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Long-term follow-up in patients with brain arteriovenous malformation based on the Quality of Life Scale and socioeconomic status. Neurosurg Rev 2022; 45:3281-3290. [PMID: 36083567 DOI: 10.1007/s10143-022-01847-8] [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: 02/13/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Intracranial haemorrhage (ICH) is associated with permanent neurological disability resulting in deterioration of the quality of life (QoL). Our study assesses QoL in patients with ruptured arteriovenous malformation (AVM) in long-term follow-up at least five years after ICH and compares their QoL with the QoL of patient with non-ruptured AVM. METHODS Using the Quality of Life Scale (QOLS), the Patient Health Questionnaire (PHQ-9) for depressive symptoms, and the socioeconomic status (SES), a prospective assessment was performed. The modified Rankin Scale (mRS) was assessed for outcome. RESULTS Of 73 patients, 42 (57.5%) had ruptured (group 1) and 31 (42.5%) a non-ruptured AVM (group 2). Mean follow-up time was 8.6 ± 3.9 years (8.5 ± 4.2 years in group 1 and 8.9 ± 3.7 years in group 2). Favourable outcome (mRS 0-1) was assessed in 60 (83.3%) and unfavourable in 12 (16.7%) patients. Thirty-one of 42 patients (73.8%) in group 1 and 29 of 30 patients in group 2 (96.7%) had favourable outcomes. Mean QOLS was 85.6 ± 14.1 (group 1 86.1 ± 15.9, group 2 84.9 ± 11.4). Patients in group 1 did not show a significant difference in QoL compared to patients in group 2 (p = 0.23). Additional analyses in group 2 (rho = - 0.73; p < 0.01) and in untreated AVM patients (rho = - 0.81; p < 0.01) showed a strong correlation between QOLS and PHQ-9. CONCLUSION Long-term follow-up showed no difference in the QoL between patients with and without ICH caused by brain AVM. Outcome- and QoL-scores were high in both groups. Further studies are necessary to evaluate depression and anxiety symptoms in patients with AVM.
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Patient-Reported Outcome for Endovascular Treatment versus Microsurgical Clipping in Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2021; 155:e695-e703. [PMID: 34500096 DOI: 10.1016/j.wneu.2021.08.131] [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: 07/10/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage has a high mortality with significant impact on quality of life despite effective management strategies including endovascular treatment and/or microsurgical clipping. Although the modalities have undergone clinical comparison, they have not been evaluated on patient-reported outcomes (PROs). This study compared endovascular versus microsurgical treatment using a PRO measure. METHODS We conducted a cross-sectional telephonic survey of adult patients conducted at Hamad General Hospital, Doha, Qatar between 2017 and 2019. Candidate study participants were identified from procedure logs and hospital electronic health records for endovascular treatment (N = 32) versus microsurgical clipping (N = 32) of cerebral aneurysm. The primary outcome measure was the short version of the Stroke-Specific Quality of Life (SS-QoL) measure. The secondary outcome measure was the screened clinician-reported modified Rankin Scale (mRS) for all screened patients (n = 137). Mean scores were compared for the 2 treatment groups. RESULTS The SS-QoL mean score was 4.23 (standard deviation ± 0.77) in endovascular treatment and 4.19 ± 0.19 in surgical clipping (P = 0.90). In exploratory analysis, mean physical domain score was 3.17 ± 0.60 versus 2.98 ± 0.66 in endovascular treatment and surgical clipping groups, respectively. Mean psychosocial domain scores were 4.43 ± 0.85 versus 4.18 ± 0.0.92, respectively. In multivariable analysis, none of the clinical variables were significantly related to SS-QoL except vasospasm irrespective of intervention received. In secondary outcome analysis, modified Rankin Scale score was higher for endovascular treatment (P = 0.04). CONCLUSIONS Published evidence has supported clinical benefits of endovascular treatment for cerebral aneurysm treatment, but this study did not find any difference in PROs. Future studies of treatments should include PRO to identify potential differences from the patient's perspective.
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Kulkarni AV, Devi BI, Konar SK, Shukla D. Predictors of Quality of Life at 3 Months after Treatment for Aneurysmal Subarachnoid Hemorrhage. Neurol India 2021; 69:336-341. [PMID: 33904447 DOI: 10.4103/0028-3886.314581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Patients with aneurysmal subarachnoid hemorrhage (SAH) have a low quality of life (QOL) despite diagnostic and therapeutic advancements. Less than half of the survivors can return to their previous jobs and have difficulty in being a functional part of society. Our study aimed to understand the overall outcome and QOL of these patients and to identify the predictive factors determining the same. Methods The clinical and radiological data were recorded at presentation, subsequent intervals at the hospital, and during discharge. Patients were interviewed telephonically or in the clinic subsequently at 3 months after treatment with following outcome assessment tools: Modified Rankin Scale (mRS), Barthel Index (BI), QOL after Brain Injury Overall Scale (QOLIBRI-OS), and Short Form 36 (SF 36) QOL scale. Results Out of the total patients (n = 143), 124 patients survived, of which 106 patients could be interviewed. The mRS, QOLIBRI-OS, BI, and SF36 had a good correlation with each other. Only 4.7% had moderate to severe disability on the mRS scale, and 2.8% had severe disability according to the Barthel index. Nearly one-third of patients had deteriorated QOL. The mental health domain was worst affected. The major determinant of QOL was GCS at presentation (mean P value 0.01), a course in the ward (0.0001), GCS at discharge (0.001). Conclusion Though fewer of the patients had a severe disability, a majority of them had deterioration in QOL.
