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Jaffa MN, Kirsch HL, Creutzfeldt CJ, Guanci M, Hwang DY, LeTavec D, Mahanes D, Natarajan G, Steinberg A, Zahuranec DB, Muehlschlegel S. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-Care and Family/Surrogate Decision-Maker Data. Neurocrit Care 2023; 39:600-610. [PMID: 37704937 DOI: 10.1007/s12028-023-01796-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND To facilitate comparative research, it is essential for the fields of neurocritical care and rehabilitation to establish common data elements (CDEs) for disorders of consciousness (DoC). Our objective was to identify CDEs related to goals-of-care decisions and family/surrogate decision-making for patients with DoC. METHODS To achieve this, we formed nine CDE working groups as part of the Neurocritical Care Society's Curing Coma Campaign. Our working group focused on goals-of-care decisions and family/surrogate decision-makers created five subgroups: (1) clinical variables of surrogates, (2) psychological distress of surrogates, (3) decision-making quality, (4) quality of communication, and (5) quality of end-of-life care. Each subgroup searched for existing relevant CDEs in the National Institutes of Health/CDE catalog and conducted an extensive literature search for additional relevant study instruments to be recommended. We classified each CDE according to the standard definitions of "core", "basic", "exploratory", or "supplemental", as well as their use for studying the acute or chronic phase of DoC, or both. RESULTS We identified 32 relevant preexisting National Institutes of Health CDEs across all subgroups. A total of 34 new instruments were added across all subgroups. Only one CDE was recommended as disease core, the "mode of death" of the patient from the clinical variables subgroup. CONCLUSIONS Our findings provide valuable CDEs specific to goals-of-care decisions and family/surrogate decision-making for patients with DoC that can be used to standardize studies to generate high-quality and reproducible research in this area.
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Affiliation(s)
- Matthew N Jaffa
- Department of Neurology, Ayer Neuroscience Institute, Hartford Hospital, Hartford, CT, USA
| | - Hannah L Kirsch
- Department of Neurology, Stanford University School of Medicine, 453 Quarry Road, MC 5235, Palo Alto, CA, USA.
| | - Claire J Creutzfeldt
- Department of Neurology, Division of Stroke and Palliative Care, University of Washington, Seattle, WA, USA
| | - Mary Guanci
- Department of Neuroscience Nursing, Massachusetts General Hospital, Boston, MA, USA
| | - David Y Hwang
- Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Dea Mahanes
- Departments of Neurology and Neurosurgery, UVA Health, Charlottesville, VA, USA
| | - Girija Natarajan
- Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - Alexis Steinberg
- Department of Neurology, Critical Care Medicine, and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Darin B Zahuranec
- Department of Neurology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesiology/Critical Care and Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Jaffa MN, Kirsch HL, Creutzfeldt CJ, Guanci M, Hwang DY, LeTavec D, Mahanes D, Steinberg A, Natarajan G, Zahuranec DB, Muehlschlegel S. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-care and Family/Surrogate Decision-Maker Data. RESEARCH SQUARE 2023:rs.3.rs-3084539. [PMID: 37461521 PMCID: PMC10350109 DOI: 10.21203/rs.3.rs-3084539/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION In order to facilitate comparative research, it is essential for the fields of neurocritical care and rehabilitation to establish common data elements (CDE) for disorders of consciousness (DoC). Our objective was to identify CDEs related to goals-of-care decisions and family/surrogate decision-making for patients with DoC. METHODS To achieve this, we formed nine CDE working groups as part of the Neurocritical Care Society's Curing Coma Campaign. Our working group focused on goals-of-care decisions and family/surrogate decision-makers created five subgroups: (1) clinical variables of surrogates, (2) psychological distress of surrogates, (3) decision-making quality, (4) quality of communication, and (5) quality of end-of-life care. Each subgroup searched for existing relevant CDEs in the NIH/CDE catalog and conducted an extensive literature search for additional relevant study instruments to be recommended. We classified each CDE according to the standard definitions of "core," "basic," "exploratory," or "supplemental," as well as their utility for studying the acute or chronic phase of DoC, or both. RESULTS We identified 32 relevant pre-existing NIH CDEs across all subgroups. A total of 34 new instruments were added across all subgroups. Only one CDE was recommended as disease core, the "mode of death" of the patient from the clinical variables subgroup. CONCLUSIONS Our findings provide valuable CDEs specific to goals-of-care decisions and family/surrogate decision-making for patients with DoC that can be used to standardize studies to generate high-quality and reproducible research in this area.
