***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: Introduction A protocol of no sedation has been shown to reduce the time patients receive mechanical ventilation and to reduce intensive care and total hospital length of stay . The long-term psychological effects of this strategy have not yet been described . The purpose of the study was to test whether a strategy of no sedation alters long-term psychological outcome compared with a st and ard strategy with sedation . Methods During intensive care stay , 140 patients requiring mechanical ventilation were r and omized to either no sedation or sedation with daily interruption of sedation . This study was done as a single-blinded cohort study . After discharge , patients were interviewed by a neuropsychologist assessing quality of life , depression , anxiety , and posttraumatic stress disorder . Results Two years after r and omization , 38 patients were eligible for interview , and 26 patients were interviewed ( 13 from each group ) . No difference was found with respect to quality of life ( Medical Outcome Study , 36-item short-form health survey ) . Both mental and physical components were nonsignificant . The Beck depression index was low in both groups ( one patient in intervention group versus three patients in the control group were depressed , p = 0.32 ) . Evaluated with the Impact of Events Scale , both groups had low stress scores ( one in the intervention group versus two in the control group had scores greater than 32 ; p = 0.50 ) . State anxiety scores were also low ( 28 in the control group versus 30 in the intervention group , p = 0.58 ) . Conclusions Our data suggest that a protocol of no sedation applied to critically ill patients undergoing mechanical ventilation does not increase the risk of long-term psychological sequelae after intensive care compared with st and ard treatment with sedation Objectives : To investigate if light sedation favorably affects subsequent patient mental health compared with deep sedation . Symptoms of posttraumatic stress disorder are common in patients after they have undergone prolonged mechanical ventilation and are associated with sedation depth . Design : R and omized , open-label , controlled trial . Setting : Single tertiary care center . Patients : Adult patients requiring mechanical ventilation . Interventions : Patients were r and omized to receive either light ( patient awake and cooperative ) or deep sedation ( patient asleep , awakening upon physical stimulation ) . Measurements and Main Results : Self-reported measures of posttraumatic stress disorder , anxiety , and depression were collected at intensive care unit discharge and 4 wks later . The primary outcomes were symptoms of posttraumatic stress disorder , anxiety , and depression 4 wks after intensive care unit discharge . A total of 137 patients were assigned to either the light ( n = 69 ) or the deep sedation ( n = 68 ) group . Seven patients withdrew consent and one patient was r and omized in error , leaving 129 patients ( n = 65 in light sedation and n = 64 in deep sedation ) available for analysis . At the 4-wk follow-up , patients in the deep sedation group tended to have more posttraumatic stress disorder symptoms ( p = .07 ) ; the deep sedation group had more trouble remembering the event ( 37 % vs. 14 % ; p = .02 ) and more disturbing memories of the intensive care unit ( 18 % vs. 4 % ; p = .05 ) . Patients in the light sedation group had an average one day less being ventilated and 1.5 fewer days in the intensive care unit . There were no differences between the two groups in the occurrence of anxiety and depression , and also no difference in mortality or in the incidence of adverse events . Conclusions : These data suggest that a strategy of light sedation affords benefits with regard to reduction of intensive care unit stay and duration of ventilation without negatively affecting subsequent patient mental health or patient safety Objective To assess survival , morbidity ( physical and psychological ) , quality of life ( QOL ) , and employment status of intensive care survivors up to 12 months after discharge from the intensive care unit ( ICU ) . Design Prospect i ve study . Setting University hospital adult ICU . Patients Between August 1 , 1995 , and July 31 , 1996 , 370 patients were admitted . Of these patients , 29 % died in the ICU . Three months after discharge from the ICU , 227 patients were alive , and 143 agreed to participate .  