Illness Recovery Research Articles

Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery.

Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.

Palliative Care in Survivors of Critical Illness: A Qualitative Study of Post-Intensive Care Unit Program Clinicians.

Background: Survivors of critical illness experience high rates of serious health-related suffering. The delivery of palliative care may assist in decreasing this burden for survivors and their families. Objectives: To understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. Design: Qualitative inquiry using semistructured interviews and framework analysis. Results were mapped using the Consolidated Framework for Implementation Research. Setting/Subjects: We interviewed 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. Results: All interprofessional clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. Facilitators promoting palliative care strategies were clinician level, including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers were reciprocals and included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers included time constraints, cost, and lack of specialty palliative care services. Conclusion: Palliative care may be an essential element of post-ICU clinic care. Implementation efforts focused on tailoring strategies to improve post-ICU program clinicians' palliative care knowledge and self-efficacy could be a key to enhanced care delivery for survivors of critical illness.

Effects of detraining on left ventricular mass in endurance-trained individuals: a systematic review and meta-analysis.

Detraining refers to a loss of training adaptations resulting from reductions in training stimulus due to illness, injury, or active recovery breaks in a training cycle and is associated with a reduction in left ventricular mass (LVM). The purpose of this study was to conduct a systematic review and meta-analysis to determine the influence of detraining on LVM in endurance-trained, healthy individuals. Using electronic databases (e.g. EMBASE and MEDLINE), a literature search was performed looking for prospective detraining studies in humans. Inclusion criteria were adults, endurance-trained individuals with no known chronic disease, detraining intervention >1 week, and pre- and post-detraining LVM reported. A pooled statistic for random effects was used to assess changes in LVM with detraining. Fifteen investigations (19 analyses) with a total of 196 participants (ages 18-55 years, 15% female) met inclusion criteria, with detraining ranging between 1.4 and 15 weeks. The meta-analysis revealed a significant reduction in LVM with detraining (standardized mean difference = -0.586; 95% confidence interval = -0.817, -0.355; P < 0.001). Independently, length of detraining was not correlated with the change in LVM. However, a meta-regression model revealed length of the detraining, when training status was accounted for, was associated with the reduction of LVM (Q = 15.20, df = 3, P = 0.0017). Highly trained/elite athletes had greater reductions in LVM compared with recreational and newly trained individuals (P < 0.01). Limitations included relatively few female participants and inconsistent reporting of intervention details. In summary, LVM is reduced following detraining of one week or more. Further research may provide a greater understanding of the effects of sex, age, and type of detraining on changes in LVM in endurance-trained individuals.

Perception and Experience of Physicians Towards the Use of a Targeted Vitamin B-Complex Combination in Attaining Faster Recovery in Acute Illnesses Like Fever vs. Other Competing Combinations in the Market

