Family satisfaction in the ICU: differences between families of survivors and nonsurvivors

BACKGROUND: We previously noted that the families of patients dying in the ICU reported higher satisfaction with their ICU experience than the families of survivors. However, the reasons for this finding were unclear. In the current study, we sought to confirm these findings and identify specific aspects of care that were rated more highly by the family members of patients dying in the ICU compared to family members of ICU survivors. METHODS: A total of 539 family members with a patient in the ICU were surveyed. Family satisfaction was measured using the 24-item family satisfaction in the ICU questionnaire. Ordinal logistic regression identified which components of family satisfaction were associated with the patient's outcome (ie, whether the patient lived or died). RESULTS: A total of 51% of respondents had a loved one die in the ICU. Overall, the families of patients dying in the ICU were more satisfied with their ICU experience than were families of ICU survivors, and the largest differences were noted for care aspects directly affecting family members. Significant differences were found for inclusion in decision making, communication, emotional support, respect and compassion shown to family, and consideration of family needs (p<0.01). CONCLUSIONS: The families of patients dying in the ICU were more satisfied with their ICU experience than were the families of ICU survivors. The reasons for this difference were higher ratings on family-centered aspects of care. These findings suggest that efforts to improve the support of ICU family members should focus not only on the families of dying patients but also on the families of patients who survive their ICU stay.     

Deformation-based morphometry reveals brain atrophy in frontotemporal dementia

OBJECTIVE: To compare deformation-based maps of local anatomical size between subjects with frontotemporal dementia (FTD) and healthy subjects to identify regions of the brain involved in FTD. DESIGN: Structural magnetic resonance images were obtained from 22 subjects with FTD and 22 cognitively normal, age-matched controls. We applied deformation-based morphometry and compared anatomy between groups using an analysis of covariance model that included a categorical variable denoting group membership and covaried for head size. SETTING: University of California, San Francisco, Memory and Aging Center, and the San Francisco Veterans Affairs Medical Center. PATIENTS: Twenty-two subjects with FTD and 22 cognitively normal, age-matched controls. INTERVENTIONS: Neurological, neuropsychological, and functional evaluations and magnetic resonance imaging. MAIN OUTCOME MEASURE: Deformation maps of local anatomical size. RESULTS: Patients with FTD showed extensive, significant atrophy of the frontal lobes, affecting both gray matter and white matter. Atrophy of similar magnitude but less significance was observed in the anterior temporal lobes. The subcortical and midbrain regions, particularly the thalamus, pons, and superior and inferior colliculi, showed strongly significant atrophy of smaller magnitude. CONCLUSIONS: We confirmed frontal and anterior temporal gray matter atrophy in FTD. The observed white matter loss, thalamic involvement, and midbrain atrophy are consistent with pathological findings in late-stage FTD. Dysfunction of ventral-frontal-brainstem circuitry may underlie some of the unique clinical features of FTD.     

Angioplasty and stenting for atherosclerotic intracranial stenosis: rationale for a randomized clinical trial

Atherosclerotic disease of the major intracranial arteries is a frequent cause of stroke. In addition, many patients who have symptomatic intracranial stenosis are at very high risk for recurrent stroke. Preliminary studies suggest that angioplasty and stenting may reduce the risk of stroke in patients who have severe stenosis of intracranial arteries. Data for angioplasty and stenting, however, consist of case series; no randomized studies have been completed to date. This article reviews these data and discusses the rationale for a randomized trial of angioplasty and stenting versus best medical management for patients who have symptomatic intracranial stenosis.     

Preventing stroke: saving lives around the world

Stroke caused an estimated 5.7 million deaths in 2005, and 87% of these deaths were in low-income and middle-income countries. Without intervention, the number of global deaths is projected to rise to 6.5 million in 2015 and to 7.8 million in 2030. The rising burden of stroke, especially in low-income and middle-income countries, leads us to propose a worldwide goal for stroke: a 2% reduction each year over and above that which may happen as a result of better case management and treatment. The experience of high-income countries indicates that sustained interventions can achieve at least the required 4% annual average decline in stroke mortality for people age 60-69 years. Achieving this goal for stroke would result in 6.4 million fewer deaths from stroke from 2005 to 2015. More of these deaths will be averted in low-income and middle-income countries than in high-income countries.     

Recent advances in research on successful or healthy aging

This article reports a selective review of biopsychosocial research on successful or healthy aging published in 2005 and 2006. We describe a number of studies that advance the understanding of the definitions, predictors, mechanisms, and potential interventions for successful aging. Successful aging is a multidimensional construct that awaits a standardized definition. A broad array of phenotypes beyond longevity has been examined, including neurocognition, subjective quality of life, and biological age. Considerable progress has been made toward understanding possible mechanisms of successful aging through translational research. Interventions to augment healthy lifestyles have great potential to enhance global healthy aging.     

Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union

Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to reach an agreement on the appropriate definitions and methodologies to standardise the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin in order to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow-up meeting was arranged in Dublin, at which time all definitions and procedures were finalised. At this stage, all authors confirmed their agreement with the consensus statement. The agreed document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, non-fatal catastrophic injury, and training and match exposures, together with criteria for classifying injuries in terms of severity, location, type, diagnosis and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.