ICU ENVIRONMENT ADDS TO TRAUMA, STUDY FINDS

What patients remember most about being treated in a hospital intensive care unit is not pleasant, according to an Italian survey.

Among the most common memories reported by ICU survivors in the survey are pain, fear, noise, thirst and lack of daylight.

Researchers followed up on all patients treated in a hospital ICU in Lucca, Italy, over a five-month period. Within three days after being discharged, patients were interviewed by an intensive care specialist who had not seen them before.

Forty-three percent of the patients reported experiencing pain, and almost all of those--94 percent--said their pain medication did not bring relief. A majority of the patients experienced sleep deprivation, fear and anxiety. Nearly half had felt lonely or isolated, and one-third said they had not been given complete information about their condition or treatment.

The 76 patients in the survey included 50 men and 26 women and ranged in age from 17 to 92. Most were in the ICU for post-surgery care or treatment for traumatic injuries or breathing problems. Another 51 patients who had been in the ICU were excluded from the study because they died, had psychiatric or neurological problems or were transferred to other hospitals.

While 28 percent of the patients said they did not have bad memories of the ICU, the other 72 percent reported a variety of unpleasant ones. These included feelings of loneliness or abandonment; thirst; unceasing noise; invasive airway and stomach tubes; pain; physical restraints; seeing or hearing others suffer or die; insomnia; absence of windows; fear; and paralysis.

"Health care staff on the intensive care unit may have underestimated the extent of patients' suffering, an observation which is by no means peculiar to this unit," concluded Bruno Simini, a specialist in intensive care and pain management at the Lucca hospital who led the research. "An intensive care unit should be a place to live, not just in which to survive."

Simini reported his findings this month in a research letter to The Lancet.

--Don Colburn

STUDY OF STUDENTS FINDS MOST ENGAGE IN BULLYING

Four out of five middle school students admit to acting like bullies at least once a month, according to a study released last Friday by U.S. researchers.

The survey, detailed during a meeting of the American Psychological Association in Boston, suggests that behavior associated with bullies, which includes teasing and ridicule as well as aggression, is far more common than previously thought.

Earlier research had concluded bullies account for up to 15 percent of the school population.

"That 15 percent represents the typical schoolyard bully. They're the ones doing it excessively," said psychologist Dorothy Espelage, an author of the study.

The remaining students who act like bullies do so to a lesser extent, she said.

In her study of 558 students, Espelage and her colleagues at the University of Illinois found that 80 percent said they had engaged in physical aggression, social ridicule, teasing, name-calling and issuing threats.

"By asking students if they had engaged in certain behaviors over the past month without telling them those behaviors are defined as bullying, we found that our results support that adolescents don't neatly fall into categories of either bullies or non-bullies," the researchers said.

--Reuter

EXPERIENCE HELPS DOCTORS COPE WITH DYING PATIENTS

Mid-career physicians tend to be more open to talking about death and dying with terminally ill patients and their families than they were as new medical school graduates, a survey shows.

"After two decades of practicing medicine, physicians' attitudes toward terminally ill patients seem to have changed," researchers concluded. Doctors become "more secure with dying patients" and more open to informing patients of their bleak prognosis, they said.

Researchers compared the responses of nearly 700 physicians surveyed in 1976, when they were fresh out of medical school, and again in 1996 after at least 20 years of medical practice. The doctors in the survey graduated from medical school between 1972 and 1975. Their average age when they were resurveyed in 1996 was 49 years.

"Overall, the physicians we surveyed appear to be distancing themselves less from their dying patients and their families than in 1976," the study found. The change in attitude was most pronounced in doctors whose specialties led them to see more dying patients and to be directly involved in patient care.

By mid-career, doctors were less likely to avoid patients dying from an irreversible condition and more likely to believe that "treating a dying patient was no longer one of the most unpleasant aspects of the medical profession," for example.

"Perhaps over time death becomes more routine and familiar and therefore less unpleasant," researchers surmised.

The study was conducted by a team from the department of sociology and anthropology at the College of Charleston in Charleston, S.C. They reported their findings this month in Archives of Internal Medicine.

The survey asked doctors how strongly they agreed or disagreed with a series of statements, such as, "I feel as comfortable with a dying patient as I do with any other patient," and "I think it is essential that a dying patient be told of his/her prognosis."

After 20 years of practicing medicine, "the physicians we surveyed seem to have become more accustomed to dealing with death and/or were forced to come to grips with their attitudes toward death," researchers concluded. "If this is the case, increased attention to death and dying education in medical schools could accelerate this transformation."

--Don Colburn