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Affiliation(s)
| | | | | | | | - David Y Hwang
- The University of North Carolina at Chapel Hill School of Medicine
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Zhang S, Yuan Y, Zhuang W, Xiong T, Xu Y, Zhang J, Tao C, Liang J, Wang Y. Contributing Factors and Induced Outcomes of Psychological Stress Response in Stroke Survivors: A Systematic Review. Front Neurol 2022; 13:843055. [PMID: 35812095 PMCID: PMC9257184 DOI: 10.3389/fneur.2022.843055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRemarkable evidence indicates that psychological stress is significantly associated with stroke. However, a uniform recommendation to identify and alleviate poststroke psychological stress responses and improve postmorbid outcomes is not currently available. Thus, this systematic review aimed to summarize the types of poststroke psychological stress, measurement tools, contributing factors, and outcomes.MethodsThis systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search was conducted in PubMed, Web of Science, Embase, CNKI, WanFangData, and CQVIP from database inception to November 2021. Cross-sectional and longitudinal studies were included in this research. Quality assessment was performed based on the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.ResultsEighteen quantitative, peer-reviewed studies were included for analysis. Selected articles mainly investigated perceived stress and posttraumatic stress disorder after stroke. We classified the contributing factors into four categories: sociodemographic factors, clinical disease factors, psychological factors, and behavioral and lifestyle factors. The postmorbid outcomes were divided into three categories: clinical disease outcomes, psychological outcomes, and behavioral and quality of life outcomes.ConclusionsCompared to common patients, stroke survivors with the following characteristics suffered an increased psychological stress response: younger age, the presence of caregivers, depression, unsuitable coping strategies, etc. Meanwhile, lower quality of life, worse drug compliance, worse functional independence, and more severe mental disorders were significantly associated with increased psychological stress symptoms. Further studies are required to provide more trustworthy and meaningful references for mitigating the damage caused by psychological stress after stroke.
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Affiliation(s)
- Song Zhang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Wenwen Zhuang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Tianqing Xiong
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yijun Xu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Jingwen Zhang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Chunhua Tao
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Jingyan Liang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yingge Wang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- *Correspondence: Yingge Wang
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Ganz FD, Raanan O, Shafir G, Levy D, Klempfner R, Beigel R, Iakobishvili Z. Distress among hospitalized patients with acute coronary syndrome. Nurs Crit Care 2021; 27:165-171. [PMID: 34766409 DOI: 10.1111/nicc.12730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have demonstrated that those suffering from acute coronary syndrome (ACS) experience various physical and psychological symptoms. Few studies have investigated the multi-factorial, holistic, unpleasant experience of distress that includes physical, psychological, social, and spiritual factors among this patient population while still hospitalized. AIM To describe the level of distress among patients hospitalized with ACS and its association with demographic and clinical factors and mortality. STUDY DESIGN The study conducted a descriptive, cross-sectional survey. METHODS The Acute Coronary Syndrome Israel Study is a national, biennial registry, enrolling all patients with ACS admitted to cardiac intensive care or cardiology wards in Israel within a 2-month period. Demographic and clinical data were retrieved from an electronic database. Distress was measured by the Distress Thermometer. Nurses collected distress data directly from patients before discharge. RESULTS Nine hundred ninety participants (50.6% response rate) were surveyed. Mean age was 62.8 (SD = 12.5). Mean distress level was 4.8 (SD = 3.45) out of 10. The most frequently reported area of distress was physical, followed by emotional. Practical and family problems were less frequent. Emotional distress was found to differ based on educational level, marital status, smoking history, and previous medical history. Distress did not predict 7- or 30-day mortality. CONCLUSIONS Respondents with ACS were in moderate distress. It is recommended that those at increased risk receive increased monitoring of emotional distress while still in hospital. Further studies should investigate this holistic view of distress among the ACS population using a variety of methods and methodologies.
