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Objective: This study aims to explore the symptom experiences and psychological feelings of lung cancer patients after radical lobectomy in China., Methods: A qualitative study was conducted using face-to-face semistructured interviews with lung cancer patients who had a radical lobectomy for treatment of their cancer during the convalescence period. Participants (n = 18) were recruited from a general hospital in China, and patients were selected using purposive sampling from September 2021 to February 2022. Interviews were recorded and transcribed verbatim, and Colaizzi's seven-step method of phenomenology was used. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was conducted to report the study., Results: Four themes were extracted from the interview data: physiological dimensions (fatigue, cough or sputum, chest tightness and shortness of breath, daily activities affected, sleep disturbance, lack of appetite); psychological dimensions (negative emotion, fear of cancer recurrence, learning to accept reality, strengthened faith and hope); family dimensions (heavy economic burden, perceived family care, improved health management behavior); and social dimensions (perceived support of medical staff, decreased sense of social value and self-identity, changes in social and working style)., Conclusion: Lung cancer patients are still troubled by many problems during the postoperative recovery period. Medical staff should design and implement effective evaluations and targeted interventions for patients' physical and mental health as soon as possible to improve patients' physical and mental health, as well as their quality of life., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Importance: Postoperative recovery is difficult to define or measure. Research addressing interventions aimed to improve recovery after abdominal surgery often focuses on measures such as duration of hospital stay and complication rates. Although these clinical parameters are relevant, understanding patients' perspectives regarding postoperative recovery is fundamental to guiding patient-centered care., Objective: To elucidate the meaning of recovery from the perspective of patients undergoing abdominal surgery., Design, Setting, and Participants: This international qualitative study involved semistructured interviews with patients recovering from abdominal surgery from October 2016 to November 2018 in tertiary hospitals in 4 countries (Canada, Italy, Brazil, and Japan). A purposive maximal variation sampling method was used to ensure the recruitment of patients with varying demographic, clinical, and surgical characteristics. Data on race were not collected. Each interview lasted between 1 and 2 hours. Interviews were recorded and then transcribed verbatim. Transcripts were then analyzed using an inductive thematic analysis approach. Data analysis was conducted from July 2019 to September 2019., Main Outcomes and Measures: The qualitative analysis revealed themes reflecting the meaning of recovery from the perspective of patients undergoing abdominal surgery., Results: Thirty patients recovering from abdominal surgery were interviewed (15 [50%] female; mean [SD] age, 57 [18] years; 10 [33%] underwent major surgery; 16 [53%] underwent laparoscopic surgery). The interviews revealed that for patients undergoing abdominal surgery, the meaning of recovery embodied 5 overarching themes: (1) returning to habits and routines, (2) resolution of symptoms, (3) overcoming mental strains, (4) regaining independence, and (5) enjoying life. Themes associating the meaning of recovery to traditional parameters, such as earlier hospital discharge or absence of complications, were not identified in the interviews., Conclusions and Relevance: This qualitative study suggests that the meaning of recovery from the perspective of patients undergoing abdominal surgery goes beyond traditional clinical parameters. The elements of recovery identified in this study should be taken into account in patient-surgeon discussions about recovery and when developing patient-centered strategies to improve postoperative outcomes.

Background: Increasingly, it has been seen that patients recovering from COVID-19 may face a second battle of coping with its mental health ramifications. These psychological issues can even be experienced by patients who were asymptomatic or had mild to moderate symptoms, potentially impacting their quality of life., Methodology: This was a prospective observational study to analyse the psychological impact of COVID-19 in recovered patients who presented as prospective convalescent plasma (CP) donors. An interview for the psychological assessment of the prospective donors was carried out. Depression and anxiety in the participants were assessed by HAM-A, and HAM-D scores and Quality of Life were assessed using the WHOQOL-BREF scale., Results: A total of 51 prospective donors were assessed, with a mean age of 34.37 (±9.08) years, with the majority being males (46). No clinically significant depression and anxiety were found on the basis of HAM-D and HAM-A scores. The worst affected quality of life parameter, based on the WHOQOL-BREF scale, was physical quality of life followed by environmental, psychological, and social relationships. Moreover, due to infection, social stigma was experienced by 49.02% of the donors, while 21.97% had anxiety related to convalescent plasma donation as a common livid experience., Conclusion: Poor quality of life and social stigma during the recovery phase is prevalent in COVID-19 recovered patients, for which formulation of holistic support strategies are the need of the hour., (Copyright © 2021. Published by Elsevier Masson SAS.)

Importance: Outpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery., Objective: To evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines., Evidence Review: An initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended)., Findings: In total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations)., Conclusions and Relevance: This review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.

Objective: How does caregivers' life satisfaction shift upon the recovery of an ill spouse? Paradoxically, there is a greater increase in life satisfaction upon death than recovery of a spouse. Our analysis explores this paradox., Method: We follow the two groups of exiting caregivers longitudinally for 4 years from when the partner is still in need of care until the death (N = 152) or recovery (N = 112) of a previously ill partner, comparing their trajectory of life satisfaction. We use the years 2001-2016 of the German-Socio-Economic Panel Study and a growth curve analysis., Results: Contrary to our expectations, bereaved caregivers experience a significantly stronger increase in life satisfaction than spouses whose partners recover from a serious illness, even when we stratify by age, gender and initial life satisfaction to account for significantly different subsample composition. Surprisingly, life satisfaction remains unchanged when the partner recovers. Only if a heavy burden in terms of unpaid care and housework hours or prior care need is lifted, do we observe an increase in life satisfaction among spouses with recovering partners, which is like the one experienced by bereaved caregivers., Discussion: More support for caregivers with high caregiving burdens may alleviate some of the strain associated with spousal caregiving, as-even if the partner dies-a decrease in spousal caregiving hours results in an uplift in life satisfaction., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To better characterize recovery after minimally invasive kidney surgery, we present a study describing patient-reported health-related quality of life (HRQOL) following minimally invasive radical nephrectomy (RN) and partial nephrectomy (PN)., Methods: Patients who underwent minimally invasive PN or RN for renal cancer were invited to enroll in a prospective, patient-reported HRQOL study using the Convalescence and Recovery Evaluation (CARE) instrument and Short Form-12. Patients completed questionnaires at baseline, 2, 4, 8, and 12 weeks after surgery. Mixed repeated measures model were used to assess time effect on HRQOL scores and predictors of scores within each surgery groups., Results: One hundred seventy-seven patients were included in the study: 50 had RN and 127 had PN. At 2 weeks, both groups had significant decreases in Overall CARE, as well as the Pain, Gastrointestinal, and Activity domain scores which remained slightly below baseline at 4 weeks. At 4 weeks only 50% of patients in both the RN and PN cohorts returned to baseline overall CARE score. By 12 weeks 82% returned to baseline overall CARE score in the RN group while 76% of patients did so in the PN group., Conclusion: Convalescence after minimally invasive renal surgery can often extend beyond 4 weeks post-treatment in PN and RN subjects. This information may be used to provide more accurate preoperative counseling in an attempt to improve overall patient satisfaction., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Self-reported depression has been observed in coronavirus disease-2019 (COVID-19) patients, infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), during discharge from the hospital. However, the cause of this self-reported depression during the convalescent period remains unclear. Here, we report the mental health status of 96 convalescent COVID-19 patients who were surveyed using an online questionnaire at the Shenzhen Samii Medical Center from March 2 to March 12, 2020 in Shenzhen, China. After obtaining their informed consent, we retrospectively analyzed the clinical characteristics of patients, including routine blood and biochemical data. The results suggested that patients with self-reported depression exhibited increased immune response, as indicated by increased white blood cell and neutrophil counts, as well as neutrophil-to-lymphocyte ratio. However, the mechanism linking self-reported depression to these cellular changes needs further study. In conclusion, self-reported depression occurred at an early stage in convalescent COVID-19 patients, and changes in immune function were apparent during short-term follow-up of these patients after discharge. Appropriate psychological interventions are necessary, and changes in immune function should be emphasized during long-term follow up of these patients., 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 © 2020 Elsevier Inc. All rights reserved.)

