Search

Abstract: Purpose: To increase our knowledge of how nurses assess breakthrough cancer pain (BTCP); and whether they find it difficult to distinguish BTCP from background pain; how they estimate the impact of BTCP on patients' daily lives, and the factors that nurses consider to induce BTCP. Variations in their use of assessment tools and their ability to distinguish between different types of pain were also examined in terms of the number of years of oncology nursing experience and the practice in different countries. Methods: In total, 1241 nurses (90% female) who care for patients with cancer, from 12 European countries, completed a survey questionnaire. Key results: Half the sample had >9 years of experience in oncology nursing. Although 39% had no pain assessment tool to help them distinguish between types of pain, 95% of those who used a tool found it useful. Furthermore, 37% reported that they had problems distinguishing background pain from BTCP. Movement was identified as the factor that most commonly exacerbated BTCP across all countries. The nurses reported that BTCP greatly interfered with patients' everyday activities, and they rated the patients' enjoyment of life as most strongly affected. The use of tools and the ability to distinguish between different pains varied between European countries and with years of experience in oncology nursing. Conclusions: The nurses reported that BTCP greatly interfered with patients' lives, and many nurses had problems distinguishing between background pain and BTCP. Nurses require more knowledge about BTCP management, and guidelines should be developed for clinical use. [Copyright &y& Elsevier]

Abstract: Context: Little is known about changes over time in multiple dimensions of the symptom experience in patients with breast cancer undergoing radiation therapy (RT). Objectives: This study evaluated for changes in and predictors of occurrence, severity, and distress of six common symptoms (lack of energy, worrying, difficulty sleeping, feeling drowsy, sweats, and pain) during RT for breast cancer. Methods: Patients (n = 188) completed the Memorial Symptom Assessment Scale before, during, and after the completion of RT, over a six-month period. Changes in symptom occurrence were evaluated using multilevel logistic regression analysis. Changes in severity and distress scores were evaluated using multilevel proportional odds ordinal logistic regression. The impact of five demographic and clinical characteristics (age, functional status, comorbidities, axillary lymph node dissection, and previous chemotherapy) was evaluated in these analyses. Results: The trajectories for occurrence, severity, and distress for the six symptoms followed similar patterns. For three of the six symptoms (lack of energy, feeling drowsy, and worrying), all three dimensions changed over time. For the other three symptoms (difficulty sleeping, sweats, and pain), no changes over time occurred for any of the symptom dimensions. The overall effect of the five covariates was to increase symptom burden across all three dimensions. Conclusion: Findings from this study provide a more complete picture of the symptom experience of women who undergo RT for breast cancer. These findings can be used to identify patients at higher risk for more severe symptoms before, during, and after RT. [Copyright &y& Elsevier]

Abstract: Purpose of the research: Breakthrough cancer pain (BTCP) is a prevalent type of pain in which the nurse can play an important role in improving patients’ pain symptoms and overall well-being. Nurses’ experience with BTCP (number of patients, and estimates of severity and frequency), the treatment of BTCP (pharmacological and nonpharmacological treatments normally used), ratings of the importance of treatment factors, and reasons given for not advising patients to take strong painkillers are presented in the present paper. Methods and sample: Nurses from 12 European countries, who cared for patients with cancer, took part in a survey. In total 1618 nurses were recruited and 1241 completed the survey questionnaire. Key results: Almost 90% of the nurses were female, and 50.4% had >9 years of experience in oncology nursing. The majority of the nurses (47%) said that a patient typically suffered from BTCP 2–3 times a day, and the severity of the pain for the patients was described as severe by 75.5%. In all, 38.4% of the nurses were unaware that medications specifically intended for treatment of BTCP exist, and 57% reported that oral opioids were normally prescribed for BTCP at their workplace. While 38% said they did not use nonpharmacological treatments for BTCP, the most common treatment approach was positional change (used by 76.6%). The treatment varied between the European countries. Conclusion: Patients do not receive the appropriate medical treatment for their BTCP. Nurses need better training about BTCP in general, and BTCP assessment and management specifically. [Copyright &y& Elsevier]

Supplemental Digital Content is Available in the Text. Two-thirds of patients with dementia in nursing homes had chronic pain, and by thorough clinical examination, half of these had pain without known cause. Pain management for patients with dementia is challenging because many experience pain while being unable to communicate their pain. The aim of this study was to describe pain, pain management, and to perform a thorough clinical examination of chronic pain conditions among patients with dementia. Residents (n = 498) from 12 nursing homes were assessed for dementia (Clinical Dementia Rating scale [CDR]) and for pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) assessment form. Of all examined nursing home patients with dementia, 68% had moderate or severe chronic pain. The final study population (n = 262) with a CDR score of ≥1 and a MOBID-2 score of ≥3 were examined by pain expert physicians for chronic pain and categorized according to the International Classification of Disease (ICD-10/-11) classification systems. More than half (54.6%) had chronic pain conditions without underlying disease classified as chronic primary pain by ICD-11. Chronic widespread pain was the most prevalent (14.5%) followed by nonspecific pain from the back (13.4%), whereas the most prevalent chronic secondary pain conditions were chronic pain caused by osteoarthritis (15.4%) and stroke (8.0%). One-fourth received opioids, which was significantly associated with severe pain (P < 0.001) compared with moderate pain, although no significant association was found between opioid use and the type of pain condition. Although knowledge of the severity and specific types of pain conditions is recommended to direct the choice of treatment, these areas are not sufficiently explored in the nursing home populations with dementia and may hinder a better treatment of pain in this population. [ABSTRACT FROM AUTHOR]

Abstract: Context: Inadequate knowledge is one barrier to effective cancer pain management. Objectives: This study''s aim was to evaluate the effects of a psychoeducational intervention (the Norwegian version of the PRO-SELF© Pain Control Program) compared with a control group in increasing patients'' knowledge of cancer pain management. Methods: Adult oncology outpatients with pain from bone metastasis of 2.5 or greater on a 0 to 10 numeric rating scale were randomized into the PRO-SELF (n =87) or control (n =92) groups. Patients completed a demographic questionnaire and the Pain Experience Scale (PES) at the beginning and end of the study to assess their knowledge and attitudes. The six-week intervention consisted of education, skills building, and nurse coaching. Mixed-model analyses with tests of a group×time interaction were done for each of the individual items and total PES scores to evaluate between-group differences in changes in knowledge over time. Results: Except for functional status, no differences were found between the PRO-SELF and control groups on any baseline demographic, clinical, or pain characteristics. Significant group×time interactions were found for all the single item and total PES scores. Compared with the control group, patients in the PRO-SELF group had significant increases in knowledge scores. Conclusion: The use of a knowledge and attitude survey, like the PES, as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management. This individualized approach to education about pain management may save staff time and improve patient outcomes. [Copyright &y& Elsevier]