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Affiliation(s)
- Freda DeKeyser Ganz
- Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel.,Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
| | - Ofra Raanan
- Sheba Medical Center School of Nursing, Tel Hashomer, Israel
| | - Gennady Shafir
- Cardiac Intensive Care Unit, Haemek Medical Center, Afula, Israel
| | - Dassy Levy
- Division of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Robert Klempfner
- Department of Cardiology, Sheba Medical Center, Cardiac Rehabilitation Institute, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beigel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Zaza Iakobishvili
- Department of Community Cardiology, Clalit Health Services, Tel Aviv, Israel.,Department of Cardiology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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Moons P, Prikken S, Luyckx K. Chronic illness as a ‘family disease’: The need for appropriate scientific methods for dyadic research. Eur J Cardiovasc Nurs 2020; 19:98-99. [DOI: 10.1177/1474515120902376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Sofie Prikken
- School Psychology and Development in Context, KU Leuven, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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Lyons KS, Lee CS. Understanding the family care dyad: A comparison of two multilevel models. Eur J Cardiovasc Nurs 2020; 19:178-184. [DOI: 10.1177/1474515120902368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although there has been increasing attention on a dyadic perspective of illness, contemporary dyadic research methods are still rarely utilized in cardiovascular disease. The focus of this paper is to describe the advantages of two types of multilevel dyadic models (the matched pairs model and the lesser known incongruence model). Data exemplars in a sample of heart failure family dyads are used to illustrate the distinct advantages of these two related multilevel dyadic models with particular emphasis on alignment with research questions. The more commonly known matched pairs model examines separate outcomes for each member of the dyad, controlling for the interdependent nature of the data. By re-parameterizing this model into a univariate dyadic outcomes model, researchers can address distinct, and sometimes more appropriate, research questions (e.g. incongruent appraisals of the illness experience). This paper promotes greater application of these methods in cardiovascular research to further understanding of the dyadic experience and more appropriately target interventions.
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Affiliation(s)
- Karen S Lyons
- William F. Connell School of Nursing, Boston College, USA
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Soares CD, Panuganti PK, Shrivastava A, Aroor S, Keinath KM, Bromagen MC, Howard ME, Carlson C, Smith JH. Experimental pain assessment in patients with poststroke aphasia. Neurology 2018; 91:e793-e799. [PMID: 30068630 DOI: 10.1212/wnl.0000000000006081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/05/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate an observational-behavioral pain tool among individuals with acute poststroke aphasia. METHODS We performed a randomized, double-blind, controlled study of experimental pain assessment among 36 adult patients with acute poststroke aphasia. Patients were administered 3 levels of mechanical pain, including placebo. The behavioral responses were video recorded and then evaluated by 3 neurology nurses using the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC-II). Pain-specific facial action units were quantified with FaceReader version 6.1. RESULTS Median PACSLAC-II ratings for 0-, 2-, and 4.5-lb weight stimuli were 2 (0, 3), 1 (0, 3), and 2 (1, 5), respectively. Overall, differences were not detected (p = 0.06). Pairwise comparisons with the Wilcoxon method demonstrated significance in differentiating PACSLAC-II ratings of patients experiencing the 4.5-lb stimulus vs either the 2-lb weight (p = 0.03) or placebo (p = 0.05). Overall interrater reliability by the Cronbach α was strong at 0.87, 0.94, and 0.96 for weights of 0, 2, and 4.5 lb, respectively. Pain-specific facial activation and negative valence were observed similarly in placebo and experimental pain groups. CONCLUSIONS Among our cohort with acute poststroke aphasia, the PACSLAC-II was not able to overall differentiate patients experiencing experimental mechanical pain, although differences in those experiencing the strongest pain stimulus were significant. The detection of pain-specific facial activation and negative valence in the placebo group indicates that pain and distress are unmet needs among stroke patients who are unable to verbally communicate.
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Affiliation(s)
- Christian D Soares
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Pradeep K Panuganti
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Arpan Shrivastava
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Sushanth Aroor
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Katie M Keinath
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Mary C Bromagen
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Megan E Howard
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Charles Carlson
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington
| | - Jonathan H Smith
- From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington.
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