Cumulative mortality was calculated using the original complete cohort . Measurements and Main Results Demographic data , severity of acute illness ( Acute Physiology and Chronic Health Evaluation [ APACHE ] II ) , admitting specialty , primary diagnosis , and length of stay were recorded . Physical and ICU-related psychological morbidity ( Hospital Anxiety and Depression scale score ) were recorded . Health-related QOL was assessed using the Short-Form 36 . All the question naires were completed in the clinic at 3 months . Assessment of physical morbidity and employment status at 6 and 12 months were conducted by telephone . The cumulative mortality was 39 % at 3 months , 41 % at 6 months , and 43 % at 12 months . Deaths after 3 months occurred in the group who refused follow-up . The median age for the follow-up group was 51 yrs ; the gender split was 68 women and 75 men ; the mean admission APACHE II score was 18.79 ( sd 6.15 ) ; and the median length of ICU stay was 3.8 days . At 3 months , ∼80 % of all patients interviewed were satisfied with their QOL . Older men ( > 65 yrs ) and younger women ( < 65 yrs ) demonstrated significantly better health with respect to some subdomains of the Short-Form 36 compared with their counterparts . The prevalence of psychological distress ( Hospital Anxiety and Depression scale score , ≥8 ) was low : 11.9 % had heightened anxiety , and 9.8 % were depressed . There were high levels of fatigue , poor concentration , and sleep disturbance ; the latter was more marked in women ( p = .022 ) . Improvement in all three symptoms occurred during the next 9 months . Significantly more women reported loss of hair ( p < .0001 ) . Men were slower to return to employment ; 75 % of women had returned by 6 months compared with only 65 % of men at 1 yr . Conclusion Assessment of outcome after ICU stay must include QOL measurements . Three months after discharge , there is a low incidence of ICU-related psychological or psychiatric illness and the majority of patients are satisfied . Differences in the incidence and nature of morbidity exist between the genders Introduction There is growing evidence of poor mental health and quality of life among survivors of intensive care . However , it is not yet clear to what extent the trauma of life-threatening illness , associated drugs and treatments , or patients ' psychological reactions during intensive care contribute to poor psychosocial outcomes . Our aim was to investigate the relative contributions of a broader set of risk factors and outcomes than had previously been considered in a single study . Methods A prospect i ve cohort study of 157 mixed-diagnosis highest acuity patients was conducted in a large general intensive care unit ( ICU ) . Data on four groups of risk factors ( clinical , acute psychological , socio-demographic and chronic health ) were collected during ICU admissions . Post-traumatic stress disorder ( PTSD ) , depression , anxiety and quality of life were assessed using vali date d question naires at three months ( n = 100 ) . Multivariable analysis was used . Results At follow-up , 55 % of patients had psychological morbidity : 27.1 % ( 95 % CI : 18.3 % , 35.9 % ) had probable PTSD ; 46.3 % ( 95 % CI : 36.5 % , 56.1 % ) probable depression , and 44.4 % ( 95 % CI : 34.6 % , 54.2 % ) anxiety . The strongest clinical risk factor for PTSD was longer duration of sedation ( regression coefficient = 0.69 points ( 95 % CI : 0.12 , 1.27 ) per day , scale = 0 to 51 ) . There was a strong association between depression at three months and receiving benzodiazepines in the ICU ( mean difference between groups = 6.73 points ( 95 % CI : 1.42 , 12.06 ) , scale = 0 to 60 ) . Use of inotropes or vasopressors was correlated with anxiety , and corticosteroids with better physical quality of life . The effects of these clinical risk factors on outcomes were mediated ( partially explained ) by acute psychological reactions in the ICU . In fully adjusted models , the strongest independent risk factors for PTSD were mood in ICU , intrusive memories in ICU and psychological history . ICU mood , psychological history and socio-economic position were the strongest risk factors for depression . Conclusions Strikingly high rates of psychological morbidity were found in this cohort of intensive care survivors . The study 's key finding was that acute psychological reactions in the ICU were the strongest modifiable risk factors for developing mental illness in the future . The observation that use of different ICU drugs correlated with different psychological outcomes merits further investigation . These findings suggest that psychological interventions , along with pharmacological modifications , could help reduce poor outcomes , including PTSD , after intensive care Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Patient-centered health care is a central