Background: This study tests the hypotheses that health-related quality of life (HRQOL) in prevalent dialysis patients with diabetes is lower than in dialysis patients without diabetes, and is at least as poor as diabetic patients with another severe complication, i.e.. foot ulcers. This study also explores the mortality risk associated with diabetes in dialysis patients. Methods: HRQOL was assessed using the Short Form-36 Health Survey (SF-36), in a cross-sectional study of 301 prevalent dialysis patients (26% with diabetes), and compared with diabetic patients not on dialysis (n = 221), diabetic patients with foot ulcers (n = 127), and a sample of the general population (n = 5903). Mortality risk was assessed using a Kaplan-Meier plot and Cox proportional hazards analysis. Results: Self-assessed vitality, general and mental health, and physical function were significantly lower in dialysis patients with diabetes than in those without. Vitality (p = 0.011) and general health (p <0.001) was impaired in diabetic patients receiving dialysis compared to diabetic patients with foot ulcers, but other subscales did not differ. Diabetes was a significant predictor for mortality in dialysis patients, with a hazard ratio (HR) of 1.6 (95% CI 1.0-2.5) after adjustment for age, dialysis vintage and coronary artery disease. Mental aspects of HRQOL were an independent predictor of mortality in diabetic patients receiving dialysis after adjusting for age and dialysis vintage (HR 2.2, 95% CI 1.0-5.0). Conclusions: Physical aspects of HRQOL were perceived very low in dialysis patients with diabetes, and lower than in other dialysis patients and diabetic patients without dialysis. Mental aspects predicted mortality in dialysis patients with diabetes. Increased awareness and measures to assist physical function impairment may be particularly important in diabetes patients on dialysis. [ABSTRACT FROM AUTHOR]

Background: Pain measurement in nonverbal older adults is best based on behavioural observation, e.g. using an observational measurement tool such as Doloplus-2. The purposes of this study were to examine the use of Doloplus-2 in a nonverbal nursing home population, and to evaluate its reliability and validity by comparing registered nurses' estimation of pain with Doloplus-2 scores. Method: In this cross-sectional study, Doloplus-2 was used to observe the pain behaviour of patients aged above 65 years who were unable to self-report their pain. Nurses also recorded their perceptions of patient pain (yes, no, don't know) before they used Doloplus-2. Data on demographics, medical diagnoses, and prescribed pain treatment were collected from patient records. Daily life functioning was measured and participants were screened using the Mini Mental State Examination. Results: In total, 77 nursing home patients were included, 75% were women and the mean age was 86 years (SD 6.6, range 68-100). Over 50% were dependent on nursing care to a high or a medium degree, and all were severely cognitively impaired. The percentage of zero scores on Doloplus-2 ranged from 17% (somatic reactions) to 40% (psychosocial reactions). Cronbach's alpha was 0.71 for the total scale. In total, 52% of the patients were judged by nurses to be experiencing pain, compared with 68% when using Doloplus-2 (p = 0.01). For 29% of the sample, nurses were unable to report if the patients were in pain. Conclusions: In the present study, more patients were categorized as having pain while using Doloplus-2 compared with nurses' estimation of pain without using any tools. The fact that nurses could not report if the patients were in pain in one third of the patients supports the claim that Doloplus-2 is a useful supplement for estimating pain in this population. However, nurses must use their clinical experience in addition to the use of Doloplus-2, as behaviour can have different meaning for different patients. Further research is still needed about the use of Doloplus-2 in patients not able to self-report their pain. [ABSTRACT FROM AUTHOR]

In this study, we present longitudinal data on changes in psychological distress among 232 Norwegian undergraduate students of nursing, physiotherapy, and occupational therapy. Psychological distress was assessed by applying the 12-item version of the General Health Questionnaire. Nursing students became substantially more distressed during the three years of their programme compared to physiotherapy and occupational therapy students. Multivariate analyses showed that the students' levels of psychological distress at the beginning of the study was the most important predictor of psychological distress at the end of the study. Other significant predictors were qualities of the individual student's personal life, clarity in educational structure, subjective experience of study workload, and level of support in student milieu. [ABSTRACT FROM AUTHOR]

Aim: To examine differences in reported pain, pain management and satisfaction with pain management between middle-aged and elderly patients. The study also examined differences in global quality of life (QoL) and pain interference with patient function between middle-aged and elderly patients with bone metastases. Method: A one-day prevalence study was performed, targeting hospitalized cancer patients 18 years and over in Norwegian hospitals; 79 patients with bone metastases were included. Results: In total, 89% of patients reported daily pain, and there was no significant difference between the two age groups (p=0.52). Elderly patients reported significantly higher scores for 'worst pain' (p=0.036) and 'pain seventy intensity' (p=0.027), but received strong opioids for their cancer pain significantly less often than middle-aged patients (p=0.024). We found a significant linear association between increasing age and decreasing scores on Cleeland's pain management index (p=0.002). There were no statistically significant differences between age groups in satisfaction with pain management, pain interference with functioning or global QoL. Conclusion: These results indicate that more focus is needed on pain management in elderly cancer patients with bone metastases. [ABSTRACT FROM AUTHOR]

Objective: A study was undertaken to test the psychometric properties of the Fatigue Severity Scale (FSS), and to explore the relationship between fatigue and sociodemographic variables in the general population. Method: A national representative sample of 1893 respondents was randomly selected from a pool of 4,000 Norwegians aged 19–81 years. A mailed questionnaire that included the FSS was used to measure fatigue severity. Results: The FSS showed satisfactory internal consistency (Cronbach's alpha 0.88). The prevalence of high fatigue (FSS score>?=?5) was 23.1% in the total sample. More women (26.2%) than men (19.8%) experienced high fatigue (p?=?0.004). Respondents with chronic illness (more than six months) reported a higher mean (M?=?4.69, SD?=?1.35) than the rest of the sample (M?=?3.67, SD?=?1.17) (p<0.001). An inverse correlation was found between fatigue and level of formal education (r?=?0.20, p<0.001). Conclusion: The psychometric properties of the Norwegian version of FSS were satisfactory. To avoid over-diagnosing people for high level of fatigue, the threshold for high fatigue probably should be 5 on the FSS scale instead of 4 as had been suggested originally, but further validation of the cut-off point is needed. [ABSTRACT FROM AUTHOR]

Multiple symptoms can have a negative impact on quality of life (QoL), but there is little information about the impact of multiple symptoms on QoL of patients with colorectal cancer (CRC) during outpatient chemotherapy. Therefore, the purpose was to assess the physical and mental QoL in CRC patients over six months of chemotherapy, to evaluate the association of QoL with the presence of multiple symptoms, and to determine which demographic and clinical characteristics are associated with physical and mental QoL scores. Outpatients with CRC (N = 120) completed the Medical Outcomes Study Short Form (SF-12) and Memorial Symptom Assessment Scale (MSAS) at eight time points during six months of chemotherapy. Linear mixed models for repeated measures were used to analyse QoL over time; and its association with demographic and clinical characteristics; and with the presence of multiple symptoms (e.g., 'numbness/tingling' and 'problems with sexual interest'). The CRC patients had worse physical and mental QoL scores than the general population at all time points. Impaired physical QoL was significantly associated with psychological symptom burden (p < 0.001) and numbness/tingling (p < 0.027). Impaired mental QoL was associated with physical symptom burden (p < 0.001), with being female (p < 0.009), younger age (p < 0.024), and having problems with sexual interest (p < 0.009). Impaired QoL was associated with symptoms in CRC outpatients. This information about the symptoms and characteristics associated with worse QoL during chemotherapy may help clinicians identify and inform at-risk patients. •Impaired quality of life (QoL) was associated with symptoms in colorectal cancer (CRC) outpatients. • Impaired physical QoL was associated with psychological symptom burden and numbness/tingling. • Imparied mental QoL was associated with physical symptom burden, female sex, younger age, and problems with sexual interest. • Systematic symptom assessment reduces the risk of underestimation of the symptom burden and its impact on QoL. [ABSTRACT FROM AUTHOR]

