From bedside to beyond: The long-term impact of early mobilization in the ICU

What are the barriers to nurses mobilising adult patients in intensive care units? An integrative review

Evidence on timing for mobilization after chronic subdural hematoma (cSDH) surgery is heterogeneous, and practices differ considerably among neurosurgical centers. The Impact of an Early Out-of-Bed Paradigm in Postoperative Outcomes of Chronic Subdural Hematomas: GET-UP Randomized Prospective Trial (GET-UP Trial) is a randomized clinical trial comparing a postoperative early mobilization protocol to bed rest. Previously reported results at clinical discharge and 1 month after surgery indicated a decreased risk of medical complications in the early mobilization group. Herein, the authors report outcomes at the 1-year follow-up. The GET-UP Trial is a prospective, randomized, unicentric, open-label study with an intention-to-treat primary analysis designed to evaluate the impact of an early mobilization protocol after burr hole craniostomy for cSDH on the occurrence of medical complications and functional outcomes. Between January 2019 and August 2021, a total of 208 patients were recruited and randomized to either an early mobilization group, in which patients began elevation of the head of the bed within the first 12 hours after surgery, or to a bed rest group, in which patients remained recumbent for 48 hours. Outcomes assessed at the 1-year follow-up included functional status as measured by the Glasgow Outcome Scale-Extended (GOSE) and repeat surgery for hematoma recurrence (surgical recurrence). A total of 203 patients completed 1 year of follow-up: 101 in the bed rest group and 102 in the early mobilization group. No significant baseline pre-randomization clinical differences were observed between the two management groups. At 1 year after surgery, a favorable functional outcome, defined as a GOSE score ≥ 5, was observed in 59 patients (58.4%) in the bed rest group and 78 (76.5%) in the early mobilization group (p = 0.006). Death occurred in 25 patients (24.8%) in the bed rest group and 16 (15.7%) in the early mobilization group (p = 0.108). Surgical recurrence was noted in 6 patients (5.9%) in the bed rest group and 7 (6.9%) in the early mobilization group (p = 0.788). Multivariate analysis showed an independent association between early mobilization and an increase in favorable functional outcomes (OR 2.006, 95% CI 1.076-3.739, p = 0.028). The GET-UP Trial is the first randomized clinical trial assessing the impact of mobilization strategies on medical complications after burr hole craniostomy for cSDH. Regarding functional results 1 year after surgery, early mobilization was associated with an improvement in functional outcomes without an increase in surgical recurrence. These findings support the preference for an early mobilization protocol in cSDH patients over mandatory bed rest strategies.

What is in the journal: Quality and safety.

This article analyses the early career occupational mobility of people from a Turkish or Moroccan descent in Flanders (Belgium). Previous research showed that second-generation migrants are less successful than natives when entering the labour market. We compare the progress in socio-economic status (SES) that youngsters of native and non-native descent make from their first to later jobs at the start of their career. Both second-generation immigrants and native majority young adults experience upward occupational mobility during this crucial phase of their occupational career. The gap between native and ethnic minority youth, however, does not narrow over the course of the years. The first job offers less SES for non-natives compared to that of natives, and the minority-native gap in occupational attainment remains constant afterwards. The future career is largely determined by the characteristics of the start of the occupational career, and educational attainment even before. Promising, however, might be the finding that a first job with a relative low occupational status does offer better opportunities for Turkish and Moroccan second-generation migrants than for native majority youth to do some catching up later on. In combination with a long-term negative impact of initial unemployment, ethnic minority youth perhaps are best off with starting to work as soon as possible after school leaving.