The aim of this study is to explore participants' views and experiences of an eHealth phase 3 cardiac rehabilitation (CR) intervention: Physical Activity Towards Health (PATHway). Sixty participants took part in the PATHway intervention. Debriefs were conducted after the six-month intervention. All interviews were audio recorded and transcribed verbatim. Transcripts were analysed with Braun and Clarke's thematic analysis. Forty-four (71%) debriefs were conducted (n = 34 male, mean (SD) age 61 (10) years). Five key themes were identified: (1) Feedback on the components of the PATHway system, (2) Motivation, (3) Barriers to using PATHway, (4) Enablers to using PATHway, and (5) Post programme reflection. There were a number of subthemes within each theme, for example motivation explores participants motivation to take part in PATHway and participants motivation to sustain engagement with PATHway throughout the intervention period. Participant engagement with the components of the PATHway system was variable. Future research should focus on optimising participant familiarisation with eHealth systems and employ an iterative approach to development and evaluation., Competing Interests: The authors have declared that no competing interests exist.

Background: This study aimed to analyze clinical and imaging features of children with severe Japanese encephalitis (JE), and to analyze causes and solutions for psychiatric symptoms of JE during the convalescent period., Methods: We analyzed clinical information for 78 children with severe JE at the Department of Neurology, Department of Infection, and Department of Rehabilitation in our hospital during 2014-2016. Seventy-eight cases of severe JE were divided into patients with psychiatric symptoms and no psychiatric symptoms groups. We focused on analysis of the patients with psychiatric symptoms group., Results: The incidence of psychiatric symptoms during the convalescent period was 46.15% (36/78). Antipsychotic drugs can effectively control psychiatric symptoms and shorten duration of symptoms. Seventy-one patients underwent reexamination with a head MRI. Of these, 8 cases (8/36 = 22.22%) in patients with psychiatric symptoms group showed new lesions in the basal ganglia, insula, and hippocampus. During the 12-month follow-up, two cases showed reappearance of psychiatric symptoms that had been relieved previously., Conclusion: This study found that severe JE cases revealed a considerable proportion with psychiatric symptoms during the convalescent period., (Copyright © 2019 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Study Design: Retrospective cohort study., Objectives: To investigate the relationship of nutritional status with improvement of activities of daily living in individuals with cervical spinal cord injury., Setting: A convalescent rehabilitation ward at the Toyama Prefectural Rehabilitation Hospital and Support Center for Children with Disabilities in Japan., Methods: This retrospective analysis investigated adults (age ≥20 years) with cervical spinal cord injury who were consecutively admitted to a convalescent rehabilitation ward between 2006 and 2015. Data of 154 patients were analyzed. Nutritional status was evaluated using the Subjective Global Assessment (SGA; 3 groups: well-nourished, suspected of being malnourished or moderately malnourished, severely malnourished) and body mass index (BMI; 3 groups: underweight, standard, and overweight and obese). The main outcome was functional independence measure (FIM) efficiency. Multiple regression analysis was performed to investigate the relationship of SGA and BMI to FIM efficiency., Results: FIM efficiency was significantly higher in the well-nourished group based on the SGA than in the two groups with malnutrition (P = .007: 0.32 vs. 0.26 vs. 0.10). Multivariate regression analysis revealed that FIM efficiency was similar in the underweight and standard group, but was significantly higher in the overweight and obese group (P = .006: 0.20 vs. 0.21 vs. 0.31)., Conclusions: SGA and BMI on admission may be independently associated with FIM efficiency in patients with cervical spinal cord injury.

Background and Aims: To optimize therapeutic decision-making in early invasive colorectal cancer (T1 CRC) patients, it is important to elicit the patient's perspective next to considering medical outcome. Because empirical data on patient-reported impact of different treatment options are lacking, we evaluated patients' quality of life, perceived time to recovery, and fear of cancer recurrence after endoscopic or surgical treatment for T1 CRC., Methods: In this cross-sectional study, we selected patients with histologically confirmed T1 CRC who participated in the Dutch Bowel Cancer Screening Programme and received endoscopic or surgical treatment between January 2014 and July 2017. Quality of life was measured using the European Organization for Research and Treatment 30-item Core Quality of Life Questionnaire and the 5-level EuroQoL 5-dimension questionnaire. We used the Cancer Worry Scale (CWS) to evaluate patients' fear of cancer recurrence. A question on perceived time to recovery after treatment was also included in the set of questionnaires sent to patients., Results: Of all 119 eligible patients, 92.4% responded to the questionnaire (endoscopy group, 55/62; surgery group, 55/57). Compared with the surgery group, perceived time to recovery was on average 3 months shorter in endoscopically treated patients after adjustment for confounders (19.9 days vs 111.3 days; P = .001). The 2 treatment groups were comparable with regard to global quality of life, functioning domains, and symptom severity scores. Moreover, patients in the endoscopy group did not report more fear of cancer recurrence than those in the surgery group (CWS score, 0-40; endoscopy 7.6 vs surgery 9.7; P = .140)., Conclusions: From the patient's perspective, endoscopic treatment provides a quicker recovery than surgery, without provoking more fear of cancer recurrence or any deterioration in quality of life. These results contribute to the shared therapeutic decision-making process of clinicians and T1 CRC patients., (Copyright © 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Objective: Studies that investigate predictive factors for spontaneous recovery (reversion) from mild cognitive impairment (MCI) are only beginning to emerge, and the long-term course of MCI is not properly understood. We aimed to investigate stability of the MCI diagnosis, predictors for reversion, as well as the trajectory of MCI over the course of 12 years., Materials and Methods: Data were drawn from the Swedish population study: Good Aging in Skåne with MCI defined according to the expanded Mayo Clinic criteria. A total of 331 participants, aged 60-95 years with MCI, were used to investigate 6-year MCI stability and reversion, and 410 participants were used to inspect 12-year MCI trajectory. Predictors for reversion included demographical factors, psychological status, and factors tied to the cognitive testing session and the operationalization of the MCI criteria., Results: Over half (58%, 95% CI 52.7-63.3) of the participants reverted back to normal cognitive functioning at 6-year follow-up. Of those with stable MCI, 56.5% (95% CI 48.2-64.8) changed subtype. A total of 23.9% (95% CI 13.7-34.1) of the 6-year follow-up reverters re-transitioned back to MCI at 12-year follow-up. ORs for reversion were significantly higher in participants with lower age (60-year-olds: OR 2.19, 95% CI 1.08-4.43, 70-year-olds: OR 3.11, 95% CI 1.27-7.62), better global cognitive functioning (OR 1.15, 95% CI 1.03-1.29), good concentration (OR 2.53, 95% CI 1.06-6.05), and single-domain subtype (OR 2.68, 95% CI 1.51-4.75)., Conclusion: Our findings provide further support that MCI reversion to normal cognitive functioning as well as re-transitioning to MCI is fairly common, suggesting that the MCI trajectory does not necessarily lead straight to dementia. Additionally, assessment of factors associated with reversion can aid clinicians to make accurate MCI progression prognosis., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

