorder using the Impact of Events Scale. Multivariable models examined the extent to which baseline sociodemographic, injury, health status and service interaction factors predicted the risk of post-traumatic stress disorder symptoms among hospitalised and non-hospitalised groups. RESULTS Symptoms suggestive of post-traumatic stress disorder were reported by 17% of hospitalised and 12% of non-hospitalised participants. Perceived threat to life at the time of the injury doubled this risk among hospitalised (adjusted relative risk: 2.0; 95% confidence interval: 1.2-3.2) and non-hospitalised (relative risk: 1.8; 95% confidence interval: 1.2-2.8) participants. Among hospitalised participants, other predictors included female gender, Pacific and 'other' minority ethnic groups, pre-injury depressive symptoms, financial insecurity and perceived inadequacies in healthcare interactions, specifically information and time to discuss problems. Among non-hospitalised survivors, predictors included smoking, hazardous drinking, assault and poor expectations of recovery. CONCLUSION One in six hospitalised and one in eight non-hospitalised people reported post-traumatic stress disorder symptoms 12 months following injury. Perceived threat to life was a strong predictor of this risk in both groups. Identifying early predictors of post-traumatic stress disorder, regardless of whether the injury required hospitalisation, could help target tailored interventions that can reduce longer-term psychosocial morbidity.
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Affiliation(s)
- Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ari Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Rebbecca Lilley
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Suzanne Wilson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jesse Kokaua
- Centre for Pacific Health, Va'a o Tautai, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Peng F, Koh WY, Chung CH, Chien WC, Lin CE. Risks of mental disorders among intensive care unit survivors: A nationwide cohort study in Taiwan. Gen Hosp Psychiatry 2022; 77:147-154. [PMID: 35660739 DOI: 10.1016/j.genhosppsych.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk of mental disorders among the intensive care unit (ICU) survivors compared with the hospitalized non-ICU and non-hospitalized patients. METHOD We extracted data from the Taiwanese National Health Insurance Research Database (NHIRD) to conduct a retrospective cohort study. Multivariate Cox proportional hazard regression models were used to analyze the data. Identified from the NHIRD, we matched 15,918 patients with ICU admissions, 63,672 patients without any inpatient admission (non-inpatient department [non-IPD] cohort), and 63,672 patients admitted to a general ward but not the ICU (non-ICU cohort). The patient records were extracted between the periods of 2000-2015 to identify any occurrence of mental disorders. RESULTS During the study period, the overall risk of mental disorder diagnosis was 1.68-fold higher in the ICU cohort than the non-IPD cohort (95% confidence interval (CI): 1.23-1.89, P < 0.001). Alternatively, there were no differences in risks for any mental disorders between the ICU and non-ICU cohorts. CONCLUSION Both admissions to the ICU and the general ward cohorts were associated with a higher risk of any mental disorders compared to the general population. Further clinical studies are warranted to confirm this association due to residual or unmeasured risk factors.
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Affiliation(s)
- Fan Peng
- Department of General Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Wan-Ying Koh
- School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Centre, Taipei, Taiwan, ROC.
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Centre, Taipei, Taiwan, ROC; Graduate Institute of Life Science, National Defense Medical center, Taiwan, ROC.
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
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7
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Obed D, Schroeter A, Gruber L, Salim M, Krezdorn N, Vogt PM. Outcomes following burn injury in intensive care patients with major psychiatric disorders. Burns 2022; 49:830-837. [PMID: 35817650 DOI: 10.1016/j.burns.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/02/2022]
Abstract
AIMS Patients with psychiatric comorbidity have been shown to experience high rates of burn injury. Burn epidemiology, etiology, and outcomes have been sparsely documented for patients with major psychiatric disorders. The aim of this study was to analyze the epidemiologic characteristics and outcomes in intensive care burn patients with pre-existing and acute major psychiatric disorders . METHODS A retrospective study was performed including intensive care burn patients admitted between March 2007 and December 2020. Demographic, clinical and epidemiological data were collected and analyzed. Major psychiatric co-morbidities were collected according to ICD-9 and ICD-10 classifications. Patients were stratified according to F-diagnoses. RESULTS A total of 1325 patients were included. 16.6 % of all patients had one or more major psychiatric disorders- 9.3 % with anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders, 9.2 % with mood (affective) disorders, 3.5 % with schizophrenia and other non-mood psychotic disorders, and 1.8 % with disorders of adult personality and behavior. Patients with major psychiatric disorders presented with significantly higher burn severity, reflected by higher abbreviated burn severity index (ABSI) scores (5.9 vs. 5.3, p < 0.001) and larger total body surface area (TBSA) affected (15.9 vs. 12.5 %, p = 0.002). Burned TBSA ≥ 30 and inhalation injuries were observed more frequently in patients with MDP, however without statistical significance. They also experienced prolonged hospital length-of-stay (LOS) (25.5 vs. 16.3 days, p < 0.001), prolonged intensive care unit LOS (14.8 vs. 7.7 days, p < 0.001), underwent surgical interventions (3.5 vs. 2.3, p < 0.001) and mechanical ventilation more frequently (34.1 % vs. 16.5 %, p = 0.43) and had significantly longer ventilation durations (73.5 vs. 31.2 h, p = 0.002). Mortality rates were lower compared to patients without major psychiatric disorders (5.9 vs. 8.1, p < 0.001). CONCLUSIONS The prevalence of major psychiatric disorders in burn patients is considerably high. Patients with psychiatric comorbidities were found to have greater burn severity, prolonged total hospital and ICU LOS, underwent surgical interventions and mechanical ventilation more frequently and had prolonged ventilation duration. Our results highlight the importance of identifying burn patients with major psychiatric disorders who may necessitate additional resources and require extensive inpatient psychiatric care and counseling.
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Affiliation(s)
- Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
| | - Andreas Schroeter
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Lisa Gruber
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Mustafa Salim
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
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Gramaglia C, Gattoni E, Gambaro E, Bellan M, Balbo PE, Baricich A, Sainaghi PP, Pirisi M, Binda V, Feggi A, Jona A, Marangon D, Prosperini P, Zeppegno P. Anxiety, Stress and Depression in COVID-19 Survivors From an Italian Cohort of Hospitalized Patients: Results From a 1-Year Follow-Up. Front Psychiatry 2022; 13:862651. [PMID: 35782424 PMCID: PMC9247238 DOI: 10.3389/fpsyt.2022.862651] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Mental health-related symptoms can persist over time beyond the most common respiratory clinical features of COVID-19. A recent meta-analysis underlined that mental health sequalae may be relevant for COVID-19 survivors and reported the following prevalence rates: 20% for post-traumatic stress disorder, 22% for anxiety, 36% for psychological distress, and 21% for depression. In the context of a multi-disciplinary follow-up project, we already investigated the mid-term (4 months) psychiatric outcomes in a sample of COVID-19 survivors. Patients were re-assessed after 1-year since hospital discharge. Methods Follow-up conducted after 1 year involved 196 individuals recovered from COVID-19. Patients were assessed with a multi-disciplinary approach; including both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview (MINI) to assess the presence of anxiety, stress, and depressive symptoms and the following self-administered questionnaires: Beck Anxiety Inventory, Beck Depression Inventory-II, Resilience Scale for Adults, Impact of Event Scale, and COVID-19 Peritraumatic Distress Index (CPDI). Results Anxiety (p < 0.0001) and depressive (p < 0.0003) symptoms registered at the clinical interview showed a significant improvement from the 4 to 12-months follow-up. Logistic regression model showed that female gender (p = 0.006), arterial hypertension (p = 0.01), obesity (0.04), anxiety (p < 0.0001), and depressive (p = 0.02) symptoms at 4-months follow-up were associated with persistence of anxiety symptoms at 12 months. At logistic regression analysis female gender (p = 0.02) and depressive symptoms at 4-months follow-up (p = 0.01) were associated with depressive symptoms after 12 months. Conclusion Severity of the disease in the acute phase, in this study, was not a determining factor in identifying subjects at risk of developing clinically relevant anxiety and depression as a consequence of COVID-19 disease. Findings from the logistic regressions suggest that the factors most affecting depression and anxiety in COVID survivors after 12 months were female gender, the presence of anxiety and depression after 4 months and some physical symptoms, not necessarily COVID-related. Impact of infection and consequent hospitalization for COVID-19 did no longer represent a relevant issue for depressive symptoms, compared to other general factors.
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Affiliation(s)
- Carla Gramaglia
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gattoni
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Mattia Bellan
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | | | - Alessio Baricich
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Pier Paolo Sainaghi
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Valeria Binda
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Alessandro Feggi
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Amalia Jona
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Debora Marangon
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | | | - Patrizia Zeppegno
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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9
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Irwin E, Chapman T, Johanson E, Robinson L. Early Intervention Eye Movement Desensitization and Reprocessing Following Major Musculoskeletal Trauma: How Soon Is Too Soon? JOURNAL OF EMDR PRACTICE AND RESEARCH 2022. [DOI: 10.1891/emdr-2021-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Major trauma centers have increased survival following serious physical injury, resulting in increased demand for specialist multidisciplinary rehabilitation. We aimed to explore the feasibility of using early intervention eye movement desensitization and reprocessing (EMDR) therapy in an acute inpatient setting, using a non-concurrent, multiple-baseline, pre-post test case-series design. Unfortunately, no patients were recruited. This paper sets out the challenges and reflections of setting up a psychological intervention study in this setting and provides suggestions for further research.
