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Diestro JDB, Vyas M, Jung Y, Kishibe T, Leochico C, Espiritu A, Dorotan MK, Dimal N, Omar AT, Sienes A, Saposnik G, Marotta TR, Zafar A, Mendes Pereira V, Spears J. Long-term neuropsychiatric complications of aneurysmal subarachnoid hemorrhage: a narrative review. J Neurointerv Surg 2024:jnis-2023-020979. [PMID: 38609175 DOI: 10.1136/jnis-2023-020979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024]
Abstract
This review focuses on the often-neglected long-term neuropsychiatric consequences of aneurysmal subarachnoid hemorrhage (aSAH), beyond traditional randomized trial outcomes of mortality and retreatment. While current guidelines recommend screening for these sequalae, it may not be routinely practiced. This review will underscore the prevalence and management of common neuropsychiatric sequalae, including anxiety, depression, cognitive dysfunction, headaches, seizures, and sexual dysfunction, all of which can significantly impact the quality of life of survivors of aSAH. We emphasize the critical role neurointerventionalists can play by going beyond the customary practice of radiological monitoring for treated aneurysms by screening for and helping guide management of these common neuropsychiatric complications.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Manav Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Youngkyung Jung
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Health Sciences Library, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Carl Leochico
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Rehabilitation Medicine, University of the Philippines Manila, Manila, Philippines
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
| | - Adrian Espiritu
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, North Yorkshire, Canada
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Maria Kristina Dorotan
- Division of Epilepsy, Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nico Dimal
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abdelsimar Tan Omar
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - April Sienes
- Trauma and Neurosurgery Program, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Atif Zafar
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Nobels-Janssen E, Postma EN, Abma IL, van Dijk JMC, de Ridder IR, Schenck H, Moojen WA, den Hertog MH, Nanda D, Potgieser ARE, Coert BA, Verhagen WIM, Bartels RHMA, van der Wees PJ, Verbaan D, Boogaarts HD. Validity of the modified Rankin Scale in patients with aneurysmal subarachnoid hemorrhage: a randomized study. BMC Neurol 2024; 24:23. [PMID: 38216872 PMCID: PMC10785372 DOI: 10.1186/s12883-023-03479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/27/2023] [Indexed: 01/14/2024] Open
Abstract
PURPOSE The modified Rankin Scale (mRS), a clinician-reported outcome measure of global disability, has never been validated in patients with aneurysmal subarachnoid hemorrhage (aSAH). The aims of this study are to assess: (1) convergent validity of the mRS; (2) responsiveness of the mRS; and (3) the distribution of mRS scores across patient-reported outcome measures (PROMs). METHODS This is a prospective randomized multicenter study. The mRS was scored by a physician for all patients, and subsequently by structured interview for half of the patients and by self-assessment for the other half. All patients completed EuroQoL 5D-5L, RAND-36, Stroke Specific Quality of Life scale (SS-QoL) and Global Perceived Effect (GPE) questionnaires. Convergent validity and responsiveness were assessed by testing hypotheses. RESULTS In total, 149 patients with aSAH were included for analysis. The correlation of the mRS with EQ-5D-5L was r = - 0.546, while with RAND-36 physical and mental component scores the correlation was r = - 0.439and r = - 0.574 respectively, and with SS-QoL it was r = - 0.671. Three out of four hypotheses for convergent validity were met. The mRS assessed through structured interviews was more highly correlated with the mental component score than with the physical component score of RAND-36. Improvement in terms of GPE was indicated by 83% of patients; the mean change score of these patients on the mRS was - 0.08 (SD 0.915). None of the hypotheses for responsiveness were met. CONCLUSION The results show that the mRS generally correlates with other instruments, as expected, but it lacks responsiveness. A structured interview of the mRS is best for detecting disabling neuropsychological complaints. REGISTRATION URL: https://trialsearch.who.int ; Unique identifier: NL7859, Date of first administration: 08-07-2019.