Background: Vitamin B-complex aids in the development and maintenance of a healthy immune system and also helps to prevent or lessen various infections, especially cases of acute sickness like fever. This study investigates the opinions and experiences of doctors about the effectiveness and usefulness of the targeted vitamin B-complex combinations comprising of pyridoxine hydrochloride, cyanocobalamin, nicotinamide, chromium chloride, sodium selenite, L-lysine in hastening the recovery from acute diseases like fever and others. It offers insight on the perceived advantages, disadvantages and general efficacy of target vitamin B-complex combinations in comparison to other current medications by assessing doctors' preferences, clinical observations and patient outcomes. Additionally, the study also outlines the role of selenium, chromium and L-lysine aiding in the faster recovery along with the targeted vitamin B-complex combination. Studies show that selenium supplementation can reduce mortality rates in viral infections, improve recovery rates in COVID-19 patients and improve the recovery rate. Chromium offers antioxidant properties, and influences immune response and hence helps in the faster recovery of several acute illnesses. Lysine serves as a pivotal building block for proteins, which in turn contribute significantly to the growth and restoration of bodily tissues following damage. Methods: The study was a retrospective study in July 2023 used a questionnaire-based survey to assess the efficacy and tolerability of vitamin B-complex combinations for faster recovery in acute illnesses, focusing on fever. The study used a validated questionnaire with 13 questions, and data was entered into asoftware database. Complete cases were analyzed, and missing data was excluded due to low occurrence. The final report was prepared after cleaning the data. Result: The study included 132 doctors from various medical specializations aimed to understand their perception and experience of using vitamin B-complex for faster recovery from acute illnesses. The most important factor contributing to choosing vitamin B-complex was the uses of micronutrients, which help produce red blood cells (40.2%), followed by use in treating mouth ulcers (31.1%) and are critical for pregnant ladies (28.8%). Antioxidants like selenium and chromium were found to be significantly effective (57.6%) for faster recovery in acute illnesses, while 39.4% considered them moderately effective. The study revealed that 88.6% of doctors considered the use of vitamin B-complex combination advantageous due to the presence of folic acid, L-lysine and selenium, and that 97.7% of doctors had a positive attitude about continuing to prescribe vitamin B-complex supplementation in the future. The study found that the current vitamin B-complex combination outperforms its competitors mostly (82%), especially in helping to recover from acute illnesses faster. It was also found to be friendly for the elderly, as no side effects were observed. Conclusion: Results suggest that the targeted vitamin B-complex combination can improve acute disease management and help health care professionals make informed decisions for optimal well-being. The findings contribute to a deeper understanding of the medical decisionmaking process and the nuanced considerations that impact the prescription of specific treatment options for acute illnesses.

A randomized controlled trial on the effectiveness of the abridged illness management and recovery program for people with schizophrenia spectrum disorders.

This study aimed to investigate the effectiveness of an abridged version of the Illness Management and Recovery Programme (AIMR) that was modified and developed in Hong Kong through a mult-centre randomized controlled trial for patients with schizophrenia spectrum disorders. This study was implemented in 10 occupational therapy departments, psychiatric day hospitals of 7 Hospital Authority clusters in Hong Kong. A total of 211 patients with schizophrenia or schizoaffective disorder was recruited and randomized into either the experimental or the control condition. In the control group, the subjects went through conventional occupational therapy programmes. In the experimental group, the subjects went through an additional 10-session programme of AIMR. were measured at baseline, completion of the AIMR, and 3-month after the AIMR programme. Measures include the expanded version of the Brief Psychiatric Rating Scale (BPRS-E), the client version of the Illness Management and Recovery Scale (IMRS), the Snyder Hope Scale, the Social and Occupational and Occupational Functioning Assessment Scale (SOFAS), the WHO Quality of Life Scale (WHOQOL-BREF), and the Chinese Version of the Short Warwick-Edinburgh Mental Well-Being Scale (C-SWEMWBS). Both the experimental and control cohorts had comparable clinical and socio-demographic characteristics except years of education and duration of illness. These two variables were entered as covariates in the linear mixed model which showed that the experimental group had significantly higher improvement than the control group in terms of illness management (F = 4.82; p = .03; Cohen's d = .45), functional (F = 10.65; p = .001; Cohen's d = .58), and hope (F = 5.52; p = .02; Cohen's d = .08) measures after the completion of treatment. The results supported the effectiveness of the AIMR programm which would be important in the recovery oriented practices in psychiatry.

L-Arginine in Restoring ‘Immune Dysregulation’ in Long COVID: It’s the Therapeutic Role Beyond the Routine Dietary Supplement!

