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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the fast-evolving landscape of modern healthcare&#44; integrating cutting-edge technology into intensive care units &#40;ICUs&#41; has undoubtedly transformed how we diagnose&#44; monitor&#44; and treat critically ill patients&#46; Yet&#44; amid the constant hum of machines and the precise calculations of algorithms&#44; it is easy to lose sight of a fundamental truth&#58; that behind every patient&#44; a family is grappling with uncertainty&#44; fear&#44; and a profound sense of responsibility&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The already well-known Humanisation of Intensive Care movement &#40;Proyecto HU-CI&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> seeks to change how we deliver our care towards a more friendly and human-centred model&#46; Within its eight research areas&#44; we find &#8220;promoting the presence and participation of family members in the ICU&#8221;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Even though we encourage this participation and involve family members in the care and accompaniment of the patient throughout the process of &#8220;critical illness&#8221; &#40;which includes not only the ICU stay but also the period after admission and the patient&#39;s return home&#41;&#44; we must not forget that family members suffer in this process&#46; Therefore&#44; high-quality family-centred care should be considered a fundamental skill for ICU clinicians&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Within this new journal&#8217;s issue&#44; we find an interesting study that puts this problem back on the table&#46; Tejero-Aranguren et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> carried out a prospective observational cohort study to &#40;1&#41; determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients and &#40;2&#41; identify risk factors related to its development in both the patient and the family member&#46; They assessed patients and families three months after ICU discharge in a follow-up visit using different known scales used to address &#40;1&#41; the patient&#8217;s physical&#44; social&#44; and psychological dimensions &#40;in this case&#44; they used Barthel&#44; SF-12&#44; HADS&#44; Pfeiffer and IES-6&#41; and &#40;2&#41; the caregiver burden &#40;measured using Apgar and Zarit scores&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The following results are worth noting&#58; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">They observed a high incidence of PICS-F &#40;34&#46;6&#37; &#91;25&#8211;45&#46;7&#93;&#41;&#44; highlighting a severe burden &#40;measured by Zarit score&#41; in 3&#46;8&#37; of the families&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0030" class="elsevierStylePara elsevierViewall">The presence of PICS-F was determined by the presence of PICS in the patient&#44; but they did not identify any family member risk factor for the development of PICS-F&#46; The patient variables related to the presence of PICS-F in the primary caregiver were longer length-of-stay&#44; higher number of days under mechanical ventilation or deep sedation&#44; lower Barthel score and higher HADS score&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Moreover&#44; patients showed worse quality of life than reference population values &#40;e&#46;g&#46; only 24&#46;3&#37; of the patients had returned to work upon follow-up consultation&#44; 10&#46;4&#37; showed cognitive impairment&#44; and 51&#46;2&#37; were still under anxiolytic or antidepressant treatment&#41;&#46;</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">Readers may highlight the typical limitations of a study&#58; single-centred study&#44; low number of recruited patients and families&#44; long list of exclusion criteria&#44; and univariate analysis&#46; However&#44; as the authors comment&#44; this is a good starting point for further research&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The highly technical nature of critical care complicates delivering patient and family-centred care&#46; A better understanding of &#40;1&#41; the patient&#39;s needs and perceptions regarding family participation in essential care and &#40;2&#41; barriers that hinder a patient- and family&#8208;centred environment can help&#46; Education and training of relatives and ICU healthcare providers are necessary to address safety and quality of care concerns&#44; though most studies lack further specification&#46; It is also imperative to consider screening and follow-up of caregivers for mental health problems&#44; especially within the post-ICU programmes&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;9</span></a> A recent study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> observed an improvement in some components of mental health &#40;fear&#44; self-esteem&#44; coping&#44; sleep disorders&#41; and the patient&#39;s ability to perform basic activities of daily living after implementing a protocol for preventing and managing post-intensive care syndrome&#46; Moreover&#44; the positive results on the Zarit scale &#40;caregiver overload&#41; also stem from the high level of support perceived by the patients&#39; families and relatives&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We must work together to create a humanistic ICU environment for our patients and ourselves&#59; it not only enhances patient and family experiences but can also contribute to improved clinical outcomes and reduced healthcare provider burnout&#46; We must understand that our care goes beyond the critically ill patient and must include the care of family members&#46; It is time for effective multidisciplinary management&#46; It is time to work hand in hand with physiotherapists&#44; psychologists&#47;psychiatrists&#44; occupational therapists&#44; and social workers to promote patient&#8217;s full recovery and a quick return to an active and fulfilling life for our patients and their families&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">There is no conflict of interest&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">No financing required&#46;</p></span></span>"
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Editorial
Filling in the puzzle