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10
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Cognitive, EEG, and MRI features of COVID-19 survivors: a 10-month study. J Neurol 2022; 269:3400-3412. [PMID: 35249144 PMCID: PMC8898558 DOI: 10.1007/s00415-022-11047-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 01/21/2023]
Abstract
Background and objectives To explore cognitive, EEG, and MRI features in COVID-19 survivors up to 10 months after hospital discharge. Methods Adult patients with a recent diagnosis of COVID-19 and reporting subsequent cognitive complaints underwent neuropsychological assessment and 19-channel-EEG within 2 months (baseline, N = 49) and 10 months (follow-up, N = 33) after hospital discharge. A brain MRI was obtained for 36 patients at baseline. Matched healthy controls were included. Using eLORETA, EEG regional current densities and linear lagged connectivity values were estimated. Total brain and white matter hyperintensities (WMH) volumes were measured. Clinical and instrumental data were evaluated between patients and controls at baseline, and within patient whole group and with/without dysgeusia/hyposmia subgroups over time. Correlations among findings at each timepoint were computed. Results At baseline, 53% and 28% of patients showed cognitive and psychopathological disturbances, respectively, with executive dysfunctions correlating with acute-phase respiratory distress. Compared to healthy controls, patients also showed higher regional current density and connectivity at delta band, correlating with executive performances, and greater WMH load, correlating with verbal memory deficits. A reduction of cognitive impairment and delta band EEG connectivity were observed over time, while psychopathological symptoms persisted. Patients with acute dysgeusia/hyposmia showed lower improvement at memory tests than those without. Lower EEG delta band at baseline predicted worse cognitive functioning at follow-up. Discussion COVID-19 patients showed interrelated cognitive, EEG, and MRI abnormalities 2 months after hospital discharge. Cognitive and EEG findings improved at 10 months. Dysgeusia and hyposmia during acute COVID-19 were related with increased vulnerability in memory functions over time. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11047-5.
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11
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Tugnoli S, Spadaro S, Corte FD, Valpiani G, Volta CA, Caracciolo S. Health Related Quality of Life and Mental Health in ICU Survivors: Post-Intensive Care Syndrome Follow-Up and Correlations between the 36-Item Short Form Health Survey (SF-36) and the General Health Questionnaire (GHQ-28). Health (London) 2022. [DOI: 10.4236/health.2022.145037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Stockly OR, Wolfe AE, Goldstein R, Roaten K, Wiechman S, Trinh NH, Goverman J, Stoddard FJ, Zafonte R, Ryan CM, Schneider JC. Predicting Depression and Post-Traumatic Stress Symptoms Following Burn Injury: A Risk Scoring System. J Burn Care Res 2021; 43:899-905. [PMID: 34751379 DOI: 10.1093/jbcr/irab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Depression and post-traumatic stress are common psychiatric comorbidities following burn injury. The purpose of this study was to develop an admission scoring system that assesses the risk of development of depression or post-traumatic symptoms in the burn population. This study is a retrospective review of the prospectively collected Burn Model System National Database. Adult burn survivors enrolled from 2014-2018 (n=486) were included. The primary outcome was the presence of depression or post-traumatic stress symptoms at 6, 12, or 24 months post-injury. Logistic regression analysis was used to identify demographic and clinical predictors of depression and post-traumatic stress symptoms. A risk scoring system was then created based on assigning point values to relevant predictor factors. The study population had a mean age of 46.5±15.8 years, mean burn size of 18.3±19.7%, and was 68.3% male. Prior to injury, 71.3% of the population was working, 47.9% were married, and 50.8% had completed more than a high school education. An 8-point risk scoring system was developed using the following predictors of depression or post-traumatic stress symptom development: gender, psychiatric treatment in the past year, graft size, head/neck graft, etiology of injury, and education level. This study is the first to develop a depression and post-traumatic stress symptom risk scoring system for burn injury. This scoring system will aid in identifying burn survivors at high risk of long-term psychiatric symptoms that may be used to improve screening, monitoring, timely diagnosis and interventions.
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Affiliation(s)
- Olivia R Stockly
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Nhi-Ha Trinh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Harvard Medical School, Boston, MA.,Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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13
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Brienza A, Suffoletto BP, Kuhn E, Germain A, Jaramillo S, Repine M, Callaway CW, Pacella-LaBarbara ML. The role of specific sources of social support on postinjury psychological symptoms. Rehabil Psychol 2021; 66:600-610. [PMID: 34398631 PMCID: PMC8648976 DOI: 10.1037/rep0000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The role of perceived social support from specific sources (e.g., families, friends, and significant others) on the development of postinjury posttraumatic stress disorder (PTSD) and associated psychological symptoms (e.g., depression and anxiety) remains relatively unexplored. We examined the predictive role of social support from specific sources on psychological symptoms among emergency department (ED) patients following motor vehicle crash (MVC). Research Methods/Design: Sixty-three injured patients (63.5% female; 37 years old on average) with moderately painful complaints were recruited in the EDs of two Level-1 trauma centers within 24 hr post-MVC. In the ED, participants completed surveys of baseline psychological symptoms and perceived social support; follow-up surveys were completed at 90 days postinjury. RESULTS Most of the sample (84.1%) was discharged home from the ED with predominantly mild injuries and did not require hospitalization. After adjusting for race, sex, age, and baseline symptoms, hierarchical regression analyses demonstrated that lower perceived social support in the ED predicted higher PTSD symptoms and depressive symptoms (but not anxiety) at 90 days. This effect seemed to be specific to significant others and friends but not family. CONCLUSIONS/IMPLICATIONS MVC-related injuries are robust contributors to psychological sequelae. These findings extend prior work by highlighting that perceived social support, particularly from significant others and friends, provides unique information regarding the development of psychological symptoms following predominantly mild MVC-related injuries. This data may serve to inform recovery expectations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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14
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Chatukuta M, Groce N, Mindell J, Kett M. The availability of psychological support following road travel injuries in Namibia: A qualitative study. PLoS One 2021; 16:e0258197. [PMID: 34597352 PMCID: PMC8486108 DOI: 10.1371/journal.pone.0258197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022] Open
Abstract
Road traffic injuries (RTIs) are a major problem worldwide with a high burden of mental health problems and the importance of psychological support following road injury is well documented. However, globally there has been very little research on the accessibility of psychological services following road injury. Namibia is one of the countries most affected by RTIs but no previous studies have been done on this. In this qualitative study we investigated the availability of psychological services to RTI injured in Namibia. Our study findings are in line with those of other global studies in showing inadequate access to psychological support for injury survivors and we discuss the reasons. It is hoped these findings will help policymakers develop ways of enhancing access to psychological support for the many people injured in RTIs in Namibia. The models they develop may also be of use to other LMICs countries with high RTI rates.
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Affiliation(s)
- Mitchel Chatukuta
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
| | - Nora Groce
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
| | - Jenny Mindell
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
| | - Maria Kett
- Research Department of Epidemiology and Public Health, University College London (UCL), London, United Kingdom
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15
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Olafson K, Marrie RA, Bolton JM, Bernstein CN, Bienvenu OJ, Kredentser MS, Logsetty S, Chateau D, Nie Y, Blouw M, Afifi TO, Stein MB, Leslie WD, Katz LY, Mota N, El-Gabalawy R, Enns MW, Leong C, Sweatman S, Sareen J. The 5-year pre- and post-hospitalization treated prevalence of mental disorders and psychotropic medication use in critically ill patients: a Canadian population-based study. Intensive Care Med 2021; 47:1450-1461. [PMID: 34495357 DOI: 10.1007/s00134-021-06513-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/18/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. METHODS Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. RESULTS The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92-0.97, p < 0.0001; 5-year APR 0.99, 95% CI 0.98-1.00, p = 0.1), but higher following discharge (1-year APR 1.08, 95% CI 1.05-1.11, p < 0.0001, 5-year APR 1.03, 95% CI 1.01-1.05, p < 0.0001). A high proportion of ICU patients received antidepressant, anxiolytic and sedative-hypnotic prescriptions before and after their hospitalization. In multivariable analyses, ICU exposure was associated with an increase in mood, anxiety and psychotic disorders, and sedative-hypnotics use (p < 0.0001 for all Time × Group interactions). CONCLUSIONS During the 5 years after admission to ICU, there is a significant increase in treated prevalence of mental disorders and psychotropic medication use compared to the 5 years prior to ICU and compared to general population and hospital cohorts. Prevention and intervention programs that identify and treat mental disorders among survivors of critical illness warrant further study.
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Affiliation(s)
- Kendiss Olafson
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada.
| | - Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maia S Kredentser
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Surgery, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Yao Nie
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Marcus Blouw
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada
| | - Tracie O Afifi
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Murray B Stein
- University of California San Diego, La Jolla, CA, USA.,VA San Diego Healthcare System, San Diego Healthcare System, San Diego, CA, USA
| | - William D Leslie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, GF 532, 820 Sherbrook Ave, Winnipeg, MB, R3A 1R9, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Murray W Enns
- Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Leong
- Rady Faculty of Health Sciences, College of Pharmacy, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sophia Sweatman
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario, ON, Canada
| | - Jitender Sareen
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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16
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Tang EHM, Bedford LE, Yu EYT, Tse ETY, Dong W, Wu T, Cheung BMY, Wong CKH, Lam CLK. Unintentional Injury Burden in Hong Kong: Results from a Representative Population-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8826. [PMID: 34444574 PMCID: PMC8392553 DOI: 10.3390/ijerph18168826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
Abstract
Unintentional injuries are major causes of mortality and morbidity. Although generally perceived as accidents, it is possible to identify those at higher risk and implement appropriate prevention measures. This study aims to investigate the common causes of unintentional injuries and their associated risk factors among a large representative sample. Data of 12,022 individuals who completed the Hong Kong Population Health Survey 2014/15 were extracted. The primary outcome was the prevalence of having unintentional injury(-ies) in the previous 12 months that was severe enough to limit daily activities. Multivariable logistic regression analyses were conducted to identify associations between injuries and sociodemographic, clinical and lifestyle factors. 14.5% of respondents reported episode(s) of unintentional injury in the past 12 months in the population level. The main causes of top three most severe unintentional injuries were sprains (24.0%), falls (19.9%) and being hit/struck (19.6%). 13.2% injury episodes were work-related among the most severe episode. Factors independently associated with significantly higher risks of injury included currently employed, homemaker or student, born in Hong Kong (as compared with immigrants), doctor-diagnosed chronic conditions, harmful alcohol consumption, insufficient sleep, and disturbed sleep. To summarize, unintentional injuries are highly prevalent and associated with harmful drinking, insufficient sleep, and disturbed sleep, which are potential modifiable risk factors for prevention.