Background: Although patient-centred care could help increase the value of healthcare, practice variations in hip and knee surgery suggest that physicians guide clinical decisions more than patients do. This raises the question whether treatment outcomes still meet patients' expectations. This study investigated whether treatment outcomes measured by patient-reported outcome measures fulfil patients' main expectations (i.e. decreased pain or improved functioning)., Methods: Patients who underwent hip or knee surgery in 20 Dutch hospitals in 2014 were invited to a survey consisting of the KOOS Physical Function Short Form or the HOOS Physical Function Short Form, the NRS pain and the EQ-5D. Patients were asked their main reason for surgery and whether the expectations regarding this reason were fulfilled., Results: A total of 2776 patients completed the survey. The most common reason for surgery was improved functioning (43.7%). Patients who were unable to choose between pain relief and improved functioning and patients who aimed for pain relief experienced more problems before surgery. However, patients who were unable to choose improved more than patients who wanted to improve their functioning on the NRS pain during use and the EQ-5D. More patients who aimed for pain relief felt that their expectations were fulfilled compared to other patients., Conclusions: Although an expectation for an outcome was not related to a greater improvement on that outcome, patient expectations were an indication of patients' improvement due to surgery. Differences in expectation fulfilment may be due to unrealistic expectations. To achieve optimal value, tailoring treatment using patient preferences and managing patient expectations is vital.

Aims and Objectives: To describe the lived experience of recovery during the first 6 months after colorectal cancer surgery., Background: Colorectal cancer is the third most common cancer diagnosis worldwide. Early discharge places demands on healthcare professionals to prepare patients for their return home and to provide them with appropriate support throughout the recovery process. This requires knowledge of what it is like to recover from colorectal cancer surgery., Design: A qualitative phenomenological design was used to describe the structure of recovery after colorectal cancer surgery., Methods: Ten patients recovering from colorectal cancer surgery were interviewed at one month and six months after surgery. The descriptive phenomenological method by Giorgi was used throughout the study., Results: Postoperative recovery was described as a progressive process. This process was accompanied by experiences of physical powerlessness, difficulties with food intake, altered bowel function and dependency on others. The experiences were most intense at the beginning of the recovery but disappeared as time went by and normality in life returned., Conclusion: While recovering from colorectal cancer surgery, patients experience obstacles that impede their ability to live life as normal. Six months after surgery, those experiences disappear or become adjusted to being part of normal life., Relevance to Clinical Practice: Patients should be provided with information about the expected postoperative recovery before discharge from hospital. The need for professional support appears to be most frequently needed in early recovery, but it should be considered on an individual basis., (© 2017 John Wiley & Sons Ltd.)

Some institutions do not have an isolation room. Agitation is managed otherwise, with the idea that restraint or isolation can only be a terrible experience. The care pathway is therefore designed to favour autonomy and to limit restrictions of freedom. In this context, professionals are in constant contact with the user. Example of a unit which advocates this concept of rehabilitation., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Objective: To investigate the attitudes of the parents toward circumcision for 6－14 years old children and their satisfaction with the results., Methods: We performed circumcision in the Department of Urology of Zhongda Hospital for 220 children aged 6－14 years from 220 families between January 2010 and August 2016, including 70 cases of traditional and 150 cases of Shang Ring circumcision. We conducted telephone follow-ups among the parents of the patients concerning the decision-maker, reasons and regret for circumcision, acceptance of a second operation, source of information, satisfaction with surgical results, and reasons for dissatisfaction., Results: Most decisions for circumcision were made by the father, chiefly for health and hygiene. Their main sources of information on circumcision were Internet and friends. The parents of 29 patients were dissatisfied for long recovery or peri- and post-operative pain, including 19 cases (27.1%， 19/70) of traditional and 10 cases (6.7%， 10/150) of Shang Ring circumcision, with statistically significant differences between the two groups (P <0.05)., Conclusions: Most parents were satisfied with circumcision, and the main reasons for dissatisfaction were long recovery and pain. The rate of satisfaction with Shang Ring circumcision was higher than that with traditional circumcision. Shang Ring circumcision is recommended for children aged 6－14 years old.

Purpose: The purpose of this paper is to illuminate the importance of patient care and to explicate the impact of attention on my recovery from bilateral knee replacement surgery and a subsequent revision., Method: The paper uses vignettes to illustrate attention in patient-practitioner interaction., Results: Attention is a precursor to understanding the patient as a unique individual and the problems the patient brings to the therapy experience., Conclusions: The capacity of practitioners to attend to their patients has an impact on patient satisfaction and recovery. Implications for Rehabilitation Attention is the precursor to establishing positive therapeutic alliances with patients. It is essential to attend to the patient as a person with unique experiences, perspectives, and attitudes and to modify treatment based on the person's priorities and desires. Practitioners need to develop the interaction skills necessary to understand their patients as unique individuals.