component of current health policy agendas . Shared decision making ( SDM  ) is considered to be the pinnacle of patient engagement and methods to promote this are becoming commonplace . However , the measurement of SDM continues to prove challenging . Review s have highlighted the need for a patient-reported measure of SDM that is practical , valid , and reliable to assist implementation efforts . In consultation with patients , we developed CollaboRATE , a 3-item measure of the SDM process . Objective There is a need for scalable patient-reported measure of the SDM process . In the current project , we assessed the psychometric properties of CollaboRATE . Methods A representative sample of the US population were recruited online and were r and omly allocated to view 1 of 6 simulated doctor-patient encounters in January 2013 . Three dimensions of SDM were manipulated in the encounters : ( 1 ) explanation of the health issue , ( 2 ) elicitation of patient preferences , and ( 3 ) integration of patient preferences . Participants then completed CollaboRATE ( possible scores 0 - 100 ) in addition to 2 other patient-reported measures of SDM : the 9-item  Shared Decision Decision Making Question naire ( SDM-Q-9 ) and the Doctor Facilitation subscale of the Patient ’s Perceived Involvement in Care Scale ( PICS ) . A sub sample of participants was resurveyed between 7 and 14 days after the initial survey . We assessed CollaboRATE ’s discriminative , concurrent , and divergent validity , intrarater reliability , and sensitivity to change . Results The final sample consisted of 1341 participants .  CollaboRATE demonstrated discriminative validity , with a significant increase in CollaboRATE score as the number of core dimensions of SDM increased from zero ( mean score : 46.0 , 95 % CI 42.4 - 49.6 ) to 3 ( mean score 85.8 , 95 % CI 83.2 - 88.4 ) . CollaboRATE also demonstrated concurrent validity with other measures of SDM , excellent intrarater reliability , and sensitivity to change ; however , divergent validity was not demonstrated . Conclusions The fast and frugal nature of CollaboRATE lends itself to routine clinical use . Further assessment of CollaboRATE in real-world setting s is required OBJECTIVES To measure levels of anxiety , depression and post-traumatic stress among survivors of a critical illness and to relate these symptoms to general health parameters . DESIGN A prospect i ve study of patients who had spent a minimum 3 days ( median 9 days ) in a general intensive care unit ( ICU ) . Of these patients , 51 were interviewed 3 months after discharge and 45 of them were review ed at 9 months . METHODS General health was assessed by a  physical symptom score , the EuroQol ' thermometer ' and the Short Form 36 ( SF-36 ) question naire .  Physical and mental component summary measures ( PCS , MCS ) were calculated from the SF-36 data . Psychological health was assessed using both the Hospital Anxiety and Depression Scale and the Impact of Events Scale . RESULTS At both 3 and 9 months after ICU discharge 24 % of patients qualified as a ' case ' of anxiety , while similar figures were seen for intrusion ( 24 and 20 % ) . The incidence of depression ( 35 and 47 % ) and avoidance ( 36 and 38 % ) was higher on each occasion . Four of the eight SF-36 domains improved with time , as did PCS ( from 29.0 to 35.4 ) , but there was no significant difference in physical symptom score , EuroQol value or MCS . Strong correlations were seen between the physical and psychological parameters at each time point . CONCLUSIONS A substantial proportion of patients who survive a critical illness show evidence of anxiety and depression up to 9 months later , and most of them also have symptoms indicative of post-traumatic stress . Delayed physical recovery may contribute to this psychological morbidity . ICU follow-up clinics should be able to detect patients suitable for psychological intervention Objectives To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life  after discharge from intensive care . Design A pragmatic , non-blinded , multicentre , r and omised controlled trial . Setting Three UK hospitals ( 
    Output:
    
Age , gender , severity of illness , diagnosis and length of stay were not associated with anxiety symptoms .
Psychiatric symptoms during admission and memories of in-ICU delusional experiences were potential risk factors .
Physical rehabilitation and ICU diaries had potential benefit .
One third of ICU survivors  experience anxiety symptoms that are persistent during their first year of recovery .
Psychiatric symptoms during admission and memories of in-ICU delusional experiences were associated with post-ICU anxiety .