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Affiliation(s)
- E Nobels-Janssen
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - E N Postma
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - I L Abma
- IQ healthcare and Department of Rehabilitation, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - J M C van Dijk
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | - I R de Ridder
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute, Maastricht, The Netherlands
| | - H Schenck
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute, Maastricht, The Netherlands
| | - W A Moojen
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Haga Teaching Hospital, The Hague, The Netherlands
| | - M H den Hertog
- Department of Neurology, Isala Hospital, Zwolle, The Netherlands
| | - D Nanda
- Department of Neurosurgery, Isala Hospital, Zwolle, The Netherlands
| | - A R E Potgieser
- Department of Neurosurgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - B A Coert
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - W I M Verhagen
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - R H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands
| | - P J van der Wees
- IQ healthcare and Department of Rehabilitation, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - D Verbaan
- Amsterdam UMC, Department of Neurosurgery, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands
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Wang B, Peng G, Chen L, Guo M, Zhou J, Liu Y, Chen Z, Wang L. Effect of transcutaneous electrical acupoint stimulation on remifentanil dosage during craniotomy aneurysm clipping: a prospective, randomized controlled study. BMC Complement Med Ther 2023; 23:453. [PMID: 38093254 PMCID: PMC10717748 DOI: 10.1186/s12906-023-04297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Craniotomy aneurysm clipping is one of the main treatments for intracranial aneurysm (IA). Endotracheal intubation and intraoperative operation may induce dramatic hemodynamic fluctuations and increase the risk of aneurysm rupture. Intraoperative high-dose opioid use is the main measure to reduce the intraoperative stress response, but it increases the incidence of complications such as postoperative vomiting and delayed awakening. Transcutaneous electrical acupoint stimulation (TEAS) stimulates β-endorphin expression levels and reduces opioid requirements. In this study, we aimed to assess the effects of TEAS on remifentanil dosage and oxidative stress (OS) in craniotomy aneurysm clipping. METHOD Forty-two patients with craniotomy aneurysm clipping were randomized into two groups: the TEAS group (T group) and the sham TEAS group (S group). "Hegu" (LI4), "Neiguan" (PC6) and "Zusanli" points (ST36) were selected, and a "HANS" percutaneous acupoint electrical stimulator was used for intervention 30 min before anesthesia induction until the end of the operation. The primary outcome was intraoperative remifentanil dosage. The secondary outcomes were intraoperative propofol dosage, mean arterial pressure (MAP) and heart rate (HR) 5 min before the TEAS intervention (T0), 5 min before head holder pinning (T1), immediately after pinning (T2), 5 min before craniotomy (T3), immediately after craniotomy (T4), at craniotomy (T5), and at the end of surgery (T6), as well as serum β-endorphin levels at T1, T2 and T6 and neuron-specific enolase (NSE), S100β, superoxide dismutase (SOD) and malondialdehyde (MDA) levels at T1, T2 and 24 h after surgery (T7). RESULTS The dosage of remifentanil in the T group was reduced compared to that in the S group (P < 0.05). At T2, T4 and T5, the MAP and HR in the T group were lower than those in the S group (P < 0.05). At T2 and T7, the levels of NSE, S100β and MDA in group T were lower than those in group S (P < 0.05), while the SOD levels in group T were higher than those in group S (P < 0.05). CONCLUSIONS The use of TEAS can reduce the dosage of remifentanil and reduce hemodynamic fluctuations during craniotomy aneurysm clipping. It reduces the occurrence of OS and central nervous system damage during surgery and has a certain brain protective effect. TRIAL REGISTRATION ChiCTR2100052353. https://www.chictr.org.cn/about.html .
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Affiliation(s)
- Bingyu Wang
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
- The Second Hospital of Ningbo, Ningbo, 315100, China
| | - Guanfa Peng
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Li Chen
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, No. 128, Jinling West Road, Ganzhou, 34100, China
| | - Mingling Guo
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Jianshun Zhou
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Yingying Liu
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Zhen Chen
- The First Clinical College of Medicine, Gannan Medical University, Ganzhou, 34100, China
| | - Lifeng Wang
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, No. 128, Jinling West Road, Ganzhou, 34100, China.