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Affiliation(s)
- Eric Ho Man Tang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Weinan Dong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Tingting Wu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
| | - Bernard Man Yung Cheung
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China;
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China; (E.H.M.T.); (L.E.B.); (E.T.Y.T.); (W.D.); (T.W.); (C.K.H.W.); (C.L.K.L.)
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17
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Vlake JH, Wesselius S, van Genderen ME, van Bommel J, Boxma-de Klerk B, Wils EJ. Psychological distress and health-related quality of life in patients after hospitalization during the COVID-19 pandemic: A single-center, observational study. PLoS One 2021; 16:e0255774. [PMID: 34379644 PMCID: PMC8357130 DOI: 10.1371/journal.pone.0255774] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to explore predictors for psychological distress and HRQoL, and to examine whether psychological distress was higher in COVID-19 confirmed patients, and in those treated in Intensive Care Units (ICUs). Methods In this single-center, observational cohort study, adult patients hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 PCR results and the necessity for ICU treatment. The primary outcome was psychological distress, expressed as symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression, up to three months post-discharge. Health-related quality of life (HRQoL) was the secondary outcome. Exploratory outcomes comprised predictors for psychological distress and HRQoL. Results 294 of 622 eligible patients participated in this study (median age 64 years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% and 20% probable anxiety, and 32% and 24% probabledepression at one and three months after hospital discharge, respectively. ICU patients reported less frequently probable depression, but no differences were found in PTSD, anxiety, or overall HRQoL. COVID-19 patients had a worse physical quality of life one month after discharge, and ICU patients reported a better mental quality of life three months after discharge. PTSD severity was predicted by time after discharge and being Caucasian. Severity of anxiety was predicted by time after discharge and being Caucasian. Depression severity was predicted by time after discharge and educational level. Conclusion COVID-19 suspected patients hospitalized during the pandemic frequently suffer from psychological distress and poor health-related quality of life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at least as affected as COVID-19 and ICU patients, underscoring that (post-)hospital pandemic care should not predominantly focus on COVID-19 infected patients.
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Affiliation(s)
- Johan Hendrik Vlake
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
- * E-mail:
| | - Sanne Wesselius
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Michel Egide van Genderen
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jasper van Bommel
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bianca Boxma-de Klerk
- Department of Statistics and Education, Franciscus Academy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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18
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Das B, Saha S, Kabir F, Hossain S. Effect of Graded Early Mobilization on Psychomotor Status and Length of Intensive Care Unit Stay in Mechanically Ventilated Patients. Indian J Crit Care Med 2021; 25:416-420. [PMID: 34045809 PMCID: PMC8138646 DOI: 10.5005/jp-journals-10071-23789] [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] [Indexed: 12/03/2022] Open
Abstract
Introduction The main purpose of this study was to evaluate the effectiveness of graded early mobilization on psychomotor status and duration of ICU stay of patients with mechanical ventilation. Materials and methods Results In the control group mean FIM score was 17.40 (SD±4.88), and in the intervention group mean score was 65.70 (SD±12.18). The mean difference was statistically significant in the ‘t’ test (p-value > 0.001). In the control group, the mean GAD-7 score was 19.50 (SD±2.71), and in the intervention group the mean GAD-7 score was 7.5 (SD±2.59). The mean difference was statistically significant in the ‘t’ test. (p-value > 0.001). The mean length of ICU stay in the control group was 5.60 (SD±1.07) and in the intervention group it was 3.10 (SD±0.56). The mean difference was statistically significant in the ‘t’ test (p-value > 0.001). Conclusion This research showed that graded early mobilization was highly effective to improve the motor and psychological status of mechanically ventilated patients and reduce their length of ICU stay. How to cite this article Das B, Saha S, Kabir F, Hossain S. Effect of Graded Early Mobilization on Psychomotor Status and Length of Intensive Care Unit Stay in Mechanically Ventilated Patients. Indian J Crit Care Med 2021;25(4):416–420.
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Affiliation(s)
- Bijoy Das
- Department of Physiotherapy, BRB Hospitals Limited, Dhaka, Bangladesh
| | - Sanchita Saha
- Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), Mirpur, Dhaka, Bangladesh
| | - Feroz Kabir
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Sazzad Hossain
- Department of Intensive Care Unit, BRB Hospitals Limited, Dhaka, Bangladesh
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19
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Abstract
A significant number of coronavirus disease SARS-CoV-2 (COVID-19) patients continue to have symptoms related to COVID-19 after the acute phase of illness. This post-COVID condition is sometimes called 'post-COVID syndrome', 'long COVID' or 'post-acute COVID-19'. Persistent psychiatric symptoms among COVID-19 survivors such as depression, anxiety, post-traumatic symptoms and cognitive impairment may be related to psychological factors and neurobiological injury. COVID-19 related neurological symptoms including anosmia, ageusia, dizziness, headache and seizures may persist for a long time after the acute COVID-19 illness. Many COVID-19 survivors experience persistent physical symptoms such as cough, fatigue, dyspnea and pain after recovering from their initial illness. There is a high probability that symptoms of psychiatric, neurological and physical illnesses, as well as inflammatory damage to the brain in individuals with post-COVID syndrome increase suicidal ideation and behavior in this patient population. COVID-19 survivors without post-COVID syndrome may also be at elevated suicide risk. Studies of suicidality in COVID-19 survivors are urgently needed and will be a new area of suicide research. An appropriate management of psychiatric, neurological and medical conditions may reduce suicide risk among COVID-19 survivors with or without post-COVID syndrome.
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Affiliation(s)
- L Sher
- From the Inpatient Psychiatry, James J. Peters Veterans’ Administration Medical Center, 130 W. Kingsbridge Road, Bronx, NY 10468, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA
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El Khatib A, Jeschke MG. Contemporary Aspects of Burn Care. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:386. [PMID: 33923571 PMCID: PMC8073568 DOI: 10.3390/medicina57040386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
The past one hundred years have seen tremendous improvements in burn care, allowing for decreased morbidity and mortality of this pathology. The more prominent advancements occurred in the period spanning 1930-1980; notably burn resuscitation, early tangential excision, and use of topical antibiotic dressings; and are well documented in burn literature. This article explores the advancements of the past 40 years and the areas of burn management that are presently topics of active discussion and research.
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Affiliation(s)
- Arij El Khatib
- Unité des Grands Brûlés, University of Montreal Medical Centre Sanguinet, 1051, Rue Sanguinet, Montréal, QC H2X 0C1, Canada
| | - Marc G. Jeschke
- Department of Surgery, Division of Plastic Surgery, Department of Immunology, Ross Tilley Burn Centre-Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Rm D704, Toronto, ON M4N 3M5, Canada;
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21
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Sirancova K, Raudenska J, Zajicek R, Dolezal D, Javurkova A. Psychological aspects in early adjustment after severe burn injury. J Burn Care Res 2021; 43:9-15. [PMID: 33677575 DOI: 10.1093/jbcr/irab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn injury is one of the most serious traumatic events with possible psychological and psychosocial consequences. Health status perception is one of the main health outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, suggesting that early screening for psychological vulnerabilities may be beneficial. The aim of our study was to identify the personality, clinical, and sociodemographic characteristics related to patient´s subjective perception of health, depression, and anxiety, in a sample of 52 adult patients with severe burn injury shortly before discharge from specialty Burn clinic. Subjective health perception was predicted by depression (β = -.143, t(47) = -3.94, P < .001) and neuroticism (β = -.106, t(43) = -4.83, P < .001), and it correlated positively with extraversion (r = .2858, P = .0465) and conscientiousness (r = .3663, P = .0096). Depression was predicted by neuroticism (F(1,49) = 18.4; P < .001) and correlated with attachment avoidance (r = .29, P = .0383) and negatively with extraversion (r = -.32, P = .0220). Anxiety was related to attachment anxiety (F(1,49) = 4.25; P = .045), neuroticism (F(1,49) = 15.75; P < .001), and agreeableness (r = -.36, p = .0101). Unemployed patients experienced higher levels of depression and anxiety. This research suggests that personality traits and adult attachment may play an important role in the acute phase of the recovery from a severe burn injury. These findings can be relevant for early intervention and holistic rehabilitation.
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Affiliation(s)
- Katarina Sirancova
- Department of Psychology, Faculty of Arts, Charles University, Prague.,Department of Clinical Psychology, University Hospital FNKV, Prague
| | - Jaroslava Raudenska
- Department of Psychology, Faculty of Arts, Charles University, Prague.,Department of Nursing, 2nd Medical School, Charles University, Prague
| | - Robert Zajicek
- Department of Burns Medicine Faculty Hospital Kralovske Vinohrady and Charles University Third Faculty of Medicine
| | - Daniel Dolezal
- Department of Clinical Psychology, University Hospital FNKV, Prague.,Department of Burns Medicine Faculty Hospital Kralovske Vinohrady and Charles University Third Faculty of Medicine
| | - Alena Javurkova
- Department of Psychology, Faculty of Arts, Charles University, Prague.,Department of Clinical Psychology, University Hospital FNKV, Prague.,Department of Nursing, 2nd Medical School, Charles University, Prague
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22
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The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease. J Gen Intern Med 2021; 36:713-721. [PMID: 32959346 PMCID: PMC7947104 DOI: 10.1007/s11606-020-06195-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND A better understanding of the long-term health effects of combat injury is important for the management of veterans' health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. OBJECTIVE To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. DESIGN Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. PARTICIPANTS Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. MAIN MEASURES Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. KEY RESULTS After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18-3.55), DM (HR 4.45, 95% CI 2.15-9.18), and CAD (HR 4.87, 95% CI 2.11-11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05-1.24) and CAD (HR 1.62, 95% CI 1.11-2.37). CONCLUSIONS Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.
