Restrictive Visitation Policies and Related Post-Traumatic Stress Among Families of Critically Ill Patients With COVID-19.
Ontology highlight
ABSTRACT:
SUBMITTER: White KR
PROVIDER: S-EPMC10290160 | biostudies-literature | 2023 Jun
REPOSITORIES: biostudies-literature
Publications
Restrictive Visitation Policies and Related Post-Traumatic Stress Among Families of Critically Ill Patients With COVID-19.
White Katherine R KR Lee Jane J JJ Sarigiannis Kalli A KA Tringali Jonathan J JJ Vu James J Eaton England Ashley A Lietzau Stephanie S Hebert Charles C Banayan David D Basapur Santosh S Glover Crystal M CM Shah Raj C RC Gerhart James J Greenberg Jared A JA
Chest 20230624 6
Similar Datasets
Project description:PurposeDuring the first wave of the COVID-19 pandemic, restricted visitation policies were enacted at acute care facilities to reduce the spread of COVID-19 and conserve personal protective equipment. In this study, we aimed to describe the impact of restricted visitation policies on critically ill patients, families, critical care clinicians, and decision-makers; highlight the challenges faced in translating these policies into practice; and delineate strategies to mitigate their effects.MethodA qualitative description design was used. We conducted semistructured interviews with critically ill adult patients and their family members, critical care clinicians, and decision-makers (i.e., policy makers or enforcers) affected by restricted visitation policies. We transcribed semistructured interviews verbatim and analyzed the transcripts using inductive thematic analysis.ResultsThree patients, eight family members, 30 clinicians (13 physicians, 17 nurses from 23 Canadian intensive care units [ICUs]), and three decision-makers participated in interviews. Thematic analysis was used to identify five themes: 1) acceptance of restricted visitation (e.g., accepting with concerns); 2) impact of restricted visitation (e.g., ethical challenges, moral distress, patients dying alone, intensified workload); 3) trust in the healthcare system during the pandemic (e.g., mistrust of clinical team); 4) modes of communication (e.g., communication using virtual platforms); and 5) impact of policy implementation on clinical practice (e.g., frequent changes and inconsistent implementation).ConclusionsRestricted visitation policies across ICUs during the COVID-19 pandemic negatively affected critically ill patients and their families, critical care clinicians, and decision-makers.
| S-EPMC9385091 | biostudies-literature
Project description:BackgroundSurvivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking.MethodsThe present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU.ResultsClinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients.ConclusionsMental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment.Trial registrationGerman Clinical Trials Register No. DRKS00003386 . Registered 13 November 2011.
| S-EPMC6368748 | biostudies-literature
Project description:ObjectiveTo determine the feasibility of a flexible visitation system in the intensive care unit (ICU).MethodsA randomized, open-label, parallel group clinical trial was conducted. All patients admitted to the ICU of the Lanzhou University Second Hospital from April to June 2022 were enrolled. The enrolled patients were randomly divided into an experimental group and a control group according to a computer-generated random sequence table.ResultsA total of 410 patients were admitted. According to the inclusion and exclusion criteria, 140 patients were included in the experimental group (flexible visitation group) and 140 in the control group (normal visitation group). The average number of visitation minutes per day between the experimental group and the control group was 24.7 versus 23.9 min (p > 0.05).Among the outcome indicators, delirium occurred in 8 (5.7%) patients in the intervention group and in 24 (17.1%) patients in the control group (p = 0.003). Five complaints (mainly pressure ulcers) were received, with one in the experimental group and the others in the control group. There were 28 cases of nosocomial infection in the experimental group and 29 cases in the control group; therefore, the incidence of nosocomial infection was 20% versus 20.7% (p = 0.882). A total of 280 questionnaires were collected, with a retrieval rate of 100%. The satisfaction of patients in the experimental group and the control group was 98.6% and 92.1%, respectively (p = 0.011). The flexible visiting system reduced the ICU length of stay (LOS). The ICU LOS of the experimental group was 6 versus 8 days for the control group (p = 0.041). However, the flexible visiting system did not reduce the hospital stay (17 vs. 19 days, p = 0.923).ConclusionConducting a flexible visitation system in ICUs could reduce the incidence of delirium in critically ill patients and improve the quality of nursing care; furthermore, the rate of nosocomial infections was not increased. These findings need to be further verified by a multicentre, large-scale clinical trial.
