human
***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: Purpose Cognitive impairment after critical illness is common and debilitating . We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness . Methods We r and omized 87 medical and surgical ICU patients with respiratory failure and /or shock in a 1:1:2 manner to three groups : usual care , early once-daily physical therapy , or early once-daily physical therapy plus a novel , progressive , twice-daily cognitive therapy protocol . Cognitive therapy included orientation , memory , attention , and problem-solving exercises , and other activities . We assessed feasibility outcomes of the early cognitive plus physical therapy intervention . At 3 months , we also assessed cognitive , functional , and health-related quality of life outcomes . Data are presented as median ( interquartile range ) or frequency ( % ) . Results Early cognitive therapy was a delivered to 41/43 ( 95 % ) of cognitive plus physical therapy patients on 100 % ( 92–100 % ) of study days beginning 1.0 ( 1.0–1.0 ) day following enrollment . Physical therapy was received by 17/22 ( 77 % ) of usual care patients , by 21/22 ( 95 % ) of physical therapy only patients , and 42/43 ( 98 % ) of cognitive plus physical therapy patients on 17 % ( 10–26 % ) , 67 % ( 46–87 % ) , and 75 % ( 59–88 % ) of study days , respectively . Cognitive , functional , and health-related quality of life outcomes did not differ between groups at 3-month follow-up . Conclusions This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy . Future work to determine optimal patient selection , intensity of treatment , and benefits of cognitive therapy in the critically ill is needed Objective : To determine whether early activity is feasible and safe in respiratory failure patients . Design : Prospect i ve cohort study . Setting : From June 1 , 2003 , through December 31 , 2003 , we assessed safety and feasibility of early activity in all consecutive respiratory failure patients who required mechanical ventilation for > 4 days admitted to our respiratory intensive care unit ( RICU ) . A majority of patients were treated in another intensive care unit ( ICU ) before RICU admission . We excluded patients who required mechanical ventilation for ≤4 days . Patients : Eight‐bed RICU at LDS Hospital . Interventions : We assessed patients for early activity as part of routine respiratory ICU care . We prospect ively recorded activity events and adverse events . We defined three activity events as sit on bed , sit in chair , and ambulate . We defined six activity‐related adverse events as fall to knees , tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , oxygen desaturation < 80 % , and extubation . Measurements and Main Results : During the study period , we conducted a total of 1,449 activity events in 103 patients . The activity events included 233 ( 16 % ) sit on bed , 454 ( 31 % ) sit in chair , and 762 ( 53 % ) ambulate . In patients with an endotracheal tube in place , there were a total of 593 activity events , of which 249 ( 42 % ) were ambulation . There were < 1 % activity‐related adverse events , including fall to the knees without injury , feeding tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , and desaturation < 80 % . No patient was extubated during activity . Conclusions : We conclude that early activity is feasible and safe in respiratory failure patients . A majority of survivors ( 69 % ) were able to ambulate > 100 feet at RICU discharge . Early activity is a c and i date therapy to prevent or treat the neuromuscular complications of critical illness Introduction Despite studies demonstrating benefit , patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization . No research ers have reported filter pressures during mobilization , and it is unknown whether mobilization is safe or affects filter lifespan . Our objective in this study was to test the safety and feasibility of mobilization in this population . Methods A total of 33 patients undergoing continuous renal replacement therapy via femoral , subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled . Patients underwent one of three levels of mobilization intervention as appropriate : ( 1 ) passive bed exercises , ( 2 ) sitting on the bed edge or ( 3 ) st and ing and /or marching .  Catheter dislodgement , haematoma and bleeding during and following interventions were evaluated . Filter pressure parameters and lifespan ( hours ) , nursing workload and concern were also measured . Results No episodes of filter occlusion or failure occurred during any of the interventions . No adverse events were detected . The intervention filters lasted longer than the nonintervention filters ( regression coefficient = 13.8 ( robust 95 % confidence interval ( CI ) = 5.0 to 22.6 ) , P = 0.003 ) . In sensitivity analyses , we found that filter life was longer in patients who had more position changes ( regression coefficient = 2.0 ( robust 95 % CI = 0.6 to 3.5 ) , P = 0.007 ) . The nursing workloads between the intervention shift and the following shift were similar . Conclusions Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life . These findings have significant implication s