BackgroundHeart failure (HF) is a growing global health concern, and adherence to early cardiac rehabilitation (CR) remains suboptimal. Exergaming is a promising alternative to conventional exercise programs for patients with HF. However, existing research has limitations, and the integration of exergaming into clinical practice remains challenging. Most notably, current studies often rely on commercially available systems that are not tailored to needs specific to patients with HF, lack long-term adherence strategies, and have limited evaluation in the initial phases of cardiac rehabilitation.ObjectiveThis study aimed to design, develop, and assess the usability of a novel exergaming prototype (ie, HEFMOB), integrating immersive virtual reality (VR), real-time biometric monitoring, and autonomous session management to support early-phase, exercise-based CR in patients with HF.MethodsA multidisciplinary team developed HEFMOB through iterative prototyping. The final system included a pedal-based VR cycling game and an upper-limb mobilization minigame, with real-time monitoring of heart rate, blood pressure, and peripheral capillary oxygen saturation. Usability was assessed in two phases: (1) an expert evaluation and refinement phase and (2) a single-session usability phase involving 10 patients with HF (4 female). The sessions were recorded and individually evaluated by 2 researchers using the Serious Game Usability Evaluator tool. After each session, the participants completed the System Usability Scale (SUS) and a subscale of Intrinsic Motivation Inventory (IMI) to rate the usability of the exergaming prototype and enjoyment, respectively. Descriptive statistics were reported.ResultsThe participants had a mean age of 64.8 (SD 8.4) years, BMI of 26.7 (SD 4.6) kg/m2, and left ventricular ejection fraction of 40.5% (SD 7.4%). All participants completed the session without adverse events. The SUS score averaged 71.5, SD 17.8 (indicating good usability) and IMI scores indicated very high enjoyment (mean 25.1, SD 3.5). A total of 136 gameplay-related events were recorded: negative (n=76, mostly confusion), neutral (n=49), and positive (n=11). Interface-related issues (n=61) were most common, followed by design (n=52) and hardware (n=23).ConclusionsHEFMOB appears to be a promising, engaging, and well-tolerated tool for delivering tailored exergaming interventions in patients with HF. High usability and enjoyment ratings support its acceptability, while structured user experience analysis provided valuable insights for system refinement. This study marks a critical step toward integrating personalized, gamified exercise in inpatient settings, especially where early mobilization is lacking. Building on these findings, future research will assess long-term usability and clinical impact through a multicenter randomized controlled trial.

Invited Commentary

Introduction: Femoral collum fractures are a common injury in the geriatric population, particularly postmenopausal women with osteoporosis. The intracapsular location of the fracture and proximity to the blood supply of the femoral head increases the risk of complications such as non-union and avascular necrosis. Early and appropriate treatment is essential to minimize long-term functional impact. Case Illustration: A 67-year-old woman experienced severe pain in the right hip after slipping while mopping the floor. The patient was unable to stand or walk after the incident. History showed osteoporosis which was not treated regularly. Radiologic examination revealed a right collum femur fracture with Garden type IV classification. The patient underwent arthroplasty bipolar and a gradual physiotherapy rehabilitation program for six months. Discussion: This case illustrates a common pattern of osteoporotic fractures in the elderly, where minor trauma can cause severe damage to the bone. The selection of arthroplasty is appropriate to the patient's bone condition and fracture type, providing stability and allowing early mobilization. Intensive rehabilitation has been shown to support functional recovery. Long-term management of osteoporosis with antiresorptive therapy such as zoledronate, patient education, and environmental modification are also important for the prevention of recurrent fractures. Conclusion: A comprehensive approach that includes surgery, early rehabilitation, and management of osteoporosis can result in a better.

Previous research showed that second-generation migrants are less successful than natives when entering the labour market. This article analyses the early career occupational mobility of young people from a Turkish or Moroccan descent in Flanders. We compare the progress in socio-economic status (SES) that youngsters of native and non-native descent make from their first to later jobs at the start of their career. Both immigrants and native majority young adults experience upward occupational mobility during this crucial phase of their occupational careers. The gap between native and ethnic minority youth, however, does not narrow over the course of the years, with one exception because youth with non-traditional migrant background who migrated at a young age are more upwardly mobile during the first years of their career than the natives. The future career is largely determined by the characteristics of the start of the occupational career, and educational attainment even before. A first job with a relative low occupational status does however offer better opportunities for Turkish and Moroccan second-generation migrants than for native majority youth to do some catching up later on. In combination with a long-term negative impact of initial unemployment, these ethnic minority youth perhaps are best off with starting to work as soon as possible after school leaving.