COVID-19 pandemic is over now and we are in great peace of relief after three years. This pandemic has observed significant impact on quality of life globally and the put unforgettable imprints on history of mankind. Reason for more havoc in this pandemic was less studied virus by medical scientists regarding its pathophysiology, available treatment options and lack of effective vaccine to tackle this dragon. COVID-19 is the first observed and reported pandemic of corona virus related global disease apart from its previous SARS and MERS. Fast track developments in medical treatment options due to this ultrafast digital and artificial intelligence techniques have curtailed mortality on large scale globally. Although mortality is significantly reduced, morbidity is documented on a large scale worldwide in this pandemic. Morbidity due to COVID-19 now called as ‘Long COVID’, which is underreported &amp; half-heartedly evaluated globally. Long COVID is related to persistent immune dysregulation occurs during evolution of COVID-19 as natural trend of disease. Immune dysregulation has documented during course of active viremia, during recovery of viral illness and after post viral phase. Immune dysregulation occurs in ‘selected group’ of cases irrespective of disease severity and vaccination status and observed in cases with negligible illness to advanced one mandates further research. Thus, Immune dysregulation in COVID-19 is predominant cause for long covid and leading to brainstorming effect on medical scientists and researchers as of today. Globally, one third of recovered or affected cases of COVID-19 are facing long covid and needs prompt treatment options to tackle this dragon related long term effect on body. ‘Immunomodulatory’ or immunity modifying agents are the primary targets to curtail immune dysregulation and long covid. Some experts recommend ‘disease modifying agents’ to treat long covid cases. Still, many miles to go to reach to effective treatment options for long covid and we don’t have effective options for this ‘health issue of global concern’. L-Arginine is amino acid with multiple beneficial effects such as immunomodulatory effects which will regulates immunological response in inhibit dysregulated immune system additional to its universally known antioxidant, vasodilatory and regenerative and cellular proliferation effects on immune cells. These Immunomodulatory and or diseases modifying effects of L-Arginine makes it the future candidate with ‘game changer’ role for management of Long covid resulting from immune dysregulation as a core pathophysiologic pathway of this Dragon Pandemic.

Hydroxychloroquine as ‘Potential Treatment Option’ for Persistent Immune Dysregulation in Long COVID: Revisiting Its New Use as a ‘Versatile’ Molecule!

COVID-19 pandemic is over now and we are in great peace of relief after three years of first case reported in China. This pandemic has observed a significant impact on quality of life globally and this puts unforgettable imprints on the history of mankind. Reason for more havoc in this pandemic was less studied virus before this ‘unpredicted or surprise pandemic’ by medical scientists regarding its pathophysiology, available treatment options and lack of effective vaccine to tackle this dragon. Rationale would be COVID-19 is the first observed and reported pandemic of corona virus related global disease apart from its previously occurring SARS and MERS Epidemics. Fast track developments in medical treatment options with use of ultrafast digital and artificial intelligence techniques have curtailed mortality on a large scale globally. Although mortality is significantly reduced, morbidity is documented in significant number of cases worldwide after this Dragon related pandemic. Morbidity due to COVID-19 now called as ‘Long COVID’, which is underreported &amp; half-heartedly evaluated globally. Long COVID is related to persistent immune dysregulation which occurred during evolution of COVID-19 as a natural trend of disease &amp; documented during the course of active viremia, during recovery of viral illness and after the post viral phase. Immune dysregulation occurs in a ‘selected group’ of cases irrespective of disease severity and vaccination status, and observed in cases irrespective of severity of illness as with negligible illness resulted into brainstorming effect on medical scientists and researchers as of today to advanced and mandates further global research. Globally, one third of recovered or affected cases of COVID-19 are facing long covid and need prompt treatment options to tackle this dragon related long term effect on body. ‘Immunomodulatory’ or immunity modifying agents are the primary targets to curtail immune dysregulation and long covid. Some experts recommend ‘disease modifying agents’ to treat long covid cases. Still, many miles to go to reach effective treatment options for long covid and we don’t have effective options as of now for this ‘health issue of global concern’ related to Dragon. Hydroxychloroquine is initially used as an antimalarial and as an anti-inflammatory molecule for decades in various rheumatic conditions with satisfactory results. Despite decades of dependable use and predictable results in the treatment of rheumatic disease, HCQ remains a drug with an ever-expanding number of underlying mechanisms. HCQ was tried initially for prophylaxis treatment of COVID-19 due to its anti-inflammatory properties but has not shown any dramatic results. WHO has removed HCQ from the treatment plan after many trial results with disappointing outcomes. HCQ is a drug with multiple beneficial pleiotropic effects such as immunomodulatory effects which regulates immunological responses that inhibit dysregulated immune system. These Immunomodulatory and or diseases modifying effects of HCQ makes it the future candidate with ‘game changer’ role for management of Long covid resulting from immune dysregulation as a core pathophysiologic pathway of this Dragon Pandemic. Revisiting this old drug with ‘versatile effects’ can be used as treatment option for short time as frontline molecule for Long covid when no definitive options are available after consideration of risk benefit ratio which is a cost-effective treatment option.