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Affiliation(s)
- Akshay V Kulkarni
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Subhas K Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Vetkas A, Prans E, Kõks S, Rätsep T, Asser T. Aneurysmal subarachnoid haemorrhage: effect of CRHR1 genotype on fatigue and depression. BMC Neurol 2020; 20:142. [PMID: 32305063 PMCID: PMC7165373 DOI: 10.1186/s12883-020-01727-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional health disturbances are common after aneurysmal subarachnoid hemorrhage (aSAH) and their causes are largely unexplored. Corticotropin-releasing hormone receptor 1 (CRHR1) is a key factor in stress reactivity and development of mental health disturbances after adverse life-events. METHODS We explore the effect of CRHR1 genotype on mental health after aSAH in a retrospective cohort study. One hundred twenty-five patients have been assessed using EST-Q mental health questionnaire. Genotyping of CRHR1 single nucleotide polymorphisms (SNP-s) was performed (Rs7209436, Rs110402, Rs242924). RESULTS Fatigue was present in almost half of aSAH patients, depression and anxiety in one-third. There was a high prevalence of insomnia and panic complaints. Rs110402 minor allele decreased the risk of depression (OR = 0.25, p = 0.027 for homozygotes). Depression was present in 14% vs 41% in minor and major allele homozygotes, respectively. Rs110402, Rs242924 and Rs7209436 minor alleles and TAT-haplotype, formed by them, were protective against fatigue. After Bonferroni correction only the association of Rs110402 with fatigue remained statistically significant (OR = 0.21, p = 0.006 for minor allele homozygotes). Results remained statistically significant when adjusted for gender, admission state, age and time from aSAH. In multiple regression analysis occurrence of fatigue was dependent on anxiety, modified Rankin score and Rs110402 genotype (R2 = 0.34, p < 0.001). CONCLUSIONS CRHR1 minor genotype was associated with a lower risk of fatigue and depression after aSAH. Genetic predisposition to mental health disturbances associated with negative life-events could be a risk factor for fatigue and depression after aSAH and selected patients might benefit from advanced counselling in the recovery phase.
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Affiliation(s)
- Artur Vetkas
- Tartu University Hospital, Tartu, Estonia. .,Tartu University, Tartu, Estonia.
| | | | - Sulev Kõks
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia.,The Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Tõnu Rätsep
- Tartu University Hospital, Tartu, Estonia.,Tartu University, Tartu, Estonia
| | - Toomas Asser
- Tartu University Hospital, Tartu, Estonia.,Tartu University, Tartu, Estonia
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Vetkas A, Prans E, Kõks S, Rätsep T, Asser T. Aneurysmal subarachnoid haemorrhage: Effect of CRHR1 genotype on mental health-related quality of life. Sci Rep 2020; 10:724. [PMID: 31959877 PMCID: PMC6971041 DOI: 10.1038/s41598-020-57527-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/31/2019] [Indexed: 11/09/2022] Open
Abstract
Quality of life (QoL) disturbances are common after aneurysmal subarachnoid hemorrhage (aSAH) both in physical and mental health domains and their causes are not clearly understood. Corticotropin-releasing hormone receptor 1 (CRHR1) is involved in stress reactivity and development of mental health disturbances after negative life-events. We performed a retrospective cohort study of long-term QoL outcomes among 125 surgically treated aSAH patients (2001-2013). QoL was assessed with Short Form Health Survey (SF-36) and compared to an age and gender matched general population. Genotyping of CRHR1 single nucleotide polymorphisms was performed (Rs7209436, Rs110402, Rs242924) and their effect on QoL scores was explored. aSAH patients experienced a reduced quality of life in all domains. CRHR1 minor genotype was associated with higher SF-36 mental health (OR = 1.31-1.6, p < 0.05), role-emotional (OR = 1.57, p = 0.04) and vitality scores (OR = 1.31-1.38, p < 0.05). Association of all studied SNP's with vitality and Rs242924 with mental health scores remained statistically significant after Bonferroni correction. Mental quality of life scores were associated with physical state of patients, antidepressant history and CRHR1 genotype. Predisposition to mental health disturbances after stressful life-events might be associated with reduced mental QoL after aSAH and selected patients could be provided advanced counselling in the recovery phase.
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Affiliation(s)
| | | | - Sulev Kõks
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia.,The Perron Institute for Neurological and Translational Science, Perth, WA, Australia
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Kuo LM, Tsai WC, Chiu MJ, Tang LY, Lee HJ, Shyu YIL. Cognitive dysfunction predicts worse health-related quality of life for older stroke survivors: a nationwide population-based survey in Taiwan. Aging Ment Health 2019; 23:305-310. [PMID: 29266975 DOI: 10.1080/13607863.2017.1414148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study investigated the associations of cognitive status with specific/overall health-related quality of life (HRQoL) in older stroke survivors in Taiwan. METHOD A subsample of 592 older stroke survivors in a nationwide population-based survey of cognitive-dysfunction prevalencewas analyzed. HRQoL was assessed using the EuroQol five-dimension questionnaire (EQ-5D). RESULTS Stroke survivors with dementia were 5.60 times more likely to have mobility problems, 12.20 times to have self-care problems, 16.61 times to have problems in usual activities, 4.31 times to have pain/discomfort, and 3.28 times to have anxiety/depression than stroke survivors with normal cognitive function. Stroke survivors with mild cognitive dysfunction (MCD) were 2.57 times more likely to have mobility problems, 3.17 times to have self-care problems, 3.31 times to have problems in usual activities, 2.11 times to have pain/discomfort, and 2.35 times to have anxiety/depression than those with normal cognitive function. Both dementia (b = -15.13, p < .001) and MCD (b = -6.24, p < .001) significantly contributed to lower EQ-5D VAS; both dementia (b = -.15, p < .001) and MCD (b = -.10, p < .001) significantly contributed to lower EQ-5D index. CONCLUSION Dementia and MCD strongly predicted worse overall and specific HRQoL dimensions, especially self-care and usual activities for older stroke survivors.