| S-EPMC10358547 | biostudies-literature
Project description:Post-traumatic stress disorder (PTSD) develops in a portion of individuals exposed to extreme trauma. Glycosylation is a post-translational modification that affects protein functions and is altered in various pathophysiological states and aging. There are still no validated biomarkers of PTSD. The aim of this study was to evaluate the N-glycomic profile in 543 male Caucasian individuals (299 veterans with PTSD and 244 control subjects). The study included discovery (N = 233) and replication (N = 310) cohort. Hydrophilic interaction HPLC and ultra-performance liquid chromatography were used to separate and detect 39 plasma and 24 IgG N-glycan species, respectively. All results were corrected for the effects of age and multiple testing. Significant results included only significantly altered N-glycans in cases/controls in both cohorts, in the same direction. Results showed that six plasma N-glycans (four increased and two decreased) were altered in PTSD vs. controls in both cohorts, but IgG N-glycans were similar between groups. The severity of PTSD was not associated with different plasma N-glycans. This is the first study detecting alterations in plasma N-glycans in PTSD. These N-glycans are also associated with other neuropsychiatric disorders and inflammation, suggesting possible shared glycosylation mechanisms.
| S-EPMC6995522 | biostudies-literature
Project description:Mothers of premature infants are at high risk of experiencing birth trauma and poor postpartum mental health. However, for some, this experience can lead to personal growth. This study examines Lithuanian women with preterm births, where birth-related PTSD is notably higher despite a lower preterm birth rate. Given the common emotional responses of guilt and shame, we explore whether proneness to these emotions moderates the relationship between birth-related PTSD and post-traumatic growth. A cross-sectional study was conducted using an anonymous e-survey to collect data. Women (N = 79) who experienced a preterm birth during 2020 to 2021 participated in the study at least 2 months postpartum, completing the City Birth Trauma Scale (City BiTS), the Guilt and Shame Proneness Scale (GASP), and the Post Traumatic Growth Inventory (PTGI). The relationship between birth-related post-traumatic stress and post-traumatic growth was assessed using linear regression, while the roles of guilt and shame proneness in this relationship were evaluated using moderated regression. The results showed that higher birth-related post-traumatic stress symptoms were associated with greater post-traumatic growth. However, proneness to shame-related negative self-evaluation weakened this relationship, particularly in women with very preterm births. These findings suggest that trauma models should incorporate the moderating role of shame in recovery outcomes. Women with very preterm births who are prone to shame may require more focused attention from healthcare specialists, with targeted interventions to address these emotional challenges and enhance post-traumatic growth. Additionally, policy initiatives should prioritize support programs tailored to the unique psychological needs of these women.
| S-EPMC11613246 | biostudies-literature
Project description:BackgroundOxidative injury occurs in septic people, but the role of oxidative stress and antioxidants has rarely been evaluated in foals.Objectives/hypothesisTo measure reactive oxygen species (ROS), biomarkers of oxidative injury, and antioxidants in neonatal foals. We hypothesized that ill foals would have higher blood concentrations of ROS and biomarkers of oxidative injury and lower concentrations of antioxidants compared to healthy foals.AnimalsSeventy-two hospitalized and 21 healthy neonatal foals.MethodsProspective cohort study. Reactive oxygen species (hydrogen peroxide [H2O2]), biomarkers of oxidative injury (malondialdehyde [MDA], protein carbonyl), and antioxidants (superoxide dismutase [SOD], catalase [CAT], glutathione, and glutathione reductase [GR] and peroxidase [GPx]) were measured from foals at admission. Measured variables were compared between healthy and ill foals using a 1-way ANOVA by Tukey's multiple comparisons test.ResultsIll foals (n = 51) had significantly higher mean concentrations of H2O2 (healthy 2.6 ± 1.4 nmol/mL, ill 6.8 ± 4.6 L nmol/mL; 95% CI), MDA (healthy 31.2 ± 14.4 nmol/mL, ill 114.3 ± 94.0 nmol/mL; 95% CI), and protein carbonyl (healthy 0.07 ± 0.01 nmol/mg protein, ill 0.12 ± 0.02 nmol/mg protein, 95% CI). Significant lower CAT (healthy 0.4 ± 0.3 mU/mg protein, ill 0.02 ± 0.02 mU/mg protein, 95% CI), glutathione (healthy 238.5 ± 101.9 μg/mL, ill 110.7 ± 37.8 μg/mL, 95% CI; P < .0001), GR (healthy 1.6 ± 1.8 mU/mg protein, ill 0.4 ± 0.5 mU/mg protein, 95% CI), and GPx (healthy 0.01 ± 0.003 mU/mg protein, ill 0.007 ± 0.002 mU/mg protein, 95% CI) were also noted.Conclusions and clinical importanceOxidative stress and lower antioxidant concentrations occur in ill and bacteremic neonatal foals. These variables should be considered during the treatment of ill foals.