Illness Management and Recovery (IMR): Implementation in an Italian Department of Mental Health and Pathological Addictions

Illness Management and Recovery (IMR) is a manualized psychosocial intervention developed to guide patients towards their recovery. This study presents the implementation of IMR within the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy. IMR was provided from April 2017 to July 2021 by trained professionals, who recruited psychiatric outpatients with different diagnoses, in a stable phase of the illness and motivated to engage in the program. The modules and sessions were tailored according to the specificity of the patients (e.g., diagnoses, age) and the services providing it. The characteristics of the patients and the services who adopted IMR were extracted from electronic health records, and by a summary form filled out by providers. The IMR scale (IMRS) was completed at the end of the intervention. A total of 126 patients completed the IMR intervention: they were mainly men (61.1%), with a mean age of 40.1 (12.9) years old, significantly heterogeneous for psychiatric diagnosis and duration of illness (p < .001). IMR was provided mainly in a group format (82.5%) at the community mental health (54.8%) and addiction (41.2%) services. A wide variability was observed in terms of number [1–10/person] and type of module administered, average duration of the intervention/user (9.6, [2–38 months]) and number of sessions/user (21.4 [1–70]). IMRS showed a high correlation between patient and provider (Pearson, p = .001). This study showed the feasibility of the implementation of the IMR intervention within an entire department, with a great variability in terms of patients’ clinical characteristics, number, and type of IMR module received. Future research should include a standardized measurement of outcomes to tailor the intervention.

Beyond Implementation: Mental Health Professionals’ Perspectives on What is Needed to Sustain Providing the Illness Management and Recovery Program

AbstractAlthough increasingly more mental health services worldwide have implemented Illness Management and Recovery (IMR), the evidence-based psychosocial program, research has shown the program’s low rate of sustainability over time. Thus, knowledge about what professionals perceive to be important for sustaining IMR program is needed. The aim of this study was to explore the perspectives of professionals who work at sites that have offered IMR for at least 6 years regarding what they perceive as being crucial for sustaining IMR program. Focus group interviews were conducted with 36 mental health care professionals in Norway who have experience with providing group-based IMR treatment to people with severe mental illness. Data from the interviews were subjected to reflexive thematic analysis. Three factors were determined to be essential to promoting the sustainable practice of IMR: anchoring in the organization, access to training and guidance, and the allocation of time for preparation and reflection. Achieving IMR’s long-term sustainability requires building joint ownership and a shared future vision for the program within the administering organization. To motivate professionals to continue providing IMR treatment, sufficient time and space are needed in order to provide professionals with training, continued guidance and supervision, and time to reflect on their clinical practice. Moreover, engaged leadership is crucial to facilitating professionals’ access to required resources.

Fidelity and Clinical Competence in Providing Illness Management and Recovery: An Explorative Study

Illness Management and Recovery (IMR) is a psychosocial intervention supporting people with serious mental illnesses. In this study, 15 IMR groups were assessed for fidelity and clinician competency to establish the implementation level of all IMR elements and explore complementarity of the IMR Treatment Integrity Scale (IT-IS) to the standard IMR Fidelity Scale. Use of the IT-IS was adapted, similar to the IMR Fidelity Scale. Descriptive statistics were applied. Implementation success of IMR elements varied widely on the IMR Fidelity Scale and IT-IS (M = 3.94, SD = 1.13, and M = 3.29, SD = 1.05, respectively). Twelve IMR elements (60%) were well-implemented, whereas eight (40%) were implemented insufficiently, including some critical cognitive-behavioral techniques (e.g., role-playing). The scales appeared largely complementary, though strongly correlated (r (13) = 0.74, p = 0.002). Providing all IMR elements adequately requires a variety of clinical skills. Specific additional training and supervision may be necessary.