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Rouzfarakh M, Deldar K, Froutan R, Ahmadabadi A, Mazlom SR. The effect of rehabilitation education through social media on the quality of life in burn patients: a randomized, controlled, clinical trial. BMC Med Inform Decis Mak 2021; 21:70. [PMID: 33618721 PMCID: PMC7901117 DOI: 10.1186/s12911-021-01421-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Burn is one of the most brutal harms to the human body and mind and its wide-ranging complications have many adverse effects on the patients' quality of life. The present study was conducted to investigate the effect of rehabilitation education through social media on burn patients' quality of life. METHODS The present randomized, controlled, clinical trial was conducted on 60 patients admitted to Imam Reza Hospital Burn Center in the city of Mashhad, Iran, who were randomly assigned to either the intervention or control groups (n = 30 per group). The researcher then created a WhatsApp channel to provide educational content and a WhatsApp group for burns patients to join and get their questions answered. The intervention group patients pursued their post-discharge education through the social media for a month. The control group patients received their discharge education according to the ward's routine procedures through pamphlets and face-to-face training by the personnel. As the study's main variable, the Burn Specific Health Scale-Brief was completed by both groups before and 1 and 2 months after the intervention. Data were analyzed using the ANCOVA and repeated-measures ANOVA. RESULTS There was no significant differences between the intervention and control groups in terms of the QOL score and any of the domains at baseline. The results indicated the significant effect of the intervention both 1 and 2 months post-intervention on the QOL score and all the domains (P < 0.05), except for body image (Pmodel1 = .550 and Pmodel2 = .463) and skin sensitivity (Pmodel1 = .333 and Pmodel2 = .104). CONCLUSION The post-discharge rehabilitation education of burns patients through social media improves their quality of life and can be used as an appropriate educational and follow-up method in different stages of the rehabilitation of burn patients. TRIAL REGISTRATION NO. : IRCT20190622043971N1, 05-10-2019.
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Affiliation(s)
- Maryam Rouzfarakh
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kolsoum Deldar
- School of Paramedicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Razieh Froutan
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Ahmadabadi
- Surgical Oncology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mazlom
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Bendiksen B, Heir T, Minteh F, Ziyada MM, Kuye RA, Lien IL. The association between physical complications following female genital cutting and the mental health of 12-year-old Gambian girls: A community-based cross-sectional study. PLoS One 2021; 16:e0245723. [PMID: 33481926 PMCID: PMC7822282 DOI: 10.1371/journal.pone.0245723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Female genital cutting (FGC) involve an acute physical trauma that hold a potential risk for immediate and long-term complications and mental health problems. The aim of this study was to examine the prediction of depressive symptoms and psychological distress by the immediate and current physical complications following FGC. Further, to examine whether the age at which 12-year-old Gambian girls had undergone the procedure affected mental health outcomes. METHOD This cross-sectional study recruited 134 12-year-old girls from 23 public primary schools in The Gambia. We used a structured clinical interview to assess mental health and life satisfaction, including the Short Mood and Feeling Questionnaire (SMFQ), the Symptom check list (SCL-5) and Cantril's Ladder of Life Satisfaction. Each interview included questions about the cutting procedure, immediate- and current physical complications and the kind of help and care girls received following FGC. RESULTS Depressive symptoms were associated with immediate physical health complications in a multivariate regression model [RR = 1.08 (1.03, 1.12), p = .001], and with present urogenital problems [RR = 1.19 (1.09, 1.31), p < .001]. The girls that received medical help following immediate complications had a lower risk for depressive symptoms [RR = .73 (.55, .98), p = .04]. Psychological distress was only associated with immediate complications [RR = 1.04 (1.01, 1.07), p = .004]. No significant differences in mental health outcomes were found between girls who underwent FGC before the age of four in comparison to girls who underwent FGC after the age of four. CONCLUSION Our findings indicate that the immediate and long-term complications following FGC have implications for psychological health. Only a minimal number of girls received medical care when needed, and the dissemination of health education seems crucial in order to prevent adverse long-term physical and psychological health consequences.
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Affiliation(s)
- Bothild Bendiksen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- * E-mail:
| | - Trond Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- The University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Fabakary Minteh
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Brikama Campus, The Gambia
| | - Mai Mahgoub Ziyada
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- The University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Rex A. Kuye
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Brikama Campus, The Gambia
| | - Inger-Lise Lien
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Gender differences in quality of life and psychological impact of facial burn scars in a tertiary care center. Burns 2020; 47:1153-1160. [PMID: 33277095 DOI: 10.1016/j.burns.2020.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
AIM To compare the quality of life and psychological impact of cases of facial burn scar between male and female patients. STUDY TYPE An observational cross sectional study done in a tertiary care university level teaching hospital, on a hospital based sample over a period ranging from January 2018 to July 2019. METHODOLOGY The study was carried out on 32 patients of facial burn scar, who were screened for psychiatric diagnoses by MINI International Neuropsychiatric Interview; severity of depression and anxiety assessed by HDRS and HAM A; assessed for QoL and scar ratings of both patient and observer. QoL was assessed using the WHO QOL BREF questionnaire. The scar assessment was done with the help of POSAS by interviewing the patient and examination of the scar. RESULTS None of other socio-demographic variables patient showed any significant association with the number of psychiatric diagnoses of the patient or QoL domains; barring years of schooling, which had a significant positive correlation with the psychological domain score of QoL. Being male or female also did not show any significant differences with the anxiety or depression severity. No burn or scar related variable could reach significant association, except scar itching, stiffness scores of POSAS P and overall scar opinion score of POSAS O, with the number of psychiatric diagnoses of the patient. Extent of scar had significant negative associations with the physical and psychological domains of QoL. Significant negative correlations were found between scar variables like stiffness, pigmentation, relief, pliability, and overall opinion and QoL domain scores. The total observer score of POSAS and the overall opinion of observer had much stronger negative correlation than the patient score; the latter having a significant association with the depression severity as well. CONCLUSION No statistically significant gender difference in QoL and psychological impact of patients with facial burn scar were found. However educational level was found to positively influence the psychological well-being of the patients; whereas scar extent was found to negatively affect the physical and psychological domains of QoL.
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Zheng H, Wu K, Zhou Y, Fu L, Zhang D, Liu Z. Prevalence and associated factors of post-traumatic stress disorder in burned patients and their family members. Burns 2020; 47:1102-1109. [PMID: 33303262 DOI: 10.1016/j.burns.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is common among burn patients and their family members. The objective of this study was to document the prevalence of PTSD and explore the sociodemographic and burn-specific associated factors of PTSD among Chinese burn survivors and their family members. METHODS A total of 131 adult patients with unintentional burns and 194 family members of burn patients were recruited from two burn units. All participants completed a general information form and the PTSD Checklist for the DSM-5 (PCL-5). RESULTS Fifty-five (42.0%) burn victims and ninety-nine (51.0%) family members of burn victims met the criteria for PTSD; the average score of the sample was 31.21 ± 21.56 and 33.16 ± 19.30. Logistic regression analysis revealed that middle age (45-55 years), poor economic status, greater total body surface area (TBSA) and longer time since the burn incident positively predicted the PTSD of patients and that female family members had a higher risk of PTSD. CONCLUSIONS Burn patients and their family members are susceptible to PTSD. Suitable and long-term psychological intervention programmes should be executed for burn patients and their family members.
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Affiliation(s)
- Hao Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Kankan Wu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yueyue Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lin Fu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Daiyu Zhang
- Aiwuhen Burn Rehabilitation and Care Center, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.
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Bhatti DS, Ul Ain N, Zulkiffal R, Al-Nabulsi ZS, Faraz A, Ahmad R. Anxiety and Depression Among Non-Facial Burn Patients at a Tertiary Care Center in Pakistan. Cureus 2020; 12:e11347. [PMID: 33304682 PMCID: PMC7719504 DOI: 10.7759/cureus.11347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: A patient who suffers from burn injuries can be subjected to various mental and psychological conditions that can adversely affect their health and wellbeing. Material and methods: A cross-sectional study was conducted between 1st September 2019 and 30th March 2020 in a tertiary care hospital in Pakistan. Patients were selected in the outpatient department and follow-up was done at two and four weeks following definitive. Some 225 patients in our study fulfilled the inclusion criteria. Patients were assessed using Urdu translated scales. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were used. Data were analyzed with the help of SSPS software version 13.0. Result: Out of 119 (52.8 %) male patients, the highest percentage was of accidental injuries 106 (89%) followed by suicidal burns 9 (7.5%). A similar trend was seen in females; out of n=106 females, 92 (86%) presented with accidental burn injuries and only 11 (10%) patients have a history of suicidal burns. A fraction of the sample had a history of homicidal burn injuries, with 4 (3%) male and 3 (2%) female patients. The variation of anxiety level and depth of burn varied considerably. Among patients who suffered superficial thickness burns (n=105, 47%), 69.5% of patients experienced mild anxiety symptoms. Only 28 (26.6%) patients had moderate anxiety and severe anxiety was the lowest, at only 3.8% (n=4). A similar trend was observed in deep burn patients, but the level of severe anxiety was significantly higher at 26%. This was statistically significant (p < 0.05). Deep burn patients had the highest percentage (n=54, 45.3%) of very severe depression compared to only 10% in superficial burns. The variation between the two categories was statistically significant (p < 0.05). The majority of (35.2%) patients experienced mild symptoms of depression and this correlated with superficial burn injuries. Conclusion: A burn injury can seriously affect the mental wellbeing of patients. With the severity of burn injury we saw that severe depression was prevalent. This aspect must be taken into consideration when treating such patients and it warrants a multidisciplinary team (MDT) strategy.
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Affiliation(s)
| | - Nur Ul Ain
- Plastic and Reconstructive Surgery, Holy Family Hospital, Rawalpindi, PAK
| | | | | | - Ahmad Faraz
- Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
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Riordan P, Stika M, Goldberg J, Drzewiecki M. COVID-19 and clinical neuropsychology: A review of neuropsychological literature on acute and chronic pulmonary disease. Clin Neuropsychol 2020; 34:1480-1497. [PMID: 32883155 DOI: 10.1080/13854046.2020.1810325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The illness resulting from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as COVID-19, has quickly escalated to a worldwide pandemic. Although understanding of the short and long-term manifestations of COVID-19 remains incomplete, there is a preponderance of respiratory pathology in COVID-19 and potential for chronic loss of pulmonary function in recovered patients, raising concerns for associated cognitive impacts.Method: We conducted a narrative review of the existing literature on neuropsychological variables in acute/severe respiratory disease and various forms of chronic pulmonary disease to inform expectations about potential cognitive manifestations of COVID-19.Results: Cognitive dysfunction is common but not inevitable in acute and chronic pulmonary disease, although unique predictors and symptom trajectories appear to be associated with each.Conclusions: Although the full scope of neuropathophysiology associated with COVID-19 remains to be established, pulmonary insults associated with the disease are likely to produce cognitive dysfunction in a substantial percentage of patients.