Background Robotic-assisted radical cystectomy (RARC) is gaining traction as a surgical approach, but there are limited data on patient-reported outcomes for this technique compared to open radical cystectomy (ORC). Objective To compare health-related quality of life (HRQoL) and short-term convalescence among bladder cancer patients who underwent ORC and RARC. Methods Review of a single-institution bladder cancer database was conducted. Baseline and postoperative HRQoL was evaluated using the Bladder Cancer Index (BCI) for 324 patients who had ORC (n = 267) or RARC (n = 57) between 2008 and 2012. The BCI assesses function and bother in urinary, bowel, and sexual domains. Among 87 distinct patients (ORC n = 67, RARC n = 20), we also evaluated short-term postoperative convalescence using the Convalescence and Recovery Evaluation (CARE) questionnaire. Our primary outcomes were HRQoL within 12 months and short-term convalescence within 6 weeks following cystectomy. We fit generalized estimating equation regression models to estimate longitudinal changes in BCI scores within domains, and CARE domain score differences were tested with Wilcoxon rank-sum tests. Results Clinical characteristics and baseline BCI/CARE scores were similar between the 2 groups (all P > .05). Within 1 year after surgery, recovery of HRQoL across all BCI domains was comparable, with scores nearly returning to baseline at 1 year for all patients. CARE scores at 4 weeks revealed that patients treated with ORC had better pain (29.1 vs 20.0, P = .02) domain scores compared to RARC. These differences abated by week 6. Conclusions HRQoL recovery and short-term convalescence were similar in this cohort following ORC and RARC., (© The Author(s) 2016.)

Objective: Intensive care unit diaries have been shown to improve post-critical illness recovery, however, prior reports of diary implementation are heterogeneous. We sought to construct a common framework for designing and implementing Intensive Care Unit diaries based on prior studies., Review Method Used/data Sources: We conducted a focused review of the literature regarding intensive care diaries based on a systematic search of several databases. Two reviewers assessed 56 studies and data were abstracted from a total of 25 eligible studies conducted between 1990 and 2014. We identified key information regarding the development, design, and implementation of the journals. We then grouped elements that appeared consistently across these studies within three main categories: (1) diary target populations; (2) diary format and content; and (3) the manner of diary return and follow-up., Results: Most studies were conducted in European countries in adult intensive care units and targeted patients in both medical and surgical units. The timing of diary initiation was based on the elapsed length of stay or duration of mechanical ventilation. We categorised diary format and content as: entry content, authors, use of standardised headings, type of language, initiation, frequency of entries, and physical location of diaries. Diaries were hand written and many studies found that photographs were an essential element in ICU diaries. We categorised the manner of diary return and follow-up. The context in which intensive care unit diaries were returned were felt to be important factors in improving the use of diaries in recovery., Conclusions: In conclusion, we describe a common framework for the future development of intensive care unit diaries that revolves around the target population for the diaries, their format and content, and the timing of their use. Future studies should address how these elements impact the mechanisms by which intensive are diaries exert beneficial effects., (Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Purpose/objective: To explore demographic, clinical, and psychological factors in intensive care unit (ICU), including self-reported sleep quality and experiences that were associated with posttraumatic stress (PTS) symptoms 6 months after discharge from hospital., Research Method/design: A prospective survey was conducted (N = 222). On the day of transfer to the hospital ward, ICU patients reported pain and state-anxiety levels, as well as ICU and prehospital sleep quality. Two months after hospital discharge, they reported sleep quality at home and experiences in ICU. Six months after hospital discharge, sleep quality, PTS symptoms (measured with the Posttraumatic Stress Disorder Checklist-Specific; PCL-S; VA National Center for PTSD, 2014) and psychological well-being (using Depression, Anxiety and Stress Scales-21; DASS-21; Ware, Kosinski, & Keller, 1994) were reported. Descriptive data analyses were performed and factors associated with PTS symptoms were explored with multiple linear regression., Results: The sample was predominately male (65%), with a mean age 57 years. At baseline, pain intensity was low (M ± SD; 2.25 ± 1.14) and state-anxiety levels were moderate (2.50 ± 2.90). At 6 months, 30% of the sample demonstrated depression, and 13.5% (mean PCL-S score: 26.54 ± 10.52) reported symptoms reflective of PTS. The regression model explained 68.2% of the variance in the PCL-S score. Higher PTS scores were independently associated with frightening experiences in ICU, higher stress and depression scores, pain intensity at baseline, and sleep quality at 6 months., Conclusion/implications: Continuing symptoms of PTS were evident in 14% of the cohort. Screening for prevention and treatment of delirium while a patient is in ICU is essential, and psychological screening and follow-up during recovery would therefore also be beneficial for many patients. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Surgical resilience describes psychological resilience within a surgical setting. Within a surgical setting, psychologically resilient patients have improved recovery and wound-healing. The search for biological correlates in resilient patients has led to the hypothesis that certain endogenous biomarkers (namely neuropeptide Y (NPY), testosterone, and dehydroepiandrosterone (DHEA)) are altered in resilient patients. The concept of surgical resilience raises the question of whether enhanced recovery following surgery can be demonstrated in patients with high titres of resilience biomarkers as compared to patients with low titres of resilience biomarkers. To determine the prognostic value of resilience biomarkers in surgical recovery, a cohort of patients undergoing major surgery should initially be psychometrically tested for their resilience levels before and after surgery so that biomarker levels of NPY, testosterone and DHEA can be compared to a validated psychometric test of resilience. The primary outcome would be length of hospital stay with and without an enhanced recovery program. Secondary outcome measures such as complications, time in rehabilitation and readmission could also be included. If the hypothesis is upheld, resilience biomarkers could be used to support more individualised perioperative management and lead to more efficient and effective allocation of healthcare resources., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: The content validity of patient-reported outcomes (PROs) commonly used to measure postoperative recovery is unknown. The objective of this study was to develop a conceptual framework for recovery after abdominal surgery and to analyze the content of PRO instruments against this conceptual framework., Methods: Qualitative methods were used to develop a conceptual framework for recovery. Patients undergoing abdominal surgery and healthcare professionals were interviewed. Recovery-related concepts were identified using a thematic analysis, and concepts were then linked to the International Classification of Functioning, Disability and Health (ICF). The contents of eight PRO instruments that have been used to measure recovery were then examined using this conceptual framework., Results: A total of 17 patients and 15 healthcare professionals were interviewed. A total of 22 important recovery-related concepts were identified and linked to the ICF. The four most important concepts were "Energy level," "Sensation of pain," "General physical endurance," and "Carrying out daily routine." The number of important recovery-related concepts covered by each instrument ranged from 1 to 22 (mean 7.3 concepts). The SF36 (n = 22), European Organization for the Treatment and Research of Cancer Quality-of-Life Questionnaire-C30 (n = 20), and the Gastrointestinal Quality-of-Life Index (n = 19) covered the greatest number of important recovery concepts. No instrument covered all of the important concepts., Conclusions: The comparison of the contents of PRO instruments commonly used to measure postoperative recovery after abdominal surgery demonstrated major gaps in the representation of concepts that are important to patients and healthcare professionals.