for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12611000733976 ( registered 13 July 2011 OBJECTIVE To evaluate whether the level of mobilization achieved and the barriers for progressing to the next mobilization level differ between nurses and physical therapists . DESIGN Prospect i ve , observational study . SETTING Twenty-bed surgical intensive care unit ( SICU ) of the Massachusetts General Hospital . PARTICIPANTS Sixty-three critically ill patients . METHODS Physical therapists and nurses performed 179 mobilization therapies with 63 patients . OUTCOME MEASUREMENT Mobilization was defined as the process of enhancing mobility in the SICU , including bed mobility , edge of bed activities , transfers out of bed to a chair , and gait training ; the mobilization level was measured on the SICU optimal mobilization scale , a 5-point ( 0 - 4 ) numerical rating scale . RESULTS Patients ' level of mobilization achieved by physical therapists was significantly higher compared with that achieved by nurses ( 2.3 ± 1.2 mean ± SD versus 1.2 ± 1.2 , respectively P < .0001 ) . Different barriers for mobilization were identified by physical therapists and nurses : hemodynamic instability ( 26 % versus 12 % , P = .03 ) and renal replacement therapy ( 12 % versus 1 % , P = .03 ) were barriers rated higher by nurses , whereas neurologic impairment was rated higher by physical therapists providers ( 18 % versus 38 % , P = .002 ) . No mobilization-associated adverse events were observed in this study . CONCLUSIONS This study showed that physical therapists mobilize their critically ill patients to higher levels compared with nurses . Nurse and physical therapists identify different barriers for mobilization . Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients INTRODUCTION Survivors of complex critical illness and their family caregivers require support during their recovery , rehabilitation , and return to community living ; however , the nature of these supports and how they may change over time remain unclear . Using the Timing It Right framework as a conceptual guide , this qualitative pilot study explored survivors ' and caregivers ' needs during the episode of critical illness through their return to independent living . METHODS Five survivors and seven family caregivers were recruited and consented from the main Towards RECOVER pilot study , design ed to characterize the long term outcomes of survivors of the ICU who have been mechanically ventilated for more than one week . Using the Timing It Right framework , we prospect ively conducted qualitative interviews to explore participants ' experiences and needs for information , emotional support , and training at 3 , 6 , 12 , and 24 months after intensive care unit ( ICU ) discharge . We completed 26 interviews , which were audio recorded , professionally transcribed , checked for accuracy , and analyzed using framework methodology . RESULTS In this small pilot sample , caregiver and patient perspectives were related and , therefore , are presented together . We identified 1 overriding theme : survivors do not experience continuity of medical care during recovery after critical illness . Three subthemes highlighted the following : ( 1 ) informational needs change across the care continuum , ( 2 ) fear and worry exist when families do not know what to expect , and ( 3 ) survivors transition from dependence to independence . CONCLUSIONS Interventions design ed to improve family outcomes after critical illness should address both survivors ' and caregivers ' support needs as they change across the illness and recovery trajectory . Providing early intervention and support and clarifying expectations for transitions in care and recovery may decrease fears of the unknown for both caregivers and survivors . Ongoing family-centered follow-up programs may also help survivors regain independence and help caregivers manage their perceived responsibility for the patients ' health . Using these insights for intervention development could ultimately improve long-term outcomes for both survivors and caregivers Introduction  Mobilisation of patients  in the intensive care unit ( ICU ) is an area of growing research . Currently , there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses . Methods The objectives of the study were to ( 1 ) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs , ( 2 ) compare mobilisation practises between Australian and Scottish ICUs and ( 3 ) identify barriers to mobilisation in Australian and Scottish ICUs . We conducted a prospect i ve , observational , cohort study with a 4-week inception period . Patients were censored for follow-up upon ICU discharge or after 28 days , whichever occurred first . Patients were included if they were > 18 years of age , admitted to an ICU and received mechanical ventilation in the ICU . Results Ten tertiary ICUs in Australia and nine in Scotl and participated in the study . The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery ( 43.3 % ) , whereas the Scottish cohort had none . Therefore , comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery . In total , 60.2 % of the 347 patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay ( p < 0.001 ) . Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort ( hazard ratio 1.83 , 95 % confidence interval 1.38–2.42 ) . However , the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort ( 41.1 % vs 16.3 % , p < 0.001 ) . Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts . Physiological instability and the presence of an endotracheal tube were also frequently reported barriers . Conclusions This is the first study to benchmark baseline practise of early mobilisation internationally , and it demonstrates variation in early mobilisation practises between Australia and Scotl and Background Physiotherapy is integral to patient management in the Intensive Care Unit . The precise role that physiotherapists play in the critical care differs significantly worldwide . The aim of the study was to describe the profile of patients and the current patterns of physiotherapy services  delivered for patients admitted in the five public hospital intensive care units in Zimbabwe . Methods A prospect i ve record review was performed and records of all consecutive patients admitted into the five units during a two months period were included in the analysis . The data was collected using a checklist and the following were recorded for each patient : 1 ) demographic information , 2 ) admission diagnoses , 3 ) surgery classification , 4 ) method and time of mechanical ventilation 5 )  physiotherapy techniques and frequency and 6 ) the length of stay . Results A total of 137 patients were admitted to five units during the study . The mean age of patients in the study was 36.0 years ( SD = 16.6 ) . A mortality rate of 17.5 % was observed with most of the patients being below the age of 45 years . The majority of the patients , 61(45 % ) had undergone emergency surgery and were in the ICU for postoperative treatment , whilst only 19(14 % ) were in the units for clinical treatment ( non-surgical ) . On admission , 72(52.6 % ) of the patients were on  mechanical ventilation .  The mean duration on mechanical ventilation for patients was 4.0 days ( SD = 2.7 ) and a length of stay in the unit of 4.5 days ( SD = 3.0).Of the patients who were admitted into the ICU 120 ( 87.6 % ) had at least one session of physiotherapy treatment during their stay . The mean number of days physiotherapy treatment was received was 3.71 ( SD = 3.14 ) days . The most commonly used physiotherapy techniques were  active assisted limb movements  ( 66.4 % ) , deep breathing exercises ( 65.0 % ) and forced expir 
    Output:
    
agent
***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: Purpose Cognitive impairment after critical illness is common and debilitating . We developed a cognitive therapy program for critically ill patients and assessed the feasibility and safety of administering combined cognitive and physical therapy early during a critical illness . Methods We r and omized 87 medical and surgical ICU patients with respiratory failure and /or shock in a 1:1:2 manner to three groups : usual care , early once-daily physical therapy , or early once-daily physical therapy plus a novel , progressive , twice-daily cognitive therapy protocol . Cognitive therapy included orientation , memory , attention , and problem-solving exercises , and other activities . We assessed feasibility outcomes of the early cognitive plus physical therapy intervention . At 3 months , we also assessed cognitive , functional , and health-related quality of life outcomes . Data are presented as median ( interquartile range ) or frequency ( % ) . Results Early cognitive therapy was a delivered to 41/43 ( 95 % ) of cognitive plus physical therapy patients on 100 % ( 92–100 % ) of study days beginning 1.0 ( 1.0–1.0 ) day following enrollment . Physical therapy was received by 17/22 ( 77 % ) of usual care patients , by 21/22 ( 95 % ) of physical therapy only patients , and 42/43 ( 98 % ) of cognitive plus physical therapy patients on 17 % ( 10–26 % ) , 67 % ( 46–87 % ) , and 75 % ( 59–88 % ) of study days , respectively . Cognitive , functional , and health-related quality of life outcomes did not differ between groups at 3-month follow-up . Conclusions This pilot study demonstrates that early rehabilitation can be extended beyond physical therapy to include cognitive therapy . Future work to determine optimal patient selection , intensity of treatment , and benefits of cognitive therapy in the critically ill is needed Objective : To determine whether early activity is feasible and safe in respiratory failure patients . Design : Prospect i ve cohort study . Setting : From June 1 , 2003 , through December 31 , 2003 , we assessed safety and feasibility of early activity in all consecutive respiratory failure patients who required mechanical ventilation for > 4 days admitted to our respiratory intensive care unit ( RICU ) . A majority of patients were treated in another intensive care unit ( ICU ) before RICU admission . We excluded patients who required mechanical ventilation for ≤4 days . Patients : Eight‐bed RICU at LDS Hospital . Interventions : We assessed patients for early activity as part of routine respiratory ICU care . We prospect ively recorded activity events and adverse events . We defined three activity events as sit on bed , sit in chair , and ambulate . We defined six