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Do critical illness survivors with multimorbidity need a different model of care?

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Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials

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Summary: This study investigates whether patient characteristics modify the effect of physical rehabilitation on health-related quality of life and objective physical performance using pooled individual patient data from randomized controlled trials.

CRITICAL CARE MEDICINE (2023)

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Association of Neighborhood Deprivation and Depressive Symptoms With Epigenetic Age Acceleration: Evidence From the Canadian Longitudinal Study on Aging

Divya Joshi et al.

Summary: This study examined the association between neighborhood deprivation and DNAm GrimAge and PhenoAge acceleration in adults, and assessed the interaction with depressive symptoms. The results found that higher levels of neighborhood deprivation and depressive symptoms were associated with higher DNAm GrimAge acceleration. However, the association was slightly lower and not statistically significant for DNAm PhenoAge. There was no evidence of a statistical interaction between neighborhood deprivation and depressive symptoms.

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Review Biochemistry & Molecular Biology

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Carlos Lopez-Otin et al.

Summary: Aging is driven by hallmarks that manifest with age, accelerate aging when accentuated experimentally, and can be decelerated, stopped, or reversed with therapeutic interventions. The twelve proposed hallmarks of aging include genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, disabled macroautophagy, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, altered intercellular communication, chronic inflammation, and dysbiosis. These hallmarks are interconnected with each other and with the recently proposed hallmarks of health.
Article Respiratory System

Fragmentation of care between intensive and primary care settings and opportunities for improvement

Nina Leggett et al.

Summary: This study explores the gaps in care provided across the transitions from the intensive care unit (ICU) to primary care and investigates the experiences of patients, caregivers, intensivists, and general practitioners (GPs) through semi-structured interviews. The study identifies issues at different healthcare tiers, including health system factors, clinician factors, and patient and carer factors. The findings provide important insights for future research to improve the integration of care for this vulnerable and underserved cohort.

THORAX (2023)

Article Critical Care Medicine

Neighborhood Socioeconomic Disadvantage and Disability After Critical Illness*

Jason R. Falvey et al.

Summary: Neighborhood socioeconomic disadvantage is associated with a higher disability burden in the 12 months after a critical illness. Future studies should evaluate barriers to functional recovery for ICU survivors living in disadvantaged neighborhoods.

CRITICAL CARE MEDICINE (2022)

Article Critical Care Medicine

Impact of frailty on persistent critical illness: a population-based cohort study

Jai N. Darvall et al.

Summary: This study analyzed how patient frailty affects the development and death of persistent critical illness (PerCI). The results showed that patients with frailty are more likely to develop PerCI and have a higher mortality rate compared to those without frailty. Furthermore, the importance of frailty as a predictor of mortality increases with ICU length of stay.

INTENSIVE CARE MEDICINE (2022)

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Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis: The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial*

Stephanie Parks Taylor et al.

Summary: This study evaluated the impact of a nurse navigator-led, multicomponent Sepsis Transition And Recovery program on 30-day mortality and readmission outcomes after sepsis hospitalization. The results showed that patients who received the program had a lower proportion of mortality or rehospitalization within 30 days after discharge.

CRITICAL CARE MEDICINE (2022)

Article Multidisciplinary Sciences

Long-term outcomes of hospital survivors following an ICU stay: A multi-centre retrospective cohort study

Zakary Doherty et al.

Summary: This study investigates the long-term survival of patients who were discharged from Intensive Care Units in Victoria, Australia and identifies factors associated with time to death. The results show that Australian patients have worse long-term survival than the general population, except for elderly patients admitted following cardiac surgery. Various demographic, socio-economic, diagnostic, acute and chronic illness factors are associated with long-term survival.

PLOS ONE (2022)

Article Medicine, General & Internal

Does a screening checklist for complex health and social care needs have potential clinical usefulness for predicting unplanned hospital readmissions in intensive care survivors: development and prospective cohort study

Timothy Simon Walsh et al.

Summary: This study aimed to develop and evaluate a screening checklist to predict readmissions or deaths for ICU survivors. The results showed that the checklist had a moderate sensitivity and specificity in predicting readmissions or deaths.

BMJ OPEN (2022)

Review Health Care Sciences & Services

Integrated Care Components in Transitional Care Models from Hospital to Home for Frail Older Adults: A Systematic Review

Merel Leithaus et al.

Summary: This review study examined transitional care from hospital to home, summarized the use of integrated care components, and described their impact on hospital readmission and emergency department visit outcomes. The study found that components such as a small sized care team, intensive follow-up, shared decision making, and informal caregiver involvement were likely to reduce hospital readmissions and ED visits.

INTERNATIONAL JOURNAL OF INTEGRATED CARE (2022)

Article Medicine, General & Internal

Multimorbidity

Soren T. Skou et al.

Summary: Multimorbidity has substantial effects on individuals, carers and society. The mechanisms underlying its development are complex and related to ageing and broader determinants of health. Little is known about prevention, but interventions focusing on psychosocial and behavioral factors are likely to be beneficial. Most clinical guidelines and healthcare training focus on single diseases, whereas multimorbidity requires person-centered care.

NATURE REVIEWS DISEASE PRIMERS (2022)

Review Cardiac & Cardiovascular Systems

Mechanisms of Post-critical Illness Cardiovascular Disease

Andrew Owen et al.

Summary: Prolonged critical care stays can lead to the development of cardiovascular and renal diseases due to the immune response and treatments during severe illness, resulting in inflammation and immunosenescence.

FRONTIERS IN CARDIOVASCULAR MEDICINE (2022)

Article Health Care Sciences & Services

Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study

Ivan D. Benitez et al.

