Rationale: Despite functional impairments, intensive care unit (ICU) survivors can perceive their quality of life as acceptable. Objectives: To investigate discrepancies between calculated health, based on self-reported physical, mental, and cognitive functioning and perceived health, 1 year after ICU admission. Methods: Data from an ongoing prospective multicenter cohort study, MONITOR-IC, were used. Patient-reported physical, mental, and cognitive functioning and perceived health (EuroQol visual analog scale; range, 0-100) 1 year post-ICU of patients admitted to 1 of 11 participating ICUs between July 2016 and September 2021 were analyzed. The relationship between functional outcomes and perceived health was modeled using linear regression. Calculated health for each patient was estimated using this model and compared with patients' perceived health, the difference reflecting a discrepancy. On the basis of a minimal clinically important difference of 8 points, three groups were defined: patients who rated their health better than calculated (positive discrepancy), patients who rated their health worse than calculated (negative discrepancy), and patients whose perceived health was concordant with their calculated health. Results: A total of 2,545 patients were analyzed, of whom 45.0% (n = 1,146) showed a discrepancy between calculated and perceived health. Patients with a negative discrepancy rated their health significantly lower (median, 50; interquartile range, 36-66) than patients with a positive discrepancy (median, 84; interquartile range, 75-90). Importantly, there were no significant differences in physical, mental, and cognitive functioning between patients with a negative versus positive discrepancy. Patients with a negative discrepancy had a higher education level and were more often unemployed. Conclusions: One year post-ICU, almost half of ICU survivors showed a discrepancy between calculated health and perceived health.

To evaluate the effect of discussing personalized predictions of long-term quality of life (QoL) on patient and family experiences and outcomes, and on experiences of ICU clinicians. We conducted a randomized clinical trial in two Dutch hospitals, assigning adult ICU patients to receive usual care or the intervention: discussing the expected long-term QoL based on a validated prediction model, during a family meeting in the ICU. Primary outcome was patient and family experience with shared decision-making (CollaboRATE, range 0–100), evaluated < 3 days after the family meeting. Secondary outcomes included ICU professionals’ experiences (Collaboration and Satisfaction about Care Decisions [CSACD] and Ethical Decision-Making Climate Questionnaire [EDMCQ]), symptoms of anxiety and depression among patients and family, and patients’ QoL 3 months and 1 year post-ICU. 160 patients were included, of whom 81 were randomized to receive the intervention and 79 to receive usual care. No significant differences were seen in patients’ and family members’ experiences (median CollaboRATE score 89 [IQR 85–100] in the intervention arm vs 93 [IQR 85–100] in the usual care arm, p = 0.6). The outcomes of patients did not differ, whereas at 1 year post-ICU family members in the usual care group reported a larger increase in depression symptoms (mean 2.3 [SD 4.2] vs 0.2 [SD 3.9], p = 0.04). Regarding ICU professionals’ experiences, an improvement in CSACD score was observed post-intervention (median 40 [IQR 34–45] vs 37 [IQR 32–43], p = 0.01), while no significant change in EDMCQ was found. Incorporating personalized predictions of long-term QoL in family meetings had no measurable effect on patients’ and family members’ experiences. However, a positive effect on family members’ symptoms of depression and ICU professionals’ experienced collaboration was observed. This study was registered at ClinicalTrials.gov: NCT05155150.

OBJECTIVES:After ICU admission, the quality of life (QoL) of ICU survivors is often significantly lower compared to their peers. However, recent studies showed that this impaired QoL cannot be fully explained by the physical, mental, and cognitive problems post-ICU, alluding to other determinants of QoL. Therefore, we aimed to explore ICU survivors' experienced QoL 1-2 years post-ICU, focusing on factors beyond functional outcomes. DESIGN:Qualitative interview study. SETTING:Seven hospitals in the Netherlands. PATIENTS:ICU survivors aged greater than or equal to 16 years admitted to the ICU between July 2022 and January 2023. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:ICU patients were purposively sampled. Interviews were audiotaped, transcribed, and analyzed according to the principles of thematic content analysis. All interviews were coded independently by two researchers and participant recruitment was continued until no new themes were identified. Twenty-four semistructured interviews were performed between March and June 2024. The interviews resulted in 28 categories, from which seven main themes emerged regarding patients' experienced QoL: functional impairments (e.g., physical problems), participation (e.g., independence, work), support (e.g., informal care), environment (e.g., financial resources, personal circumstances), individual values (e.g., perspective on life, religion), comparison (e.g., expectations, reference), and coping (e.g., adaptation, acceptance). Patients described how these themes affected their QoL, both positively and negatively. CONCLUSIONS:This study shows that perceived QoL after critical illness is impacted not only by patients' functional impairments but also by participation, support, environment, individual values, comparison, and coping. The themes identified in this study stress the importance of considering patients' individual and context factors to provide optimal post-ICU support.

