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Kamal AK, Khoja A, Usmani B, Muqeet A, Zaidi F, Ahmed M, Shakeel S, Soomro N, Gowani A, Asad N, Ahmed A, Sayani S, Azam I, Saleem S. Translating knowledge for action against stroke--using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke). Trials 2016; 17:52. [PMID: 26818913 PMCID: PMC4728820 DOI: 10.1186/s13063-016-1175-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022] Open
Abstract
Background Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers. Methods Movies4Stroke will be a randomized control, outcome assessor blinded, parallel group, single center superiority trial. Participants with an acute stroke, medically stable, with mild to moderate disability and having a stable primary caregiver will be included. After obtaining informed consent the stroke survivor-caregiver dyad will be randomized. Intervention participants will have the movie program software installed in their phone, desktop, or Android device which will allow them to receive, view and repeat 5-minute videos on stroke-related topics at admission, discharge and first and third months after enrollment. The control arm will receive standard of care at an internationally accredited center with defined protocols. The primary outcome measure is medication adherence as ascertained by a locally validated Morisky Medication Adherence Scale and control of major risk factors such as blood pressure, blood sugar and blood cholesterol at 12 months post discharge. Secondary outcome measures are post-stroke complications and mortality, caregiver knowledge and change in functional outcomes after acute stroke at 1, 3, 6, 9 and 12 months. Movies4Stroke is designed to enroll 300 participant dyads after inflating 10 % to incorporate attrition and non-compliance and has been powered at 95 % to detect a 15 % difference between intervention and usual care arm. Analysis will be done by the intention-to-treat principle. Discussion Movies4Stroke is a randomized trial testing an application aimed at supporting caregivers and stroke survivors in a LMIC with no rehabilitation or chronic support systems. Trial registration NCT02202330 (28 January 2015) Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1175-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayeesha Kamran Kamal
- Section of Neurology, Department of Medicine, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
| | - Adeel Khoja
- Stroke Service, the International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health), Aga Khan University, Karachi, Pakistan.
| | | | - Abdul Muqeet
- Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan.
| | - Fabiha Zaidi
- Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan.
| | - Masood Ahmed
- Movies for Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Saadia Shakeel
- Movies for Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Nabila Soomro
- Section of Neurology, Department of Medicine, Aga Khan University and Director, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan.
| | - Ambreen Gowani
- Stroke Service, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
| | - Asma Ahmed
- Section of Diabetes, Endocrinology and Metabolism, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Saleem Sayani
- eHealth Resource Centre, Aga Khan Development Network, Karachi, Pakistan.
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
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Abstract
The science of nursing has long been discussed as a blending of the art and science of caring, and nursing research builds the evidence of support for nursing practice. Nurses and nursing care are key to successful neurocritical care research endeavors. Ideally nursing care should be evidence based and supported by solid research. The goal of nursing research is to expand the knowledge of caring for patients. Within the scope of nursing research, the priorities for research in neurocritical care should support this goal. In this manuscript, we discuss what we believe are the priorities of neurocritical care nursing research, the obstacles, and some possible solutions.
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Hedlund M, Zetterling M, Ronne-Engström E, Carlsson M, Ekselius L. Depression and post-traumatic stress disorder after aneurysmal subarachnoid haemorrhage in relation to lifetime psychiatric morbidity. Br J Neurosurg 2011; 25:693-700. [PMID: 21591856 PMCID: PMC3233275 DOI: 10.3109/02688697.2011.578769] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Little is known about the roles that lifetime psychiatric disorders play in psychiatric and vocational outcomes of aneurysmal subarachnoid haemorrhage (SAH). Materials and methods Eighty-three SAH patients without apparent cognitive dysfunction were assessed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) after their SAH. Diagnoses were assessed for three time periods, ‘lifetime before SAH', ‘12 months before SAH’ and ‘7 months after SAH'. Results Forty-five percentage of patients with SAH reported at least one lifetime psychiatric disorder. After SAH, symptoms of depression and/or post-traumatic stress disorder (PTSD) were seen in 41%, more often in those with a psychiatric history prior to SAH (p = 0.001). In logistic regressions, depression after SAH was associated with a lifetime history of major depression, or of anxiety or substance use disorder, as well as with lifetime psychiatric comorbidity. Subsyndromal or full PTSD was predicted by a lifetime history of major depression. After the SAH, 18 patients (22%) had received psychotropic medication and/or psychological treatment, 13 of whom had a disorder. Those with a lifetime history of major depression or treatment with antidepressants before SAH had lower return to work rates than others (p = 0.019 and p = 0.031, respectively). This was also true for those with symptoms of depression and/or PTSD, or with antidepressant treatment after SAH 0 = 0.001 and p = 0.031, respectively). Conclusions Depression and PTSD are present in a substantial proportion of patients 7 months after SAH. Those with a history of psychiatric morbidity, any time before the SAH, are more at risk and also constitute a risk group for difficulties in returning to work.
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Affiliation(s)
- Mathilde Hedlund
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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