Dysphagia outcomes in COVID-19 patients: experiences in long-term acute care hospital (LTACH).

Long term acute care hospitals (LTACHs) saw a significant increase in COVID-19 patients with prolonged acute illness recovery. Speech language pathologists (SLP) in LTACHs were integral in assessing swallowing and providing rehabilitation for dysphagia, however, there is limited research on LTACHs and dysphagia. Our aim was to describe this unique dysphagia management experience to improve future patient care. Retrospective chart reviews were conducted for patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to October 31, 2021. Demographic information, videofluoroscopic swallow study (VFSS) reports with Penetration and Aspiration Scale (PAS) scores and SLP notes were reviewed. Descriptive statistics and chi-square analysis were performed. A total of 213 patients met inclusion criteria. Most patients presented with tracheostomy (93.9%) and were NPO (92.5%) on admission. A strong correlation (p = 0.029) was noted between dependence on mechanical ventilation and significant airway invasion, as indicated by PAS score of 7 or 8 on VFSS. There was a strong association (p = 0.001) between patients who had tracheostomy placed within 33days of VFSS and recommendation for thin liquids. Upon discharge, the majority of patients (83.57%) transitioned successfully to oral diets, however, a strong association (p = 0.009) between higher age (≥ 62) and NPO at discharge was demonstrated. Patients admitted post COVID-19 to LTACH, especially those requiring tracheostomy, demonstrated various degrees of dysphagia and benefited from SLP intervention and instrumental swallow assessments. Most patients admitted to LTACH for COVID-19 were successfully rehabilitated for dysphagia.

Conceptions of Recovery and Relapse of Severe Mental Illness from the Perspective of Mental Health Personnel in Mexico City

AbstractThis study explores recovery from severe mental disorders from the perspective of 89 mental health care professionals working in Mexico City, using a mixed method approach. The participants were recruited and interviewed from mental health and addiction treatment facilities in Mexico City using convenience sampling techniques. Transcribed interviews were coded and analyzed for thematic content regarding recovery and relapse of mental illness. On the quantitative level, we used a sample of 11 items from the Mexican adaptation of the Opinions about Mental Illness questionnaire to compare the attitudes of health personnel and consider differences by gender. Of the respondents, 18% did not believe that recovery was possible for individuals with severe mental disorders, but most believed in recovery in at least some cases. The results also indicated a strong orientation toward recovery in the clinical sense, focused on patients’ symptomatology. There were significant differences in attitudes toward mental illness items by gender. Men showed more favorable attitudes than women (F = 6.60, p = .05). However, the small size of our sample limits the generalizability of the findings. Educational strategies based on social contact with persons with mental health problems could be useful in modifying negative attitudes toward mental illness.

Facilitators and barriers in the implementation of a culturally adapted Arabic version of Illness Management and Recovery (IMR) among Palestinian Arabs in Israel.

The Illness Management and Recovery (IMR) program has been implemented in several countries including Israel. This study examines, from the perspective of Arab practitioners, facilitators and barriers in the implementation of a culturally-adapted version of the IMR intervention among Arabs with serious mental illness in Israel. Fourteen Arab practitioners who had delivered the culturally adapted IMR were interviewed. The analysis of the interviews identified facilitators and barriers, divided into universal factors found when implementing the intervention elsewhere in the world, and culture-specific ones. Facilitators included the manual on which the intervention was based, bypassing verbal communication, ongoing supervision during implementation, the group process, co-facilitation and the cultural adaptations. The barriers included three universal ones: Meeting needs beyond IMR due to service shortage, Reputation is everything: Self- and social stigma and Pulling the others back: Difficulties in reading and writing-and one that was culture-specific: family over-involvement. Identifying facilitators and barriers in the implementation of the adapted IMR can contribute to the implementation of evidence-based practices (EBPs) in the mental health area. Notably, multiple culture-specific facilitators have been identified, as opposed to only one culture-specific barrier, suggesting that cultural differences may be overcome in implementing EBPs developed in the West.