Background: Despite decline in U.S. traffic fatalities, non-fatal injuries remain a main cause of reduced self-reported health. The authors used a nationally representative survey to examine the long-term (≥1 year) implications of traffic injuries on self-care, depression, mobility, pain and activity domains of a widely used measure assessing Health-Related Quality of Life (HRQOL)., Methods: 30,576 participants from panels (2000-2002) of the Medical Expenditure Panel Survey (MEPS) were followed for about two years. The associations between reporting a traffic injury in the first follow-up year and the five domains of the Euroqol Health index (EQ-5D) were assessed using mixed logistic models with outcome severe/moderate problem in each domain. Models adjustment variables included age, gender, education, income, diabetes, asthma, smoking and insurance status., Results: 590 participants reported traffic injuries. In the first follow-up analysis, having an injury was associated with deficits in all domains of the EQ-5D. With the exception of self-care, similar findings were reported in the second follow-up (≥1 year) after injuries with strongest associations between traffic injuries and both mobility and activity (both OR=2.9, P<0.01)., Conclusions: Traffic injuries are significantly associated with long-term reduced HRQOL. Injured individuals may benefit from early intervention programs to prevent the development of secondary complications and reduced HRQOL., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The physical reactions to hematopoietic stem cell donation have been extensively studied, but less is known about factors that predict poorer donation experiences. The aim of this prospective study was to examine demographic and health-related quality of life (HRQOL) factors that might be associated with recovery and side effects. We also described the changes in HRQOL during the donation process. In total, 275 peripheral blood stem cell (PBSC) and 37 bone marrow (BM) consecutive donors completed the SF-36 questionnaire predonation and 4 weeks, and 3 months postdonation. Predonation HRQOL markers were the strongest predictors of time to recovery. Poorer predonation physical health was associated with longer recovery (P = .017) and certain side effects in PBSC donors. Poorer predonation mental health was associated with longer recovery in BM donors (P = .03) and pain after PBSC donation (P = .003). Physical HRQOL scores declined significantly from predonation to 4 weeks postdonation. This was shown both for PBSC and BM donors (P < .001 and P = .009, respectively), but the decline was much greater for BM donors. There was a return to predonation HRQOL values 3 months after donation in both groups with values well above the mean of the general population (P < .001)., (Copyright © 2015 American Society for Blood and Marrow Transplantation. All rights reserved.)

The present study is an observational cross-sectional study. The main purpose of this research was to analyze the perception and behaviors of parents in a series of pediatric upper extremity fracture cases. Hundred and seventeen patients younger than 12 years who were conservatively treated for the upper extremity fracture were included in our study. Parents of the patients were requested to answer a family-centered questionnaire related to their child's fracture and its treatment. When the parents were asked whether they believe casting would be sufficient or not as the treatment of their child's fracture, 84.6% answered 'yes', 13.7% answered 'I am not sure,' and 1.7% answered 'no.' Sixty-four of the parents were not worried about any residual defect in joint or extremity functions related to fracture, whereas 21 were worried and 32 were not sure on this. The rate of searching further information about the child's fracture was 34.2% and the mostly used source was the Internet. Twenty-eight of the 117 respondents (23.9%) emphasized that they would reduce the time their child spend outside the home at least for a while after the removal of cast. When conservatively treating a child's fracture, physicians dealing with traumatology should always consider the parents' perception and behaviors as critically important.

Background: During intensive care unit (ICU) admission, patients experience extreme physical and psychological stressors, including the abnormal ICU environment. These experiences impact on a patient's recovery from critical illness and may result in both physical and psychological disorders. One strategy that has been developed and implemented by clinical staff to treat the psychological distress prevalent in ICU survivors is the use of patient diaries. These provide a background to the cause of the patient's ICU admission and an ongoing narrative outlining day-to-day activities., Objectives: To assess the effect of a diary versus no diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1), Ovid MEDLINE (1950 to January 2014), EBSCOhost CINAHL (1982 to January 2014), Ovid EMBASE (1980 to January 2014), PsycINFO (1950 to January 2014), Published International Literature on Traumatic Stress (PILOTS) database (1971 to January 2014); Web of Science Conference Proceedings Citation Index - Science and Social Science and Humanities (1990 to January 2014); seven clinical trial registries and reference lists of identified trials. We applied no language restriction., Selection Criteria: We included randomized controlled trials (RCTs) or clinical controlled trials (CCTs) that evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs., Data Collection and Analysis: We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to prespecified criteria., Main Results: We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). The study involving relatives of ICU patients was a substudy of family members from one of the ICU patient studies. There was a mixed risk of bias within the included studies. Blinding of participants to allocation was not possible and blinding of the outcome assessment was not adequately achieved or reported. Overall the quality of the evidence was low to very low. The patient diary intervention was not identical between studies. However, each provided a prospectively prepared, day-to-day description of the participants' ICU admission.No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. However, the results were imprecise and consistent with benefit in either group, or no difference. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38)., Authors' Conclusions: Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

Background: Two distinct and large bodies of literature exist on resilience that are of potential interest for surgical outcomes. First is the literature on the impact of resilience on surgical recovery and wound-healing. Second is the literature on biomarkers for resilience, which largely focuses on neuropeptide Y (NPY), testosterone and dehydroepiandrosterone (DHEA). Despite this activity, there is a dearth of literature linking these two bodies of research by investigating biomarkers for surgical resilience and its impact on surgical recovery. This paper reviews both bodies of literature within the context of surgical recovery., Method: Literature searches within Medline and Embase were conducted for studies and previous reviews of resilience biomarkers and for the impact of individual resilience on surgical recovery. Reference lists of the reviews were searched for additional papers. No systematic review is yet possible due to the novelty of the use of resilience biomarkers within a surgical context., Results: This is the first review to explore a potential link between resilience biomarkers and surgical recovery. There are a number of biomarkers that correlate with individual resilience levels and resilient individuals exhibit better recovery trajectories following surgery, suggesting a novel use of such biomarkers for the identification of "surgical resilience"., Conclusion: By identifying surgical resilience, there is potential for utilising these biomarkers as prognostic indicators of likely recovery trajectories from surgery, which in turn complement individualised peri-operative management., (Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Background: Auditory stimulation is often used to evoke responses in unresponsive patients who have suffered severe brain injury. In order to investigate visual responses, we examined visual evoked potentials (VEPs) and behavioral responses to visual stimuli in vegetative patients during recovery to consciousness., Methods: Behavioral responses to visual stimuli (visual localization, comprehension of written commands, and object manipulation) and flash VEPs were repeatedly examined in eleven vegetative patients every two weeks for an average period of 2.6months, and patients' VEPs were compared to a healthy control group. Long-term outcome of the patients was assessed 2-3years later., Results: Visual response scores increased during recovery to consciousness for all scales: visual localization, comprehension of written commands, and object manipulation. VEP amplitudes were smaller, and latencies were longer in the patient group relative to the controls. VEPs characteristics at first measurement were related to long-term outcome up to three years after injury., Conclusions: Our findings show the improvement of visual responding with recovery from the vegetative state to consciousness. Elementary visual processing is present, yet according to VEP responses, poorer in vegetative and minimally conscious state than in healthy controls, and remains poorer when patients recovered to consciousness. However, initial VEPs are related to long-term outcome., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The authors present in the article the results of studying quality of life of patients at various terms after endured iliofemoral phlebothrombosis (from 0 to 60 months), who, depending upon embologenicity of the thrombus in order to prevent pulmonary embolism, were either subjected to implantation of a cava filter or not. The patients were subdivided into two groups: the study group (129 subjects) included those presenting with acute or recently endured iliofemoral phlebothrombosis and a cava filter implanted at various time having elapsed after. The comparison group consisted of 96 patients with endured iliofemoral phlebothrombosis within the same terms and having received conservative treatment without implantation of a cava filter. Quality of life was assessed by two questionnaires, i.e. MOS-SF-36 and CIVIQ. The authors concluded that the patients with endured iliofemoral phlebothrombosis without implantation of a cava filter in the anamnesis demonstrated slightly better measures of quality of life.

