***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Patients ' deaths in the ICU have been associated with a high burden of psychologic symptoms in families . This study identifies characteristics associated with psychologic symptoms in family members . METHODS Families of patients dying in the ICU or within 30 h of ICU discharge in 11 hospitals previously participated in a r and omized trial . In the current study , we assessed these families for symptoms of posttraumatic stress disorder ( PTSD ) and depression with follow-up surveys . Outcomes included vali date d measures of PTSD ( PTSD Checklist ) and depressive ( Patient Health Question naire ) symptoms . Predictors included family member mental-health history , involvement in decision making , and demographics . RESULTS Surveys were completed by 226 families . Response rate was 46 % in the original r and omized trial and 82 % in this study . Prevalence ( 95 % CI ) of PTSD and depressive symptoms were 14.0 % ( 9.7%-19.3 % ) and 18.4 % ( 13.5%-24.1 % ) , respectively . Family characteristics associated with increased symptoms included : female gender ( PTSD , P = .020 ; depression , P = .005 ) , knowing the patient for a shorter duration ( PTSD , P = .003 ; depression , P = .040 ) , and discordance between family members ' preferences for decision making and their actual decision-making roles ( PTSD , P = .005 ; depression , P = .049 ) . Depressive symptoms were also associated with lower educational level ( P = .002 ) . Families with psychologic symptoms were more likely to report that access to a counselor ( PTSD , P < .001 ; depression , P = .003 ) and information about spiritual services might have been helpful while the patient was in the ICU ( PTSD , P = .024 ; depression , P = .029 ) . CONCLUSIONS Families demonstrated a high prevalence of psychologic symptoms after a death in the ICU . Characteristics associated with symptoms may help target interventions to reduce these symptoms . TRIAL REGISTRATION clinical trials.gov ; Identifier : NCT00685893 BACKGROUND Formal family meetings have been recommended as a useful approach to assist in goal setting , facilitate decision making , and reduce use of ineffective re sources in the ICU . We examined patient outcomes before and after implementation of an intensive communication system ( ICS ) to test the effect of regular , structured formal family meetings on patient outcomes among long-stay ICU patients . METHODS One hundred thirty-five patients receiving usual care and communication were enrolled as the control group , followed by enrollment of intervention patients ( n = 346 ) , from five ICUs . The ICS included a family meeting within 5 days of ICU admission and weekly thereafter . Each meeting discussed medical up date , values and preferences , and goals of care ; treatment plan ; and milestones for judging effectiveness of treatment . RESULTS Using multivariate analysis , there were no significant differences between control and intervention patients in length of stay ( LOS ) , the primary end point . Similarly , there were no significant differences in indicators of aggressiveness of care or treatment limitation decisions ( ICU mortality , LOS , duration of ventilation , treatment limitation orders , or use of tracheostomy or percutaneous gastrostomy ) . Exploratory analysis suggested that in the medical ICUs , the intervention was associated with a lower prevalence of tracheostomy among patients who died or had do-not-attempt-resuscitation orders in place . CONCLUSIONS The negative findings of the main analysis , in combination with preliminary evidence of differences among types of unit , suggest that further examination of the influence of patient , family , and unit characteristics on the effects of a system of regular family meetings may be warranted . Despite the lack of influence on patient outcomes , structured family meetings may be an effective approach to meeting information and support needs . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01057238 ; URL : www . clinical trials.gov OBJECTIVE : The current study evaluates a treatment intervention developed with the goal of reducing symptoms of posttraumatic stress , depression , and anxiety in parents of premature infants . METHODS : A total of 105 mothers of preterm infants ( 25–34 weeks ’ gestational age ; > 600 g ) were r and omized to receive a 6-session intervention developed to target parental trauma as well as facilitate infant redefinition ( n = 62 ) or to an active comparison group ( n = 43 ) . Mothers in the intervention group received a combination of trauma-focused treatments , including psychoeducation , cognitive restructuring , progressive muscle relaxation , and development of their trauma narrative . The intervention also incorporated material targeting infant redefinition , defined as the process of changing the mother ’s negative perceptions of her infant and the parenting experience . RESULTS : Mothers in the intervention group reported a greater reduction in both