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Affiliation(s)
- Li-Min Kuo
- a Department of Gerontological Health Care, College of Nursing , National Taipei University of Nursing and Health Sciences , Taipei , Taiwan
| | - Wen-Che Tsai
- b Department of Psychiatry , College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Ming-Jang Chiu
- c Department of Neurology, National Taiwan University Hospital, College of Medicine , National Taiwan University , Taipei , Taiwan.,d Graduate Institute of Brain and Mind Sciences , National Taiwan University , Taipei , Taiwan.,e Graduate Institute of Psychology , National Taiwan University , Taipei , Taiwan.,f Graduate Institute of Biomedical Engineering and Bioinformatics , National Taiwan University , Taipei , Taiwan
| | - Li-Yu Tang
- g Taiwan Alzheimer's Disease Association , Taipei , Taiwan
| | - Huey-Jane Lee
- g Taiwan Alzheimer's Disease Association , Taipei , Taiwan
| | - Yea-Ing L Shyu
- h School of Nursing, College of Medicine , Chang Gung University , Taoyuan , Taiwan.,i Department of Orthopedic Surgery , Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan.,j Department of Nursing , Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan.,k Department of Gerontological Care and Management , Chang Gung University of Science and Technology , Taoyuan , Taiwan
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Late ophthalmological manifestations in patients with subarachnoid hemorrhage and coiling of cerebral aneurysm. Neurol Neurochir Pol 2018; 52:181-187. [DOI: 10.1016/j.pjnns.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 08/16/2017] [Accepted: 09/14/2017] [Indexed: 11/18/2022]
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8
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Rubbert C, Caspers J, Petridis AK, Turowski B, May R. Dynamics of cerebral perfusion deficits after aneurysmal SAH – predictive value of early MTT for subsequent MTT deterioration. J Neuroradiol 2017; 44:371-376. [DOI: 10.1016/j.neurad.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/21/2017] [Accepted: 06/04/2017] [Indexed: 12/16/2022]
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9
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Garton ALA, Sisti JA, Gupta VP, Christophe BR, Connolly ES. Poststroke Post-Traumatic Stress Disorder: A Review. Stroke 2016; 48:507-512. [PMID: 27932604 DOI: 10.1161/strokeaha.116.015234] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/24/2016] [Accepted: 11/09/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Andrew L A Garton
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.).
| | - Jonathan A Sisti
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - Vivek P Gupta
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - Brandon R Christophe
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
| | - E Sander Connolly
- From the College of Physicians and Surgeons, Columbia University, New York (A.L.A.G., J.A.S., V.P.G.); and Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York (B.R.C., E.S.C.)
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10
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Wong GK, Lee A, Wong A, Ho FL, Leung SL, Zee BC, Poon WS, Siu DY, Abrigo JM, Mok VC. Clinically important difference of Stroke-Specific Quality of Life Scale for aneurysmal subarachnoid hemorrhage. J Clin Neurosci 2016; 33:209-212. [DOI: 10.1016/j.jocn.2016.05.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/05/2016] [Indexed: 11/24/2022]
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Huenges Wajer IMC, Visser-Meily JMA, Greebe P, Post MWM, Rinkel GJE, van Zandvoort MJE. Restrictions and satisfaction with participation in patients who are ADL-independent after an aneurysmal subarachnoid hemorrhage. Top Stroke Rehabil 2016; 24:134-141. [DOI: 10.1080/10749357.2016.1194557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Irene M. C. Huenges Wajer
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M. A. Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Rehabilitation Center De Hoogstraat and Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paut Greebe
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel W. M. Post
- Center of Excellence in Rehabilitation Medicine, Rehabilitation Center De Hoogstraat and Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriel J. E. Rinkel
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine J. E. van Zandvoort
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute for Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
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12
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Mahran SA, Abdulrahman MA, Janbi FS, Jamalellail RA. The health-related quality of life in stroke survivors: clinical, functional, and psychosocial correlate. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2015. [DOI: 10.4103/1110-161x.168198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Madsen TE, Seigel TA, Mackenzie RS, Marcolini EG, Wira CR, Healy ME, Wright DW, Gentile NT. Gender differences in neurologic emergencies part I: a consensus summary and research agenda on cerebrovascular disease. Acad Emerg Med 2014; 21:1403-13. [PMID: 25422086 DOI: 10.1111/acem.12528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/19/2014] [Accepted: 09/09/2014] [Indexed: 12/12/2022]
Abstract
Cerebrovascular neurologic emergencies including ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are leading causes of death and disability that are frequently diagnosed and treated in the emergency department (ED). Although sex and gender differences in neurologic emergencies are beginning to become clearer, there are many unanswered questions about how emergency physicians should incorporate sex and gender into their research initiatives, patient evaluations, and overall management plans for these conditions. After evaluating the existing gaps in the literature, a core group of ED researchers developed a draft of future research priorities. Participants in the 2014 Academic Emergency Medicine consensus conference neurologic emergencies working group then discussed and approved the recommended research agenda using a standardized nominal group technique. Recommendations for future research on the role of sex and gender in the diagnosis, treatment, and outcomes pertinent to ED providers are described for each of three diagnoses: stroke, SAH, and migraine. Recommended future research also includes investigation of the biologic and pathophysiologic differences between men and women with neurologic emergencies as they pertain to ED diagnoses and treatments.