Context: Pain management education may improve pain control for some patients, whereas individual differences exist.Objectives: To evaluate possible critical components, facilitators, and hindrances for improved knowledge about pain management, in not hospitalized adult oncology patients with pain from bone metastasis participating in a pain management intervention.Methods: This substudy is a qualitative evaluation of the PRO-SELF Pain Control Program, tested in a randomized controlled trial. During six weeks, 87 participants in the intervention group received tailored coaching encounters by a trained oncology nurse. Three encounters for each patient were audio recorded. The encounter between patient's with the largest (n = 12) and lowest (n = 8) change in knowledge about pain management from before to after the intervention was transcribed verbatim and analyzed with qualitative content analysis.Results: The critical components of the intervention were repetition of information, struggling with resistance, use of peer experiences, and keeping track of variations. Facilitators of improvement were patients' trust and preparedness to try new procedures, the patient's self-awareness and body awareness, and taking active role in own care. Difficulties in processing complex information, culturally conditioned behaviors, fear, and lack of knowledge were the most important barriers to the success of the intervention.Conclusion: Education in pain management in cancer patients requires repeated information, allowing time for overcoming resistance related to dysfunctional beliefs and fear. To facilitate the patient's involvement in their pain management, tailored and person-centered education is needed. [ABSTRACT FROM AUTHOR]

Background: The concept of hope has been measured using the Herth Hope Index (HHI) in different samples, but varying factor structures comprising different items from the HHI have been reported. Therefore, further testing with regard to the dimensionality of the instrument is recommended. Rasch modeling can be used to evaluate validity evidence of an instrument's underlying structure, to identify items with poor fit to the rest of the scale, and to identify items that perform inconsistently across groups. The aim of this study was to assess the HHI's psychometric properties in a sample of cancer patients using a Rasch model. Adult oncology outpatients (n = 167) with pain from bone metastasis were included, and medical records were reviewed for disease and treatment information. Patients completed the 12-item HHI, which measures various dimensions of hope using a 4-point Likert scale that ranges from 1 (strongly disagree) to 4 (strongly agree). The internal scale validity, person response validity, unidimensionality, and uniform differential item functioning were evaluated by applying a Rasch rating scale model.Results: Five (42%) of the twelve items (#3, #4, #5, #6 and #7) did not meet the criterion set for item goodness-of-fit. After removing these 5 items, the resulting 7-item scale demonstrated acceptable item fit to the model, acceptable unidimensionality (52.6% of the variance explained), acceptable person goodness-of-fit, adequate separation, and no differential item function.Conclusion: A 7-item version of the HHI had better psychometric properties than the original 12-item version among patients with cancer-related pain.Trial Registration: The protocol ID is 158,707/V10 and it was registered on ClinicalTrials.gov as NCT00760305 . Registered September 25, 2008. [ABSTRACT FROM AUTHOR]

Purpose Being a parent of a very-low-birth-weight (VLBW) infant can be stressful. We aimed to describe parental hope 42 months after the birth of a VLBW infant and determine whether there is an association between hope and parenting stress with quality of life (QoL), respectively. Design and Methods Fifty-nine parents of VLBW infants completed questionnaires about hope, parenting stress and QoL. Pearson correlation coefficients (r) and linear regression models were used to examine the relationship between the selected variables. To compare groups, t -test was used and Cohen's d for effect size was calculated. Results Parents of VLBW infants were more hopeful than the general population ( p < 0.001). Parenting stress and hope were both independently associated with QoL (p < 0.001). The subgroup of parents of infants with birth weight < 1000 g had less hope ( p = 0.041) and higher parenting stress (p = 0.041) than parents of infants with birth weight 1000–1500 g. Conclusions Hope and parenting stress were both independent determinants of QoL. Parents of the presumably sickest infants had less hope and higher parenting stress than parents of VLBW infants with a birth weight over 1000 g. Hope should be further explored as a coping mechanism in parents of VLBW infants. Practice Implications The clinical implications of the strong association between hope, parenting stress and QoL remain to be determined, but reducing stress and strengthening hope seem to be important. This should be taken into account both at hospital discharge and at follow-up, especially for lower-birth-weight infants. [ABSTRACT FROM AUTHOR]

Aim Design Data Sources Review Methods Results Conclusions Impact Patient or Public Contribution To identify occurrence of harmful incidents related to patient positioning on operating table.Systematic review and meta‐analysis.Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flow diagram depicting the flow information.The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta‐analysis.Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross‐sectional design, and 12 were register‐based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta‐analysis of the two RCTs showed higher risk of chemosis with head‐down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]).Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously.This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high‐quality, well‐designed studies that focus on harmful incidents and prevention of harm related to patient positioning.No patient or public contribution, as this is a review of previous research. [ABSTRACT FROM AUTHOR]

Objective. Total knee arthroplasty is a painful procedure. No studies have evaluated modifiable predictors of acute postoperative pain trajectories during hospitalization. Methods. Consecutive patients (N5188) were enrolled in a longitudinal cohort study and completed a demographic questionnaire, as well as the Brief Pain Inventory, Hospital Depression and Anxiety Scale, Lee Fatigue Scale, Fatigue Severity Scale, and Brief Illness Perception Questionnaire on the day before surgery. Clinical data were extracted from medical records. Setting and Patients. Each patient completed a pain diary that assessed pain at rest and with activity, and hours per day in pain every evening from day of surgery until postoperative day 3. Using hierarchical linear modeling, we investigated which demographic, clinical, symptom, and psychological characteristics predicted initial levels as well as the trajectories of acute pain at rest and with activity, and hours per day in pain. Results. Higher levels of all three acute pain characteristics on the day of surgery resulted in worse trajectories. Higher pain scores with rest and with activity on the day of surgery were associated with more days with femoral block, higher average dose of opioids, and higher emotional response to osteoarthritis. Higher number of comorbidities, higher average dose of opioids, and lower perceived control predicted more hours per day in pain on the day of surgery. Conclusions. This study identified several potentially modifiable predictors of worsening pain trajectories following total knee arthroplasty. Optimal pain management warrants identification of these high-risk patients and treatment of modifiable risk factors. [ABSTRACT FROM AUTHOR]