Completando el puzzle
Beatriz Lobo-Valbuena
Hospital Universitario del Henares, Coslada, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the fast-evolving landscape of modern healthcare&#44; integrating cutting-edge technology into intensive care units &#40;ICUs&#41; has undoubtedly transformed how we diagnose&#44; monitor&#44; and treat critically ill patients&#46; Yet&#44; amid the constant hum of machines and the precise calculations of algorithms&#44; it is easy to lose sight of a fundamental truth&#58; that behind every patient&#44; a family is grappling with uncertainty&#44; fear&#44; and a profound sense of responsibility&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The already well-known Humanisation of Intensive Care movement &#40;Proyecto HU-CI&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> seeks to change how we deliver our care towards a more friendly and human-centred model&#46; Within its eight research areas&#44; we find &#8220;promoting the presence and participation of family members in the ICU&#8221;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Even though we encourage this participation and involve family members in the care and accompaniment of the patient throughout the process of &#8220;critical illness&#8221; &#40;which includes not only the ICU stay but also the period after admission and the patient&#39;s return home&#41;&#44; we must not forget that family members suffer in this process&#46; Therefore&#44; high-quality family-centred care should be considered a fundamental skill for ICU clinicians&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Within this new journal&#8217;s issue&#44; we find an interesting study that puts this problem back on the table&#46; Tejero-Aranguren et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> carried out a prospective observational cohort study to &#40;1&#41; determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients and &#40;2&#41; identify risk factors related to its development in both the patient and the family member&#46; They assessed patients and families three months after ICU discharge in a follow-up visit using different known scales used to address &#40;1&#41; the patient&#8217;s physical&#44; social&#44; and psychological dimensions &#40;in this case&#44; they used Barthel&#44; SF-12&#44; HADS&#44; Pfeiffer and IES-6&#41; and &#40;2&#41; the caregiver burden &#40;measured using Apgar and Zarit scores&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The following results are worth noting&#58; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">They observed a high incidence of PICS-F &#40;34&#46;6&#37; &#91;25&#8211;45&#46;7&#93;&#41;&#44; highlighting a severe burden &#40;measured by Zarit score&#41; in 3&#46;8&#37; of the families&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0030" class="elsevierStylePara elsevierViewall">The presence of PICS-F was determined by the presence of PICS in the patient&#44; but they did not identify any family member risk factor for the development of PICS-F&#46; The patient variables related to the presence of PICS-F in the primary caregiver were longer length-of-stay&#44; higher number of days under mechanical ventilation or deep sedation&#44; lower Barthel score and higher HADS score&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Moreover&#44; patients showed worse quality of life than reference population values &#40;e&#46;g&#46; only 24&#46;3&#37; of the patients had returned to work upon follow-up consultation&#44; 10&#46;4&#37; showed cognitive impairment&#44; and 51&#46;2&#37; were still under anxiolytic or antidepressant treatment&#41;&#46;</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">Readers may highlight the typical limitations of a study&#58; single-centred study&#44; low number of recruited patients and families&#44; long list of exclusion criteria&#44; and univariate analysis&#46; However&#44; as the authors comment&#44; this is a good starting point for further research&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The highly technical nature of critical care complicates delivering patient and family-centred care&#46; A better understanding of &#40;1&#41; the patient&#39;s needs and perceptions regarding family participation in essential care and &#40;2&#41; barriers that hinder a patient- and family&#8208;centred environment can help&#46; Education and training of relatives and ICU healthcare providers are necessary to address safety and quality of care concerns&#44; though most studies lack further specification&#46; It is also imperative to consider screening and follow-up of caregivers for mental health problems&#44; especially within the post-ICU programmes&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;9</span></a> A recent study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> observed an improvement in some components of mental health &#40;fear&#44; self-esteem&#44; coping&#44; sleep disorders&#41; and the patient&#39;s ability to perform basic activities of daily living after implementing a protocol for preventing and managing post-intensive care syndrome&#46; Moreover&#44; the positive results on the Zarit scale &#40;caregiver overload&#41; also stem from the high level of support perceived by the patients&#39; families and relatives&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We must work together to create a humanistic ICU environment for our patients and ourselves&#59; it not only enhances patient and family experiences but can also contribute to improved clinical outcomes and reduced healthcare provider burnout&#46; We must understand that our care goes beyond the critically ill patient and must include the care of family members&#46; It is time for effective multidisciplinary management&#46; It is time to work hand in hand with physiotherapists&#44; psychologists&#47;psychiatrists&#44; occupational therapists&#44; and social workers to promote patient&#8217;s full recovery and a quick return to an active and fulfilling life for our patients and their families&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">There is no conflict of interest&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">No financing required&#46;</p></span></span>"
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