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Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors
- Sophia Wang, Philip Hanneman, Chenjia Xu, Sujuan Gao, Duane Allen, Dmitry Golovyan, You Na Kheir, Nicole Fowler, Mary Austrom, Sikandar Khan, Malaz Boustani, Babar Khan
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- Journal:
- International Psychogeriatrics / Volume 32 / Issue 12 / December 2020
- Published online by Cambridge University Press:
- 30 August 2019, pp. 1409-1418
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- Article
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Background:
As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). We describe how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI).
Methods:The CCRC was designed using an eight-step process known as the AI Science Playbook. Patients who required mechanical ventilation or were delirious ≥48 hours during their ICU stay were enrolled in the CCRC. One hundred twenty subjects who completed baseline HABC-M CG assessments and had demographics collected were included in the analysis to identify baseline characteristics that correlated with higher HABC-M CG scores. A subset of patients and caregivers also participated in focus group interviews to describe their perceptions of PICS.
Results:Quantitative analyses showed that the cognitive impairment was a major concern of caregivers. Focus group data also confirmed that caregivers of ICU survivors (n = 8) were more likely to perceive cognitive and mental health symptoms than ICU survivors (n = 10). Caregivers also described a need for ongoing psychoeducation about PICS, particularly cognitive and mental health symptoms, and for ongoing support from other caregivers with similar experiences.
Conclusions:Our study demonstrated how the AI Science Playbook was used to build the first ICU survivor clinic in the United States. Caregivers of ICU survivors continue to struggle with PICS, particularly cognitive impairment, months to years after discharge. Future studies will need to examine whether the CCRC model of care can be adapted to other complex patient populations seen by health-care professionals.
5 - Internet Resources and the Study of Chinese Foreign Relations
- Edited by Allen Carlson, Mary E. Gallagher, University of Michigan, Ann Arbor, Kenneth Lieberthal, Melanie Manion, University of Wisconsin, Madison
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- Book:
- Contemporary Chinese Politics
- Published online:
- 05 June 2012
- Print publication:
- 29 July 2010, pp 88-106
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- Chapter
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Summary
For decades, students of Chinese foreign policy were confronted with a stark dearth of information relating to China’s position in the international arena. In the 1960s, Allen Whiting’s seminal work, China Crosses the Yalu, while drawing from the author’s extensive governmental experience, referenced only a limited pool of official Chinese sources to describe Beijing’s stance on the Korean peninsula. In the 1970s, the main source of information for Samuel Kim’s book, China, the United Nations and World Order, was Chinese votes in the United Nations General Assembly. A few years later, A. Doak Barnett’s short, but influential, The Making of Foreign Policy in China, was also marked by the use of a limited number of sources. In contrast, in the late 1980s, a new generation of scholars began to gain access to a somewhat broader set of data. The best examples of this trend were Tom Christensen’s consideration of newly available documents relating to the Korean War, followed by Iain Johnston, David Shambaugh, and Robert Ross’s utilization of extensive interview data. However, this being the case, the general informational frame for researching Chinese foreign policy has remained relatively static since the early 1990s, with researchers repeatedly making use of the same limited set of sources (a handful of Chinese-language journals dedicated to international politics, official statements, a smattering of 内部 documents, and interviews with a small circle of foreign policy elites). In comparison, it is widely perceived that the study of Chinese foreign policy is now poised to enter a new era. Indications of such an incipient development are purported to be found in the expanding availability of new data. The most prominent of these sources is generally seen to be the Chinese Internet, which appears to contain a treasure trove of new information related to China’s foreign relations. The question then becomes how significant is the Internet to the study of Chinese foreign policy?