The article, based on the literature review, presents actual concerns on prognosis and opportunity to achieve recovery in persons with schizophrenia. Catamnestic long-term studies published during last decades more often indicated a favorable course of schizophrenia than it was in the past. One explanation may be the progress in pharmacotherapy, which allows the achievement of a better outcome in the treatment. On the other hand, the researchers have been committed to more detailed studies on the course of schizophrenia by more frequently repeated public testimonials of the ill persons, which forced the prognosis to be more optimistic. A good example is the discussion about the recovery in schizophrenia and the change in perception of the disease, despite differences in the attitudes between clinicians and patients. Seeing the opportunity to conduct a normal life in spite of serious mental disease is challenging for patients and their relatives, as well for psychiatrists and therapists. It motivates to overcome the limitations that the disease brings and the barriers in society.

This study examined prevalence and predictors of posttraumatic growth in 180 accidentally injured patients of mainland China in their convalescence stage, investigating its relationships with demographic and accidental injury variables, personality, posttraumatic stress disorder (PTSD) symptoms, and coping styles. Our results showed that posttraumatic growth (PTG) presented mostly in the domain of Relating to Others and indicated that PTG was significantly related to marital status, educational level, personality, coping styles, and PTSD symptoms. Avoidance of PTSD symptoms, Openness to experience, and positive coping were significant predictors of PTG. The findings emphasize that when promoting PTG of accidentally injured patients, healthcare providers should facilitate patients utilizing personal resources, understand PTG coexists with PTSD symptoms, and adjust interventions based on the coping styles the patients have adopted.

Objective: To describe the duration of bipolar I major and minor depressive episodes and factors associated with time to recovery., Method: As part of the National Institute of Mental Health Collaborative Depression Study, 219 participants with bipolar I disorder based on Research Diagnostic Criteria analogs to DSM-IV-TR criteria were recruited at 5 academic medical centers from 1978 to 1981 and followed for up to 25 years with the Longitudinal Interval Follow-Up Evaluation. The probability of recovery over time from depressive episodes, the primary outcome measure, was examined with mixed-effects grouped-time survival models., Results: The median duration of major depressive episodes was 14 weeks, and over 70% of participants recovered within 12 months of episode onset. The median duration of minor depressive episodes was 8 weeks, and approximately 90% of participants recovered within 6 months of onset of the episode. Aggregated data demonstrated similar durations of the first 3 major depressive episodes. However, for each participant with multiple episodes of major depression or minor depression, the duration of each episode was not consistent (intraclass correlation coefficient = 0.07 and 0.25 for major and minor depression, respectively). The total number of years in episode over follow-up with major plus minor depression prior to onset of a major depressive episode was significantly associated with a decreased probability of recovery from that episode; with each additional year, the likelihood of recovery was reduced by 7% (hazard ratio = 0.93; 95% CI, 0.89-0.98; P = .002)., Conclusions: Bipolar I major depression generally lasts longer than minor depression, and the duration of multiple episodes within an individual varies. However, the probability of recovery over time from an episode of major depression appears to decline with each successive episode., (© Copyright 2013 Physicians Postgraduate Press, Inc.)

Background: Knowledge is lacking on what predicts psychological distress in cardiac surgery patients., Aim: To describe the post-operative symptoms of anxiety and depression in cardiac surgery patients; to detect associations between those symptoms and patient's experiences of illness and hospitalisation and also their family and social situations; and identify experiences and situations that predict symptoms of anxiety and depression at home when measured at least four weeks after hospital discharge., Method: In this prospective explorative panel study all eligible cardiac surgery patients over a six month period in 2007 were invited to participate. Data was collected at the hospital and at home. Two questionnaires were developed and included the hospital anxiety and depression scale (HADS), questions on family and social issues, patient's experience of illness, hospitalisation and family and social situations., Results: Of the 66 participants few had symptoms of anxiety and depression at hospital or at home. Significant associations were found between symptoms of anxiety and depression measured at home and the same symptoms at hospital; pain and general post-operative symptoms; satisfaction with discharge education; self-assessed post-operative recovery and quality of sleep at home. Post-operative anxiety was predicted by depression at the hospital, not feeling rested upon awakening and presence of pain at home. Post-operative depression was predicted by depression at the hospital and not feeling rested upon awakening., Conclusion: Signs of patients' anxiety and depression should be assessed before surgery and appropriate intervention planned accordingly in order to support patients at risk of post-operative psychological distress.

Background: Health-related quality of life (HRQOL) is an important endpoint following cardiac surgery. Particularly in older age, HRQOL, rather than longevity, is the primary goal of treatment. However, prospective studies describing recovery and HRQOL are still scarce., Aims: To explore recovery patterns and HRQOL in patients undergoing cardiac surgery, emphasizing older patients ≥75 years of age., Methods: In a prospective population-based study, 534 patients (23% ≥75 years) were consecutively included before surgery. HRQOL, medical and socio-demographic variables were measured by questionnaires at baseline, 6 and 12 months after surgery. HRQOL was measured by the short-form health survey (SF-36)., Results: Five hundred and twenty patients were alive 12 months after surgery, 89% responded after 6 and 12 months. Older patients as well as younger patients had a clear overall improvement in HRQOL over the first year after cardiac surgery, more specifically during the first 6 months. The same pattern was found in self-reported NYHA class which improved from baseline to 6 months and stabilized between 6 and 12 months. The only SF-36 scale with different development was Role Physical where younger patients improved more than older patients. Before surgery, patients had substantially lower scores than the population norms. However, on most dimensions of HRQOL older patients reached the level of the norm population after surgery., Conclusion: A selected group of elderly patients can undergo cardiac surgery with excellent results concerning survival and HRQOL. This is of major importance both discussing health care resources and decision making concerning individual patients.