Background and purpose — Functional limitations after total knee arthroplasty (TKA) are common. In this longitudinal study, we wanted to identify subgroups of patients with distinct trajectories of pain-related interference with walking during the first year after TKA and to determine which demographic, clinical, symptom-related, and psychological characteristics were associated with being part of this subgroup. Patients and methods — Patients scheduled for primary TKA for osteoarthritis (n = 202) completed questionnaires that evaluated perception of pain, fatigue, anxiety, depression, and illness on the day before surgery. Clinical characteristics were obtained from the medical records. Interference of pain with walking was assessed preoperatively, on postoperative day 4, and at 6 weeks, 3 months, and 12 months after TKA. Results — Using growth mixture modeling, 2 subgroups of patients were identified with distinct trajectories of pain-related interference with walking over time. Patients in the Continuous Improvement class (n = 157, 78%) had lower preoperative interference scores and reported a gradual decline in pain-related interference with walking over the first 12 months after TKA. Patients in the Recurrent Interference class (n = 45, 22%) reported a high degree of preoperative pain-related interference with walking, initial improvement during the first 3 months after TKA, and then a gradual increase—returning to preoperative levels at 12 months. Patients in the Recurrent Interference class had higher preoperative pain, fatigue, and depression scores, and poorer perception of illness than the Continuous Improvement class. Interpretation — 1 in 5 patients did not improve in pain-related interference with walking at 12 months after TKA. Future studies should test the efficacy of interventions designed to modify preoperative characteristics. [ABSTRACT FROM PUBLISHER]

Objectives: Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods: Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results: Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion: Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background: One in five patients report chronic pain following total knee arthroplasty (TKA) and are considered non-improvers. Psychological interventions such as cognitive behavioral therapy (CBT), combined with exercise therapy and education may contribute to reduced pain an improved function both for patients with OA or after TKA surgery, but the evidence for the effectiveness of such interventions is scarce. This randomized controlled trial with three arms will compare the clinical effectiveness of patient education and exercise therapy combined with internet-delivered CBT (iCBT), evaluated either as a non-surgical treatment choice or in combination with TKA, in comparison to usual treatment with TKA in patients with knee OA who are considered candidates for TKA surgery.Methods: The study, conducted in three orthopaedic centers in Norway will include 282 patients between ages 18 and 80, eligible for TKA. Patients will be randomized to receive the exercise therapy + iCBT, either alone or in combination with TKA, or to a control group who will undergo conventional TKA and usual care physiotherapy following surgery. The exercise therapy will include 24 one hour sessions over 12 weeks led by a physiotherapist. The iCBT program will be delivered in ten modules. The physiotherapists will receive theoretical and practical training to advise and mentor the patients during the iCBT program. The primary outcome will be change from baseline to 12 months on the pain sub-scale from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the remaining 4 sub-scales from the KOOS (symptoms, function in daily living, function in sports and recreation, and knee-related quality of life), EQ-5D-5L, the Pain Catastrophizing Scale, the 30-s sit-to-stand test, 40-m walking test and ActiGraph activity measures. A cost-utility analysis will be performed using QALYs derived from the EQ-5D-5L and registry data.Discussion: This is the first randomized controlled trial to investigate the effectiveness of exercise therapy and iCBT with or without TKA, to optimize outcomes for TKA patients. Findings from this trial will contribute to evidence-based personalized treatment recommendations for a large proportion of OA patients who currently lack an effective treatment option.Trial Registration: Clinicaltrials.gov : NCT03771430 . Registered: Dec 11, 2018. [ABSTRACT FROM AUTHOR]

Purpose: Colorectal cancer (CRC) patients experience several physical and psychological co-occurring symptoms, but little is known about symptom variation during chemotherapy cycles. Therefore, the aims were (1) to assess the occurrence and severity of frequently occurring symptoms (worrying, lack of energy, numbness/tingling, nausea, and pain) at multiple time points during chemotherapy, (2) to investigate differences in symptom trajectories between chemotherapy groups, and (3) to determine whether selected patient and clinical characteristics are associated with symptom severity throughout the treatment trajectory.Methods: In total, 120 CRC patients receiving chemotherapy with curative or palliative intent completed the Memorial Symptom Assessment Scale (MSAS), Self-Administered Comorbidity Questionnaire (SCQ-19), and Karnofsky Performance Status (KPS) scale eight times, during two cycles of chemotherapy and 3 and 6 months after enrolment. Data were analyzed using linear mixed models for repeated measures to assess the effects of selected variables on outcomes over time.Results: The patients experienced greatest symptom severity in the days following the administration of chemotherapy; these were lack of energy, numbness/tingling (oxaliplatin group), and nausea. Palliative patients reported significantly higher pain scores compared with curative patients over time, whereas the severity of worrying decreased over time in both treatment groups. Age, sex, educational level, performance status, treatment intent and type of chemotherapy were significantly associated with symptom severity throughout the chemotherapy trajectory.Conclusion: Clinicians can use these findings to identify and inform patients about risk for more severe symptom burden, in order to offer supportive care at the right time during the chemotherapy treatment. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate hope in hepatitis C patients 9 years after curative treatment with pegylated interferon and ribavirin. Background: Successful treatment of hepatitis C leads to improved quality of life in responders compared with non‐responders. The long‐term effect of successful treatment on hope in these patients is not known. Design: Cross‐sectional follow‐up study of patients who displayed a sustained virological response to previous hepatitis C treatment. Methods: Patients infected with hepatitis C genotype 2 or 3 from a randomized controlled study during 2004–2006 were included. A representative subgroup of those who achieved a sustained virological response was re‐evaluated in 2012–2014. The patients were examined, had a blood test and completed a questionnaire (Herth Hope Index and demographic and clinical characteristics). The hope level was compared between patients and an age‐matched sample from the general population (N = 1,481). The data were analysed using multiple regression. Results: A total of 104 Norwegian and Swedish hepatitis C patients were included in this follow‐up study; their mean age was 48 years, and 61% were men. Patients treated for hepatitis C scored higher than the general population on the total Herth Hope Index and for 11 of the 12 individual items. Age, gender, educational level, employment status and civil status were associated with a higher Herth Hope Index in those who had received hepatitis C treatment. Conclusion: Patients achieving a sustained viral response had a higher hope level than the general population 9 years after successful treatment of hepatitis C virus infection. [ABSTRACT FROM AUTHOR]

Context: Intensive care unit (ICU) patients experience physical and psychological challenges related to ICU admission in the acute and recovery phases after a critical illness. Involvement of family caregivers (FCs) is essential in the patients' struggle to survive critical illness. FCs report a high symptom burden related to ICU admission. Previous research has investigated mainly single symptoms. Little is known about multiple symptom burden related to FC experiences in an ICU.Objective: This study aimed: 1) to describe the occurrence, severity, and distress related to multiple symptoms in FCs of ICU patients, and 2) to identify associations between the background characteristics and symptom burden of FCs.Methods: This cross-sectional study investigated multiple symptoms in adult FCs of ICU patients. FCs completed a self-report symptom assessment questionnaire within 2 weeks after the patient's admission to the ICU.Results: FCs (N=211) experienced a median of 9 (range 0-24) symptoms, among which, worrying (91%) was the most occurring. Severity and distress varied between symptoms. Younger age, being a spouse of an ICU patient, and having more comorbidities were significantly associated with the number of symptoms.Conclusions: FCs of ICU patients experience multiple symptoms, among which, psychological symptoms are most occurring. Age, relationship to the patient, and comorbidities were significantly associated with the number of symptoms reported by FCs. Comprehensive symptom assessment may identify FCs who are at risk of developing a high symptom burden when the patient is admitted to the ICU. [ABSTRACT FROM AUTHOR]

