Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis
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    Psychological outcomes with no Psychologists as providers?

    As a Rehabilitation Psychologist who has seen the remarkable effects of psychologist involvement with critically ill patients or recently critically ill patients, and their families, I continue to read articles like this with feelings of bafflement and sadness. The PERSON and their FAMILY have so much to understand and process, and a good psychologist who is informed and experienced regarding these challenges can do SO MUCH good in helping better participation, better comprehension, better discharge planning. Also, very much of the variance in patients' responses to care and rehabilitation stems from residual or recurring delirium or sub-syndromal delirium, as well as lingering cognitive deficits not attributable to current delirium. Psychologists and Nurses are ideal partners in monitoring and responding to delirium. And, patients and families respond VERY WELL to basic education about delirium. Even patients with fluctuating mental status can retain some information about delirium so that when their thinking clouds again they react with less suspicion, paranoia and shame. . And they can process later what has happened, and can report incipient symptoms to their Nurses. PLEASE consider how to bring Psychologists on board with teams on ICUs and step down units. And please listen to the ones already working in rehabilitation, including acute and subacute settings. Thank you.

    Conflict of Interest:
    None declared.