***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Although Post-traumatic Stress Disorder ( PTSD ) is common among patients seeking care at medical clinics , little is known about the performance of screening instruments for this disorder in these setting s. Previous studies of acute trauma population s using the  PTSD Checklist ( PCL )  have suggested that scores of 45 - 50 provide the best discrimination between cases and noncases . We gave the PCL  to 1,225 r and omly selected women enrolled in an HMO . After interviewing a sample of 261 of these women using a structured , clinician-administered PTSD interview , we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis . The optimum balance of sensitivity and specificity for this population was a score of 30 , yielding a sensitivity of.82 and specificity of.76 . The positive and negative likelihood ratios for this cut score were 3.40 and 0.24 , respectively . By comparison , the use of 45 as a cut score would result in very low sensitivity ( .36 ) in this setting . The lower cut score found in this study may indicate that the use of previously published cut scores of 45 - 50 may not optimize the function of the PCL as a screening tool outside of acute trauma setting s due to an unacceptably high number of false negative cases 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 Introduction : Severe traumatic brain injury ( STBI ) can cause psychological stress in proxies in the long-term . This study assessed post-traumatic stress ( PTS ) symptoms in proxies of survivors of STBI in the short-term and investigated stress-associated factors . Methods : Prospect i ve cross-sectional study , conducted at three Swiss trauma centres over 1 year . Patient and proxy demographics , trauma data including Glasgow Coma Scale ( GCS ) and management data were collected . The proxies ’ PTS symptoms were assessed by applying the Impact of Event Scale – Revised ( IES-R ) , once in the first month after the accident ( median : 11 days ) . Results : Sixty-nine proxies were included ; 52 proxies were female ( 77.8 % ) .  Mean IES-R sum score for intrusions was 13.38 ( SD = 7.26 ) , for avoidance 8.91 ( SD = 5.94 ) , and for hyperarousal 9.07 ( SD = 6.75 ) . Clinical ly significant PTS symptoms were observed in 36 proxies ( 52.2 % ) ; mean IES-R sum scores were significantly higher in women . IES-R sub-scale values were inversely related with GCS at the scene of the accident and on hospital admission . Conclusions : More than half of proxies had clinical ly significant PTS symptoms shortly after their relative 's accident . More severe PTS symptoms were found in women and in proxies of patients with poorer initial GCS scores . Further research into risk groups in the short- and long-term and the long-term impact on patients of PTS syndrome in proxies is warranted OBJECTIVES To describe the occurrence of delirium in a cohort of older medical intensive care unit ( ICU ) patients and its short-term duration in the hospital and to determine the association between preexisting dementia and the occurrence of delirium . DESIGN Prospect i ve cohort study . SETTING Fourteen-bed medical ICU of an 800-bed university teaching hospital . PARTICIPANTS One hundred eighteen consecutive patients aged 65 and older admitted to the ICU . MEASUREMENTS Baseline characteristics were obtained through surrogate interviews and medical chart review . Dementia was determined using two vali date d surrogate-rated instruments .  Delirium  was assessed daily in the ICU using the Confusion Assessment Method ( CAM ) for the ICU ( CAM-ICU ) . After discharge from the ICU , patients were followed for up to 7 days using the CAM . RESULTS Delirium was present in 37 of 118 ( 31 % ) patients on admission . Only 45 patients had a normal mental status on admission , of whom 14 ( 31 % ) became delirious during their hospital stay . In the post-ICU period , delirium occurred in 40 % of patients . Almost half of patients with delirium in the ICU had persistent delirium in the post-ICU period . Overall , 83 of 118 ( 70 % ) had delirium during hospitalization . Stupor or coma occurred in 44 % of the patients overall , and 89 % of survivors of stupor/coma progressed to delirium . Patients with dementia were 40 % more likely to be delirious ( relative risk = 1.4 , 95 % confidence interval = 1.1 - 1.7 ) , even after controlling for comorbidity , baseline functional status , severity of illness , and invasive procedures . CONCLUSION Delirium is a frequent complication in older ICU patients and often persists beyond their ICU stay . Delirium in older ICU persons is a dynamic and complex process . Dementia is an important predisposing risk factor for the development of delirium in this population during and after the ICU stay STUDY OBJECTIVES The physical and psychological effects of caregiving have been examined in several population s. To date , no one has examined the effects of caregiving on caregivers of patients receiving long-term mechanical ventilation ( LTV ) [ patients who required > 4 days of continuous in-hospital mechanical ventilation ] who reside in a home or institutional setting after hospital discharge . The purpose of this study was to describe the characteristics and examine depression , burden , overload , and physical health in this caregiver population over a 6-month period after hospital discharge . DESIGN This was a prospect i ve longitudinal descriptive study of posthospital outcomes for patients receiving LTV and their caregivers . SETTING AND PARTICIPANTS Caregivers of 135 patients receiving LTV admitted to the ICUs of a university