Longitudinal Impact of Self-Compassion and Psychological Flexibility on Mental Illness Recovery: The Mediating Roles of Self-Stigma and Mental Health Service Engagement

Longitudinal Impact of Self-Compassion and Psychological Flexibility on Mental Illness Recovery: The Mediating Roles of Self-Stigma and Mental Health Service Engagement

Meaningful goal setting: Practitioners’ perspectives on goal setting in the illness management and recovery program.

The aim of our study was to gain insight into how practitioners in mental health care support people with severe psychiatric disabilities in setting and pursuing personal goals that are meaningful to them. We conducted focus groups with 36 mental health practitioners in Norway and interpreted the data by using reflexive thematic analysis. Four themes emerged from the analysis: (a) active collaboration to understand what is meaningful to the individual, (b) being nonjudgmental during the process of goal setting, (c) helping individuals break goals into smaller goals and steps, and (d) allowing time for the process of trying to achieve goals. Although goal setting is central to the Illness Management and Recovery program, practitioners perceive the work as quite demanding. To succeed, practitioners need to acknowledge goal setting as a long-lasting and shared process, not as a means to an end. As people with severe psychiatric disability often need help in goal setting, practitioners should play an important role in supporting them in setting goals, making plans for achieving them, and taking actual steps in that direction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Feasibility and acceptability of the Critical Illness Recovery for ChiLdrEn (CIRCLE) program

Feasibility and acceptability of the Critical Illness Recovery for ChiLdrEn (CIRCLE) program

Longitudinal impact of experienced discrimination on mental health among people with mental disorders

The present study examined the longitudinal impact of stigma on mental health among people with mental disorders. Specifically, this study tested whether higher levels of experienced discrimination would be longitudinally associated with lower levels of symptomatic remission, functional restoration, well-being, and life satisfaction and whether these associations would be mediated by higher levels of self-stigma content and process. A total of 202 people with mental disorders completed questionnaires at three time points (i.e., T1, T2, and T3) over two years. Path analyses showed that experienced discrimination at T1 was positively associated with self-stigma content and process at T2, which were, in turn, negatively associated with symptomatic remission, functional restoration, well-being, and life satisfaction at T3. Bootstrap analyses further revealed that experienced discrimination at T1 had indirect effects on symptomatic remission, functional restoration, well-being, and life satisfaction at T3 through self-stigma content and process at T2. This study shows that experienced discrimination may exacerbate self-stigma content and process and, in turn, impede recovery and wellness among people with mental disorders. Our findings highlight the importance of designing and implementing stigma and self-stigma reduction programs in order to enable people with mental disorders to attain mental illness recovery and positive mental health.

Abstract WP183: Social Activities Are Positively Associated With Medication Adherence In Stroke Survivors

Introduction: Social support may influence illness incidence or recovery through effects on health-related behaviors, and one aspect is emotional support, which includes the offering of empathy, friendship, care, and trust along with information. While we have previously reported on the positive relationship of family and friend networks in risk reduction, our objective was to examine whether participation in formalized group activities was related to medication adherence post-stroke. Methods: Using Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) data, information regarding religious and nonreligious social activities was collected at baseline. The outcome variable was measured by the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8; score 0-8). Medium/high adherence (MMAS-8≥6) at 6- and 12-months post-discharge was modeled against social activities separately using logistic regression adjusting for age, gender, race/ethnicity, education, family and friend networks, NIH stroke scale at admission, and the intervention. Results: Of the 541 participants who completed the baseline questionnaire, 286 and 344 had valid MMAS-8 scores for post 6-months and 12-months follow-up data collection. Medication adherence was poor among the participants. Only 44% for 6-months and 46% for 12-months had medium or high medication adherence. Participants going to nonreligious social events (n = 67, 21%) had higher odds of having medium/high medication adherence (OR = 3.08, 95% CI: 1.15-8.25) at 12-months. Discussion: Nonreligious social activities, including meetings of social clubs or other non-religious groups not relevant to work, were shown to be positively related to 12-months post-discharge medication adherence among stroke patients. Social activities may play an important role in emotional support and may be an opportunity for targeted secondary stroke prevention.