Context: Colorectal cancer (CRC) is one of the most common cancers worldwide. Patients with CRC may have multiple cooccurring symptoms as a result of their disease or its treatment. Little is known about potential differences in symptom burden in CRC patients scheduled to receive curative versus palliative chemotherapy (CTX).Objectives: The purposes of this study were to investigate the overall symptom burden of patients with CRC before their first CTX treatment or before the initiation of a new CTX regimen and to evaluate for differences in symptom occurrence, severity, and distress between patients with CRC who were scheduled to receive curative versus palliative CTX.Methods: Consecutive patients with CRC were recruited (n = 120), and symptoms were assessed using the Memorial Symptom Assessment Scale before the initiation of the CTX. The most common symptoms that occurred in ≥30% of the patients were evaluated. Differences in occurrence rates and severity and distress scores between the curative (n = 68) and palliative (n = 52) patient groups were evaluated using binary logistic regression and ordinal logistic regression analyses, respectively.Results: In both groups, patients reported an average of 10 cooccurring symptoms. Worrying (65%), lack of energy (59%), feeling drowsy (54%), feeling bloated (53%), pain (51%), and difficulty sleeping (50%) were the most prevalent symptoms. Problems with sexual interest had the highest severity and distress scores in both groups. For the 13 most common symptoms, no significant differences were found between the two patient groups on any of the Memorial Symptom Assessment Scale dimensions (i.e., occurrence, severity, distress).Conclusion: Regardless of the reason for CTX, CRC patients experience a large number of cooccurring symptoms. [ABSTRACT FROM AUTHOR]

Context: The symptom experience of patients with chronic obstructive pulmonary disease (COPD) is extremely complex. It is characterized by multiple co-occurring symptoms. However, very few studies have described this experience in COPD patients.Objectives: The aims of this study were to evaluate for differences in symptom occurrence rates, as well as ratings of symptom severity, frequency, and distress among patients (n = 267) with moderate, severe, and very severe COPD.Methods: The Memorial Symptom Assessment Scale was used to evaluate the multiple dimensions of the patient's symptom experience. Binary and ordinal logistic regression analyses with stage of disease as an ordinal predictor variable were used to evaluate for differences in symptom occurrence rates and ratings of symptom severity, frequency, and distress.Results: Regardless of the severity of their disease, patients reported an average of 12 co-occurring symptoms. Shortness of breath and lack of energy were the only two symptoms that differed significantly among the three disease severity groups in terms of occurrence, severity, frequency, and distress. Patients with very severe COPD reported the highest ratings for shortness of breath and lack of energy across all four symptom dimensions.Conclusion: Regardless of stage of disease, the high symptom burden identified in this study underscores the need for COPD patients to be screened for multiple co-occurring symptoms. [ABSTRACT FROM AUTHOR]

Context: Lung cancer surgery is among the surgical procedures associated with the highest prevalence of pain, but prospective longitudinal studies after the pain trajectory are scarce.Objectives: We aimed to describe the pain trajectory in patients undergoing surgery for primary lung cancer and investigate whether distinct groups of patients could be identified based on different pain trajectories.Methods: Patients (n = 264; 95% thoracotomies) provided data on the average and worst pain intensity, pain location, and comorbidities before, and at one month and five, nine, and 12 months after surgery. Pain profiles were analyzed by latent class mixed models.Results: The occurrence of any pain increased from 40% before surgery to 69% after one month and decreased to 56%, 57%, and 55% at five, nine, and 12 months, respectively. Latent class mixed models identified two classes both for average and worst pain; one class started low with high ratings after one month, then returning to a level slightly higher than baseline. The other class started higher with similar scores through the trajectory. Patients reporting no pain (8%) were placed in a separate class. Higher comorbidity score, preoperative use of both pain and psychotropic medicine characterized the class with overall highest pain for average and/or worst pain.Conclusion: Pain was highly prevalent after surgery, and subgroups could be identified based on different pain trajectories. Patients reported both postoperative pain and pain from chronic conditions. Knowledge about vulnerable patients and risk factors for pain is important to tailor interventions and information about pain. [ABSTRACT FROM AUTHOR]