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Affiliation(s)
- Tracy E. Madsen
- Department of Emergency Medicine; The Alpert Medical School of Brown University Rhode Island Hospital; Providence RI
| | - Todd A. Seigel
- Department of Medicine; UCSF School of Medicine; San Francisco CA
| | | | | | - Charles R. Wira
- Department of Emergency Medicine; Yale University; New Haven CT
| | - Megan E. Healy
- Department of Emergency Medicine; Temple University School of Medicine; Philadelphia PA
| | - David W. Wright
- Department of Emergency Medicine; Emory University School of Medicine; Atlanta GA
| | - Nina T. Gentile
- Department of Emergency Medicine; Temple University School of Medicine; Philadelphia PA
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Khajeh L, Blijdorp K, Neggers SJ, Ribbers GM, Dippel DW, van Kooten F. Hypopituitarism after subarachnoid haemorrhage, do we know enough? BMC Neurol 2014; 14:205. [PMID: 25312299 PMCID: PMC4207357 DOI: 10.1186/s12883-014-0205-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/02/2014] [Indexed: 12/20/2022] Open
Abstract
Background Fatigue, slowness, apathy and decrease in level of activity are common long-term complaints after a subarachnoid haemorrhage (SAH). They resemble the symptoms frequently found in patients with endocrine dysfunction. Pituitary dysfunction may be the result of SAH or its complications. We therefore hypothesized that it may explain some of the long-term complaints after SAH. We reviewed the literature to clarify the occurrence, pattern and severity of endocrine abnormalities and we attempted to identify risk factors for hypopituitarism after SAH. We also assessed the effect of hypopituitarism on long-term functional recovery after SAH. Methods In a MEDLINE search for studies published between 1995 and 2014, we used the term subarachnoid haemorrhage in combination with pituitary, hypopituitarism, growth hormone, gonadotropin, testosterone, cortisol function, thyroid function and diabetes insipidus. We selected all case-series and cohort studies reporting endocrine function at least 3 months after SAH and studied their reported prevalence, pathogenesis, risk factors, clinical course and outcome. Results We identified 16 studies describing pituitary function in the long term after SAH. The reported prevalence of endocrine dysfunction varied from 0 to 55% and the affected pituitary axes differed between studies. Due to methodological issues no inferences on risk factors, course and outcome could be made. Conclusions Neuroendocrine dysfunction may be an important and modifiable determinant of poor functional outcome after SAH. There is an urgent need for well-designed prospective studies to more precisely assess its incidence, clinical course and effect on mood, behaviour and quality of life. Electronic supplementary material The online version of this article (doi:10.1186/s12883-014-0205-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ladbon Khajeh
- Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Karin Blijdorp
- Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
| | - Sebastian Jcmm Neggers
- Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre and Rijndam Rehabilitation Centre, Rotterdam, the Netherlands.
| | - Diederik Wj Dippel
- Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Fop van Kooten
- Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Kiphuth IC, Utz KS, Noble AJ, Köhrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. Stroke 2014; 45:3360-6. [PMID: 25278556 DOI: 10.1161/strokeaha.113.004459] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE A transient ischemic attack (TIA) involves temporary neurological symptoms but leaves a patient symptom-free. Patients are faced with an increased risk for future stroke, and the manifestation of the TIA itself might be experienced as traumatizing. We aimed to investigate the prevalence of posttraumatic stress disorder (PTSD) after TIA and its relation to patients' psychosocial outcome. METHODS Patients with TIA were prospectively studied, and 3 months after the diagnosis, PTSD, anxiety, depression, quality of life, coping strategies, and medical knowledge were assessed via self-rating instruments. RESULTS Of 211 patients with TIA, data of 108 patients were complete and only those are reported. Thirty-two (29.6%) patients were classified as having PTSD. This rate is 10× as high as in the general German population. Patients with TIA with PTSD were more likely to show signs of anxiety and depression. PTSD was associated with the use of maladaptive coping strategies, subjectively rated high stroke risk, as well as with younger age. Finally, PTSD and anxiety were associated with decreased mental quality of life. CONCLUSIONS The experience of TIA increases the risk for PTSD and associated anxiety, depression, and reduced mental quality of life. Because a maladaptive coping style and a subjectively overestimated stroke risk seem to play a crucial role in this adverse progression, the training of adaptive coping strategies and cautious briefing about the realistic stroke risk associated with TIA might be a promising approach. Despite the great loss of patients to follow-up, the results indicate that PTSD after TIA requires increased attention.
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Affiliation(s)
- Ines C Kiphuth
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
| | - Kathrin S Utz
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.).
| | - Adam J Noble
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
| | - Martin Köhrmann
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
| | - Thomas Schenk
- From the Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany (I.C.K., K.S.U., M.K., T.S.); and Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom (A.J.N.)
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Jaja BNR, Attalla D, Macdonald RL, Schweizer TA, Cusimano MD, Etminan N, Hanggi D, Hasan D, Johnston SC, Le Roux P, Lo B, Louffat-Olivares A, Mayer S, Molyneux A, Noble A, Quinn A, Schenk T, Spears J, Singh J, Todd M, Torner J, Tseng M, van den Bergh W, Vergouwen MDI, Wong GKC. The Subarachnoid Hemorrhage International Trialists (SAHIT) Repository: Advancing Clinical Research in Subarachnoid Hemorrhage. Neurocrit Care 2014; 21:551-9. [DOI: 10.1007/s12028-014-9990-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hütter BO, Kreitschmann-Andermahr I. Subarachnoid hemorrhage as a psychological trauma. J Neurosurg 2014; 120:923-30. [DOI: 10.3171/2013.11.jns121552] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Despite the progress made in the management of subarachnoid hemorrhage (SAH), many patients complain of persistent psychosocial and cognitive problems. The present study was performed to explore the significance of psychological traumatization by the bleeding with respect to psychosocial results after SAH.
Methods
A series of 45 patients were examined in a cross-sectional study an average of 49.4 months after SAH by means of a quality-of-life questionnaire, the Beck Depression Inventory, the German version of the Impact of Event Scale (IES), and a clinical interview (Structured Clinical Interview for DSM Disorders) to make the diagnosis of chronic posttraumatic stress disorder (PTSD). Twenty-nine patients underwent surgery for treatment of a ruptured aneurysm; the remaining 16 patients had SAH of unknown origin.
