Initiative for Burnout of ICU Caregivers: Feasibility and Preliminary Results of a Psychological Support.

BACKGROUND: Intensive care unit (ICU) caregivers are at high risk of burnout and the shortage of this highly specialized personal is a problem. The feasibility and impact of a psychological intervention were never assessed in this special context. METHODS: A randomized controlled single-blind study in an ICU. The first intervention consisted in weekly problem-based sessions led by psychologists with small groups of caregivers using a systemic approach over 3 months. The modified intervention was lead for 9 months. The scores of Maslach Burnout Inventory and Hospital Anxiety and Depression Scale were compared between the intervention and control groups, before and after the intervention. RESULTS: One-hundred and sixty six caregivers were randomized in intervention and control groups. The major finding was the way the psychologists could modify the original methodology in order to enable caregivers to attend the sessions. Burnout scores tended to decrease across the whole ICU team after the intervention period, more in the intervention group. Participation in the study was poor at 6 months after intervention. CONCLUSIONS: This is the first study attempting to evaluate a psychological intervention on the mental health of ICU caregivers. It shows a modified method of a psychological support with a systemic approach in the special environment of ICU. Notwithstanding the modest results related to the short length of the process and the turnover of the personal, we demonstrated that such an approach is feasible. Further studies on larger scale and of longer duration are needed to investigate the effect of such interventions on the mental health of ICU caregivers.

Feasibility of a multiple-choice mini mental state examination for chronically critically ill patients.

OBJECTIVES: Following treatment in an ICU, up to 70% of chronically critically ill patients present neurocognitive impairment that can have negative effects on their quality of life, daily activities, and return to work. The Mini Mental State Examination is a simple, widely used tool for neurocognitive assessment. Although of interest when evaluating ICU patients, the current version is restricted to patients who are able to speak. This study aimed to evaluate the feasibility of a visual, multiple-choice Mini Mental State Examination for ICU patients who are unable to speak. DESIGN: The multiple-choice Mini Mental State Examination and the standard Mini Mental State Examination were compared across three different speaking populations. The interrater and intrarater reliabilities of the multiple-choice Mini Mental State Examination were tested on both intubated and tracheostomized ICU patients. SETTING: Mixed 36-bed ICU and neuropsychology department in a university hospital. SUBJECTS: Twenty-six healthy volunteers, 20 neurological patients, 46 ICU patients able to speak, and 30 intubated or tracheostomized ICU patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multiple-choice Mini Mental State Examination results correlated satisfactorily with standard Mini Mental State Examination results in all three speaking groups: healthy volunteers: intraclass correlation coefficient = 0.43 (95% CI, -0.18 to 0.62); neurology patients: 0.90 (95% CI, 0.82-0.95); and ICU patients able to speak: 0.86 (95% CI, 0.70-0.92). The interrater and intrarater reliabilities were good (0.95 [0.87-0.98] and 0.94 [0.31-0.99], respectively). In all populations, a Bland-Altman analysis showed systematically higher scores using the multiple-choice Mini Mental State Examination. CONCLUSIONS: Administration of the multiple-choice Mini Mental State Examination to ICU patients was straightforward and produced exploitable results comparable to those of the standard Mini Mental State Examination. It should be of interest for the assessment and monitoring of the neurocognitive performance of chronically critically ill patients during and after their ICU stay. The multiple-choice Mini Mental State Examination tool's role in neurorehabilitation and its utility in monitoring neurocognitive functions in ICU should be assessed in future studies.

Advance Directives and Communication Skills of Prehospital Physicians Involved in the Care of Cardiovascular Patients.