Summary: This study identified different phenotypes of COVID-19 patients based on comorbidity patterns, with high-comorbidity and renal-comorbidity being associated with in-hospital complications, mortality risk, treatment response, and sequelae, with chronic kidney disease playing a major role.

LANCET REGIONAL HEALTH-EUROPE (2022)

Article Critical Care Medicine

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study

Samuel M. Brown et al.

Summary: Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs.

CRITICAL CARE (2022)

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Hallmarks of Health

Carlos Lopez-Otin et al.

Summary: Health is more than just the absence of disease; it involves a combination of organizational and dynamic features that maintain physiology. Biological causes of health include spatial compartmentalization, maintenance of homeostasis, and adequate responses to stress. Disruption of these features can lead to pathogenic processes.
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Factors associated with employment outcome after critical illness: Systematic review, meta-analysis, and meta-regression

Han Su et al.

Summary: This study synthesized data on the prevalence and risk factors for return to work in ICU survivors, finding that employment outcomes are influenced by disability policies and temporal factors. Countries with policies that provide higher support for disabled workers have higher return to work rates in the first 3 years following ICU admission, but from 3-5 years, countries with lower support policies have better employment outcomes.

JOURNAL OF ADVANCED NURSING (2021)

Article Anesthesiology

Polypharmacy and emergency readmission to hospital after critical illness: a population-level cohort study

Angus J. Turnbull et al.

Summary: Polypharmacy is common and associated with a higher risk of emergency hospital readmission in ICU survivors. Each additional prescription increases the hazard of emergency readmission by 3%.

BRITISH JOURNAL OF ANAESTHESIA (2021)

Article Critical Care Medicine

Association of Job Characteristics and Functional Impairments on Return to Work After ARDS

Han Su et al.

Summary: The study found that pre-ARDS workload was not associated with post-ARDS return to work, but post-ARDS functional impairment, pain, and fatigue were negatively correlated with return to work. These findings are significant for designing vocational interventions for ARDS survivors.
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Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

Bronwen Connolly et al.

Summary: The study surveyed the provision of recovery, rehabilitation and follow-up services for adult critical care patients in the UK, with findings showing that inpatient and outpatient services were mainly delivered by nurses and co-delivered by two or more healthcare professionals. Lack of funding was identified as a primary barrier to service provision, with post-hospital discharge physical rehabilitation programs being relatively few but peer support services being more available. The effects of the COVID-19 pandemic resulted in changes in service provision, with future plans focusing on expanding current outpatient services.

BMJ OPEN (2021)

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Laurel Raffington et al.

Summary: This study found that children growing up in socioeconomically disadvantaged environments experience accelerated biological aging compared to children in more affluent environments. Factors such as Latinx ethnicity, advanced puberty, higher BMI, and tobacco exposure were associated with faster biological aging. However, the relationship between socioeconomic disadvantage and accelerated aging remained significant even after controlling for these factors.

PEDIATRICS (2021)

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Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic's first wave

Ana Cristina Castro-Avila et al.

Summary: This study aimed to identify follow-up services for COVID-19 patients discharged from ICU and explore the opinions of ICU staff and GPs on their future needs and coordination of care. The research found that a majority of GPs were unaware of local hospital's follow-up services and that 25% of ICUs suspended follow-up services during the peak of the pandemic. Funding complexities, expertise, and communication were identified as key barriers to providing follow-up care, emphasizing the need for improved communication and coordination between specialists and GPs for all discharged ICU patients, not just those with COVID-19.

BMJ OPEN (2021)

Article Critical Care Medicine

Multimorbidity and Its Relationship With Long-Term Outcomes After Critical Care Discharge A Prospective Cohort Study

Joanne McPeake et al.

Summary: This study found that survivors of critical care experience increased resource use in the year after discharge, but did not show higher long-term mortality rates. Emotional health issues were associated with long-term mortality, and multimorbidity, lifestyle factors, and socioeconomic status seemed to influence long-term outcomes.
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Transitions of Care After Critical Illness-Challenges to Recovery and Adaptive Problem Solving*

Kimberley J. Haines et al.

Summary: The study found that survivors of critical illness and their caregivers experience a range of challenges across the transitions of care, with distinct themes related to the caregiver experience. However, survivors and caregivers used comparable problem-solving strategies to navigate the challenges encountered during the transitions of care.

CRITICAL CARE MEDICINE (2021)

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Association of Social Isolation With Disability Burden and 1-Year Mortality Among Older Adults With Critical Illness

Jason R. Falvey et al.

Summary: The study found that social isolation is associated with greater disability burden and higher mortality in the year following critical illness. Each 1-point increase in social isolation score was associated with a 7% increase in disability count and a 14% increase in 1-year mortality risk. The findings suggest the need for social isolation screening and intervention frameworks for older adults with critical illness.

JAMA INTERNAL MEDICINE (2021)

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Long term outcomes following critical care hospital admission: A prospective cohort study of UK biobank participants

Joanne McPeake et al.

Summary: This study analyzed data from 1,618 patients to understand the impact of a critical care admission on long-term outcomes. Patients exposed to critical care were more likely to experience mental health issues such as depression and social problems such as social isolation and the need for government funded welfare support following discharge. Social and emotional health were closely correlated in the critical care cohort, while the nature of physical problems changed over time.

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Prevalence and Course of Frailty in Survivors of Critical Illness*

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Medication-related Problems in Intensive Care Unit Survivors: Learning from a Multicenter Program

Pamela MacTavish et al.

ANNALS OF THE AMERICAN THORACIC SOCIETY (2020)

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Frailty and Multimorbidity: A Systematic Review and Meta-analysis

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Jennifer R. A. Jones et al.

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Nita Khandelwal et al.

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Eddie Donaghy et al.

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INTENSIVE CARE MEDICINE (2018)

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Frailty and Subsequent Disability and Mortality among Patients with Critical Illness

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