Results
Twelve patients (27%) exhibited PTSD, and almost two-thirds of the 45 patients in the study reported substantial fear of recurrent hemorrhage. Not only the presence of PTSD but the severity of psychological traumatization as assessed by the IES explained up to 40% of the variance of the self- and proxy-rated impairments. Multivariate analyses revealed psychological traumatization (IES) and neurological state on admission (Hunt and Hess grade) as substantial predictors of the self- and proxy-rated quality of life, explaining 31% and 42% of the variance, respectively.
Conclusions
Even several years after SAH, the severity of psychological traumatization by the bleeding substantially determines the degree of psychosocial impairment. In the future, this issue should be addressed in the care of these patients. Furthermore, the development of psychological interventions is called for to prevent the emergence of PTSD after SAH.
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Affiliation(s)
- Bernd-Otto Hütter
- 1Department of Neurosurgery, Clinical Neuropsychology Division, University Hospital Essen, University Duisburg-Essen
| | - Ilonka Kreitschmann-Andermahr
- 2Department of Neurosurgery, University Hospital Erlangen; and
- 3Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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Klimo P, Thompson CJ, Ragel BT, Boop FA. Methodology and reporting of meta-analyses in the neurosurgical literature. J Neurosurg 2014; 120:796-810. [PMID: 24460488 DOI: 10.3171/2013.11.jns13195] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECT Neurosurgeons are inundated with vast amounts of new clinical research on a daily basis, making it difficult and time-consuming to keep up with the latest literature. Meta-analysis is an extension of a systematic review that employs statistical techniques to pool the data from the literature in order to calculate a cumulative effect size. This is done to answer a clearly defined a priori question. Despite their increasing popularity in the neurosurgery literature, meta-analyses have not been scrutinized in terms of reporting and methodology. METHODS The authors performed a literature search using PubMed/MEDLINE to locate all meta-analyses that have been published in the JNS Publishing Group journals (Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery: Spine, and Neurosurgical Focus) or Neurosurgery. Accepted checklists for reporting (PRISMA) and methodology (AMSTAR) were applied to each meta-analysis, and the number of items within each checklist that were satisfactorily fulfilled was recorded. The authors sought to answer 4 specific questions: Are meta-analyses improving 1) with time; 2) when the study met their definition of a meta-analysis; 3) when clinicians collaborated with a potential expert in meta-analysis; and 4) when the meta-analysis was the only focus of the paper? RESULTS Seventy-two meta-analyses were published in the JNS Publishing Group journals and Neurosurgery between 1990 and 2012. The number of published meta-analyses has increased dramatically in the last several years. The most common topics were vascular, and most were based on observational studies. Only 11 papers were prepared using an established checklist. The average AMSTAR and PRISMA scores (proportion of items satisfactorily fulfilled divided by the total number of eligible items in the respective instrument) were 31% and 55%, respectively. Major deficiencies were identified, including the lack of a comprehensive search strategy, study selection and data extraction, assessment of heterogeneity, publication bias, and study quality. Almost one-third of the papers did not meet our basic definition of a meta-analysis. The quality of reporting and methodology was better 1) when the study met our definition of a meta-analysis; 2) when one or more of the authors had experience or expertise in conducting a meta-analysis; 3) when the meta-analysis was not conducted alongside an evaluation of the authors' own data; and 4) in more recent studies. CONCLUSIONS Reporting and methodology of meta-analyses in the neurosurgery literature is excessively variable and overall poor. As these papers are being published with increasing frequency, neurosurgical journals need to adopt a clear definition of a meta-analysis and insist that they be created using checklists for both reporting and methodology. Standardization will ensure high-quality publications.
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Affiliation(s)
- Paul Klimo
- Semmes-Murphey Neurologic & Spine Institute
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Tamargo RJ. Studies of Cognitive Function After Aneurysmal Subarachnoid Hemorrhage Need Control Groups. World Neurosurg 2014; 81:34-6. [DOI: 10.1016/j.wneu.2013.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/12/2013] [Indexed: 11/28/2022]
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Kelly ML, Sulmasy DP, Weil RJ. Spontaneous intracerebral hemorrhage and the challenge of surgical decision making: a review. Neurosurg Focus 2013; 34:E1. [PMID: 23634913 DOI: 10.3171/2013.2.focus1319] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Decision making for patients with spontaneous intracerebral hemorrhage (ICH) poses several challenges. Outcomes in this patient population are generally poor, prognostication is often uncertain, and treatment strategies offer limited benefits. Studies demonstrate variability in the type and intensity of treatment offered, which is attributed to clinical uncertainty and habits of training. Research has focused on new techniques and more stringent evidence-based selection criteria to improve outcomes and produce consensus around treatment strategies for patients with ICH. Such focus, however, offers little description of how ICH treatment decisions are made and how such decisions reflect patient preferences regarding medical care. A growing body of literature suggests that the process of decision making in ICH is laden with bias, value assumptions, and subjective impressions. Factors such as geography, cognitive biases, patient perceptions, and physician characteristics can all shape decision making and the selection of treatment. Such factors often serve as a barrier to providing patient-centered medical care. In this article, the authors review how surgical decision making for patients with ICH is shaped by these decisional factors and suggest future research pathways to study decision making in ICH. Such research efforts are important for establishing quality guidelines and pay-for-performance measures that reflect the preferences of individual patients and the contextual nature of medical decision making.