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Affiliation(s)
- Patrick Riordan
- Mental Health Service, Hines VA Medical Center, Hines, IL, USA.,Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Monica Stika
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Joshua Goldberg
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
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Sareen J, Olafson K, Kredentser MS, Bienvenu OJ, Blouw M, Bolton JM, Logsetty S, Chateau D, Nie Y, Bernstein CN, Afifi TO, Stein MB, Leslie WD, Katz LY, Mota N, El-Gabalawy R, Sweatman S, Marrie RA. The 5-Year Incidence of Mental Disorders in a Population-Based ICU Survivor Cohort. Crit Care Med 2020; 48:e675-e683. [PMID: 32697508 DOI: 10.1097/ccm.0000000000004413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To estimate incidence of newly diagnosed mental disorders among ICU patients. DESIGN Retrospective-matched cohort study using a population-based administrative database. SETTING Manitoba, Canada. PARTICIPANTS A total of 49,439 ICU patients admitted between 2000 and 2012 were compared with two control groups (hospitalized: n = 146,968 and general population: n = 141,937), matched on age (± 2 yr), sex, region of residence, and hospitalization year. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Incident mental disorders (mood, anxiety, substance use, personality, posttraumatic stress disorder, schizophrenia, and psychotic disorders) not diagnosed during the 5-year period before the index ICU or hospital admission date (including matched general population group), but diagnosed during the subsequent 5-year period. Multivariable survival models adjusted for sociodemographic variables, Charlson comorbidity index, admission diagnostic category, and number of ICU and non-ICU exposures. ICU cohort had a 14.5% (95% CI, 14.0-15.0) and 42.7% (95% CI, 42.0-43.5) age- and sex-standardized incidence of any diagnosed mental disorder at 1 and 5 years post-ICU exposure, respectively. In multivariable analysis, ICU cohort had increased risk of any diagnosed mental disorder at all time points versus the hospitalized cohort (year 5: adjusted hazard ratio, 2.00; 95% CI, 1.80-2.23) and the general population cohort (year 5: adjusted hazard ratio, 3.52; 95% CI, 3.23-3.83). A newly diagnosed mental disorder was associated with younger age, female sex, more recent admitting years, presence of preexisting comorbidities, and repeat ICU admission. CONCLUSIONS ICU admission is associated with an increased incidence of mood, anxiety, substance use, and personality disorders over a 5-year period.
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Affiliation(s)
- Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kendiss Olafson
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maia S Kredentser
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcus Blouw
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yao Nie
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tracie O Afifi
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - William D Leslie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sophia Sweatman
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ruth Ann Marrie
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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31
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Wu TY, Sun FJ, Tung KY, Yeh HT, Liu CY. Reliability and Validity of the Chinese Version of the PTSD Symptom Scale-Interview for Patients With Severe Burn in Taiwan. J Burn Care Res 2019; 39:507-515. [PMID: 29901796 DOI: 10.1093/jbcr/irx007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined the psychometric properties of the Chinese version of the Post-traumatic Syndrome Scale-Interview (C-PSSI) for severe burn victims of the Formosa Fun Coast Explosion that occurred in Taiwan. A purposive sampling, cross-sectional, descriptive design study was selected. Participants were patients with severe burns from the Formosa Fun Coast Explosion, selected from teaching medical centers in Taiwan. They completed the C-PSSI and Patient Health Questionnaire-9 (PHQ-9). Statistical analysis was conducted to evaluate the psychometric properties, including reliability, construct validity (using confirmatory factor analysis), convergent validity, and criterion-related validity of the questionnaire. Data on 63 participants were analyzed. The Cronbach's α of the entire C-PSSI was .88, ranging from .73 to .82 for the three subscales of this instrument. The item-total correlation coefficient was from .42 to .81. Examining the convergent validity revealed that two subscores of the C-PSSI were significantly correlated with PHQ-9 total scores (ρ = .58, .44, P < .01). Criterion-related validity was confirmed because the PHQ-9 total scores were significantly correlated with the total C-PSSI scores (ρ = .54, P < .01). Confirmatory factor analysis confirmed the construct validity, with a good model fit. Integrated moderate to good psychometric properties were demonstrated and a three-factor model of the C-PSSI was verified in patients with severe burn in Taiwan. The C-PSSI exhibited adequate psychometric properties for posttraumatic stress disorder evaluation in patients with severe burn in Taiwan. The Chinese version of this scale can be used to assess the psychological problems of victims of traumatic events.
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Affiliation(s)
- Te-Yu Wu
- Department of Nursing, National Taipei University of Nursing and Health Sciences.,Department of Intensive Care Unit, MacKay Memorial Hospital.,Department of Nursing, MacKay Junior College of Medicine, Nursing and Management
| | - Fang-Ju Sun
- Department of Nursing, MacKay Junior College of Medicine, Nursing and Management.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Hui-Tzu Yeh
- Department of Intensive Care Unit, MacKay Memorial Hospital.,Department of Nursing, MacKay Junior College of Medicine, Nursing and Management
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Department of Speech Language Pathology and Audiology, College of Health Technology and College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Nilsson A, Orwelius L, Sveen J, Willebrand M, Ekselius L, Gerdin B, Sjöberg F. Anxiety and depression after burn, not as bad as we think-A nationwide study. Burns 2019; 45:1367-1374. [PMID: 31378623 DOI: 10.1016/j.burns.2019.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A history of psychiatric disorders is more common among patients who have had burns than in the general population. To try and find out the scale of the problem we have assessed self-reported symptoms of anxiety and depression after a burn. METHODS Consecutive patients with burns measuring more than 10% total body surface area or duration of stay in hospital of seven days or more were included. Personal and clinical details about the patients were extracted from the database at each center. Data were collected from the Hospital Anxiety and Depression Scale, as well as Health-Related Quality of Life (HRQoL; Short Form-36, SF-36) and questionnaires about socioeconomic factors. All results were obtained 12 and 24 months after the burn, and compared with those from a reference group. RESULTS A total of 156 patients responded to the questionnaires. Mean (SD) age and TBSA (%) were 46 (16.4) years and 23.6 (19.2) %, respectively. There were no differences in incidence between the burn and reference groups in anxiety or depression either 12 or 24 months after the burn. Those who reported higher anxiety and depression scores also had consistently poorer HRQoL as assessed by the SF-36. CONCLUSION Seen as a group, people who have had burns report anxiety and depression the same range as a reference group. Some patients, however, express more anxiety and depression, and concomitantly poorer HRQoL. These patients should be identified, and offered additional support.
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Affiliation(s)
- Andreas Nilsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Region Östergötland, Linköping, Sweden.
| | - Lotti Orwelius
- Department of Anesthesia and Intensive Care, Region Östergötland, Linköping, Sweden; Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Josefin Sveen
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mimmie Willebrand
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Bengt Gerdin
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden; Uppsala Burn Centre, Uppsala, Sweden
| | - Folke Sjöberg
- Department of Anesthesia and Intensive Care, Region Östergötland, Linköping, Sweden; Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Burn Centre in Linköping, Departments of Hand and Plastic Surgery, Linköping, Sweden
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33
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Thomas BD, Ford CG, Addicks SH, Williford DN, Manegold EM, Randall CL, Aballay AM, Hajduk GM, Duncan CL. Implementation of a Psychosocial Screener for Adults in an Outpatient Burn Clinic. J Burn Care Res 2019; 40:331-335. [PMID: 30806462 DOI: 10.1093/jbcr/irz020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/05/2019] [Accepted: 02/20/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Ben D Thomas
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cameron G Ford
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Sarah H Addicks
- Department of Family Medicine, University of Minnesota School of Medicine, Rochester, Minnesota
| | - Desireé N Williford
- Department of Psychology, West Virginia University, Morgantown, West Virginia
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ellen M Manegold
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Ariel M Aballay
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Gina M Hajduk
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, West Virginia
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
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Pedras S, Preto I, Carvalho R, Graça Pereira M. Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study. Psychol Health 2019; 34:535-549. [PMID: 30632805 DOI: 10.1080/08870446.2018.1545907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation. DESIGN A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients. MAIN OUTCOME MEASURES IES-R, WOC and HADS. RESULTS Traumatic stress symptoms were prevalent at T1 (M = 15.65, SD = 15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ = 0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE = 0.032, p = 0.002) per assessment. CONCLUSIONS Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.
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Affiliation(s)
- Susana Pedras
- a School of Psychology , University of Minho , Braga , Portugal
| | - Isabel Preto
- b Faculty of Engineering , University of Porto , Porto , Portugal
| | | | - M Graça Pereira
- a School of Psychology , University of Minho , Braga , Portugal
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Lane-Fall MB, Kuza CM, Fakhry S, Kaplan LJ. The Lifetime Effects of Injury: Postintensive Care Syndrome and Posttraumatic Stress Disorder. Anesthesiol Clin 2018; 37:135-150. [PMID: 30711227 DOI: 10.1016/j.anclin.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Postintensive care syndrome (PICS) is a heterogeneous syndrome marked by physical, cognitive, and mental health impairments experienced by critical care survivors. It is a syndrome that bears significant human and health care costs. Additional research is needed to identify risk factors and diagnostic, preventative, and treatment strategies for PICS. Trauma intensive care unit patients are particularly vulnerable to posttraumatic stress disorder, which shares some of the adverse long-term consequences of PICS and also requires additional research into effective preventative and management strategies.