Aim/objective: Iatrogenic withdrawal syndrome occurs frequently during the tapering phase of opioids and benzodiazepines in paediatric intensive care units. The aim of this study was to explore physicians' and nurses' experiences in patient care and staff collaboration during the tapering phase using a new "algorithm for tapering analgosedation" METHODS: We used a qualitative explorative design with focus groups. The framework method was followed including transcription, familiarisation, coding, developing a framework, applying the framework, charting data into the framework matrix, and interpreting the data. The study was conducted at two paediatric intensive care units at Oslo University Hospital in Norway. Nurses and physicians who had used the new algorithm participated in the study., Findings: Three focus-group interviews were conducted with a total of 15 informants. Three main themes were identified with relevant subthemes: "Caring for a child in withdrawal", "Advantages of the algorithm", and "Challenges of the algorithm". The algorithm positively affected patient care and staff collaboration during tapering. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced nurses due to the risk of false-positive patient assessments., Conclusion: Nurses and physicians in our study experienced that the new algorithm promoted staff collaboration and positively affected patient care. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced staff and resources for continuous staff education., Competing Interests: Conflict of interest The authors declare that they have no personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Functional disabilities are common in intensive care unit (ICU) survivors and may affect their ability to live independently. Few previous studies have investigated long-term functional outcomes with health status before ICU admission (pre-ICU health), and they are limited to specific patient groups., Objectives: The objective of this study was to investigate the prevalence of functional disabilities and examine pre-ICU health variables as possible predictive factors of functional disabilities 12 months after ICU admission in a mixed population of ICU survivors., Methods: This prospective cohort study was conducted in six ICUs in Norway. Data on pre-ICU health were collected as soon as possible after ICU admission using patients, proxies, and patient electronic health records and at 12 months after ICU admission. Self-reported functional status was assessed using the Katz Index of independence in personal activities of daily living (P-ADL) and the Lawton instrumental activities of daily living scale (I-ADL)., Results: A total of 220 of 343 (64%) ICU survivors with data on pre-ICU health completed the questionnaires at 12 months and reported the following functional disabilities at 12 months: 31 patients (14.4%) reported P-ADL dependencies (new in 16 and persisting in 15), and 80 patients (36.4%) reported I-ADL dependencies (new in 41 and persisting in 39). In a multivariate analysis, worse baseline P-ADL and I-ADL scores were associated with dependencies in P-ADLs (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.14-3.06) and I-ADLs (OR: 1.52; 95% CI: 1.03-2.23), respectively, at 12 months. Patients who were employed were less likely to report I-ADL dependencies at 12 months (OR: 0.34; 95% CI: 0.12-0.95)., Conclusion: In a subsample of ICU survivors, patients reported functional disabilities 12 months after ICU admission, which was significantly associated with their pre-ICU functional status. Early screening of pre-ICU functional status may help identify patients at risk of long-term functional disabilities. ICU survivors with pre-ICU functional disabilities may find it difficult to improve their functional status., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Intensive care unit (ICU) patients experience several symptoms, yet patterns of symptoms and their relationship with demographic and clinical characteristics have not previously been investigated., Objectives: To identify and compare subgroups (i.e. latent symptom classes) of intensive ICU patients based on prevalence of co-occurring symptoms over seven days., Research Methodology: Prospective cohort study of adult ICU patients' self-reports of five symptoms during seven days in ICU. Latent class analysis was applied to identify subgroups of ICU patients., Setting: Multicenter study with patients from six mixed ICUs in Norway., Main Outcome Measures: Patient Symptom Survey was used to assess five symptoms (i.e., thirst, pain, anxiousness, tiredness, shortness of breath)., Results: Among 353 included patients, median age was 63 years and 60.3 % were male. Subgroups of patients were identified in a Low class (n = 126, 35.7 %), Middle Class (n = 177, 50.1 %) and High Class (n = 50, 14.2 %) based on reporting of the prevalence of five symptoms. Patients in the Low class had a low prevalence of all symptoms. Middle Class patients had a high prevalence of thirst and tiredness and a low prevalence of pain, anxiousness and shortness of breath. The High class patients had a high prevalence of all symptoms. Symptom prevalence remained stable in the Low and Middle class over time and increased over time in the High class. There were significant differences among symptom classes in use of mechanical ventilation (p = 0.012), analgesics (p < 0.001), alpha-2 agonists (p = 0.004) and fluid restriction (p = 0.006). Patients in the High class received more of these ICU-treatments., Conclusions: Findings suggest that subgroups of ICU patients with distinct symptom experiences can be identified. The High prevalence class patients had consistently high levels of all symptoms across seven ICU days and received more ICU-related interventions., Implication for Clinical Practice: Some ICU patients experience a consistently high prevalence of co-occurring symptoms. Clinicians should be aware of treatment factors that could be linked to a high burden of symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: A diary written for intensive care patients might help fill in memory gaps and promote psychological recovery. In Norway intensive care diaries are mainly authored by nurses and national recommendations ensure a systematic approach to the intervention. Studies describing the patient experience of nurse-written intensive care diaries are needed., Objectives: The aim of this exploratory study is to investigate patientś experience of receiving and reading a nurse-written diary., Design and Setting: This is a cross-sectional multicentre survey among patients discharged from seven intensive care units in Norway., Results: Among the 88 patients included, 90 % were satisfied with the diary handover process. As many as 88 % of the respondents agreed that the diary demonstrated good care, helped them realize how critically ill they had been and understand why recovery takes time (76 %), and made them grateful for surviving (74 %). One third of the respondents (30 %) reported that the diary saddened them, 6 % reported that the diary reminded them of a time in their lives they would rather forget, while 17 % reported that critical events were missing in the diary. However, nearly all patients were in favour of continuing the diary intervention (98 %)., Conclusion: Overall, the respondents were satisfied with the nurse-written diary, the handover as well as the content, and they recommended that the intervention should be sustained., Implications for Clinical Practice: The handover of the diary should be tailored to meet the individual preferences of the patients in terms of timing and approach, since the diary intervention may not suit all patients. Improvements to the intervention could be a more complete narrative in the diary including both positive and critical events during the intensive care trajectory., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To review the literature on thirst in intensive care unit (ICU) patients and report potential causes, risk factors, diagnosis and measurement tools, as well as potential co-occurrence with other distressing symptoms, and the management of thirst in the ICU., Design: A scoping review employing the Joanna Briggs Institute methodology., Methods: PubMed, MEDLINE, EMBASE and CINAHL were searched from inception to April 2024. Any type of empirical study reporting thirst or associated xerostomia in adult patients (≥18 years) admitted to an ICU or high dependency unit for more than 24 h were included., Results: The search yielded 907 unique records, and after evaluating 65 full-text publications, 21 studies were included. Thirst intensity was addressed most often (eleven studies), whereas the experience (or quality) of thirst and the validation of a measurement instrument, were addressed in only one study. Although co-occurrence of symptoms was addressed in four studies, only one pilot study looked into the interaction of thirst with other symptoms. Intervention studies have been focussing primarily on mouth-care interventions., Conclusion: Thirst is a distressing symptom in the ICU, with reported high prevalence and intensity. Knowledge about its causes, interventions that incorporate minimising its risk, occurrence and intensity are limited., Implications for Clinical Practice: Health care providers should acknowledge thirst as a prominent symptom for ICU patients. They should possess knowledge on the factors that potentially evoke or aggravate thirst. Regular and timely relief of thirst by oral care with cold swabs and the application of menthol can be regarded as a first choice of intervention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Health status, including cognitive functioning before critical illness, is associated with long-term outcomes in intensive care unit survivors. Premorbid data are therefore of importance in longitudinal studies. Few patients can self-report at intensive care admission. Consequently, proxy assessments of patients' health status are used. However, it remains unclear how accurately proxies can report on an intensive care patient's cognitive status., Objectives: The aim of this study was to examine the agreement between patient- and proxy-reporting of the Cognitive Failures Questionnaire and to compare the agreement between proxy reports using the latter questionnaire and the Informant Questionnaire of Cognitive Decline in the Elderly as a reference., Methods: The present cohort study is part of a longitudinal multicentre study collecting both patient and proxy data using questionnaires and clinical data from medical records during intensive care unit stays. Agreement on patient and proxy pairs was examined using intraclass correlation coefficient (ICC), Spearman's correlation, percentage agreement, and Gwet's AC1 statistics. Agreement between the proxy-reported questionnaires was examined using percentage agreement and Gwet's AC1 statistics., Results: In total, we collected 99 pairs of patient-proxy assessments and 158 proxy-proxy assessments. The ICC for the sum scores revealed moderate agreement (n = 99; ICC = 0.59; 99% confidence interval [CI]: [0.30-0.76]) between patient and proxy. Agreement on items was poor (AC1 = 0.13; 99% CI: [0.01-0.24]) to moderate (AC1 = 0.55; 99% CI: [0.43-0.68]). Agreement using cut-off scores (>43) to indicate cognitive impairment was very good (89.9%, AC1 = 0.87; 99% CI: [0.79-0.95]). Agreement between the proxy-reported Cognitive Failures Questionnaire (>43) and the reference questionnaire (≥3.5) was also very good (n = 158; 85%, AC1 = 0.82; 99% CI: [0.74-0.90])., Conclusions: Proxy assessments of the Cognitive Failures Questionnaire (>43) may be used to indicate cognitive impairment if patients are unable to self-report. Agreement was high between the two questionnaires determined by proxies, showing that these can be used interchangeably to assess cognitive functioning if proxy reporting is needed., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Abstract: Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = -0.15, 95% CI [-0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [-0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [-0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain., (Copyright © 2024 International Association for the Study of Pain.)