Background: After being through a myocardial infarction (MI), a severe recovery period ensues for the patient. Long-term follow-ups are helpful, but what this should include differs between patients. Today there is no established approach to identify needs for support after an MI., Aim: The aim was to describe sense of coherence (SOC) over time in relation to sex, as well as further SOC in relation to quality of life (QoL) and treatment satisfaction in patients with an MI., Methods: This study had an observational and longitudinal design and followed 18 women and 60 men with an acute MI for 49-67 months after the onset of MI. Instruments used were the SOC-13 and the Seattle angina questionnaire., Results: Women scored lower SOC than men. A main effect of time was shown for comprehensibility which increased significantly from baseline to the long-term follow-up. Women increased from a lower level to an equal level as men at the long-term follow-up. The total SOC was significantly associated with QoL and treatment satisfaction., Conclusion: High comprehensibility and high SOC give the patient a better basis to handle life after MI. Thus, healthcare professionals should keep in mind that SOC and especially comprehensibility have meaning for the patient's ability to handle her or his recovery. Healthcare professionals need to together with the patient identify and work with lifestyle factors that contribute to increased comprehensibility about the disease, which gives the patient the foundation to preserve and promote her or his health both in the short and long term.

Objectives: To explore and explain the challenges, concerns, and coping modalities in ICU-survivors living with a partner or spouse during the first 12 months post ICU discharge., Design: Qualitative, longitudinal grounded theory study., Settings: Five ICUs in Denmark, four general, one neurosurgical., Methods: Thirty-five interviews with patients and their partners at three and 12 months post ICU discharge plus two group interviews with patients only and two with partners only., Findings: The ICU survivors struggled for independence and focussed chiefly on 'recovering physical strength', 'regaining functional capacity', and 'resuming domestic roles'. The first year of recovery evolved in three phases characterised by training, perseverance and continued hope for recovery. The ICU survivors did not seem to worry about traumatic experiences. Rather, their focus was on a wide range of other aspects of getting well., Conclusion: The study offers new insight into post-ICU convalescence emphasising patients' motivation for training to recover. The findings may contribute to defining the best supportive measures and timing of rehabilitation interventions in ICU and post ICU that may help ICU-survivors in their struggle for independence throughout recovery., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: There is a lack of a consistent, operational definition of what it means to be a cancer survivor despite widespread use of the term. The term carries positive connotations of 'beating' cancer, but some people living past cancer do not identify with this portrayal., Methods: The term 'cancer survivor' was first developed and used in the USA for advocacy reasons and to promote research and care of this growing population. Some organizations define a cancer survivor from the time of cancer diagnosis. Researcher and policy makers may use different definitions based on their research or funding priorities., Results: The use of the term 'cancer survivor', its acceptability and its interpretation amongst people living past a cancer diagnosis and primary treatment is relatively understudied. There may be numerous interpretations of cancer survivorship amongst people living past cancer, and some individuals may not relate to the term. DISCUSSION AND IMPLICATIONS FOR CANCER SURVIVORS: Instead of working towards a universal definition of cancer survivorship, we suggest that researchers and policy makers use operational descriptions when discussing the diverse population of people living past a cancer diagnosis.

Background: Cancer patients' strengths and capabilities have received little attention from healthcare providers whose primary focus is on patients' problems. Thus, providers miss an important opportunity to build on cancer patients' strengths. New care approaches are needed that nourish patients' strengths and encourage them to take an active role in their care. Focusing on health assets is 1 such approach. However, so far, little is known about the strengths cancer patients use and experience during their illness and recovery., Objective: The objective of the study was to explore and describe cancer patients' experiences and perception of their strengths, needed or used by themselves or supported by their care providers., Methods: In this qualitative, exploratory study, we collected data from 26 participants in 4 focus group interviews. We conducted a qualitative, thematic analysis with an inductive approach to analyze the interview transcripts., Results: Cancer patients described a large repertoire of strengths they used or wished for during illness and recovery including good mood, mindfulness, willpower, positive relationships, hopes and beliefs, protection, and taking action and control. Patients also reported that healthcare providers rarely focused on patients' strengths, something they fervently wished for., Conclusion: Patients want their strengths to be more appreciated and encouraged by care providers, to become active partners in care and feeling in control., Implications for Practice: Our findings support that patients' own strengths are a crucial factor to get through their illness. Nurses should therefore have a greater focus on eliciting and nourishing patients' personal strengths in their care.

Purpose: This study aimed to investigate how stroke survivors describe their expectations regarding life when coming home, and how these expectations were met on discharge from the rehabilitation clinic and during their first 3 months at home., Method: Semistructured interviews were performed repeatedly with five people, two women and three men, during 3 months around their discharge from hospital. Fifteen interviews were performed and analyzed using content analysis., Results: On discharge from the rehabilitation clinic, the informants described experience of being at a dividing line between the safety of the ward and the unknown at home. Expectations for improvement were high. A few weeks later, they described being on parallel tracks in life, waiting for improvement and adjusting to life at home. Three months after discharge, they were still waiting for improvement and had begun to realize that life might never be the same as before the stroke., Conclusions: Patients after stroke may have high, sometimes unrealistic expectations of recovery at discharge. Health care professionals need to support patients in adjusting to real life by balancing high expectations with realistic views on the prognosis, this to enhance the rehabilitation process. Practicing at home or in a home-like environment is one way to highlight capacity and personal resources.

Objective: Recovery narratives describe the culturally shared understandings about the ideal or desirable way to recover from an illness experience. This paper examines ethnic differences in recovery narratives among women participating in breast cancer support groups in Central Florida, USA. It compares groups serving African-American, Latina, and European American women, with the objective of better understanding the appeal of ethnic-specific illness support groups for culturally diverse populations., Design: A mixed-method study design combined qualitative and quantitative measures, including in-depth interviews, participant observation at support group meetings, collection of printed documents, and a structured survey., Results: Core elements of the recovery narrative drew from the dominant societal cancer discourse of optimism and personal transformation through adversity; however, important ethnic differences were evident in the meaning assigned to these themes. Groups gave distinctive salience to themes of faith and spirituality, empowerment through the migration experience, and becoming a better person through the journey of recovery., Conclusion: The findings suggest that ethnic cancer support groups draw upon dominant societal discourses about cancer, but they espouse distinctive recovery narratives that are consonant with the groups' cultural models of illness. Similarity between ethnic members' individual recovery narratives and that of the group may contribute to the appeal of ethnic illness support groups for culturally diverse populations.

