Classification of pain and its treatment at an intensive care rehabilitation clinic

Introduction Treatment in an Intensive Care Unit (ICU) often necessitates uncomfortable and painful procedures for patients throughout their admission. There is growing evidence to suggest that chronic pain is becoming increasingly recognised as a long term problem for patients following an ICU admission [1]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU discharge at Glasgow Royal Infirmary. This study investigated the incidence and location of chronic pain in patients discharged from ICU and classified the analgesics prescribed according to the World Health Organization analgesic Methods The InS:PIRE programme involved individual sessions for patients and their caregivers with a physiotherapist and a pharmacist along with interventions from medical, nursing, psychology and community services. The physiotherapist documented the incidence and pain location during the assessment. The pharmacist recorded all analgesic medications prescribed prior to admission and at their clinic visit. The patient’s analgesic medication was classified according to the WHO pain ladder from zero to three, zero being no pain medication and three being treatment with a strong opioid. Data collected was part of an evaluation of a quality improvement initiative, therefore ethics approval was waived. Results Data was collected from 47 of the 48 patients who attended the rehabilitation clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67 %)). Prior to admission to ICU 43 % of patients were taking analgesics and this increased to 81 % at the time of their clinic visit. The number of patients at step two and above on the WHO pain ladder also increased from 34 % to 56 %. Conclusions Of the patients seen at the InS:PIRE clinic two-thirds stated that they had new pain since their ICU admission. Despite the increase in the number and strength of analgesics prescribed, almost a quarter of patients still complained of pain at their clinic visit. These results confirm that pain continues to be a significant problem in this patient group. Raising awareness in primary care of the incidence of chronic pain and improving its management is essential to the recovery process following an ICU admission

Physical outcome measure for critical care patients following intensive care discharge

Introduction: The aim of this study was to evaluate the most suitable physical outcome measures to be used with critical care patients following discharge. ICU survivors experience physical problems such as reduced exercise capacity and intensive care acquired weakness. NICE guideline ‘Rehabilitation after critical illness’ (1) recommends the use of outcome measures however does not provide any specific guidance. A recent Cochrane review noted wide variability in measures used following ICU discharge (2). Methods: Discharged ICU patients attended a five week multidisciplinary programme. Patients’ physical function was assessed during the programme, at 6 months and 12 months post discharge. Three outcome measures were included in the initial two cohorts. The Six Minute Walk Test (6MWT) and the Incremental Shuttle Walk test (ISWT) were chosen as they have been used within the critical care follow up setting (2). The Chester Step Test (CST) is widely thought to be a good indicator of ability to return to work (one of the programmes primary aims). Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected for the initial patients attending the programme (n = 13), median age was 52 (IQR = 38-72), median ICU LOS was 19 days (IQR = 4-91), median APACHE II was 23 (IQR = 19-41) and 11 were men. One patient was so physically debilitated that the CST or ISWT could not be completed however a score was achieved using the 6MWT. Another patient almost failed to achieve level 1 of the ISWT. Subsequent patients for this project (total n = 47) have all therefore been tested using the 6MWT. Good inter-rater and intrarater reliability and validity have been reported for the 6MWT (3). Conclusions: Exercise capacity measurement is not achievable for some patients with either the ISWT or the CST due to the severity of their physical debilitation. Anxiety, post-traumatic stress disorder and depression are common psychological problems post discharge (4), therefore using a test with a bleep is not appropriate. Therefore, the 6MWT is the most appropriate physical outcome measure to be used with critical care patients post discharge

A critical and empirical analysis of the national-local ‘gap’in public responses to large-scale energy infrastructures

This is the author accepted manuscript. The final version is available from Taylor & Francis (Routledge) via the DOI in this record.A national-local ‘gap’ is often used as the starting point for analyses of public responses to large scale energy infrastructures. We critique three assumptions found in that literature: the public's positive attitudes, without further examining other type of perceptions at a national level; that local perceptions are best examined through a siting rather than place-based approach; that a gap exists between national and local responses, despite a non-correspondence in how these are examined. Survey research conducted at national and local levels about electricity transmission lines in the UK confirm these criticisms. Results do not support a gap between national and local levels; instead, both differences and similarities were found. Results show the value of adopting a place-based approach and the role of surveys to inform policy making are discussed.This research was supported by the Research Council of Norway (SusGrid Grant No. 207774) and the Engineering and Physical Sciences Research Council (FlexNet: EP/EO4011X/1). The authors would also like to acknowledge the beneficial comments and advice of their colleagues at the Environment and Sustainability Research Group, Geography, University of Exeter, regarding previous versions of this paper, as well as the helpful comments of the three anonymous reviewers that commented on it. Thanks are also due to colleagues from the SusGrid project, specifically Audun Ruud and Oystein Aas, and the participants in the research, for their contributions to this paper