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Burzyńska M, Uryga A, Załuski R, Goździk A, Adamik B, Robba C, Goździk W. Cerebrospinal Fluid and Serum Biomarker Insights in Aneurysmal Subarachnoid Haemorrhage: Navigating the Brain-Heart Interrelationship for Improved Patient Outcomes. Biomedicines 2023; 11:2835. [PMID: 37893210 PMCID: PMC10604203 DOI: 10.3390/biomedicines11102835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The pathophysiological mechanisms underlying severe cardiac dysfunction after aneurysmal subarachnoid haemorrhage (aSAH) remain poorly understood. In the present study, we focused on two categories of contributing factors describing the brain-heart relationship. The first group includes brain-specific cerebrospinal fluid (CSF) and serum biomarkers, as well as cardiac-specific biomarkers. The secondary category encompasses parameters associated with cerebral autoregulation and the autonomic nervous system. A group of 15 aSAH patients were included in the analysis. Severe cardiac complications were diagnosed in seven (47%) of patients. In the whole population, a significant correlation was observed between CSF S100 calcium-binding protein B (S100B) and brain natriuretic peptide (BNP) (rS = 0.62; p = 0.040). Additionally, we identified a significant correlation between CSF neuron-specific enolase (NSE) with cardiac troponin I (rS = 0.57; p = 0.025) and BNP (rS = 0.66; p = 0.029), as well as between CSF tau protein and BNP (rS = 0.78; p = 0.039). Patients experiencing severe cardiac complications exhibited notably higher levels of serum tau protein at day 1 (0.21 ± 0.23 [ng/mL]) compared to those without severe cardiac complications (0.03 ± 0.04 [ng/mL]); p = 0.009. Impaired cerebral autoregulation was noted in patients both with and without severe cardiac complications. Elevated serum NSE at day 1 was related to impaired cerebral autoregulation (rS = 0.90; p = 0.037). On the first day, a substantial, reciprocal correlation between heart rate variability low-to-high frequency ratio (HRV LF/HF) and both GFAP (rS = -0.83; p = 0.004) and S100B (rS = -0.83; p = 0.004) was observed. Cardiac and brain-specific biomarkers hold the potential to assist clinicians in providing timely insights into cardiac complications, and therefore they contribute to the prognosis of outcomes.
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Affiliation(s)
- Małgorzata Burzyńska
- Clinical Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.B.); (W.G.)
| | - Agnieszka Uryga
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland
| | - Rafał Załuski
- Department of Neurosurgery, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Anna Goździk
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Barbara Adamik
- Clinical Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.B.); (W.G.)
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy;
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16145 Genoa, Italy
| | - Waldemar Goździk
- Clinical Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.B.); (W.G.)
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Nobels-Janssen E, Abma IL, de Ridder IR, Haeren RHL, Hertog MH, Nanda D, van der Pol B, Verhagen WIM, Bartels RHMA, van der Wees PJ, Boogaarts HD. The SOS-SAH questionnaire in clinical practice: a multi-method evaluation study. BMC Neurol 2023; 23:236. [PMID: 37337139 DOI: 10.1186/s12883-023-03280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND In patients with mild disabilities after aneurysmal subarachnoid hemorrhage (aSAH), invisible symptoms might be easily overlooked during consultations in the outpatient clinic. We hypothesize that the Questionnaire for the Screening of Symptoms in aneurysmal Subarachnoid Hemorrhage (SOS-SAH), a disease-specific patient-reported outcome measure, might aid in screening for symptoms after aSAH. The objective of this explorative study is to evaluate the perceived impact of using the SOS-SAH in daily clinical practice for patients after aSAH, as well as to explore potential barriers to further implementation. METHODS This multi-method study consists of a quantitative and a qualitative component. To evaluate differences in quality of care, a patient experience survey was sent to patients receiving usual care and to patients who received the SOS-SAH. A multiple linear regression model was applied, with the intervention group and case mix adjusters as independent variables. We described differences in the number of symptoms discussed between patients receiving usual care and those receiving care post-implementation. Following implementation, 16 patients and 6 healthcare professionals were interviewed about their perceptions concerning the impact of and barriers to using the SOS-SAH. A thematic analysis was performed to identify the main themes. RESULTS The survey did not reveal any differences between the usual-care group and the post-implementation group on the scales of the patient experience survey. After implementation of the SOS-SAH, the number of symptoms discussed during consultation did not increase. The interviews suggest that the SOS-SAH may improve the preparation of patients by providing them with greater insight into their complaints and by raising issues for the consultation. It could also enhance the structure and efficiency of consultation, in addition to improving communication about issues that matter to patients. All patients and healthcare professionals recommended continuing the use of the SOS-SAH in daily practice. CONCLUSIONS Although no quantitative improvements were found in patient experience and symptoms discussed during consultation, implementation of the SOS-SAH could aid in screening for symptoms in patients after aSAH, and it might have a positive influence on patient preparation, while helping to structure consultations between patients and healthcare professionals.