| S-EPMC11758150 | biostudies-literature
Project description:Recent genome-wide association studies (GWAS) have identified genetic markers of post-traumatic stress disorder (PTSD) in civilian and military populations. However, studies have yet to examine the genetics of PTSD while factoring in risk for alcohol dependence, which commonly co-occur. We examined genome-wide associations for DSM-IV PTSD among 4,978 trauma-exposed participants (31% with alcohol dependence, 50% female, 30% African ancestry) from the Collaborative Study on the Genetics of Alcoholism (COGA). We also examined associations of polygenic risk scores (PRS) derived from the Psychiatric Genomics Consortium (PGC)-PTSD Freeze 2 (N = 3533) and Million Veterans Program GWAS of PTSD (N = 5200) with PTSD and substance dependence in COGA, and moderating effects of sex and alcohol dependence. 7.3% of COGA participants met criteria for PTSD, with higher rates in females (10.1%) and those with alcohol dependence (12.3%). No independent loci met genome-wide significance in the PTSD meta-analysis of European (EA) and African ancestry (AA) participants. The PGC-PTSD PRS was associated with increased risk for PTSD (B = 0.126, p < 0.001), alcohol dependence (B = 0.231, p < 0.001), and cocaine dependence (B = 0.086, p < 0.01) in EA individuals. A significant interaction was observed, such that EA individuals with alcohol dependence and higher polygenic risk for PTSD were more likely to have PTSD (B = 0.090, p < 0.01) than those without alcohol dependence. These results further support the importance of examining substance dependence, specifically alcohol dependence, and PTSD together when investigating genetic influence on these disorders.
| S-EPMC10618091 | biostudies-literature
Project description: Not available
| S-EPMC1852007 | biostudies-literature
Project description:BackgroundMagnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to be balanced against the benefit of detecting prognostically relevant information on MRI. We therefore aimed to assess if day of injury serum protein biomarkers could identify critically ill TBI patients in whom the risks of transfer are compensated by the likelihood of detecting management-altering neuroimaging findings.MethodsData were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Eligibility criteria included: TBI patients aged ≥ 16 years, Glasgow Coma Score (GCS) < 13 or patient intubated with unrecorded pre-intubation GCS, CT with Marshall score < 3, serum biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) sampled ≤ 24 h of injury, MRI < 30 days of injury. The degree of axonal injury on MRI was graded using the Adams-Gentry classification. The association between serum concentrations of biomarkers and Adams-Gentry stage was assessed and the optimum threshold concentration identified, assuming different minimum sensitivities for the detection of brainstem injury (Adams-Gentry stage 3). A cost-benefit analysis for the USA and UK health care settings was also performed.ResultsAmong 65 included patients (30 moderate-severe, 35 unrecorded) axonal injury was detected in 54 (83%) and brainstem involvement in 33 (51%). In patients with moderate-severe TBI, brainstem injury was associated with higher concentrations of NSE, Tau, UCH-L1 and GFAP. If the clinician did not want to miss any brainstem injury, NSE could have avoided MRI transfers in up to 20% of patients. If a 94% sensitivity was accepted considering potential transfer-related complications, GFAP could have avoided 30% of transfers. There was no added net cost, with savings up to £99 (UK) or $612 (US). No associations between proteins and axonal injury were found in intubated patients without a recorded pre-intubation GCS.ConclusionsSerum protein biomarkers show potential to safely reduce the number of transfers to MRI in critically ill patients with moderate-severe TBI at no added cost.
| S-EPMC9706877 | biostudies-literature
Project description:The aims of this study are to describe the use of pharmaceutical venous thromboembolism (pVTE) prophylaxis in patients with traumatic brain injury (TBI) in Europe and study the association of pVTE prophylaxis with outcome. We included 2006 patients ≥18 years of age admitted to the intensive care unit from the CENTER-TBI study. VTE events were recorded based on clinical symptoms. Variation between 54 centers in pVTE prophylaxis use was assessed with a multi-variate random-effect model and quantified with the median odds ratio (MOR). The association between pVTE prophylaxis and outcome (Glasgow Outcome Scale-Extended at 6 months) was assessed at center level with an instrumental variable analysis and at patient level with a multi-variate proportional odds regression analysis and a propensity-matched analysis. A time-dependent Cox survival regression analysis was conducted to determine the effect of pVTE prophylaxis on survival during hospital stay. The association between VTE prophylaxis and computed tomography (CT) progression was assessed with a logistic regression analysis. Overall, 56 patients (2%) had a VTE during hospital stay. The majority, 1279 patients (64%), received pVTE prophylaxis, with substantial between-center variation (MOR, 2.7; p < 0.001). A moderate association with improved outcome was found at center level (odds ratio [OR], 1.2 [0.7-2.1]) and patient level (multi-variate adjusted OR, 1.4 [1.1-1.7], and propensity adjusted OR, 1.5 [1.1-2.0]), with similar results in subgroup analyses. Survival was higher with the use of pVTE prophylaxis (p < 0.001). We found no clear effect on CT progression (OR, 0.9; CI [0.6-1.2]). Overall, practice policies for pVTE prophylaxis vary substantially between European centers, whereas pVTE prophylaxis may contribute to improved outcome. Trial registration number is NCT02210221 at ClinicalTrials.gov, registered on August 6, 2014 (first patient enrollment on December 19, 2014).
| S-EPMC8804253 | biostudies-literature