medical center , a Veterans Administration hospital , and small community hospital were enrolled . MEASUREMENTS AND RESULTS Interviews of caregivers were conducted at hospital discharge and 6 months later . Descriptive statistics , analysis of variance , and multiple regression analyses were used to analyze the data . Established tools were used to assess caregiver depression , burden , overload , and physical health . Caregivers reported a drop in physical health scores from hospital discharge to 6 months after discharge ( p = 0.0001 ) . Caregivers of patients residing in an institution reported higher depression ( p = 0.039 ) and overload scores ( p = 0.002 ) than did caregivers of patients residing at home 6 months after discharge ; 51.2 % of caregivers at discharge and 36.4 % at 6 months after discharge reported symptoms consistent with some degree of depression . In addition , 12.2 % of caregivers at hospital discharge and 15.6 % at 6 months after discharge were classified as having symptoms consistent with severe depression . Caregiver physical health ( p = 0.025 ) and overload ( p = 0.006 ) made statistically significant contributions to explaining caregiver depression . CONCLUSIONS Caregivers of patients receiving LTV in our sample have similar characteristics to other caregiving population s. However , our sample had higher depression scores than those reported for many other caregiver groups We examined the psychometric properties of the  PTSD Checklist ( PCL ) , a self-report instrument design ed to assess symptoms of posttraumatic stress disorder . Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments design ed to assess various forms of psychopathology ( e.g. , depression , general anxiety , PTSD ) . Ninety participants returned for readministration of selected measures . Findings provided support for psychometric properties of the PCL  , including internal consistency , test – retest reliability , convergent validity , and discriminant validity . Additional strengths of the PCL are discussed CONTEXT Delirium is a common problem in the intensive care unit ( ICU ) . Accurate diagnosis is limited by the difficulty of communicating with mechanically ventilated patients and by lack of a vali date d delirium instrument for use in the ICU . OBJECTIVES To vali date a delirium assessment instrument that uses st and ardized nonverbal assessment s for mechanically ventilated patients and to determine the occurrence rate of delirium in such patients . DESIGN AND SETTING Prospect i ve cohort study testing the Confusion Assessment Method for ICU Patients ( CAM-ICU ) in the adult medical and coronary ICUs of a US university-based medical center . PARTICIPANTS A total of 111 consecutive patients who were mechanically ventilated were enrolled from February 1 , 2000 , to July 15 , 2000 , of whom 96 ( 86.5 % ) were evaluable for the development of delirium and 15 ( 13.5 % ) were excluded because they remained comatose throughout the investigation . MAIN OUTCOME MEASURES Occurrence rate of delirium and sensitivity , specificity , and interrater reliability of delirium assessment  s using the CAM-ICU , made daily by 2 critical care study nurses , compared with assessment s by delirium experts using Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria . RESULTS A total of 471 daily paired evaluations were completed . Compared with the reference st and ard for diagnosing delirium , 2 study nurses using the CAM-ICU had sensitivities of 100 % and 93 % , specificities of 98 % and 100 % , and high interrater reliability ( kappa = 0.96 ; 95 % confidence interval , 0.92 - 0.99 ) . Interrater reliability measures across subgroup comparisons showed kappa values of 0.92 for those aged 65 years or older , 0.99 for those with suspected dementia , or 0.94 for those with Acute Physiology and Chronic Health Evaluation II scores at or above the median value of 23 ( all P<.001 ) . Comparing sensitivity and specificity between patient subgroups according to age , suspected dementia , or severity of illness showed no significant differences . The mean ( SD ) CAM-ICU administration time was 2 ( 1 ) minutes . Reference st and ard diagnoses of delirium , stupor , and coma occurred in 25.2 % , 21.3 % , and 28.5 % of all observations , respectively . Delirium occurred in 80 ( 83.3 % ) patients during their ICU stay for a mean ( SD ) of 2.4 ( 1.6 ) days . Delirium was even present in 39.5 % of alert or easily aroused patient observations by the reference st and ard and persisted in 10.4 % of patients at hospital discharge . CONCLUSIONS Delirium , a complication not currently monitored in the ICU setting , is extremely common in mechanically ventilated patients . The CAM-ICU appears to be rapid , valid , and reliable for diagnosing delirium in the ICU setting and may be a useful instrument for both clinical and research purpose Objective : To describe the symptom experiences of family members of patients at high risk for dying in the intensive care unit and to assess risk factors associated with higher symptom burden . Design : Prospect i ve , cross-sectional study . Setting : Three intensive care units at a large academic medical center . Participants : A sample of 74 family members of 74 intensive care unit patients who had a grave prognosis and were judged to be at high risk for dying . Patients at high risk for dying were identified as having Acute Physiology and Chronic Health Evaluation II scores > 20 , an intensive care unit length of stay 
    Output:
    
Findings demonstrate a significant prevalence of family PTSD symptoms in the months following ICU hospitalization .