trauma symptoms ( Cohen ’s d = 0.41 , P = .023 ) and depression ( Cohen ’s d = 0.59 , P < .001 ) compared with the comparison group . Patients under both conditions improved significantly in terms of anxiety , with no differences between groups . Results of the moderator analysis showed that mothers with higher ratings of baseline NICU stress benefited more from the intervention compared with mothers who had lower ratings ( P = .036 ) . CONCLUSIONS : This short , highly manualized intervention for mothers of preterm infants statistically significantly reduced symptoms of trauma and depression . The intervention is feasible , can be delivered with fidelity , and has high ratings of maternal satisfaction . Given that improvements in mothers ’ distress may lead to improved infant outcomes , this intervention has the potential for a high public health impact INTRODUCTION Healthcare quality is usually evaluated through analysing medical outcomes including neonatal readmission and patient and family satisfaction . Parental involvement in neonatal care is considered as one of the most important factors , which directly affects these outcomes . The aim of the present study was to determine the effect of family-centered care including maternal participation , presence , and information about neonatal care , on maternal satisfaction and neonatal readmission ; the care services were provided by the primiparous mothers of preterm infants . MATERIAL S AND METHODS One hundred and ten primiparous mothers with preterm infants participated in this clinical trial . All sample s were r and omly divided into family-centered care ( FCC ) and control groups , through simple r and om sampling . The FCC program , which consisted of information about neonatal care , maternal presence , and participation in the care process , was implemented in the FCC group , while the control group was provided with routine care . Data were obtained using demographic and satisfaction question naires and readmission checklist . RESULTS In the FCC group , the mean score of satisfaction increased after the implementation of the program ( 22.36 and 59.28 before and after the program , respectively ) ( p<0.001 ) ; however , this increase in the control group was not significant . The obtained results regarding the different aspects of satisfaction indicated that mothers in the FCC group were more satisfied with maternal presence in the neonatal intensive care unit ( NICU ) , compared with aspects of information and participation . In addition , the number of neonatal readmission was less in the FCC group compared with the control group , and the mean duration of hospitalization was 6.96 and 12.96 days in the FCC and control groups , respectively ( p<0.001 ) . CONCLUSION FCC program seems to be effective in increasing maternal satisfaction and decreasing neonatal readmission . Therefore , it seems necessary that healthcare authorities of the departments of obstetrics and gynecology in Iran provide the opportunity for the implementation of such programs in clinical environments , which follow the policy of parental absence and participation in the intensive care units An increased proportion of deaths occur in the intensive care unit ( ICU ) . We performed this prospect i ve study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU . Relatives of 475 adult patients were followed up . Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief ( cut-off score > 25 ) . Relatives also completed the Hospital Anxiety and Depression Scale at 3 months , and the Revised Impact of Event Scale for post-traumatic stress disorder symptoms at 3 , 6 and 12 months . We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months . Among the 475 patients , 282 ( 59.4 % ) had a relative evaluated at 6 months . Complicated grief symptoms were identified in 147 ( 52 % ) relatives . Independent determinants of complicated grief symptoms were either not amenable to changes ( relative of female sex , relative living alone and intensivist board certification before 2009 ) or potential targets for improvements ( refusal of treatment by the patient , patient died while intubated , relatives present at the time of death , relatives did not say goodbye to the patient , and poor communication between physicians and relatives ) . End-of-life practice s , communication and loneliness in bereaved relatives may be amenable to improvements . End-of-life care and communication in the ICU are associated with the prevalence of complicated grief BACKGROUND Established practice is for the relatives of critically ill patients to be excluded from the clinical area during resuscitation . We aim ed to discover whether relatives wanted to be present during the resuscitation of a family member and whether witnessing resuscitation had any adverse psychological effects on bereaved relatives . METHODS In this pilot study , relatives of patients who required resuscitation  were given the option to remain with the patient during resuscitation or were not given this