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Affiliation(s)
- Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 309 Blockley Hall, Philadelphia, PA 19104, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk # 210, Philadelphia, PA 19104, USA.
| | - Catherine M Kuza
- Department of Anesthesiology and Critical Care, Keck School of Medicine of the University of Southern California, Los Angeles County Health System, 1450 San Pablo Street, Suite 3600, Los Angeles, CA 90033, USA
| | - Samir Fakhry
- Department of Surgery, Synergy Surgicalists, Inc, Reston Hospital Center, 1850 Town Center Parkway Suite 309, Reston, VA 20190, USA
| | - Lewis J Kaplan
- Surgical Services, Department of Surgery, Division of Trauma, Surgical Critical Care and Emergency Surgery, Hospital of the University of Pennsylvania, Veteran's Administration Medical Center, Corporal Michael J Crescenz VA Medical Center, Perelman School of Medicine, University of Pennsylvania, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
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36
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Jibeen T, Mahfooz M, Fatima S. Spiritual Transcendence and Psychological Adjustment: The Moderating Role of Personality in Burn Patients. JOURNAL OF RELIGION AND HEALTH 2018; 57:1618-1633. [PMID: 28856506 DOI: 10.1007/s10943-017-0484-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The current study examined the moderating role of personality traits (neuroticism and extraversion) on the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The sample (N = 98) comprised adult burn patients (age = 25-50) admitted to three hospitals in Lahore, Pakistan. They were assessed according to a demographic information sheet, the NEO Personality Inventory (McCrae and Costa in J Personal Soc Psychol 52:81-90, 1987), the Spiritual Transcendence Index (Seidlitz et al. in J Sci Study Relig 41:439-453, 2002), the Depression, Anxiety, Stress Scales-21 (Lovibond and Lovibond in Manual for the Depression Anxiety Stress scales, Psychology Foundation, Sydney, 1995), and the Perceived Benefit Scales (McMillen and Fisher in Soc Work Res 22(3):173-186, 1998). Stepwise moderated regression analysis showed that both personality traits (neuroticism and extraversion) played a moderating role in the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The findings highlight the potential role spiritual transcendence may have in understanding and improving the psychological adjustment of burn patients.
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Affiliation(s)
- Tahira Jibeen
- Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia.
| | - Musferah Mahfooz
- Humanities Department (Psychology), COMSATS Institute of Information Technology, Lahore, Pakistan
| | - Shamem Fatima
- Humanities Department (Psychology), COMSATS Institute of Information Technology, Lahore, Pakistan
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37
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Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci 2018; 30:1193-1201. [PMID: 30214124 PMCID: PMC6127491 DOI: 10.1589/jpts.30.1193] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
[Purpose] To review the literature that examines rehabilitation and early mobilization
and that involves different practices (effects of interventions) for the critically ill
patient. [Materials and Methods] A PRISMA-Systematic review has been conducted based on
different data sources: Biblioteca Virtual en Salud, CINHAL, Pubmed, Scopus, and Web of
Science were used to identify randomized controlled trials, crossover trials, and
case-control studies. [Results] Eleven studies were included. Early rehabilitation had no
significant effect on the length of stay and number of cases of Intensive Care Unit
Acquired Weaknesses. However, early rehabilitation had a significant effect on the
functional status, muscle strength, mechanical ventilation duration, walking ability at
discharge, and health quality of life. [Conclusion] Rehabilitation and early mobilization
are associated with an increased probability of walking more distance at discharge. Early
rehabilitation is associated with an increase in functional capacity and muscle strength,
an improvement in walking distance and better perception of the health-related quality of
life. Cycloergometer and electrical stimulation can be used to maintain muscle strength.
Further research is needed to establish stronger evidences.
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Affiliation(s)
- Patricia Arias-Fernández
- Health Sciences School, Department of Nursing and Physiotherapy, Intensive Care Unit, University Hospital of León, Spain
| | | | - Juan Gómez-Salgado
- Nursing School, University of Huelva: 21071 Huelva, Spain.,University Espiritu Santo, Ecuador
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Kendrick D, Baker R, Hill T, Beckett K, Coupland C, Kellezi B, Joseph S, Barnes J, Sleney J, Christie N, Morriss R. Early risk factors for depression, anxiety and post-traumatic distress after hospital admission for unintentional injury: Multicentre cohort study. J Psychosom Res 2018; 112:15-24. [PMID: 30097131 DOI: 10.1016/j.jpsychores.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To quantify psychological morbidity and identify baseline factors associated with depression, anxiety and post-traumatic distress symptoms up to 12 months post-injury. METHODS Multicentre cohort study of 668 adults, aged 16 to 70, admitted to 4 UK NHS hospital trusts. Data on injury, socio-demographic characteristics and health status was collected at recruitment. Depression, anxiety and post-traumatic distress were measured at 1, 2, 4 and 12 months post-injury. Multilevel linear regression assessed associations between patient and injury characteristics and psychological outcomes over 12 months follow-up. RESULTS Depression, anxiety and post-traumatic distress scores were highest 1 month post-injury, and remained above baseline at 2, 4 and 12 months post-injury. Moderate or severe injuries, previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age (45-64 years), greater deprivation and lower pre-injury quality of life (QoL) were associated with higher depression scores post-injury. Previous psychiatric diagnoses, higher pre-injury depression and anxiety scores, middle age, greater deprivation and lower pre-injury QoL were associated with higher anxiety scores post-injury. Traffic injuries or injuries from being struck by objects, multiple injures (≥3), being female, previous psychiatric diagnoses, higher pre-injury anxiety scores and greater deprivation were associated with higher post-traumatic distress scores post-injury. CONCLUSION A range of risk factors, identifiable shortly after injury, are associated with psychological morbidity occurring up to 12 months post-injury in a general trauma population. Further research is required to explore the utility of these, and other risk factors in predicting psychological morbidity on an individual patient basis.
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Affiliation(s)
- D Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - R Baker
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - T Hill
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - K Beckett
- Centre for Health & Clinical Research, University of the West of England, BS16 1DD, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - B Kellezi
- Department of Psychology, Nottingham Trent University, NG1 4BU, UK
| | - S Joseph
- School of Education, University of Nottingham, NG8 1BB, UK
| | - J Barnes
- Loughborough Design School, Loughborough University, LE11 3TU, UK
| | - J Sleney
- Department of Sociology, University of Surrey, GU2 7XH, UK
| | - N Christie
- Centre for Transport Studies, University College London, WC1E 6BT, UK
| | - R Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, NG7 2TU, UK
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Hollman Frisman G, Wåhlin I, Orvelius L, Ågren S. Health-promoting conversations-A novel approach to families experiencing critical illness in the ICU environment. J Clin Nurs 2018; 27:631-639. [PMID: 28722814 DOI: 10.1111/jocn.13969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To identify and describe the outcomes of a nurse-led intervention, "Health-promoting conversations with families," regarding family functioning and well-being in families with a member who was critically ill. BACKGROUND Families who have a critically ill family member in an intensive care unit face a demanding situation, threatening the normal functioning of the family. Yet, there is a knowledge gap regarding family members' well-being during and after critical illness. DESIGN The study used a qualitative inductive-descriptive design. METHODS Eight families participated in health-promoting conversations aimed to create a context for change related to the families' identified problems and resources. Fifteen qualitative interviews were conducted with 18 adults who participated in health-promoting conversations about a critical illness in the family. Eight participants were patients (six men, two women) and 10 were family members (two male partners, five female partners, one mother, one daughter, one female grandchild). The interviews were analysed by conventional content analysis. RESULTS Family members experienced strengthened togetherness, a caring attitude and confirmation through health-promoting conversations. The caring and calming conversations were appreciated despite the reappearance of exhausting feelings. Working through the experience and being confirmed promoted family well-being. CONCLUSION Health-promoting conversations were considered to be healing, as the family members take part in sharing each other's feelings, thoughts and experiences with the critical illness. RELEVANCE TO CLINICAL PRACTICE Health-promoting conversations could be a simple and effective nursing intervention for former intensive care patients and their families in any cultural context.
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Affiliation(s)
- Gunilla Hollman Frisman
- Department of Medical and Health Sciences, Anesthetics, Operations and Specialty Surgery Center, Linköping University, Linköping, Sweden
| | - Ingrid Wåhlin
- Intensive Care Department, Kalmar Hospital, Kalmar, Sweden.,School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Lotti Orvelius
- Department of Anaesthesiology and Intensive Care and Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - Susanna Ågren
- Department of Cardiothoracic Surgery and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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40
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Ashfaq A, Lashari UG, Saleem S, Naveed S, Meraj H, Waqas A. Exploring Symptoms of Post-traumatic Stress Disorders and Perceived Social Support among Patients with Burn Injury. Cureus 2018; 10:e2669. [PMID: 30042920 PMCID: PMC6054326 DOI: 10.7759/cureus.2669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Burns are a serious public health problem globally, causing an estimated 265,000 deaths per year. Although the association of burn injuries with mortality and morbidity rates has been well established, data on their psychological consequences are scarce. The present study explores the frequency of post-traumatic stress disorder (PTSD) and perceived social support among patients with burn injuries in Pakistan. Methods This cross-sectional study was conducted at two teaching hospitals in Lahore, Pakistan from May 2015 to July 2015. Eighty patients with burn injuries were included by convenience sampling and interviewed with a specifically designed questionnaire with items on demographics, and the Impact of Events Scale-Revised (IES-R) and Multidimensional Scale of Perceived Social Support (MSPSS) instruments. Results Data were analyzed for a total of 80 participants: 56 women (70.0%) and 24 men (30.0%). Mean age was 35.74 (11.15) years. A high proportion of participants perceived highest social support from friends, reported high ego resiliency levels, had more severe symptoms of avoidance and intrusion, and had high overall PTSD scores. There were no differences between groups in the proportions of respondents who reported high perceived social support from significant others or family, overall social support or symptoms of hyperarousal. Conclusion The findings reflect a high frequency of PTSD symptomatology and poor social support among Pakistani patients with burn injuries in our sample. These factors can exacerbate the patient’s physical injury, delaying both their physical and mental rehabilitation.