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Affiliation(s)
- Michael L Kelly
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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21
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Development of a short form of Stroke-Specific Quality of Life Scale for patients after aneurysmal subarachnoid hemorrhage. J Neurol Sci 2013; 335:204-9. [PMID: 24120271 DOI: 10.1016/j.jns.2013.09.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/11/2013] [Accepted: 09/25/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND The identification of aneurysmal subarachnoid hemorrhage (aSAH) patients with a decrease in health-related quality of life (HRQOL) is challenging. Stroke-Specific Quality of Life (SS-QOL) Scale is one of the commonest disease-specific quality of life measures initially developed and validated for ischemic stroke patients. A disadvantage is subject burden and a short form is more practical to use in clinical and research setting. AIM This study aimed to develop a short form (12-item) of a Chinese version of Stroke-Specific Quality of Life Scale for aSAH (SSQOL-a) for clinical and research applications. METHODS We carried out a prospective observational assessor-blinded multi-center study in Hong Kong. The study was registered at ClinicalTrials.gov of the U.S. National Institutes of Health (NCT01038193), and was approved by hospital ethics committees. RESULTS One hundred and eighty-six aSAH patients were recruited over a 30 month period during admission. One hundred (54%) aSAH patients completed the 12-month assessment battery and were included into the current study. The total score, physical component score, and psychosocial score of the 12-item Chinese version showed satisfactory internal consistency and explained high percentages of variance of the full Chinese version (92% to 96%). The 12-item Chinese version showed significant correlations with neurological, functional, generic quality of life, psychiatric, and cognitive outcome measures at 12 months. Chinese version calculated physical subscore had better discrimination in detecting complete recovery than the Dutch version calculated physical subscore in our Chinese population. CONCLUSIONS The 12-item Chinese version of SSQOL-a has a satisfactory internal consistency and criterion validity for SAH patients at 12 month assessments.
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Covey J, Noble AJ, Schenk T. Family and friends' fears of recurrence: impact on the patient's recovery after subarachnoid hemorrhage. J Neurosurg 2013; 119:948-54. [DOI: 10.3171/2013.5.jns121688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Patients with subarachnoid hemorrhage (SAH) and their close friends and family may be excessively fearful that the patient will have a recurrence, and such fears could play a critical role in the poor recovery shown by many patients The authors examined whether these fears could account for significant variance in psychosocial outcomes.
Methods
The authors prospectively studied a sample of 69 patients with SAH alongside their spouse, other family member, and/or close friend identified as their significant other (SO). The patient/SO pairs were assessed at 13 months postictus for their fears of recurrence and for health-related quality of life on the 8 domains of the 36-Item Short Form Health Survey.
Results
The SOs were found to be significantly more fearful of SAH recurrence than the patients. The SO's fears also explained unique variance in the patient's recovery on 4 of the 36-Item Short Form Health Survey domains over and above the patient's own fears, demographic and/or neurological variables, and the patient's history of psychiatric or neurological problems. The domains affected reflected activity-based and functional aspects of the patient's quality of life as opposed to more general characteristics of their emotional well-being or physical health state.
Conclusions
The patient's recovery may be compromised if their spouse, close family, and/or friends are excessively fearful about their suffering a recurrence. Perhaps the SO's fears cause them to be overprotective of the patient and to restrict their day-to-day activities. Attention must therefore be given to the experience of having a loved one suffer from an SAH, and alleviating the caregiver's fears could help to promote a better outcome for the patient.
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Affiliation(s)
- Judith Covey
- 1Department of Psychology, Durham University, Stockton-on-Tees
| | - Adam J. Noble
- 2Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, United Kingdom; and
| | - Thomas Schenk
- 3Department of Neurology, University of Erlangen-Nürnberg, Erlangen, Germany
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Czapiga B, Kozba-Gosztyla M, Czapiga A, Jarmundowicz W, Rosinczuk-Tonderys J, Krautwald-Kowalska M. Recovery and quality of life in patients with ruptured cerebral aneurysms. Rehabil Nurs 2013; 39:250-9. [PMID: 24038042 DOI: 10.1002/rnj.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE Subarachnoid hemorrhage (SAH) secondary to ruptured cerebral aneurysm is a common and frequently devastating condition with a high mortality and morbidity among survivors. The purpose of this study was to conduct a long-term follow-up of SAH patients, assess the changes in functional outcomes, describe quality of life (QOL), and determine its predictors 3.6 years after the hemorrhage. DESIGN The study design is an exploratory, descriptive correlational design. METHODS Results were collected from a sample of 113 SAH survivors treated in our institution over a 2-year period (January 2006 until December 2007). We collected data on early and long-term functional outcomes and compared the differences. The health-related QOL was measured using the Polish version of The Short Form - 36 Health Survey Questionnaire (SF-36v2). Multivariable logistic regression was derived to define independent predictors of the QOL. FINDINGS The mean follow-up time was 3.6 years. Sixty-six percent of patients had improvement in functional outcomes and among previously employed people 56% returned to work. QOL deteriorated in 24% of patients with the most affected dimension of Physical Role. Factors that predict good QOL are male gender, younger age, good economic/professional status, lack of physical handicaps, rehabilitation in a professional center, subjective improvement in health status, and absence of headaches or physical decline. CONCLUSIONS AND CLINICAL RELEVANCE Recovery process in SAH patients is dynamic and progresses over time. Since physical handicaps and low economic status significantly reduce the quality of life, an effort should be made to provide intensive rehabilitation and to encourage SAH survivors to return to work.
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Affiliation(s)
- Bogdan Czapiga
- Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
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Emotional health and quality of life after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2013; 155:1107-14. [PMID: 23532345 DOI: 10.1007/s00701-013-1683-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 03/14/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Emotional disorders and decrease in health-related quality of life (HRQoL) are well-documented sequelae of aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to analyze the impact of emotional disorders on HRQoL in survivors of SAH. METHODS This was a retrospective study enrolling 114 SAH-survivors at 1-10 years (mean 4,5 years) after the disease. Emotional State Questionnaire (EST-Q) was used to measure emotional health and the Short Form Health Survey (SF-36) was used to assess HRQoL of the patients. RESULTS Most of the patients reported good recovery, but EST-Q results revealed high prevalence of emotional disorders after SAH. Almost half of the patients had higher than cut-off values indicating fatigue (47 %) and insomnia (46 %). About one third of SAH-patients had higher than cut-off scores demonstrating depression (30 %) and anxiety (31 %). The patients scored significantly lower in all scales of SF-36 as compared to age-matched general population. All EST-Q subscale results were significantly and negatively correlated with SF-36 scores. Fatigue was independently related to all SF-36 subscales and depression to most of the mental health component scores. Emotional symptoms alone were demonstrated to explain 23-47 % of the SF-36 subscale values, and more than half of the variance of mental health component score values were found to be explained by emotional disorders (53 %). CONCLUSIONS Emotional disorders are frequent after SAH and significantly associated with impairment of HRQOL. Proper and timely screening tests are important to reveal development of emotional problems and improve QoL for the SAH-patients.