choice and directed to the relatives ' room ( control group ) . The unit of r and omisation was the patient who required resuscitation  and not the  relatives . One close relative was paired with each patient . All relatives were accompanied by a chaperone who gave emotional support and provided technical information on the resuscitation . Relatives were followed up 1 month after the resuscitation . We used a question naire to ask about the decision to be present or absent during resuscitation . Bereaved relatives also completed five st and ardised psychological question naires to assess anxiety , depression , grief , intrusive imagery , and avoidance behaviour . FINDINGS 25 patients underwent resuscitation ( 13 in witnessed resuscitation group , 12 in control group ) . Three patients in the witnessed group survived , all the control-group patients died . Two relatives in each group were lost to follow-up . Thus , eight relatives who witnessed resuscitation and ten control-group relatives were followed up . There were no reported adverse psychological effects among the relatives who witnessed resuscitation , all of whom were satisfied with their decision to remain with the patient . The clinical team became convinced of the benefits to relatives of allowing them to witness resuscitation if they wished , so the trial was terminated . INTERPRETATION In the context of the emergency department , routine exclusion of relatives from the resuscitation room may no longer be appropriate BACKGROUND Ten percent to 20 % of trauma patients admitted to the intensive care unit ( ICU ) will die from their injuries . Providing appropriate end-of-life care in this setting is difficult and often late in the patients ' course . Patients are young , prognosis uncertain , and conflict common around goals of care . We hypothesized that early , structured communication in the trauma ICU would improve end-of-life care practice . METHODS Prospect i ve , observational , prepost study on consecutive trauma patients admitted to the ICU before and after a structured palliative care intervention was integrated into st and ard ICU care . The program included part I , early ( at admission ) family bereavement support , assessment of prognosis , and patient preferences , and part II ( within 72 hours ) interdisciplinary family meeting . Data on goals of care discussion s , do-not-resuscitate ( DNR ) orders and withdrawal of life support ( W/D ) were collected from physician rounds , family meetings , and medical records . RESULTS Eighty-three percent of patients received part I and 69 % part II intervention . Discussion of goals of care by physicians on rounds increased from 4 % to 36 % of patient-days . During intervention , rates of mortality ( 14 % ) , DNR ( 43 % ) , and W/D ( 24 % ) were unchanged , but DNR orders and W/D were instituted earlier in hospital course . ICU length of stay was decreased in patients who died . CONCLUSIONS Structured communication between physician and families result ed in earlier consensus around goals of care for dying trauma patients . Integration of early palliative care alongside aggressive trauma care can be accomplished without change in mortality and has the ability to change the culture of care in the trauma ICU Study Objective To investigate  pain sensitivity after sleep restriction  and the restorative effect of napping . Design A strictly controlled r and omized crossover study with continuous polysomnography monitoring was performed . Setting Laboratory-based study . Participants 11 healthy male volunteers . Interventions Volunteers attended two three-day sessions : “ sleep restriction ” alone and “ sleep restriction and nap ” . Each session involved a baseline night of normal sleep , a night of sleep deprivation and a night of free recovery sleep . Participants were allowed to sleep only from 02:00 to 04:00 during the sleep deprivation night . During the “ sleep restriction and nap ” session , volunteers took two 30-minute naps , one in the morning and one in the afternoon . Measurements and Results Quantitative sensory testing was performed with heat , cold and pressure , at 10:00 and 16:00 , on three areas : the supraspinatus , lower back and thigh . After sleep restriction , quantitative sensory testing revealed differential changes in pain stimuli thresholds , but not in thermal threshold detection : lower back heat pain threshold decreased , pressure pain threshold increased in the supraspinatus area and no change was observed for the thigh . Napping restored responses to heat pain stimuli in the lower back and to pressure stimuli in the supraspinatus area . Conclusions S 
    Output:
    
We made 23 recommendations from moderate , low , and very low level of evidence on the topics of : communication with family members , family presence , family support , consultations and ICU team members , and operational and environmental issues .
Conclusions : These guidelines identify the evidence base for best practice s for family-centered care in the ICU .