activity‐related adverse events as fall to knees , tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , oxygen desaturation < 80 % , and extubation . Measurements and Main Results : During the study period , we conducted a total of 1,449 activity events in 103 patients . The activity events included 233 ( 16 % ) sit on bed , 454 ( 31 % ) sit in chair , and 762 ( 53 % ) ambulate . In patients with an endotracheal tube in place , there were a total of 593 activity events , of which 249 ( 42 % ) were ambulation . There were < 1 % activity‐related adverse events , including fall to the knees without injury , feeding tube removal , systolic blood pressure > 200 mm Hg , systolic blood pressure < 90 mm Hg , and desaturation < 80 % . No patient was extubated during activity . Conclusions : We conclude that early activity is feasible and safe in respiratory failure patients . A majority of survivors ( 69 % ) were able to ambulate > 100 feet at RICU discharge . Early activity is a c and i date therapy to prevent or treat the neuromuscular complications of critical illness Introduction Despite studies demonstrating benefit , patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization . No research ers have reported filter pressures during mobilization , and it is unknown whether mobilization is safe or affects filter lifespan . Our objective in this study was to test the safety and feasibility of mobilization in this population . Methods A total of 33 patients undergoing continuous renal replacement therapy via femoral , subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled . Patients underwent one of three levels of mobilization intervention as appropriate : ( 1 ) passive bed exercises , ( 2 ) sitting on the bed edge or ( 3 ) st and ing and /or marching .  Catheter dislodgement , haematoma and bleeding during and following interventions were evaluated . Filter pressure parameters and lifespan ( hours ) , nursing workload and concern were also measured . Results No episodes of filter occlusion or failure occurred during any of the interventions . No adverse events were detected . The intervention filters lasted longer than the nonintervention filters ( regression coefficient = 13.8 ( robust 95 % confidence interval ( CI ) = 5.0 to 22.6 ) , P = 0.003 ) . In sensitivity analyses , we found that filter life was longer in patients who had more position changes ( regression coefficient = 2.0 ( robust 95 % CI = 0.6 to 3.5 ) , P = 0.007 ) . The nursing workloads between the intervention shift and the following shift were similar . Conclusions Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life . These findings have significant implication s for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12611000733976 ( registered 13 July 2011 OBJECTIVE To evaluate whether the level of mobilization achieved and the barriers for progressing to the next mobilization level differ between nurses and physical therapists . DESIGN Prospect i ve , observational study . SETTING Twenty-bed surgical intensive care unit ( SICU ) of the Massachusetts General Hospital . PARTICIPANTS Sixty-three critically ill patients . METHODS Physical therapists and nurses performed 179 mobilization therapies with 63 patients . OUTCOME MEASUREMENT Mobilization was defined as the process of enhancing mobility in the SICU , including bed mobility , edge of bed activities , transfers out of bed to a chair , and gait training ; the mobilization level was measured on the SICU optimal mobilization scale , a 5-point ( 0 - 4 ) numerical rating scale . RESULTS Patients ' level of mobilization achieved by physical therapists was significantly higher compared with that achieved by nurses ( 2.3 ± 1.2 mean ± SD versus 1.2 ± 1.2 , respectively P < .0001 ) . Different barriers for mobilization were identified by physical therapists and nurses : hemodynamic instability ( 26 % versus 12 % , P = .03 ) and renal replacement therapy ( 12 % versus 1 % , P = .03 ) were barriers rated higher by nurses , whereas neurologic impairment was rated higher by physical therapists providers ( 18 % versus 38 % , P = .002 ) . No mobilization-associated adverse events were observed in this study . CONCLUSIONS This study showed that physical therapists mobilize their critically ill patients to higher levels compared with nurses . Nurse and physical therapists identify different barriers for mobilization . Routine involvement of physical therapists in directing mobilization treatment may promote early mobilization of critically ill patients INTRODUCTION Survivors of complex critical illness and their family caregivers require support during their recovery , rehabilitation , and return to community living ; however , the nature of these supports and how they may change over time remain unclear . Using the Timing It Right framework as a conceptual guide , this qualitative pilot study explored survivors ' and caregivers ' needs during the episode of critical illness through their return to independent living . METHODS Five survivors and seven family caregivers were recruited and consented from the main Towards RECOVER pilot study , design ed to characterize the long term outcomes of survivors of the ICU who have been mechanically ventilated for more than