Pharmacy intervention at an intensive care rehabilitation clinic

Introduction: During an intensive care stay, patients often have their chronic medications withheld for a variety of reasons and new drugs commenced [1]. As patients are often under the care of a number of different medical teams during their admission there is potential for these changes to be inadvertently continued [2]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their caregivers after ICU (Intensive Care Unit) discharge at Glasgow Royal Infirmary. Within this programme a medication review by the critical care pharmacist provided an opportunity to identify and resolve any pharmaceutical care issues and also an opportunity to educate patients and their caregivers about changes to their medication. Methods: During the medication review we identified ongoing pharmaceutical care issues which were communicated to the patient’s primary care physician (GP) by letter or a telephone call. The patients were also encouraged to discuss any issues raised with their GP. The significance of the interventions was classified from those not likely to be of clinical benefit to the patient, to those which prevented serious therapeutic failure. Results: Data was collected from 47 of the 48 patients who attended the clinic (median age was 52 (IQR, 44-57) median ICU LOS was 15 (IQR 9-25), median APACHE II was 23 (IQR 18-27) and 32 of the patients were men (67%). The pharmacist made 69 recommendations; including 20 relating to drugs which had been withheld and not restarted, dose adjustments were suggested on 13 occasions and new drug recommendations were made for 10 patients. Duration of treatment for new medications started during hospital admission was clarified on 12 occasions. Lastly adverse drug effects were reported on 4 occasions and the incorrect drug was prescribed on 2 occasions. Of the interventions made 58% were considered to be of moderate to high impact. Conclusions: The pharmacist identified pharmaceutical care issues with 18.6% of the prescribed medications. Just over half of the patients reported that they were not made aware of any alterations to their prescribed medication on discharge. Therefore a pharmacy intervention is an essential part of an intensive care rehabilitation programme to address any medication related problems, provide education and to ensure patients gain optimal benefit from their medication

Living with low carbon technologies: an agenda for sharing and comparing qualitative energy research

ArticleCopyright © 2015 Elsevier Ltd. All rights reserved.There is another ORE record for this publication: http://hdl.handle.net/10871/36734Policies to reduce the carbon intensity of domestic living place considerable emphasis on the diffusion of low(er) carbon technologies - from microgeneration to an array of feedback and monitoring devices. These efforts presume that low carbon technologies (LCTs) will be accepted and integrated into domestic routines in the ways intended by their designers. This study contributes to an emerging qualitative energy research (QER) literature by deploying an analytical approach that explores comparison of data from two UK projects ('Carbon, Comfort and Control' and 'Conditioning Demand') concerned, in broad terms, with householder interactions with LCTs - primarily associated with the production and maintenance of thermal comfort. In-depth, and in many cases repeat, interviews were conducted in a total of 18 households where devices such as heat pumps and thermal feedback lamps had recently been installed. We discuss this comparative process and how a reflexive reading of notions of (and strategies associated with) credibility, transferability, dependability and confirmablity enabled new ways of working and thinking with existing data. We conclude by highlighting the contrasts, conflicts, but also creativities raised by drawing these connections, and consider implications for methodologies associated with qualitative energy research.EPSRCE.O

High Resolution Near-Infrared Spectroscopy of FUors and FUor-like stars

We present new high resolution (R=18,000) near-infrared spectroscopic observations of a sample of classical FU Orionis stars (FUors) and other young stars with FUor characteristics that are sources of Herbig-Haro flows. Spectra are presented for the region 2.203 - 2.236 microns which is rich in absorption lines sensitive to both effective temperatures and surface gravities of stars. Both FUors and FUor-like stars show numerous broad and weak unidentified spectral features in this region. Spectra of the 2.280 - 2.300 micron region are also presented, with the 2.2935 micron v=2-0 CO absorption bandhead being clearly the strongest feature seen in the spectra all FUors and Fuor-like stars. A cross-correlation analysis shows that FUor and FUor-like spectra in the 2.203 - 2.236 micron region are not consistent with late-type dwarfs, giants, nor embedded protostars. The cross-correlations also show that the observed FUor-like Herbig-Haro energy sources have spectra that are substantively similar to those of FUors. Both object groups also have similar near-infrared colors. The large line widths and double-peaked nature of the spectra of the FUor-like stars are consistent with the established accretion disk model for FUors, also consistent with their near-infrared colors. It appears that young stars with FUor-like characteristics may be more common than projected from the relatively few known classical FUors.Comment: 21 pages, 4 figures, accepted by The Astronomical Journa