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Affiliation(s)
- Abeer Ashfaq
- Medicine, CMH Lahore Medical and Dental College, Lahore Cantt, Pakistan
| | - Usman G Lashari
- Family Medicine, United Arab Emirates University, Al-Ain, Abu Dhabi
| | - Saad Saleem
- Medicine, CMH Lahore Medical and Dental College, Lahore Cantt, Pakistan
| | | | - Hafsa Meraj
- Medicine, Sharif Medical and Dental College, Jati Umra, Lahore, PAK
| | - Ahmed Waqas
- Department of Psychiatry, CMH Lahore Medical College and Institute of Dentistry
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Abstract
Illicit drug use is common among patients admitted following burn injury. The authors sought to evaluate whether drug abuse results in worse outcomes. The National Burn Repository (NBR) was queried for data on all patients with drug testing results available. Outcomes included mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and duration of ventilator support. Propensity score weighting was performed to control for age, alcohol use, burn size, gender, and etiology of burn. A total of 20,989 patients had drug screen data available; 11,642 (55.5%) tested positive for at least one drug of abuse. Illicit drug use was associated with a higher proportion of patients with flame burn (53.2 vs 48.4%) and larger average burn size (11.2 vs 9.5% TBSA, P < .001). Attempted suicide was more likely if the patient had used drugs (2.8 vs 1.7%, P < .001). Drug use resulted in longer hospital and ICU LOS (14.2 vs 11.4 and 8.5 vs 5.6 days, P < .001), but did not increase the risk of mortality (5.7 vs 5.2, P = .08). After propensity score weighting, drug use did not affect mortality, hospital LOS, or duration of ventilator support, but did increase the average ICU LOS by 1.2 days (P = .001). Drug use does not affect mortality, hospital LOS, or duration of ventilator support among burned patients. After controlling for burn size, age, mechanism of injury, and gender, patients with a positive drug screen had an average increase in ICU LOS by 1 day.
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The Combination of SAT and SBT Protocols May Help Reduce the Incidence of Ventilator-Associated Pneumonia in the Burn Intensive Care Unit. J Burn Care Res 2018; 38:e574-e579. [PMID: 27755248 DOI: 10.1097/bcr.0000000000000451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are few published reports on the unique nature of burn patients using a paired spontaneous awakening and spontaneous breathing protocol. A combined protocol was implemented in our burn intensive care unit (ICU) on January 1, 2012. This study evaluates the impact of this protocol on patient outcomes in a burn ICU. We performed a retrospective review of our burn registry over 4 years, including all patients placed on mechanical ventilation. In the latter 2 years, patients meeting criteria underwent daily spontaneous awakening trial; if successful, spontaneous breathing trial was performed. Patient data included age, burn size, percent full-thickness burn, tracheostomy, and inhalation injury. Outcome measures included ventilator days, ICU and hospital lengths of stay, pneumonia, and disposition. Data were analyzed using Graphpad Prism and IBM SPSS software, with statistical significance defined as P < .05. There were 171 admissions in the preprotocol period and 136 after protocol implementation. Protocol patients had greater percent full-thickness burns, but did not differ in other characteristics. The protocol group had significantly shorter ICU length of stay, fewer ventilator days, and lower pneumonia incidence. Hospital length of stay, disposition, and mortality were not significantly different. Among patients with inhalation injuries, the protocol group exhibited fewer ventilator and ICU days. Protocol implementation in a burn ICU was accompanied by decreased ventilator days and a reduced incidence of pneumonia. A combined spontaneous awakening and breathing protocol is safe and may improve clinical practice in the burn ICU.
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Warlan H, Howland L, Connelly C. Detection of Posttraumatic Stress Symptoms in Patients After Discharge From Intensive Care. Am J Crit Care 2018; 25:509-515. [PMID: 27802952 DOI: 10.4037/ajcc2016573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite emphasis on identifying personal and clinical characteristics that place patients at higher risk for posttraumatic stress syndrome after intensive care, the extent of screening for the syndrome in intensive care patients is unknown. OBJECTIVES To examine the feasibility and acceptability of a screening tool to detect posttraumatic stress syndrome, screen for the syndrome soon after discharge from intensive care to identify patients at risk for post-traumatic stress disorder, and determine personal and clinical factors related to higher scores on the screening instrument. METHODS A single-center, cross-sectional design was used. At 2 to 4 weeks after hospital discharge, 41 patients treated in an intensive care unit completed the screening instrument and the Screening Experience Questionnaire via telephone. Associations between participants' characteristics and scores were examined, and screening experiences were described. RESULTS Participants reported that the screening instrument was easy to understand, caused little distress, and could be completed in an acceptable time frame. Participants reported that they had not been screened via a formal process or received education during or after their stay in the unit. Among the participants, 44% preferred screening in the outpatient setting. Higher scores on the screening tool were associated with history of depression, moderate levels of sedation, and intensive care unit delirium. CONCLUSIONS The majority of intensive care patients most likely are not being screened for posttraumatic stress syndrome despite a higher risk for the syndrome in these patients than in the general population.
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Affiliation(s)
- Heather Warlan
- Heather Warlan is a critical care nurse at UC San Diego Health, San Diego, California. Lois Howland is an associate professor and Cynthia Connelly is a professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, California
| | - Lois Howland
- Heather Warlan is a critical care nurse at UC San Diego Health, San Diego, California. Lois Howland is an associate professor and Cynthia Connelly is a professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, California
| | - Cynthia Connelly
- Heather Warlan is a critical care nurse at UC San Diego Health, San Diego, California. Lois Howland is an associate professor and Cynthia Connelly is a professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego, California
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Fakhry SM, Ferguson PL, Olsen JL, Haughney JJ, Resnick HS, Ruggiero KJ. Continuing Trauma: The Unmet Needs of Trauma Patients in the Postacute Care Setting. Am Surg 2017. [DOI: 10.1177/000313481708301137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma care has traditionally focused on prehospital and hospital settings, yet many injured patients report emotional distress in the postacute care setting, which is known to impair recovery. The objective of this study was to assess postdischarge emotional recovery and communication preferences. An observational cohort of 100 adult patients from our Level 1 Trauma Center was surveyed one to two months postdischarge. Among those employed preinjury, 44 per cent had not returned to work. Nearly half screened positive for emotional issues (posttraumatic stress disorder, depression, and/or psychological distress); of these, only 35 per cent considered getting professional help and only 10 per cent received help. The barrier most cited (58%) was cost; 42 per cent did not know how or where to get help. Most participants responded “no” or “I don't know” when asked if they had received information about coping with negative emotions after injury and how to seek help from a doctor to address these emotions. Two-thirds preferred to receive such information via phone call from a health care provider or by text. Eighty-nine per cent owned a cellphone. Our trauma systems are failing to provide comprehensive care or look at the ultimate outcomes of our patients, yet modern technology could provide needed resources to patients in novel ways.
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Affiliation(s)
- Samir M. Fakhry
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Jama L. Olsen
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Heidi S. Resnick
- Medical University of South Carolina, Charleston, South Carolina
| | - Kenneth J. Ruggiero
- Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Mason SA, Nathens AB, Byrne JP, Ellis J, Fowler RA, Gonzalez A, Karanicolas PJ, Moineddin R, Jeschke MG. Association Between Burn Injury and Mental Illness among Burn Survivors: A Population-Based, Self-Matched, Longitudinal Cohort Study. J Am Coll Surg 2017; 225:516-524. [PMID: 28774550 DOI: 10.1016/j.jamcollsurg.2017.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mental health disorders are prevalent before and after burn injury. However, the impact of burn injury on risk of subsequent mental health disorders is unknown. STUDY DESIGN We conducted a population-based, self-matched longitudinal cohort study using administrative data in Ontario, Canada between 2003 and 2011. All adults who survived to discharge after major burn injury were included, and all mental health-related emergency department visits were identified. Rate ratios (RRs) for mental health visits in the 3 years after burn, compared with the 3 years before, were estimated using negative binomial generalized estimating equations. RESULTS Among 1,530 patients with major burn injury, mental health visits were common both before (141 per 1,000 person years) and after (154 per 1,000 person years) injury. Mental health visits were most common in the 12 weeks immediately preceding injury. No significant difference in the overall visit rate was observed after burn (RR 0.97; 95% CI 0.78 to 1.20), although among patients with less than 1 pre-injury visit, mental health visits tripled (RR 3.72; 95% CI 2.70 to 5.14). Self-harm emergencies increased 2-fold (RR 1.95; 95% CI 1.15 to 3.33). CONCLUSIONS Mental health emergencies are prevalent among burn-injured patients. Although the overall rate of mental health visits is not increased after burn, the rate increases significantly among patients with one or fewer visits pre-injury. Self-harm risk increases significantly after burn injury, underscoring the need for screening and targeted interventions after discharge. An increased rate immediately before burn suggests an opportunity for injury prevention through mental healthcare.
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Affiliation(s)
- Stephanie A Mason
- Sunnybrook Research Institute, Toronto, Canada; Division of General Surgery, Department of General Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | - Avery B Nathens
- Sunnybrook Research Institute, Toronto, Canada; Division of General Surgery, Department of General Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - James P Byrne
- Sunnybrook Research Institute, Toronto, Canada; Division of General Surgery, Department of General Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Janet Ellis
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Robert A Fowler
- Sunnybrook Research Institute, Toronto, Canada; Division of General Surgery, Department of General Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | | | - Paul J Karanicolas
- Sunnybrook Research Institute, Toronto, Canada; Division of General Surgery, Department of General Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada; Ross Tilley Burn Centre, University of Toronto, Toronto, Canada
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Günther A, Sackey P, Bjärtå A, Schandl A. The relation between skin conductance responses and recovery from symptoms of PTSD. Acta Anaesthesiol Scand 2017; 61:688-695. [PMID: 28421596 DOI: 10.1111/aas.12890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose was to investigate if potentially stressful reminders of the intensive care unit (ICU) stay influenced variability in transient skin conductance responses, and whether such changes were associated with post-traumatic stress symptoms (PTSS), and development of symptoms over time. METHODS Thirty patients with an ICU length of stay > 48 h were included in the study. Within the week after ICU discharge (T1), patients were exposed to authentic ICU sound and questions regarding traumatic ICU memories while skin conductance reactivity was monitored. PTSS was assessed using PTSS-10 at T1 and again 3 months later (T2). Changes in number of skin conductance fluctuations per second (NSCF) between baseline and during the cueing conditions and in relation to PTSS scores (T1) were investigated. PTSS scores at T2 and changes between T1 and T2 (PTSS-CS) were used to investigate if reactivity in NSCF could predict symptoms of PTSD. RESULTS The results showed increases in NSCF during both situational and verbal cueing, compared to baseline. However, no relation to PTSS scores was indicated. Negative correlations between NSCF during situational cueing and both PTSS-T2 and PTSS-CS were found among women, but not among men. CONCLUSION A low variability, or reactivity in skin conductance responses to situational cues could imply a risk of developing, or not being able to recover from, symptoms of PTSD in women. As such, the measurement could be used to predict this risk in women. However, further studies are necessary to evaluate this area of application.