one week . Using the Timing It Right framework , we prospect ively conducted qualitative interviews to explore participants ' experiences and needs for information , emotional support , and training at 3 , 6 , 12 , and 24 months after intensive care unit ( ICU ) discharge . We completed 26 interviews , which were audio recorded , professionally transcribed , checked for accuracy , and analyzed using framework methodology . RESULTS In this small pilot sample , caregiver and patient perspectives were related and , therefore , are presented together . We identified 1 overriding theme : survivors do not experience continuity of medical care during recovery after critical illness . Three subthemes highlighted the following : ( 1 ) informational needs change across the care continuum , ( 2 ) fear and worry exist when families do not know what to expect , and ( 3 ) survivors transition from dependence to independence . CONCLUSIONS Interventions design ed to improve family outcomes after critical illness should address both survivors ' and caregivers ' support needs as they change across the illness and recovery trajectory . Providing early intervention and support and clarifying expectations for transitions in care and recovery may decrease fears of the unknown for both caregivers and survivors . Ongoing family-centered follow-up programs may also help survivors regain independence and help caregivers manage their perceived responsibility for the patients ' health . Using these insights for intervention development could ultimately improve long-term outcomes for both survivors and caregivers Introduction  Mobilisation of patients  in the intensive care unit ( ICU ) is an area of growing research . Currently , there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses . Methods The objectives of the study were to ( 1 ) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs , ( 2 ) compare mobilisation practises between Australian and Scottish ICUs and ( 3 ) identify barriers to mobilisation in Australian and Scottish ICUs . We conducted a prospect i ve , observational , cohort study with a 4-week inception period . Patients were censored for follow-up upon ICU discharge or after 28 days , whichever occurred first . Patients were included if they were > 18 years of age , admitted to an ICU and received mechanical ventilation in the ICU . Results Ten tertiary ICUs in Australia and nine in Scotl and participated in the study . The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery ( 43.3 % ) , whereas the Scottish cohort had none . Therefore , comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery . In total , 60.2 % of the 347 patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay ( p < 0.001 ) . Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort ( hazard ratio 1.83 , 95 % confidence interval 1.38–2.42 ) . However , the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort ( 41.1 % vs 16.3 % , p < 0.001 ) . Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts . Physiological instability and the presence of an endotracheal tube were also frequently reported barriers . Conclusions This is the first study to benchmark baseline practise of early mobilisation internationally , and it demonstrates variation in early mobilisation practises between Australia and Scotl and Background Physiotherapy is integral to patient management in the Intensive Care Unit . The precise role that physiotherapists play in the critical care differs significantly worldwide . The aim of the study was to describe the profile of patients and the current patterns of physiotherapy services  delivered for patients admitted in the five public hospital intensive care units in Zimbabwe . Methods A prospect i ve record review was performed and records of all consecutive patients admitted into the five units during a two months period were included in the analysis . The data was collected using a checklist and the following were recorded for each patient : 1 ) demographic information , 2 ) admission diagnoses , 3 ) surgery classification , 4 ) method and time of mechanical ventilation 5 )  physiotherapy techniques and frequency and 6 ) the length of stay . Results A total of 137 patients were admitted to five units during the study . The mean age of patients in the study was 36.0 years ( SD = 16.6 ) . A mortality rate of 17.5 % was observed with most of the patients being below the age of 45 years . The majority of the patients , 61(45 % ) had undergone emergency surgery and were in the ICU for postoperative treatment , whilst only 19(14 % ) were in the units for clinical treatment ( non-surgical ) . On admission , 72(52.6 % ) of the patients were on  mechanical ventilation .  The mean duration on mechanical ventilation for patients was 4.0 days ( SD = 2.7 ) and a length of stay in the unit of 4.5 days ( SD = 3.0).Of the patients who were admitted into the ICU 120 ( 87.6 % ) had at least one session of physiotherapy treatment during their stay . The mean number of days physiotherapy treatment was received was 3.71 ( SD = 3.14 ) days . The most commonly used physiotherapy techniques were  active assisted limb movements  ( 66.4 % ) , deep breathing exercises ( 65.0 % ) and forced expir 
    Output:
    