Advance directives (AD) were developed to respect patient autonomy. However, very few patients have AD, even in cases when major cardiovascular surgery is to follow. To understand the reasons behind the low prevalence of AD and to help decision making when patients are incompetent, it is necessary to focus on the impact of prehospital practitioners, who may contribute to an increase in AD by discussing them with patients. The purpose of this study was to investigate self-rated communication skills and the attitudes of physicians potentially involved in the care of cardiovascular patients toward AD.Self-administered questionnaires were sent to general practitioners, cardiologists, internists, and intensivists, including the Quality of Communication Score, divided into a General Communication score (QOCgen 6 items) and an End-of-life Communication score (QOCeol 7 items), as well as questions regarding opinions and practices in terms of AD.One hundred sixty-four responses were received. QOCgen (mean (±SD)): 9.0/10 (1.0); QOCeol: 7.2/10 (1.7). General practitioners most frequently start discussions about AD (74/149 [47%]) and are more prone to designate their own specialty (30/49 [61%], P < 0.0001). Overall, only 57/159 (36%) physicians designated their own specialty; 130/158 (82%) physicians ask potential cardiovascular patients if they have AD and 61/118 (52%) physicians who care for cardiovascular patients talk about AD with some of them.The characteristics of physicians who do not talk about AD with patients were those who did not personally have AD and those who work in private practices.One hundred thirty-three (83%) physicians rated the systematic mention of patients' AD in the correspondence between physicians as good, while 114 (71%) at the patients' first registration in the private practice.Prehospital physicians rated their communication skills as good, whereas end-of-life communication was rated much lower. Only half of those surveyed speak about AD with cardiovascular patients. The majority would prefer that physicians of another specialty, most frequently general practitioners, initiate conversation about AD. In order to increase prehospital AD incidence, efforts must be centered on improving practitioners' communication skills regarding death, by providing trainings to allow physicians to feel more at ease when speaking about end-of-life issues.

ICU research: the impact of invasiveness on informed consent.

PURPOSE: Studies into the preferences of patients and relatives regarding informed consent for intensive care unit (ICU) research are ongoing. We investigated the impact of a study's invasiveness on the choice of who should give consent and on the modalities of informed consent. METHODS: At ICU discharge, randomized pairs of patients and relatives were asked to answer a questionnaire about informed consent for research. One group received a vignette of a noninvasive study; the other, of an invasive study. Each study comprised two scenarios, featuring either a conscious or unconscious patient. Multivariate models assessed independent factors related to their preferences. RESULTS: A total of 185 patients (40 %) and 125 relatives (68 %) responded. The invasiveness of a study had no impact on which people were chosen to give consent. This increased the desire to get more than one person to give consent and decreased the acceptance of deferred or two-step consent. Up to 31 % of both patients and relatives chose people other than the patient himself to give consent, even when the patient was conscious. A range of 3 to 17 % of the respondents reported that they would accept a waiving of consent. Younger respondents and individuals feeling coerced into study participation wanted to be the decision makers. CONCLUSIONS: Study invasiveness had no impact on patients' and relatives' preferences about who should give consent. Many patients and relatives were reluctant to give consent alone. Deferred and two-step consent were less acceptable for the invasive study. Further work should investigate whether sharing the burden of informed consent with a second person facilitates participation in ICU research.

Synthesis, structure and properties of {M4O4} cubanes containing nickel(II) and cobalt(II).

A survey of the crystal structures containing simple {M4O4} cubane units is reported. It shows that the average M-M distance in these complexes is relatively constant for a given metal ion M. The structures are all distorted from the idealised cube to a T(d) structure, and most show a further distortion which, however, usually maintains some elements of symmetry. A system for classifying the different types of ligand in these complexes is proposed. Two new cubanes of cobalt(II) and nickel(II) with the ligand (R,R)-bis-1,2-(1-methylbenzimidazol-2-yl)ethane-1,2-diol, (R,R)- or its enantiomer have been isolated and the crystal structure of the cobalt(II) complex confirms the cubane structure. Electronic, CD and (1)H NMR spectra and magnetic susceptibility data are reported. The magnetic data for these and other compounds in the literature are discussed in terms of the structural parameters.