How We Prevent and Treat Delirium in the ICU

Long-term recovery of survivors of coronavirus disease (COVID-19) treated with extracorporeal membrane oxygenation: The next imperative

BackgroundDespite the growing prevalence of burn survivors, a gap persists in our understanding of the correlation between acute burn trauma and the long-term impact on psychosocial health. This study set out to investigate the prevalence of long-term pain and symptoms of anxiety and depression in survivors of extensive burns, comparing this to the general population, and identify injury and demographic-related factors predisposing individuals to psychosocial compromise.MethodsRE-ENERGIZE was an international, double-blinded, randomized-controlled trial that enrolled 1200 patients with partial- or full-thickness burns that required surgical treatment. For the post hoc analysis, we excluded participants who did not complete the Short Form Health Survey (SF-36) questionnaire. Normative data were taken from the 2021 National Health Interview Survey dataset. Propensity score matching was performed using the nearest-neighbor 1-to-1 method, and the two cohorts were compared in terms of chronic pain, and symptoms of anxiety and depression. A multivariable analysis was performed on the burns cohort to identify factors predicting post-discharge pain and symptoms of anxiety and depression.ResultsA total of 600 burn patients and 26,666 general population adults were included in this study. Following propensity score matching, both groups comprised 478 participants each, who were predominately male, white, overweight and between 20 and 60 years old. Compared to the general population, burn patients were significantly more likely to report the presence of moderate and a lot of pain (p = 0.002). Symptoms of anxiety were significantly higher in the burn population in two of four levels (most of the time; some of the time; p < 0.0001 for both). Responders in the burn population were significantly less likely to report the absence of depressive symptoms (p < 0.0001). Burn patients were also significantly more likely to report that their mental health affects their social life. TBSA, history of depression, and female sex were identified as independently associated factors for pain, anxiety, and depressive symptoms. The presence of chronic pain and anxiety symptoms independently predicted for symptoms of depression.ConclusionsAnalyzing the largest multicenter cohort of patients with extensive burns, we find that burn injury is associated with chronic pain, and symptoms of anxiety and depression. In addition, TBSA-burned and history of depression directly correlate with the prevalence of chronic pain, and symptoms of anxiety and depression. Finally, pain, and symptoms of anxiety and depression are interrelated and may have interactive effects on the process of recovery following burn injury. Burn patients would, therefore, benefit from a multidisciplinary team approach with early mobilization of pain and mental health experts, in order to promptly prevent the development of psychosocial challenges and their consequences.

In the 1993/94 winter exploration season, BP Exploration (Alaska) Inc., (BPXA), drilled two wells in the Pt. Thomson area of the North Slope. In March 1993, pre-fabricated, insulated panels had been transported to the North Slope and installed at the first exploration location. Their purpose was to insulate an underlying ice pad from thawing during the Arctic summer. The survival of the ice pad through the summer made possible a very early mobilization of the drilling rig the following October. This enabled sufficient time to be available that winter to drill two exploration wells in the same season, greatly reducing rig and equipment remobilization costs. Outline Exploration drilling on Alaska's North Slope is typically conducted in the winter months when locations remote from existing gravel road infrastructure can be accessed by the construction of temporary ice roads, or alternately, by the movement of equipment and supplies across the frozen tundra by all-terrain vehicles. In late 1992, BPXA began planning an exploration drilling program to be conducted in the winter of 1993/94. The area of interest lay approximately 10 miles south of Point Thomson on the Beaufort Sea coastline, and 50 miles east of the closest infrastructure at Prudhoe Bay (Fig. 1). Exploration wells in the 1970s and 1980s utilized gravel pads to support the drilling operation. It was in this time-period that the original exploration and appraisal drilling in the Pt. Thomson area took place. Operations frequently continued into the Arctic summer using helicopters as the only method of resupply. Alternately, operations were suspended at the end of the winter, for continuation after tundra freeze-up occurred the following fall. Historic exploration well costs reflected these expensive measures required. Over the past decade, the use of gravel pads for exploration wells has become an unacceptable and unnecessary option on the North Slope. This has been due to the long-term environmental impact imposed (vs. the temporary, one-season ice pads that are now utilized) and the prohibitive costs of gravel pad construction in such a remote environment. No wells had been drilled in the Pt. Thomson area since 1985. A review of the available historic well data showed that most wells had taken in excess of 150 days from spud to rig-release and on some occasions over 220 days. This far exceeded the winter season available for exploration drilling operations of about four months using the now-conventional ice pad location. Although drilling performance on these old wells seemed poor by today's standards, a review of offset data and an understanding of the sub-surface geology encountered in the area, showed this to be by far the most technically difficult drilling environment existing on the North Slope. The challenge for BPXA a decade later was two-fold:to use drilling technology and practices developed in the intervening period to safely drill new exploration wells in the area faster, and,devise a cost-effective method of extending the ice pad based drilling season. The goals were to firstly ensure that a single well could be successfully completed in one winter season, and secondly, if operations did indeed progress with a step-change improvement from previous Pt. Thomson area performance, to provide the opportunity of drilling a second well in the same season. This would greatly reduce equipment mobilization costs and obtain invaluable sub-surface information a full year earlier than would otherwise be possible. Insulation of thin gravel pads had been performed in the past as a method of retaining structural integrity of the gravel over a summer period by keeping its bound water frozen. A design study was carried out at the end of 1992 to determine the feasibility of insulating an ice pad over an Arctic summer using readily available insulation materials. A finite element analysis model was used to demonstrate the concept's merit and provide figures on insulation thickness required at the specific well location. A plan was quickly developed to design, construct and ship the pre-fabricated insulation panels. In March 1993, an ice pad was constructed on the drilling location. P. 359

