Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare and delayed complication of cranial irradiation. Presenting years and even decades after brain radiotherapy, SMART syndrome is associated with a constellation of neurological symptoms, including severe headaches, episodic visual loss, stroke-like hemiparesis, sensory change and seizures. We describe a case of a male in his 60s who presented with acute onset hemiparesis, aphasia and altered sensation, as well as new recurrent and refractory seizure activity. The patient's case is followed through his eventual diagnosis and successful treatment with high-dose pulse corticosteroids (1000 mg/day intravenous methylprednisolone for 3 days) as well as the long-term clinical and radiographical outcomes.

Background Psychological distress is common after critical illness and can result in long-term psychological morbidities. Early psychological support in the intensive care unit (ICU) may mitigate these effects, yet ICU psychology services remain uncommon in Australia, and little is known about their implementation. Building on the Psychology in Intensive Care Unit Protocol (PICUP) pilot study, further refinement requires understanding the perspectives of those who experienced the service. Aims/objectives This study qualitatively explored (i) how critical care survivors experienced early psychological screening and intervention; (ii) ICU clinicians’ views on the role and value of the psychology service; and (iii) facilitators and barriers to integrating it into routine ICU practice. Methods A qualitative descriptive design was used at a metropolitan Australian ICU where the PICUP model had been implemented. Purposive sampling identified PICUP participants who received psychological support during their admission and clinicians involved in their care. Semistructured interviews were conducted with 16 patient participants and 10 clinicians. Interviews were audio recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Results Patient participants described critical illness as a traumatic and multifaceted experience and viewed psychological support as meaningful when accessed, though many reported limited recall and unmet needs for continuity beyond the ICU. Tailoring support to individual readiness was seen as essential. Clinician participants considered psychology integral to holistic ICU care, with benefits for patient engagement, recovery, and management of complex presentations. They also identified value for significant others and staff. However, clinicians perceived unclear referral pathways, low service visibility, limited psychology resources, and the inherent complexity of the ICU constrained implementation. Conclusions Patient and clinician participants viewed the ICU psychology service as acceptable and valuable but under-resourced and insufficiently embedded. Their perspectives clarify how the service is understood in practice and what needs strengthening for effective implementation. Findings provide direction for refining the PICUP model and guiding the development of a sustainable approach to the inclusion of psychologists in Australian ICUs.

BACKGROUND:Psychological distress is common among intensive care unit (ICU) patients and can lead to long-term adverse psychological sequelae. While early psychological interventions may help mitigate these effects, their feasibility within critical care settings remains largely unexplored. Additionally, the role of psychologists in delivering such interventions in Australia remains unclear, particularly given inconsistencies in workforce availability and integration into standard care. AIMS/OBJECTIVES:The aim of this study was to (i) outline the development of a psychologist-led screening and intervention protocol in an Australian ICU and (ii) evaluate its preliminary feasibility. It also examined the suitability of a potential outcome measure to inform future trial design. METHODS:The Medical Research Council's framework for developing complex interventions in health was applied. The intervention was designed for an Australian metropolitan ICU. It consisted of a modular-based psychological intervention tailored to the patient's level of psychological distress. A single-arm prospective pilot study was conducted, and 30 patients were recruited. Feasibility was assessed based on recruitment rates, patient engagement, and outcome measure completion. RESULTS:Recruitment challenges were observed, with a low eligibility screening rate. Staffing constraints and consent-related barriers further limited recruitment. Intervention engagement was high, with 96% of consenting participants completing at least one intervention component. Outcome measure completion rates supported the feasibility of a larger trial, with preliminary findings suggesting a significant reduction in negative emotional affect over time. Consistent with the Medical Research Council's framework, refinements to the intervention are recommended. CONCLUSIONS:The findings support the feasibility of a psychologist-led intervention in the ICU, though refinements are necessary to improve recruitment, streamline delivery, and enhance engagement. This study highlights the potential of early psychological interventions to improve patients' emotional well-being. Addressing staffing limitations and consent barriers could enhance accessibility and effectiveness in future trials. REGISTRATION:This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000619640), with the first participant recruited on 4/07/2023.