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Lo B, Macdonald RL. Health-Related Quality of Life After Aneurysmal Subarachnoid Hemorrhage: New Data from a Large Series in Germany. World Neurosurg 2013; 79:243-4. [DOI: 10.1016/j.wneu.2012.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 12/18/2012] [Indexed: 11/28/2022]
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Tjahjadi M, Heinen C, König R, Rickels E, Wirtz CR, Woischneck D, Kapapa T. Health-Related Quality of Life After Spontaneous Subarachnoid Hemorrhage Measured in a Recent Patient Population. World Neurosurg 2013; 79:296-307. [DOI: 10.1016/j.wneu.2012.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 01/29/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
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He S, Mack WJ. Health-related quality of life after aneurysmal subarachnoid hemorrhage: interplay between physical, cognitive, and emotional factors. World Neurosurg 2013; 81:37-9. [PMID: 23333474 DOI: 10.1016/j.wneu.2013.01.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/12/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Shuhan He
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Kapapa T, Woischneck D, Tjahjadi M. Long-term health-related quality of life after spontaneous nontraumatic subarachnoid hemorrhage: self and proxy reports in a 10-year period. World Neurosurg 2012; 81:105-9. [PMID: 23046914 DOI: 10.1016/j.wneu.2012.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/27/2012] [Accepted: 10/02/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study sought to examine health-related quality of life several years after spontaneous nontraumatic subarachnoid hemorrhage. Recent studies report impairments to be improved as far as normal levels. We question such an improvement in our own patient population over a period of 10 years. METHODS The Medical Outcomes Study 36-Item and Medical Outcomes Study 12-Item Short-Form Health Surveys on health-related quality of life were used to question 236 patients and 235 proxies. The patients were assigned to 5 groups according to the time that had elapsed since their hemorrhage: 1 year N = 22, 2 years N = 36, 5 years N = 86, 8 years N = 61, and 10 years N = 31. Analyses of variance (ANOVA, Kruskal-Wallis) and correlation (Spearman, Kendall tau) were used in an exploratory approach. Significance was established as P ≤ 0.05. RESULTS Over a period of 10 years, health-related quality of life is found to be impaired, and is reported as such by the patients themselves and their proxies. Comparison of the mean values between the groups, ie, 1, 2, 5, and 10 years, revealed no significant differences in health-related quality of life. The calculations with a view to correlations between the group means and time since hemorrhage also produced only very weak correlations of no significance. CONCLUSIONS Health-related quality of life is impaired over a period of 10 years. Spontaneous nontraumatic subarachnoid hemorrhage should be regarded as a chronic cerebrovascular condition.
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Affiliation(s)
- Thomas Kapapa
- Universitätsklinikum Ulm, Neurochirurgische Klinik, Ulm, Germany.
| | | | - Martin Tjahjadi
- Universitätsklinikum Ulm, Neurochirurgische Klinik, Ulm, Germany
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Kapapa T, Tjahjadi M, König R, Wirtz CR, Woischneck D. Which clinical variable influences health-related quality of life the most after spontaneous subarachnoid hemorrhage? Hunt and Hess scale, Fisher score, World Federation of Neurosurgeons score, Brussels coma score, and Glasgow coma score compared. World Neurosurg 2012; 80:853-8. [PMID: 23022643 DOI: 10.1016/j.wneu.2012.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/01/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the strength of the correlation between the Hunt and Hess scale, Fisher score, Brussels coma score, World Federation of Neurosurgeons score, and Glasgow coma score and health-related quality of life. METHODS Evaluable questionnaires from 236 patients (5.6 years [± standard deviation, 2.854 years] on average after hemorrhage) were included in the analysis. Quality of life was documented using the MOS-36 item short form health survey. Because of the ordinal nature of the variables, Kendall tau was used for calculation. Significance was established as P ≤ 0.05. RESULTS Weak and very weak correlations were found in general (r ≤ 0.28). The strongest correlations were found between the Glasgow coma score and quality of life (r = 0.236, P = 0.0001). In particular, the "best verbal response" achieved the strongest correlations in the comparison, at r = 0.28/P = 0.0001. The Fisher score showed very weak correlations (r = -0.148/P = 0.012). The Brussels coma score (r = -0.216/P = 0.0001), Hunt and Hess scale (r = -0.197/P = 0.0001), and the World Federation of Neurosurgeons score (r = -0.185/P = 0.0001) revealed stronger correlations, especially in terms of the physical aspects of quality of life. CONCLUSIONS The Glasgow coma scale revealed the strongest, and the Fisher score showed the weakest correlations. Thus the Fisher score, as an indicator of the severity of a hemorrhage, has little significance in terms of health-related quality of life.
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Affiliation(s)
- Thomas Kapapa
- Universitätsklinikum Ulm, Neurochirurgische Klinik, Ulm, Germany.
