1. Potera, Carol


For some survivors and caregivers, mental health trails physical recovery


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A one-year study of survivors of severe acute respiratory syndrome (SARS) from among those infected during the epidemic that struck Toronto in 2003 showed that most achieved good physical recovery within one year. However, a survey given to survivors and their caregivers revealed that both groups had less success in coping with the psychological and social repercussions of quarantine or isolation, which was often imposed to prevent transmission of the life-threatening respiratory disease.


The prospective follow-up study examined 117 survivors, two-thirds of whom were female health care workers (median age, 42 years) and 46 caregivers, 72% of whom were the patient's spouse. At three, six, and 12 months after discharge, survivors were given physical examinations, chest X-rays, six-minute-walk tests, and pulmonary function tests and filled out questionnaires about the quality of their lives and the frequency of their visits to health care practitioners. Caregivers completed a survey about their experiences one year after discharge.


Over the course of follow-up, survivors' physical condition gradually improved, with all but one patient having normal chest X-rays and pulmonary function scores at one year. However, at that time 17% of the survivors had not yet returned to work, and an additional 9% were working less than they had before becoming ill. Survivors' social and emotional functioning also improved over the year, although 33% of them still scored below normal on quality-of-life surveys at one year. Use of mental health care services was high, with 51 patients making 668 visits to psychiatrists, psychologists, support groups, and other therapists. Caregivers also experienced psychological difficulties, as indicated by below-normal mental health and social functioning scores on a quality-of-life survey.

Figure. Carol Simmon... - Click to enlarge in new windowFigure. Carol Simmons, right, a nurse at Sunnybrook and Women's College Health Sciences Centre in Toronto, checked coworker Margaret McDermott, RN, for fever before McDermott could enter the facility on April 1, 2003. A new study shows that survivors have had difficulty coping.

The results "help to highlight the needs of patients and caregivers during and after an epidemic," write the authors. SARS patients feel shunned while under quarantine, a psychological stressor that nurses can alleviate, according to the study's lead author, Catherine Tansey, by "helping patients maintain a sense of connectedness with their families and the outside world."


Carol Potera




The Joint Commission has established two new hospital patient safety standards that must be met by January 2009. Hospitals now must establish a multidisciplinary system to protect patients from the harm that is sometimes associated with anticoagulant therapy. In addition, to increase early recognition of and improve an organization's response to a change in a patient's condition, staff members must be given criteria for calling for assistance and empowered to call for specialized help whenever a patient's condition appears to be worsening.


Offering HIV testing as a routine part of care in three urban EDs over 15 months found 97 new HIV cases, 48% of which would have gone undetected if testing had been offered only to patients who reported risk factors, according to a report published in the June 22 Morbidity and Mortality Weekly Report.



Tansey CM, et al. Arch Intern Med 2007;167(12):1312-20.