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their role in managing pain in patients with multiple traumatic injuries. By reducing reliance on systemic opioids, PNBs support effective pain control and facilitate early mobilization, aligning with enhanced recovery principles. This narrative review summarizes current evidence on the use of PNBs in the context of polytrauma, focusing on their analgesic efficacy, integration within multimodal analgesia protocols, and contribution to improved functional outcomes. Despite these advantages, clinical application is limited by specific concerns, including the potential to mask compartment syndrome, the risk of nerve injury or local anesthetic systemic toxicity (LAST), and logistical barriers in acute trauma settings. Emerging directions in the field include the refinement of ultrasound-guided PNB techniques, the expanded use of continuous catheter systems, and the incorporation of fascial plane blocks for anatomically complex or multisite trauma. Parallel efforts are focusing on the development of decision-making algorithms, improved risk stratification tools, and integration into multimodal analgesic pathways. There is also growing emphasis on standardized clinical protocols, simulation-based training, and patient education to enhance safety and consistency in practice. As evidence continues to evolve, the long-term impact of PNBs on functional recovery, quality of life, and healthcare utilization must be further explored. With thoughtful implementation, structured training, and institutional support, PNBs may evolve into a cornerstone of modern trauma analgesia.

Navigating the weight: The impact of obesity on gastrointestinal cancer surgery and strategies for improved outcomes.

The widespread adoption of smartphones and wearable technology has introduced innovative approaches in health care, particularly in postoperative rehabilitation. These technologies hold significant promise for improving recovery following lower extremity arthroplasty, especially total knee arthroplasty (TKA). Despite growing interest, the evidence on their effectiveness and long-term impact remains variable.This narrative review evaluates the utilization of smartphone applications, wearable devices, and their combined use in postoperative recovery after TKA. Key studies assessing adherence, functional outcomes, patient satisfaction, and health care utilization were analyzed to synthesize insights into their effectiveness compared to traditional rehabilitation approaches.Smartphone applications have demonstrated improvements in adherence to rehabilitation plans, pain management, and functional outcomes. For instance, interventions using text-based prompts or interactive platforms enhanced physical activity, reduced narcotic use, and improved patient-reported outcomes such as PROM adherence and range of motion (ROM). Similarly, wearable devices provided accurate feedback on activity levels and step counts, promoting early mobility and strength recovery. Combined approaches leveraging both technologies further enhanced adherence, functional recovery, and patient engagement while reducing health care utilization.The integration of smartphone and wearable technologies in TKA rehabilitation shows potential for improving recovery outcomes. While findings generally indicate noninferiority or superiority to conventional methods, limitations exist in standardization, data accuracy, and long-term benefits. Future research should focus on refining these technologies, establishing standardized guidelines, and evaluating their cost-effectiveness in diverse populations. Smartphone and wearable technologies represent safe and effective tools for enhancing postoperative outcomes in TKA patients. Their integration into clinical practice could optimize rehabilitation protocols, improve patient engagement, and potentially reduce health care costs.