Introduction: Intensive care unit clinical research is often implemented by specialised research co-ordinators (RCs). Clinical research activity within Australian and New Zealand intensive care units has escalated, particularly during the COVID-19 pandemic. Growth of the intensive care RC workforce to match research demand is poorly understood. Aim: The aim of this study was to repeat an Intensive Care Research Coordinator Interest Group workforce survey conducted in 2004 and 2009 to describe the current workforce and role satisfaction and also to determine reported symptoms of depression, anxiety, stress, and burnout in Australian and New Zealand intensive care RCs. Methods: In April 2021, an online anonymised survey was distributed to intensive care RCs to complete demographic and workforce questions, the McCloskey/Mueller Satisfaction Scale, the Depression Anxiety Stress Scales-21, and the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Results: Of 128 Intensive Care Research Coordinator Interest Group eligible members, 98 (77%) completed the survey. Respondents were mainly women (91%), the median age was 47 years, 37% have a postgraduate qualification, and a third have over 10 years of RCC experience (31%). Half do not have permanent employment (52%). The mean Depression Anxiety Stress Scales-21 scores were within the normal range, and respondents reported symptoms of depression (21 [21%]), anxiety (23 [23%]), and stress (26 [27%]). Nearly half of the respondents (44%) exhibited an early symptom of burnout by reporting problematic experiences of work. The overall role satisfaction score was 3.5/5 (neutral; neither satisfied nor dissatisfied). Conclusions: Intensive care RCs are an experienced group of professionals with limited satisfaction in the role. One-fifth of the ICU RCs experienced depression, anxiety, or stress symptoms, with close to half reporting signs of burnout. These results highlight the need to address areas of concern to ensure retention of this specialised intensive care workforce. Crown Copyright (c) 2022 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.

Introduction: Intensive care unit (ICU) clinical research is implemented by specialised research coordinators (RCs). ICU RCs were surveyed on workforce and role satisfaction in 2004. Clinical trials activity through the Australian and New Zealand Intensive Care Society, Clinical Trials Group has escalated since 2004, particularly during the COVID-19 pandemic. Progress of the ICU RC workforce and role satisfaction is poorly understood.

Introduction Hospital mortality for critically ill patients has decreased significantly throughout the developed world over the past two decades, attributable to improvements in the quality of intensive care, advances in critical care medicine and technologies that provide long-term multiorgan support. However, the long-term outcomes of intensive care unit (ICU) survivors is emerging as a real issue. Cognitive and physical impairments suffered by ICU survivors are common including profound weakness, pain and delirium which are inextricably linked. This study aims to determine the effectiveness of the Assess, prevent and manage pain; Both spontaneous awakening and spontaneous breathing trials; Choice of sedation and analgesia; Delirium: assess, prevent and manage; Early mobility and exercise; Family engagement and empowerment (ABCDEF) bundle in reducing ICU-related short-term and long-term consequences of critical illness through a randomised controlled trial (RCT). Methods and analysis The study will be a single-centre, prospective RCT. A total of 150 participants will be recruited and randomised to either receive the ABCDEF bundle protocol or non-protocolised standard care for the duration of the participant’s admission in the ICU. The primary outcome is delirium status measured using the Confusion Assessment Measure for ICU (CAM-ICU). Secondary outcomes include physical function measured by the Functional Independence Measure and quality of life measured by the European Quality of Life five dimensions, five-level questionnaire. A mixed-method process evaluation will contribute to understanding the experience of health teams who implement the ABCDEF bundle into practice. Ethics and dissemination Ethics approval was provided by the Metro South Health Human Research Ethics Committee (HREC) (EC00167) and the Griffith University’s HREC prior to study commencement. Study results will be disseminated by presentations at conferences and via publications to peer-review journals. Trial registration number ACTRN12620000736943; Pre-results.

Early rehabilitation has been found to prevent delirium and weakness that can hamper the recovery of intensive care unit (ICU) survivors. Integrated clinical practice guidelines for managing patient pain, agitation and delirium (PAD) have been developed. The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle provides a strategy to implement PAD guidelines into everyday clinical practice. However, there is limited evidence on the effectiveness of the ABCDE bundle in the literature.