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Affiliation(s)
- E Nobels-Janssen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - I L Abma
- IQ healthcare, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - I R de Ridder
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - R H L Haeren
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M H Hertog
- Department of Neurology, Isala Hospital, Zwolle, the Netherlands
| | - D Nanda
- Department of Neurosurgery, Isala Hospital, Zwolle, the Netherlands
| | - B van der Pol
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - W I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - R H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P J van der Wees
- IQ healthcare, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Züger A, Fischbeck S, Weber M, Mai S. Revision of the Advanced Cancer Patients' Distress Scale (ACPDS): a mixed-methods study among palliative patients and healthcare professionals in Germany. BMJ Open 2023; 13:e066998. [PMID: 37015787 PMCID: PMC10083778 DOI: 10.1136/bmjopen-2022-066998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES To revise the 37-item Advanced Cancer Patients' Distress Scale (ACPDS) regarding its content, comprehensibility, applicability, and relevance by healthcare professionals (HCPs) and patients in order to enhance an existing instrument that is appropriate for the needs of patients with advanced cancer admitted to palliative care. DESIGN A preliminary revision of items regarding psychometric indices and relevance to initially shorten the scale, complemented by cognitive interviews with patients combining think-aloud and verbal-probe techniques and an HCP focus group on the detected remaining items. Interviews and the focus group were audio-recorded, transcribed verbatim and analysed using MAXQDA. SETTING The study took place at a German palliative care unit. PARTICIPANTS 10 patients were interviewed (50% female) and 6 HCPs (3 physicians, 2 nurses and 1 psychologist) participated in the focus group. OUTCOME MEASURES Comprehensibility, applicability, and relevance of the ACPDS were evaluated. RESULTS Based on the psychometric revision, a reduced number of 17 items was discussed by the HCP focus group and within cognitive interviews with patients. For the rest of the analysis of the HCP focus group and the patient interview data, the introduction of the ACPDS was simplified and adapted to everyday language. As recommended by HCPs and patients, the example question was replaced. Nine items were reworded to boost clarity, openness, redundancy and mitigation. Three items were eliminated, and another three items were added. CONCLUSION With this revised 17-item version of the ACPDS, we constructed an instrument that seems to be appropriate for the needs of patients with advanced cancer in a palliative care setting. In the next step, the shortened scale will be tested on psychometric data and validated by a large sample of inpatients on palliative care suffering from advanced cancer. TRIAL REGISTRATION NUMBER DRKS ID: DRKS00022425.
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Affiliation(s)
- Andrea Züger
- Institute of the History of Medicine, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany
- Section of Translational Medical Ethics, National Center of Tumor Diseases, Heidelberg, Germany
| | - Sabine Fischbeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology and Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Martin Weber
- Department of Internal Medicine III, Interdisciplinary Department of Palliative Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sandra Mai
- Department of Internal Medicine III, Interdisciplinary Department of Palliative Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Göcking B, Biller-Andorno N, Brandi G, Gloeckler S, Glässel A. Aneurysmal Subarachnoid Hemorrhage and Clinical Decision-Making: A Qualitative Pilot Study Exploring Perspectives of Those Directly Affected, Their Next of Kin, and Treating Clinicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3187. [PMID: 36833886 PMCID: PMC9958564 DOI: 10.3390/ijerph20043187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Exploring the experience and impact of aneurysmal subarachnoid hemorrhage (aSAH) from three perspectives, that of those directly affected (AFs), their next of kin (NoK), and treating clinicians, is a way to support and empower others to make informed medical decisions. METHODS In a Swiss neurosurgical intensive care unit (ICU), eleven semi-structured interviews were conducted as part of a Database of Individual Patient Experiences (DIPEx) pilot project and thematically analyzed. Interviews were held with two clinicians, five people experiencing aSAH, and four NoK 14-21 months after the bleeding event. RESULTS Qualitative analysis revealed five main themes from the perspective of clinicians: emergency care, diagnosis and treatment, outcomes, everyday life in the ICU, and decision-making; seven main themes were identified for AFs and NoK: the experience of the aSAH, diagnosis and treatment, outcomes, impact on loved ones, identity, faith, religion and spirituality, and decision-making. Perspectives on decision-making were compared, and, whereas clinicians tended to focus their attention on determining treatment, AFs and NoK valued participation in shared decision-making processes. CONCLUSIONS Overall, aSAH was perceived as a life-threatening event with various challenges depending on severity. The results suggest the need for tools that aid decision-making and better prepare AFs and NoK using accessible means and at an early stage.