Background: Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival., Objectives: To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission., Methods: Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures., Results: High PTSS levels (IES-R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times., Conclusions: The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health professionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these., Competing Interests: Declaration of competing interest We, the authors, do not have any ethical conflicts or financial interests to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: To describe different patterns of communication aimed at preventing, identifying and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit., Design: We conducted a fieldwork study with triangulation of participant observation and individual interviews., Methods: Participant observation of nine patients and 50 clinicians: nurses, physiotherapists and physicians. Subsequent individual face-to-face interviews with nine of the clinicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview., Findings: Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co-existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress., Conclusion: Recognition of symptoms in non-speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom communication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress., Implications for Patient Care: Proactive and reactive symptom assessment of non-speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alternative communication., Impact: This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units., Reporting Method: We used the consolidated criteria for reporting qualitative research., Patient Contribution: A user representative was involved in the design of the study., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Opportunities for communication and participation in decision making are limited for critically ill patients, but family members serving as surrogates enable empowerment of these patients., Objective: The aim of this study was to explore family members' engagement in symptom communication in the intensive care unit., Methods: A qualitative descriptive design using fieldwork methodology with triangulation of participant observation and individual interviews was conducted. Nine mechanically ventilated patients were observed in interaction with family members and clinicians in the intensive care unit. Six of the observed patients, 6 family members, and 9 clinicians were interviewed after participant observation. Field notes and transcripts were analyzed using Braun and Clarke's method of thematic analysis., Results: Family members engaged actively in symptom communication, assessment, and management, and there were barriers and facilitators to family engagement. Three main themes and 9 subthemes describing family engagement emerged: (1) intermediary role (recognize and report symptoms, provide patient information, and assist in communication), (2) independent role (provide familiarity, manage symptoms, and promote patient communication), and (3) conditions for family engagement (intensive care unit environment, relationship with the patient, and patient preferences)., Discussion: Family members have unique knowledge of the patient that differs from and complement the competence of the staff, and might contribute to improved symptom communication. Future research should examine how family members can contribute to symptom communication, assessment, and management., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Post-traumatic stress symptoms (PTSS) following intensive care unit (ICU) treatment may increase morbidity and mortality. Therefore, it is important to identify patients at risk of suffering from such symptoms., Objectives: The objective of this study was to describe the prevalence and identify possible predictive factors associated with high levels of PTSS 3 months after ICU admission., Methods: A multicentre, observational study was carried out in six ICUs in Norway. Patients aged ≥18 years were included. The Impact of Event Scale-Revised measured PTSS 3 months after ICU admission. The impacts of pre-ICU measures; demographic and clinical measures; and daily measures of pain, agitation, and delirium were analysed using univariate and multivariate logistic regression models., Results: In total, of the 273 patients included, the prevalence rate of high levels of PTSS was 19.8% (n = 54) 3 months after ICU admission (95% confidence interval [CI]: [15.2, 25.0]). Female gender, age, pre-ICU unemployment, a minimum of one episode of agitation or delirium, and pre-ICU level of functioning in daily living were all significantly associated with high levels of PTSS in univariate logistic analyses. In the multivariate logistic regression, two models were analysed. In model 1, episodes of agitation during ICU stay (odds ratio [OR] = 4.73; 95% CI: [1.17, 19.0]), pre-ICU unemployment (OR = 3.33; 95% CI: [1.26, 8.81]), and pre-ICU level of functioning in daily living (OR = 0.78; 95% CI: [0.63, 0.96]) (implying lower level) increased the odds of reporting high levels of PTSS. In model 2, pre-ICU unemployment (OR = 2.70; 95% CI: [1.05, 6.93]) and pre-ICU level of functioning in daily living (OR = 0.77; 95% CI: [0.62, 0.95]) (implying lower level) increased the odds of reporting high levels of PTSS., Conclusions: Healthcare personnel are suggested to be aware of ICU patients' pre-ICU employment status, pre-ICU functioning in daily living, and agitation during ICU stay to identify those at risk of PTSS after discharge., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Hope is closely connected to experiences of health and illness. In critical illness, the future may be uncertain regarding survival, recovery, and daily functioning. More knowledge is needed on how to support hope in patients in intensive care units and during the following rehabilitation period., Objectives: The aim of this study was to explore hope and its impacting factors among critically ill patients in the intensive care unit., Methods: This was an exploratory study using semistructured interviews for data collection. Thirteen patients discharged from intensive care were interviewed while still in hospital. Data were analysed using thematic analysis. The consolidated criteria for reporting qualitative research were used for reporting this study., Findings: Three themes, consisting of 8 subthemes, were generated through the analysis. The first theme presented, 'Hope at the point of uncertainty', describes the perception of hope as a phenomenon in critical illness, while the last two, 'Nourishment for hope' and 'Barriers to hope', comprise possible promoting and constraining factors affecting hope during intensive care The overarching theme 'Hope at a crossroads' reflects the overall patient experience of hope in critical illness., Conclusion: To maintain or regain hope, healthcare personnel working with critically ill patients should be aware of the importance of encouraging and acknowledging physical progress even when small. Furthermore, they should attend to patients' relational needs and facilitate their ability to interact as the persons they are, not only as patients., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study is to describe the prevalence, intensity and distress of five symptoms in intensive care unit (ICU) patients and to investigate possible predictive factors associated with symptom intensity., Methods: This is a prospective cohort study of ICU patients. A symptom questionnaire (i.e., Patient Symptom Survey) was used to describe the prevalence, intensity and distress of pain, thirst, anxiousness, tiredness, and shortness of breath over seven ICU days. Associations between symptom intensity and possible predictive factors were assessed using the general estimating equation (GEE) model., Results: Out of 603 eligible patients, 353 (Sample 2) were included in the present study. On the first ICU day, 195 patients (Sample 1) reported thirst as the most prevalent symptom (66%), with the highest mean intensity score (6.13, 95% confidence interval (CI) [5.7-6.56]). Thirst was the most prevalent (64%) and most intense (mean score 6.05, 95%CI [5.81-6.3]) symptom during seven days in the ICU. Anxiousness was the most distressful (mean score 5.24, 95%CI [4.32-6.15]) symptom on the first day and during seven days (mean score 5.46, 95%CI [4.95-5.98]). During seven days, analgesic administration and sepsis diagnosis were associated with increased thirst intensity. Older age and being mechanically ventilated were associated with decreased pain intensity, and analgesic administration was associated with increased pain intensity. Family visits and female gender were associated with increased intensity of anxiousness and shortness of breath, respectively., Conclusions: Self-reporting ICU patients experienced a high and consistent symptom burden across seven days. Certain variables were associated with the degree of symptom intensity, but further research is required to better understand these associations., (© 2023. The Author(s).)