With survival rates of critical illness increasing, quality of life measures are becoming an important outcome of ICU treatment. Therefore, to study the impact of critical illness on quality of life, we explored quality of life before and 1 year after ICU admission in different subgroups of ICU survivors. Data from an ongoing prospective multicenter cohort study, the MONITOR-IC, were used. Patients admitted to the ICU in one of eleven participating hospitals between July 2016 and June 2021 were included. Outcome was defined as change in quality of life, measured using the EuroQol five-dimensional (EQ-5D-5L) questionnaire, and calculated by subtracting the EQ-5D-5L score 1 day before hospital admission from the EQ-5D-5L score 1 year post-ICU. Based on the minimal clinically important difference, a change in quality of life was defined as a change in EQ-5D-5L score of ≥ 0.08. Subgroups of patients were based on admission diagnosis. A total of 3913 (50.6

Porter, Lucy L. MD1,2; Simons, Koen S. MD, PhD2; van den Boogaard, Mark RN, PhD1; Zegers, Marieke PhD1 Author Information

Uncertainty is a prevalent concept within medicine, intrinsic to clinical decision-making. Managing uncertainty can be challenging, especially in specialties (i.e. General Practice) where unclear diagnoses are common. This has resulted in curriculums for such specialities introducing teaching on managing uncertainty [1]. With poor tolerance of uncertainty associated with negative outcomes in medical students [2], there is a strong argument that medical schools need to prepare students to manage uncertainty. Uncertainty simulation cases have been utilized to achieve immersive teaching on uncertainty [3], however this is limited by the resources made available by simulation departments, restricting the potential reach of this transformative learning. Aim: To deliver an immersive teaching programme for medical students that develops skills in managing uncertainty within a minimal resource environment. 8 teaching sessions with 46 students were facilitated, which involved students rotating through a circuit of 5 simulated General Practice consultation stations. Students firstly performed the station and then acted as the patient for the next candidate in a continuous cycle ( Circuit Rotation Design – Students started the circuit acting as either the doctor or patient for stations 1-5. After each 10-minute station, there were two minutes for feedback. Students then rotated in a clockwise direction becoming the patient for the station they had previously performed or performing a new station. The students continued to rotate according to this carousel circuit design until they had performed and examined all five stations Students responded positively to the teaching programme, rating its provision of confidence in managing uncertainty and managing GP scenarios (real and OSCE) as >95%. Enjoyment of the sessions was rated at 97% with main aspects being: variety of stations and interactivity. Usefulness of the sessions was rated at 98% with main aspects being: chance to practice, range of cases, receiving feedback. Simulations of GP consultations were rated as highly representative; this was achieved with minimal resources. This teaching programme developed medical students’ confidence and skills in managing uncertainty. They also felt better prepared for managing patients in a GP setting. Critical to the success of this programme was the enjoyment and perceived usefulness of the teaching, as this improved engagement with the learning outcomes. With the cohort being final year students that were integrating knowledge from previous clinical years, we hypothesize that the usefulness was due to students wanting to focus more on revision and opportunities to develop skills in managing less commonly taught but clinically important abstract concepts, such as managing uncertainty. Further programmes should expand on the simulated environments (ED, medical/surgical on-calls) and managing other clinically important abstract concepts (confrontations, prioritization, errors). Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

OBJECTIVES: To develop and externally validate a prediction model for ICU survivors’ change in quality of life 1 year after ICU admission that can support ICU physicians in preparing patients for life after ICU and managing their expectations. DESIGN: Data from a prospective multicenter cohort study (MONITOR-IC) were used. SETTING: Seven hospitals in the Netherlands. PATIENTS: ICU survivors greater than or equal to 16 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Outcome was defined as change in quality of life, measured using the EuroQol 5D questionnaire. The developed model was based on data from an academic hospital, using multivariable linear regression analysis. To assist usability, variables were selected using the least absolute shrinkage and selection operator method. External validation was executed using data of six nonacademic hospitals. Of 1,804 patients included in analysis, 1,057 patients (58.6%) were admitted to the academic hospital, and 747 patients (41.4%) were admitted to a nonacademic hospital. Forty-nine variables were entered into a linear regression model, resulting in an explained variance ( R 2 ) of 56.6%. Only three variables, baseline quality of life, admission type, and Glasgow Coma Scale, were selected for the final model ( R 2 = 52.5%). External validation showed good predictive power ( R 2 = 53.2%). CONCLUSIONS: This study developed and externally validated a prediction model for change in quality of life 1 year after ICU admission. Due to the small number of predictors, the model is appealing for use in clinical practice, where it can be implemented to prepare patients for life after ICU. The next step is to evaluate the impact of this prediction model on outcomes and experiences of patients.

Perioperative respiratory and hemodynamic adverse events are still a cause of morbidity and mortality in pediatric anesthesia. It has been suggested that volatile agents might be associated with more respiratory adverse events compared to intravenous agents (eg, propofol), which have been associated with a higher risk of bradycardia compared to volatile agents. We performed a systematic review and meta-analysis to evaluate the risk of perioperative hemodynamic and respiratory adverse events, comparing intravenous induction with inhalational induction in pediatric anesthesia. We searched PubMed, Embase, and Medline up to February 12, 2020. Randomized controlled trials were included. A quality assessment was carried out using a modified version of the "Cochrane Risk of Bias Tool for Randomized Controlled Trials." Of the 1602 applicable publications, four were included in the final review. Two studies found no significant differences in perioperative respiratory or hemodynamic adverse events. Two studies found a higher risk of respiratory perioperative adverse events in inhalation versus intravenous induction, with a relative risk varying from 1.64 to 3.83. Data were heterogenous, and pooled estimates may not be reliable. The present systematic review and meta-analysis revealed no significant difference in the occurrence of perioperative respiratory adverse events between inhalation and intravenous induction. More respiratory adverse events during and after inhalation induction were found, in particular in children with multiple risk factors for respiratory adverse events. This did not reach significance. Future research should include a large randomized controlled trial comparing inhalation and intravenous induction with respiratory and hemodynamic adverse events as primary outcome and adequately blinded outcome assessors.