Health and Disability

Nearly one-quarter of intensive care unit survivors have post-traumatic stress disorder; diaries could be successful prevention tool

Fast Facts

• Research finds that one-quarter of patients who survive a critical illness and an ICU stay experience PTSD.
• Researchers are looking into using ICU diaries as a promising therapeutic tool to prevent PTSD in ICU survivors.
• Existing psychological problems, large amounts of sedation and reports of frightening ICU memories appear to contribute to the increased risk of PTSD in ICU survivors.

Post-traumatic stress disorder is often thought of as a symptom of warfare, major catastrophes and assault. It's rarely considered in patients who survive a critical illness and stay in the intensive care unit (ICU). However, in a recent Johns Hopkins study, researchers found that nearly one-quarter of ICU survivors suffer from PTSD. They also identified possible triggers for PTSD and indicated a potential preventive strategy: having patients keep ICU diaries. The findings will be published in the May issue of Critical Care Medicine.

"PTSD can drastically impact a person's ability to communicate and connect with others, truly interrupting their lives and preventing experiences of joy," says Joe Bienvenu, M.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. "This is why our findings are important and why it's so critical that we continue to research ways to prevent PTSD."

RA is a chronic autoimmune disease affecting 1.3 million Americans. Medical evidence shows that until the late 1990s, one in three RA patients were permanently disabled within five years of disease onset. Over the last decade there has been significant improvement in treatment, with disease control now possible for many RA patients who receive early, aggressive DMARD therapy.

Treatment with DMARDs is now a standard component of guideline-based care with costs for some the newer drugs topping $20,000 annually. In fact, a recent report by GBI Research estimates that the U.S. market for RA treatment will increase from $6.4 billion in 2013 to $9.3 billion by 2020, driven in part by the increase in RA prevalence - forecasted to reach 1.68 million by 2020.

Regardless of the biologic DMARD, the study found that patients face high initial copayments, then fall into the coverage gap or "donut hole" by February or March. During the donut hole, patients' cost-sharing increases to 45% of drug costs (for 2015) until they reach catastrophic coverage. Patients generally reach catastrophic coverage between January and July. After that taxpayers, insurers and pharmaceutical companies will pick up 95% of the cost of the biologic DMARD.

A previous study of 1,100 adults with RA found that 1 in 6 decreased their medication because of cost.

In a pilot that included more than 350 chronic heart failure patients, a Philadelphia hospital was able to reduce its 30-day readmissions by 10 percent — a 40 percent improvement over baseline — by using email and text message reminders to get patients into follow-up appointments. Dr. Thompson Boyd, physician liaison at Hahnemann Hospital and Richard Imbimbo, the hospital’s CFO, spoke at HIMSS 2015 in Chicago about their 10-month pilot, which was expanded from an initial six-month pilot, with congestive heart failure patients.

She has been raising awareness of hearing loss among children.

Zorn first introduced the legislation in December, but there was little time left in the session for the bill to be considered. It would require health insurance policies to cover hearing aids for hearing loss not correctable by other covered procedures.
An insurer or HMO could limit coverage to one hearing aid in each ear every three years.

A Gallup survey released Monday shows that nearly 90 percent of American adults now have health insurance—up from eight in 10 just two years ago. That change is due in part to the 14.75 million people who purchased health coverage through the Affordable Care Act exchanges, with the largest changes in insurance status coming among Hispanics and those making less than $36,000 annually. 

The combination of two well-known drugs will have unprecedented effects on pain management, says new research from Queen's.

Combining morphine, a narcotic pain reliever, and nortriptyline, an antidepressant, has been found to successfully relieve chronic neuropathic pain - or a localized sensation of pain due to abnormal function of the nervous system - in 87 per cent of patients, and significantly better than with either drug alone.

"Chronic pain is an increasingly common problem and can exert disastrous personal, societal, and socio-economic impacts on patients, their families, and their communities," says Ian Gilron, lead author of the study. "Current neuropathic pain treatments are ineffective or intolerable for many sufferers so this new evidence supporting the morphine-nortriptyline combination is important news for patients."

During the study, average daily pain was measured using a patient's numerical rating of pain on a validated scale from 0 - 10. It was found that average daily pain before treatment was 5.6, which dropped to 2.6 when the patient was receiving the drug combination. On average, patients taking nortriptyline and morphine alone rated their pain at 3.1 and 3.4, respectively.

It was also found that common side effects for both drugs, which can include constipation and dry mouth, did not worsen during the combination treatment.

Local and national experts on domestic violence and the elderly said that while research focuses on younger victims, assaults are likely just as prevalent among the elderly. In 2012, about 5 percent of domestic violence victims in New Jersey — or 2,900 of all reported cases — were 60 or older, according to the New Jersey State Police Uniform Report on Domestic Violence. But they were the victims of 18 percent of domestic murders – seven out of 38.

And the elderly population is often underserved by services for battered women and overlooked by research on domestic violence.

“In Bergen County, in less than 12 months, we’ve had two [cases of domestic homicide involving elderly couples], so it’s pretty obvious it’s a problem,” said Elaine Meyerson, executive director of the Center for Hope and Safety in Bergen County (formerly called Shelter Our Sisters). “The question is, how do we get to them when so many of them are housebound, to teach them about safety planning? It’s a challenge, and they shouldn’t have to suffer living in a violent home, just like a 20-year-old.”

The motives in domestic homicides involving the elderly are often obscured by issues typical of aging, such as illness and isolation.