Background: The overall purpose of diaries written during an intensive care stay is to help patients fill in memory gaps from the illness trajectory, which might promote long-term psychological recovery. Diaries have also been shown to benefit nurses in maintaining a view of the patient as a person in the highly technical environment and to promote reflection. There is a lack of research on how nurses might be affected by writing a diary for critically ill patients with a poor prognosis., Objectives: The aim of this study was to investigate nurses' experience of writing diaries for intensive care patients with a poor prognosis., Methods: This study has a qualitative descriptive design and was inspired by the methodology of interpretive description. Twenty-three nurses from three Norwegian hospitals with a well-established practice of writing diaries participated in four focus groups. Reflexive thematic analysis was used. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research checklist., Findings: The overarching theme resulting from our analysis was "Finding the right words". This theme represents the challenge of writing in view of the uncertainty of the patient's survival and of who would read the diary. It was important to strike the right tone with these uncertainties in mind. When the patient's life could not be saved, the purpose of the diary expanded to comforting the family. To put an extra effort into making the diary something special when the patient was dying was also a meaningful activity for the nurses., Conclusions: Diaries may serve other purposes than helping patients to understand their critical illness trajectory. In cases of a poor prognosis, nurses adapted their writing to comfort the family rather than informing the patient. Diary writing was meaningful for the nurses in managing care of the dying patient., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Proper analgosedation is a cornerstone in the treatment of critically ill patients in Pediatric Intensive Care Units (PICUs). Medications, such as fentanyl, morphine, and midazolam, are essential to safe and respectful care. The use of these medications over time may lead to side effects such as iatrogenic withdrawal syndrome (IWS) in the tapering phase. The aim of the study was to test an algorithm for tapering analgosedation to reduce the prevalence of IWS in two Norwegian PICUs at Oslo University Hospital., Methods: A cohort of mechanically ventilated patients from newborn to 18 years with continuous infusions of opioids and benzodiazepines for 5 days or more were included consecutively from May 2016 to December 2021. A pre- and posttest design, with an intervention phase using an algorithm for tapering analgosedation after the pretest, was used. The ICU staffs were trained in using the algorithm after the pretest. The primary outcome was a reduction in IWS. The Withdrawal Assessment Tool-1 (WAT-1) was used to identify IWS. A WAT-1 score ≥3 indicates IWS., Results: We included 80 children, 40 in the baseline group, and 40 in the intervention group. Age and diagnosis did not differ between the groups. The prevalence of IWS was 95% versus 52.5% in the baseline group versus the intervention group, and the peak WAT-1 median was 5.0 (IQR 4-6.8) versus 3.0 (IQR 2.0-6.0) (p = .012). Based on SUM WAT-1 ≥ 3, which describes the burden over time better, we demonstrated a reduction of IWS, from a median of 15.5 (IQR 8.25-39) to a median of 3 (IQR 0-20) (p = <.001)., Conclusion: We suggest using an algorithm for tapering analgosedation in PICUs since the prevalence of IWS was significantly lower in the intervention group in our study., (© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Objectives: To measure the prevalence of anxiety and depression in intensive care patients six months after admission to an intensive care unit and to investigate which variables are associated with anxiety and depression at six months., Research Methodology: In this cohort study, patient-reported outcome measures were collected as soon as possible upon admission and at six months. Two logistic regression models were performed to examine variables associated with reporting anxiety and depression above ≥8 at six months., Setting: Patients were recruited from six intensive care units in two Norwegian hospitals between 2018 and 2020., Main Outcome Measures: The Hospital Anxiety and Depression Scale., Results: A total of 145 patients was included in the study. The patients reported a prevalence of 18.6% (n = 27) and 12.4% (n = 18) of anxiety and depression, respectively. Higher baseline anxiety scores were associated with both higher odds of reporting anxiety and depression above ≥8. Younger age was associated with higher odds of reporting anxiety, and being female was associated with lower odds of reporting depression., Conclusion: Several intensive care survivors reported having symptoms of anxiety and depression six months after admission to the intensive care unit. Younger age, and higher anxiety scores at baseline were variables associated with higher odds of reporting symptoms of either anxiety or depression, while being female was associated with a lower odds of reporting depression., Implications for Clinical Practice: Screening patients for anxiety and depression may help to identify vulnerable patients. Structured follow-ups with intensive care nurses in an outpatient setting may be useful to help patients to work through some of the experiences from the intensive care unit., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To describe work participation in survivors during first year after intensive care unit discharge and examine the impact of selected demographic, clinical and psychosocial factors on return to work 12 months after discharge., Research Methodology/design: A predefined sub-study (prospective cohort study) of a randomised controlled trial., Setting: A Norwegian single-centre university hospital. Medical and surgical adult intensive care survivors, working/on sick leave before admission, in the intensive care unit ≥24 h, were included., Main Outcome Measures: Return to work three, six and 12 months after discharge, and impact of age, pre-existing comorbidities, previous serious life events, coping ability, hope and social support on return to work 12 months after discharge., Results: Included were 284 patients, with mean age 47 years (SD 13.9) and 47 % women. One year after discharge, 69 % were back at work. In the regression analysis, with working at 12 months (yes/no) as the dependent variable, 178 patients, completing questionnaires at three as well as 12 months, were included. Lower age (OR 0.96, 95 % CI [0.93-0.99]), lower pre-existing comorbidities (OR 0.65, 95 % CI [0.43-0.97]), previous serious life events (OR 6.53, 95 % CI [2.14-19.94]), and greater hope at three months (OR 1.09, 95 % CI [1.01-1.17]) were all independently associated with higher odds of returning to work., Conclusion: Following intensive care, age, pre-existing comorbidities, experience of previous serious life events and hope all have a significant impact on return to work, and are important variables to consider during intensive care treatment and rehabilitation., Implications for Clinical Practice: Attention must be paid to patients with prior working capability to ensure return to work after intensive care treatment. Older adults with pre-existing comorbidities might benefit from early, individualised rehabilitation to regain previous working capacity. In addition, there is also a need to support patients' hope during and after critical illness., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Communication in the intensive care unit is challenged by patients' inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques., Objectives: The aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges., Methods: This study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel., Findings: Communication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise., Conclusions: This study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process., (Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Aim: One of the challenges of robotic-assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic-assisted surgery., Design: A descriptive qualitative design., Methods: Seven operating room nurses with experience in robotic-assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used., Results: We identified three categories, (a) patient positioning is challenging during robotic-assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic-assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic-assisted surgery., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Introduction: Thirst is one of the most bothersome symptoms experienced by intensive care unit (ICU) patients. Effective diagnosis and management of thirst in the ICU is essential, particularly as patients are less sedated than previously and more aware of this problem. Currently, no overview of publications on thirst identification and management in ICU patients exists. The scoping review will address the broad question 'What is known about thirst as a symptom in adult critically ill patients?' It aims to provide an overview of the causes and risk factors, diagnosis and measurement, the symptom dimensions and its interaction with other symptoms, and thirst management., Methods and Analysis: The review will follow the Joanna Briggs Institute methodology framework to guide the process and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Methods include: defining the review questions, eligibility criteria, concepts of interest and context; and outlining the search strategy, study selection process, data extraction and analysis. PubMed, MEDLINE, EMBASE and CINAHL will be searched from inception to April 2022., Ethics and Dissemination: Ethical approval is not required, as the scoping review will synthesise information from available publications. The scoping review will be submitted for publication to a scientific journal, presented at relevant conferences and disseminated as part of future workshops with ICU support groups and the critical care professional community., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)