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Affiliation(s)
- A. Günther
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
- Department of Cardiothoracic Surgery and Anaesthesiology; Karolinska University Hospital Solna; Stockholm Sweden
| | - P. Sackey
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
- Institution of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| | - A. Bjärtå
- Department of Psychology; Division of Social Sciences; Mid Sweden University; Östersund Sweden
| | - A. Schandl
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
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Prevalence and Characteristics of Chronic Intensive Care-Related Pain: The Role of Severe Sepsis and Septic Shock. Crit Care Med 2017; 44:1129-37. [PMID: 26958751 DOI: 10.1097/ccm.0000000000001635] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE There is only limited knowledge about chronic pain conditions resulting from critical care. Experimental and clinical data suggest a close relationship between inflammation and pain perception. Since sepsis is the most severe form of systemic inflammation, the primary objective was to evaluate chronic pain states and functional impairment of septic and nonseptic patients 6 months after discharge from ICU. Second, we aimed to obtain the total prevalence and characteristics of chronic ICU-related pain. DESIGN Case-control study. SETTING Observational study in long-term survivors of mixed surgical and medical ICUs. PATIENTS Septic and nonseptic survivors of critical care (n = 207) and healthy controls (n = 46). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We collected comprehensive information on patients' past and present pain 6 months after ICU discharge by means of the German pain questionnaire. Pain intensity levels and pain interference ratings were compared between septic and nonseptic patients and healthy controls. We found no differences in prevalence, severity, and interference of pain between septic and nonseptic patients. However, both patient groups differed significantly from controls. In secondary analysis, a third of all patients reported chronic clinically relevant pain associated with the ICU stay 6 months after ICU discharge. Half of these patients experienced chronic pain conditions before ICU admission and reported additional sources of pain. Most important, 16% of all patients had no preexisting pain condition and now experience chronic ICU-related pain. The majority of patients with chronic ICU-related pain reported a high degree of disabling pain, limiting daily activities. CONCLUSIONS A high percentage of former ICU patients develop chronic pain conditions associated with critical care. These patients differ significantly from control data in terms of pain intensity and show high levels of interference with pain. The presence of sepsis per se seems to play a marginal role for the development of chronic ICU-related pain.
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Patel MB, Jackson JC, Morandi A, Girard TD, Hughes CG, Thompson JL, Kiehl AL, Elstad MR, Wasserstein ML, Goodman RB, Beckham JC, Chandrasekhar R, Dittus RS, Ely EW, Pandharipande PP. Incidence and Risk Factors for Intensive Care Unit-related Post-traumatic Stress Disorder in Veterans and Civilians. Am J Respir Crit Care Med 2017; 193:1373-81. [PMID: 26735627 DOI: 10.1164/rccm.201506-1158oc] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE The incidence and risk factors of post-traumatic stress disorder (PTSD) related to the intensive care unit (ICU) experience have not been reported in a mixed veteran and civilian cohort. OBJECTIVES To describe the incidence and risk factors for ICU-related PTSD in veterans and civilians. METHODS This is a prospective, observational, multicenter cohort enrolling adult survivors of critical illness after respiratory failure and/or shock from three Veterans Affairs and one civilian hospital. After classifying those with/without preexisting PTSD (i.e., PTSD before hospitalization), we then assessed all subjects for ICU-related PTSD at 3 and 12 months post hospitalization. MEASUREMENTS AND MAIN RESULTS Of 255 survivors, 181 and 160 subjects were assessed for ICU-related PTSD at 3- and 12-month follow-up, respectively. A high probability of ICU-related PTSD was found in up to 10% of patients at either follow-up time point, whether assessed by PTSD Checklist Event-Specific Version (score ≥ 50) or item mapping using the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). In the multivariable regression, preexisting PTSD was independently associated with ICU-related PTSD at both 3 and 12 months (P < 0.001), as was preexisting depression (P < 0.03), but veteran status was not a consistent independent risk factor for ICU-related PTSD (3-month P = 0.01, 12-month P = 0.48). CONCLUSIONS This study found around 1 in 10 ICU survivors experienced ICU-related PTSD (i.e., PTSD anchored to their critical illness) in the year after hospitalization. Preexisting PTSD and depression were strongly associated with ICU-related PTSD.
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Affiliation(s)
- Mayur B Patel
- 1 Surgical Services, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.,2 Division of Trauma and Surgical Critical Care, Departments of Surgery and Neurosurgery, Section of Surgical Sciences, Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James C Jackson
- 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.,4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.,5 Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alessandro Morandi
- 6 Department of Rehabilitation and Aged Care Unit, Hospital Ancelle, Cremona, Italy.,7 Geriatric Research Group, Brescia, Italy
| | - Timothy D Girard
- 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.,4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher G Hughes
- 8 Anesthesia Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.,9 Division of Critical Care, Department of Anesthesiology, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer L Thompson
- 10 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amy L Kiehl
- 4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark R Elstad
- 11 George E. Wahlen Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, U.S. Department of Veterans Affairs, Salt Lake City, Utah.,12 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mitzi L Wasserstein
- 11 George E. Wahlen Department of Veterans Affairs Medical Center, VA Salt Lake City Health Care System, U.S. Department of Veterans Affairs, Salt Lake City, Utah
| | - Richard B Goodman
- 13 Seattle Division, VA Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington.,14 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jean C Beckham
- 15 Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, U.S. Department of Veterans Affairs Medical Center, Durham, North Carolina.,16 Behavioral Medicine Division, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina; and
| | - Rameela Chandrasekhar
- 10 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Robert S Dittus
- 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.,17 Division of General Internal Medicine and Public Health and Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - E Wesley Ely
- 3 Geriatric Research, Education, and Clinical Center, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.,4 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pratik P Pandharipande
- 8 Anesthesia Service, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.,9 Division of Critical Care, Department of Anesthesiology, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Kendrick D, Kelllezi B, Coupland C, Maula A, Beckett K, Morriss R, Joseph S, Barnes J, Sleney J, Christie N. Psychological morbidity and health-related quality of life after injury: multicentre cohort study. Qual Life Res 2017; 26:1233-1250. [PMID: 27785608 PMCID: PMC5376395 DOI: 10.1007/s11136-016-1439-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE To demonstrate the impact of psychological morbidity 1 month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services. METHODS Multicentre cohort study of 16-70-year-olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and 1, 2, 4 and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity 1 month post-injury and MID in HRQoL over the 12 months after injury. RESULTS A total of 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% reported a MID at 1 month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores 1 month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study. CONCLUSIONS Hospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury.
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Affiliation(s)
- D Kendrick
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - B Kelllezi
- Division of Psychology, Nottingham Trent University, Nottingham, NG1 4BU, UK
| | - C Coupland
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - A Maula
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - K Beckett
- Research and Innovation, University of the West of England, Bristol, BS2 8AE, UK
| | - R Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TU, UK
| | - S Joseph
- School of Education, University of Nottingham, Nottingham, NG8 1BB, UK
| | - J Barnes
- Loughborough Design School, Loughborough University, Loughborough, LE11 3TU, UK
| | - J Sleney
- Department of Sociology, University of Surrey, Guildford, GU2 7XH, UK
| | - N Christie
- Centre for Transport Studies, University College London, London, WC1E 6BT, UK
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50
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Jain M, Khadilkar N, De Sousa A. Burn-related factors affecting anxiety, depression and self-esteem in burn patients: an exploratory study. ANNALS OF BURNS AND FIRE DISASTERS 2017; 30:30-34. [PMID: 28592931 PMCID: PMC5446905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/11/2017] [Indexed: 06/07/2023]
Abstract
Burns are physically, psychologically and economically challenging injuries, and the factors leading to them are many and under-studied. The aim of the current study was to assess level of anxiety, depression and self-esteem in burn patients, and look at various burn-related variables that affect them. This cross-sectional study included 100 patients with burn injuries admitted to a tertiary care private hospital in an urban metropolis in India. The patients were assessed for anxiety, depression and self-esteem using the Hamilton anxiety rating scale, Hamilton depression rating scale and Rosenberg self-esteem scale respectively. Assessment was carried out within 2-8 weeks of injury following medical stabilization. The data was tabulated and statistically analyzed. The study sample was predominantly male (54%), married (69%), with a mean age of 34.1 ± 10.8 years. Accidental burns (94%) were the most common modality of injury. The majority (46%) suffered burns involving 20-59% total body surface area (TBSA), and facial burns were present (57%). No significant association was found between TBSA and anxiety, depression or self-esteem, and the same was true for facial burns. Deep burns, however, were significantly associated with anxiety (p=0.03) and depression (p=0.0002). High rates of anxiety and depression are associated with burn injuries and related to burn depth. Adjustment and recovery in these patients depends on various other factors like the patient's psychological status, nature/extent of the injury and ensuing medical care. Further research is warranted to reveal the magnitude and predictors of psychological problems in burn patients.
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Affiliation(s)
- M. Jain
- Department of Psychiatry, Masina Hospital, Mumbai, India
| | | | - A. De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India
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