Using experience-based co-design to prioritise areas for improvement for patients recovering from critical illness

ObjectivesCritical illness recovery is a journey; from intensive care unit to hospital ward to home. However, evidence is limited on how best to enable recovery from critical illness. This study aimed to prioritise areas for improvement in care and services for patients recovering from critical illness. Research designThis study used experience-based co-design. Service users and providers worked in partnership to identify and prioritise service improvements for patients who had survived an episode of critical illness. MethodQualitative interviews were carried out with patients (n = 10) who had experienced critical illness, and staff (n = 9) who had experienced caring for patients in the intensive care unit. Key patient touchpoints were identified and used to produce a film, reflecting the critical illness journey. A patient feedback event incorporated an emotional mapping exercise, to identify key points during the recovery journey. A joint patient/family (n = 10) and staff (n = 10) event was held to view the film and identify priorities for improvements. FindingsEmotional mapping highlighted areas where services were not synchronised with patients’ needs. Four patient-focussed priorities for service improvement emerged 1. Improving the critical care experience, 2. Addressing patients’ emotional and psychological needs, 3. Positioning patients at the centre of services and 4. Building a supportive framework for recovery. ConclusionEvidence-based co-design was used successfully in this study to identify priorities for improvements for patients recovering from critical illness. This approach positions patients at the centre of service improvements and realigns care delivery around what matters most to patients. Person-centred care provision underpins all identified priorities. Implications for clinical practiceIntensive care unit staff should get to know patients and their families by talking more to patients and families about their care and engaging in more non-medical conversations. Emotional and psychological support should be provided to aid rehabilitation and recovery from critical illness in the intensive care unit, on general wards, and in the community. Information and services should be available when patients need them, rather than at fixed time points or settings. Recovery services should focus on enabling and building the self-efficacy of patients to empower them to be in control of their recovery journey.

DIFFERENTIAL DIAGNOSIS OF EXACERBATIONS AND PSEUDO-EXACERBATIONS AGAINST THE BACKGROUND OF SARS-COV-2 BY THE EXAMPLE OF A CLINICAL CASE OF A PATIENT WITH MULTIPLE SCLEROSIS

Abstract. Due to the COVID-19 pandemic, there is an increasing need for information on how SARS-CoV-2 affects individuals with multiple sclerosis (MS). The patients receiving disease-modifying therapy (DMT) for MS are more likely to require medical attention for infection than the general population. SARS-CoV-2 can cause the worsening of MS symptoms and be mistaken for a relapse, so physicians must carefully assess whether a patient is experiencing a relapse or pseudo-exacerbation. Thus, there is a necessity for science-based guidelines on how to lower the risk of infection, as well as an early differential diagnosis of relapse and pseudo-exacerbation, and effective care for MS patients with COVID-19. Materials and methods of research: a patient with a history of MS treated with DMTs. The patient presented with worsening disease symptoms, likely exacerbation, and was diagnosed with COVID-19. Results: a thorough analysis of existing literature was conducted, along with a quick examination of how DMT was used in MS patients with COVID-19. The patient we dealt with was receiving DMT and experienced a severe illness. Timely use of intravenous corticosteroids and antibiotics allowed taking under control the activity of the pathological process. Fortunately, the outcome was favorable. Conclusions: this evaluation presents information about the clinical features, results, and functions of DMTs in MS patients infected with SARS-CoV-2. Healthcare professionals must carefully consider the possibility of relapse in MS patients with COVID-19, particularly during the pandemic, and should look out for pseudo-exacerbations. While many cases demonstrated a mild course of illness and successful recovery with DMTs, additional investigation is required to create guidelines supported by evidence.