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Affiliation(s)
- Beatrix Göcking
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
| | - Giovanna Brandi
- Institute of Intensive Care Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Sophie Gloeckler
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
| | - Andrea Glässel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, CH-8006 Zurich, Switzerland
- Department of Health Sciences, Institute of Public Health, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8401 Winterthur, Switzerland
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8
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Güresir E, Lampmann T, Bele S, Czabanka M, Czorlich P, Gempt J, Goldbrunner R, Hurth H, Hermann E, Jabbarli R, Krauthausen M, König R, Lindner D, Malinova V, Meixensberger J, Mielke D, Németh R, Darkwah Oppong M, Pala A, Prinz V, Rashidi A, Roder C, Sandalcioglu IE, Sauvigny T, Schebesch KM, Timmer M, Vajkoczy P, Wessels L, Wild F, Wilhelm C, Wostrack M, Vatter H, Coch C. Fight INflammation to Improve outcome after aneurysmal Subarachnoid HEmorRhage (FINISHER) trial: Study protocol for a randomized controlled trial. Int J Stroke 2023; 18:242-247. [PMID: 35361026 DOI: 10.1177/17474930221093501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
RATIONALE Aneurysmal subarachnoid hemorrhage (SAH) has high morbidity and mortality. While the primary injury results from the initial bleeding cannot currently be influenced, secondary injury through vasospasm and delayed cerebral ischemia worsens outcome and might be a target for interventions to improve outcome. To date, beside the aneurysm treatment to prevent re-bleeding and the administration of oral nimodipine, there is no therapy available, so novel treatment concepts are needed. Evidence suggests that inflammation contributes to delayed cerebral ischemia and poor outcome in SAH. Some studies suggest a beneficial effect of anti-inflammatory glucocorticoids, but there are no data from randomized controlled trials examining the efficacy of glucocorticoids. Therefore, current guidelines do not recommend the use of glucocorticoids in SAH. AIM The Fight INflammation to Improve outcome after aneurysmal Subarachnoid HEmorRhage (FINISHER) trial aims to determine whether dexamethasone improves outcome in a clinically relevant endpoint in SAH patients. METHODS AND DESIGN FINISHER is a multicenter, prospective, randomized, double-blinded, placebo-controlled clinical phase III trial which is testing the outcome and safety of anti-inflammatory treatment with dexamethasone in SAH patients. SAMPLE SIZE ESTIMATES In all, 334 patients will be randomized to either dexamethasone or placebo within 48 h after SAH. The dexamethasone dose is 8 mg tds for days 1-7 and then 8 mg od for days 8-21. STUDY OUTCOME The primary outcome is the modified Rankin Scale (mRS) at 6 months, which is dichotomized to favorable (mRS 0-3) versus unfavorable (mRS 4-6). DISCUSSION The results of this study will provide the first phase III evidence as to whether dexamethasone improves outcome in SAH.