Objective: An evaluation is made of lung function and quality of life 6 months after discharge from the Intensive Care Unit (ICU) among survivors of acute respiratory distress syndrome (ARDS) due to pandemic 2009 influenza A H1N1, based on studies of lung function and the EQ-5D health questionnaire., Design: Case series., Setting: The ICU of Dr. Leónidas Lucero Acute Cases Municipal Hospital, Bahía Blanca, Argentina., Patients: PATIENTS discharged from the ICU who had been admitted with ARDS in 2009 due to influenza A H1N1., Results: Eleven patients were studied. Seven were positive for influenza H1N1 and four were negative. The mean age was 37±9.5 years, and 73% were males. Quality of life, as measured by the EQ-5D, showed changes in the 5 components in all patients, particularly in the pain/discomfort dimension 1.55±0.52; health status (EQ%health) was 70%±24. The indices adjusted for Argentina were Time Trade Off (TTO) 0.903±0.085 and Visual Analog Scale (VAS) 0.827±0.153. In all patients, spirometry and the study of pulmonary diffusion (DLCO) showed values of >80%. There was no correlation between lung diffusion and quality of life (%DLCO and EQ%health). A correlation was observed between quality of life and TTO (EQ%health and TTO), and between quality of life and the VAS score (EQ%health and VAS)., Conclusion: Although the sample is small, our results suggest that patients with ARDS due to influenza A H1N1 evaluated 6 months after discharge from the ICU show no deterioration of lung function, and the impact on quality of life is moderate-in contrast to the situation found in patients with ARDS of other etiologies., (Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

We conducted this qualitative study to elicit the experiences of midlife women who survived myocardial infarctions (MIs) and returned home to recover. We selected a phenomenological research method based on the philosophy of Merleau-Ponty. The researcher interviewed eight women ranging in age from 45 to 65. The interviews were transcribed and analyzed using the approach of Thomas and Pollio. For the women in this study, figural themes of the experience of the MI and recovery must be understood within the existential grounds of the body and others. Themes included the following: (a) interference, (b) freedom/unfreedom, (c) knowing/not knowing, and (d) living in fear. Based on the findings of this study, we suggest that women need to be better educated before leaving the hospital. Returning home post MI was a difficult time, and the women in this study felt a support group for female MI survivors was needed.

This longitudinal questionnaire study conducted among 274 Finnish employees (57% women, average age 45.9 years) in a variety of jobs aimed at identifying groups of employees who share similar mean levels and changes in need for recovery and finding out whether factors regarded as antecedents of need for recovery distinguish between the different groups of need for recovery across one year. Using mixture modeling eight groups of need for recovery were identified. The individuals identified as closely resembling each other with respect to need for recovery and its change across one year were considered to belong to the same need for recovery group. Five of these groups indicated stable (low, moderately low, average, moderately high, and high) need for recovery and three showed change (mostly decreasing) in the level of need for recovery across one year. Employees in the favorable (low and moderately low) need for recovery groups (38%) reported to have more favorable work characteristics and better functioning recovery experiences and they spent more time on physical and social off-job activities than those in the unfavorable (high and moderately high) groups (23%). Thus, the antecedents examined play a significant role in maintaining need for recovery over time.

Purpose: To investigate the association of the intention to recover from work with fatigue and its moderating effect on the link between occupational characteristics and fatigue., Methods: Three hundred and eighty Austrian employees (nurses, teachers and administrative staff) participated in a survey assessing fatigue, the intention to create and engage in recovery activities and effort-reward imbalance as a measure of job characteristics. Data were analysed by regression analysis., Results: Recovery intention was negatively associated with fatigue. This association was especially pronounced under conditions of high effort-reward imbalance, thus suggesting a buffering effect. Effort-reward imbalance, in return, was positively related to prolonged fatigue, indicating that fatigue was partly work related in the present sample., Conclusions: Individuals differ in their intent to engage in recovery activities. Those high in recovery intention are less exhausted, especially under conditions of more demanding and less rewarding work characteristics. Thus, a promotion of recovery intentions could contribute to the prevention of work-related fatigue.

Background: Patient satisfaction with perioperative care plays an important role in the assessment of quality of care. Written evaluation forms are commonly used all over the world for this purpose. The aim of this study was to assess the quality of perioperative care, with special attention being directed to anaesthesia-associated side effects., Methods: Forty-two adult patients, of both sexes, scheduled for abdominal surgery, were asked to complete a questionnaire consisting of 11 questions on anaesthesia, side effects and the general quality of perioperative care. The results were analysed using the X2 test, and p < 0.05 was considered significant. The Pearson correlation coefficient was used for comparison., Results: There was a strong correlation between the quality of the pre-anaesthesia visit, including the information obtained on possible complications and alternative methods of anaesthesia, and the assessment of quality of the anaesthesia service. Post-anaesthesia care facilities were also found to be of major importance for patients., Conclusions: Adequate, detailed and easily understandable information plays a crucial role in patients satisfaction with anaesthesia. Special attention should be paid to the most common side effects and complications. Residents should be trained in communication in the early stages of their training.

My defi has now saved my life several times in the past. On the other hand it has also often given me a shock in situations which from a medical point of view were not absolutely necessary. In particular it is the coping with this shock which brings me to contradict the standard phrase"Don't be afraid you are protected by the defibrillator!". But I am afraid because my quality of life is substantially impaired not only by the high number of shocks suffered. Each new defi shock triggers in me a series of recurring reaction patterns. There is a tendency to observe by me that with every new shock the restoration of a rudimentary emotional equilibrium always takes longer. However, I want to be able to appear in public again without being accompanied every step of the way by the notion of collapsing in public or to twitch like an electric eel. I can't get used to the idea of an existence as a ticking time bomb.

Unlabelled: Compared to open surgery, laparoscopic treatment has been shown to have several advantages, including lower levels of postoperative pain, faster recovery, and better cosmetic results. Nevertheless, the advantages of laparoscopy are being debated as possibly not being merely related to biomedical factors., Material and Methods: The study consisted of two sub-studies. In the first study, 150 healthy, previously unoperated volunteers, not employed in the health services, were included. Healthy volunteers, from the latter study, were given questionnaires that presented different sizes of post-operative wounds and examined their perception of the severity of the illnesses that were treated by surgery leading to these wounds. In the second study, data was collected from 65 laparoscopic cholecystectomy patients and 35 patients treated by the open approach cholecystectomy. Patients from the second study were examined prior to operation and 1 month after surgery with a questionnaire evaluating their subjective perception of the disease., Results: Subjective perception of the severity of disease (SPSD) was similar between the laparoscopy and the open approach cholecystectomy patients before the operation (respectively, 6.25±1.7 and 6.06±2.2; ns). At the follow-up, a significant decrease of SPSD among laparoscopy patients was observed (post-op score = 3.28±0.8, p<0.05 in paired t-Student test), but not in the open approach patients (6.42±1.7, ns in paired t-Student test). The volunteers perceived that the disease of the laparoscopically treated patients was less serious than the disease of those treated with open surgery., Conclusions: The authors would like to emphasize that the study presents a new approach to the explanation of the so called "laparoscopy phenomenon", i.e. much faster and smoother recovery after relatively larger and more serious surgical procedures. We believe that the benefits observed among the videoscopy patients might be, apart from immunological and pain-related factors, attributed to the psychological influence of cognitive representations of the disease severity on pain, analgetics use, and recovery.