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Affiliation(s)
- Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Tim Lampmann
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Sylvia Bele
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Center for Neurosurgery, University of Cologne, Cologne, Germany
| | - Helene Hurth
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Elvis Hermann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Marius Krauthausen
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital Bonn, Bonn, Germany
| | - Ralph König
- Department of Neurosurgery, University of Ulm/BKH Günzburg, Günzburg, Germany
| | - Dirk Lindner
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Vesna Malinova
- Department of Neurosurgery, Georg-August-Universität Göttingen, Göttingen, Germany
| | | | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Robert Németh
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Andrej Pala
- Department of Neurosurgery, University of Ulm/BKH Günzburg, Günzburg, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt, Germany
| | - Ali Rashidi
- Department of Neurosurgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Constantin Roder
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | | | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Marco Timmer
- Department of General Neurosurgery, Center for Neurosurgery, University of Cologne, Cologne, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Wessels
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Wild
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Christoph Wilhelm
- Immunopathology Unit, Institute of Clinical Chemistry and Clinical Pharmacology, Medical Faculty, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Christoph Coch
- Clinical Study Core Unit, Study Center Bonn (SZB), University Hospital Bonn, Bonn, Germany
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9
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Ziebart A, Abdulazim A, Wenz F, Kleindienst N, Mocarz-Kleindienst M, Galea I, Rinkel GJE, Etminan N. Validation of the German version of the subarachnoid haemorrhage outcome tool (SAHOT). Eur Stroke J 2022; 8:320-327. [PMID: 37021152 PMCID: PMC10069186 DOI: 10.1177/23969873221144813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Objective: The subarachnoid haemorrhage (SAH) outcome tool (SAHOT) is the first SAH-specific patient reported outcome measure, and was developed in the UK. We aimed to validate the SAHOT outside the UK, and therefore endeavored to adapt the SAHOT into German and to test its psychometric properties. Methods: We adapted and pilot tested the German version. We applied the SAHOT, Quality of Life after Brain Injury, Hospital Anxiety and Depression Scale, and EuroQol questionnaires in a cohort of 89 patients with spontaneous SAH after discharge. We assessed internal consistency by Cronbach’s α, test-retest reliability by intraclass correlation, and validity by Pearson correlations with established measures. Sensitivity to change was evaluated following neurorehabilitation by effect sizes. Results: The translation of SAHOT resulted in a German version that is semantically and conceptually equivalent to the English version. Internal consistency was good regarding the physical domain (α = 0.83) and excellent for the other domains (α = 0.92–0.93). Test–retest reliability indicated a high level of stability with an intraclass correlation of 0.85 (95% CI: 0.83–0.86). All domains correlated moderately or strongly with established measures ( r = 0.41–0.74; p < 0.01). SAHOT total scores showed moderate sensitivity to change (Cohen’s d = −0.68), while mRS and GOSE showed no significant sensitivity to change. Conclusion: The SAHOT can be adapted to other health care systems and societies than the UK. The German version of the SAHOT is a reliable and valid instrument, and can be used in future clinical studies and individual assessment after spontaneous SAH.
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Affiliation(s)
- Andreas Ziebart
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Amr Abdulazim
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Wenz
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maria Mocarz-Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Translation Studies and Slavic Languages, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gabriel JE Rinkel
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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10
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Andersen CR, English SW, Delaney A. Made to measure—Selecting outcomes in aneurysmal subarachnoid hemorrhage research. Front Neurol 2022; 13:1000454. [PMID: 36212648 PMCID: PMC9532574 DOI: 10.3389/fneur.2022.1000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
There has been limited new high-level evidence generated to guide aneurysmal subarachnoid hemorrhage (aSAH) management in the past decade. The choice of outcome measures used in aSAH clinical trials may be one of the factors hindering progress. In this narrative review we consider the current process for determining “what” to measure in aSAH and identify some of the shortcomings of these approaches. A consideration of the unique clinical course of aSAH is then discussed and how this impacts on selecting the best timepoints to assess change in the chosen constructs. We also review the how to critically appraise different measurement instruments and some of the issues with how these are applied in the context of aSAH. We conclude with current initiatives to improve outcome selection in aSAH and future directions in the research agenda.
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Affiliation(s)
- Christopher R. Andersen
- Northern Clinical School, Sydney University, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Intensive Care Department, Royal North Shore Hospital, Sydney, NSW, Australia
- *Correspondence: Christopher R. Andersen
| | - Shane W. English
- Department of Medicine (Critical Care), uOttawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | - Anthony Delaney
- Northern Clinical School, Sydney University, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Intensive Care Department, Royal North Shore Hospital, Sydney, NSW, Australia
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