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Tjahjadi M, König R, Wirtz CR, Woischneck D, Kapapa T. Cerebral vasospasm and health-related quality of life after subarachnoid hemorrhage. World Neurosurg 2012; 80:113-20. [PMID: 23022640 DOI: 10.1016/j.wneu.2012.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/06/2012] [Accepted: 09/14/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the influence of cerebral vasospasm on health-related quality of life after subarachnoid hemorrhage. An additional objective was to determine how the timing of nimodipine therapy can influence health-related quality of life. METHODS Patients treated between 1998 and 2008 for nontraumatic subarachnoid hemorrhages were sent a standardized questionnaire for the purposes of documenting their health-related quality of life. Initially the patients were divided into two groups: those with and those without cerebral vasospasm after hemorrhage (radiologically confirmed). They were then differentiated according to four types of treatment options for vasospasm: 1) nimodipine since admission (N = 179); 2) nimodipine since diagnosis of vasospasm (N = 14); 3) no nimodipine/no vasospasm (N = 34); and 4) no nimodipine despite vasospasm (N = 5). Significance was established as P ≤ 0.05. RESULTS Evaluable questionnaires were returned by 236 patients (68% women, mean age 56.35 ± 12.68 years; 32% men, mean age 54.57 ± 12.20 years). Health-related quality of life generally appeared to be impaired. Yet with the exception of the subscale (1 of 8) of physical role (P = 0.019), there were no differences between patients with and without vasospasm. Variations in the different treatment options revealed significant effects in terms of the component summaries and subscales: physical role and pain, general health, vitality, social functioning, emotional role, mental health, and mental component summary (P ≤ 0.04). CONCLUSIONS Cerebral vasospasm had little influence on health-related quality of life in our patient population. Health-related quality of life cannot be used as the only argument in favor of treating cerebral vasospasm with nimodipine.
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Affiliation(s)
- Martin Tjahjadi
- Universitätsklinikum Ulm, Neurochirurgische Klinik, Ulm, Germany
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31
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Passier PECA, Visser-Meily JMA, Rinkel GJE, Lindeman E, Post MWM. Determinants of health-related quality of life after aneurysmal subarachnoid hemorrhage: a systematic review. Qual Life Res 2012; 22:1027-43. [PMID: 22956388 DOI: 10.1007/s11136-012-0236-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Many persons with subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm recover to functional independence but nevertheless experience reduced quality of life (QoL). The aim of this study was to summarize the evidence on determinants of reduced QoL in this diagnostic group. METHODS Databases PubMed, PsychINFO, and CINAHL were used to identify empirical studies reporting on quantitative relationships between possible determinants and QoL in persons with aneurysmal SAH and published in English. Determinants were classified using the International Classification of Functioning, Disability and Health (ICF). RESULTS Twenty studies met the inclusion criteria for this review, in which 13 different HRQoL questionnaires were used. Determinants related to Body Structure & Function (clinical condition at admission, fatigue, and disturbed mood), Activity limitations (physical disability and cognitive complaints), and Personal factors (female gender, higher age, neuroticism, and passive coping) are consistently related to worse HRQoL after aneurysmal SAH. Treatment characteristics were not consistently related to HRQoL. CONCLUSION This study identified a broad range of determinants of HRQoL after aneurysmal SAH. The findings provide clues to tailor multidisciplinary rehabilitation programs. Further research is needed on participation, psychological characteristics, and environmental factors as determinants of HRQoL after SAH.
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Affiliation(s)
- P E C A Passier
- Rudolf Magnus Institute of Neuroscience and Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht and Rehabilitation Centre De Hoogstraat, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Davis MC, El-Sayed AM, Ziewacz JE, Jayachandran P, Geisert WC, Zamora-Berridi GJ, Sullivan SE. Sex Disparities in Postoperative Outcomes After Neurosurgical Intervention. Neurosurgery 2012; 70:959-64; discussion 964. [DOI: 10.1227/neu.0b013e31823e9706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Noble AJ, Baisch S, Covey J, Mukerji N, Nath F, Schenk T. Subarachnoid hemorrhage patients' fears of recurrence are related to the presence of posttraumatic stress disorder. Neurosurgery 2012; 69:323-32; discussion 332-3. [PMID: 21415779 DOI: 10.1227/neu.0b013e318216047e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) patients illustrate a chronic fear of recurrence. A third of patients develop posttraumatic stress disorder (PTSD) after SAH, and PTSD after other conditions is associated with a more negative outlook on life. OBJECTIVE We examined whether recurrence fears are related to PTSD and whether this is associated with the patients making more negative health appraisals. We also examined the helpfulness of current treatments. METHODS Two SAH samples were generated. Sample 1 (n = 82) was assessed 13 months after ictus for PTSD, cognition, fear of recurrence, and beliefs concerning future health. Sample 2 (n = 60) was assessed 18 months after ictus for PTSD and to determine how much current treatments increased their confidence about not having another SAH. RESULTS Thirty-four percent of sample 1 had PTSD. Although clinically and cognitively comparable, PTSD patients feared recurrence more and were comparatively more pessimistic about their chances of further SAH. Thirty-six percent of sample 2 had PTSD. These most fearful patients reported finding current treatments the least helpful. CONCLUSION Fear of recurrence after SAH is related to PTSD. Participants with PTSD were more pessimistic about their future health. Treatment for PTSD could alleviate fears of SAH recurrence and promote better outcome.
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Affiliation(s)
- Adam J Noble
- Institute of Psychiatry, King's College London, London, United Kingdom.
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Wong GKC, Poon WS, Boet R, Chan MTV, Gin T, Ng SCP, Zee BCY. Health-related quality of life after aneurysmal subarachnoid hemorrhage: profile and clinical factors. Neurosurgery 2011; 68:1556-61; discussion 1561. [PMID: 21311383 DOI: 10.1227/neu.0b013e31820cd40d] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health-related quality of life has recently been suggested as a supplement to the traditional neurological outcome measures from the patient's perspective according to the World Health Organization model and may capture the effects of other factors such as posttraumatic stress disorder and neuroendocrine dysfunction. OBJECTIVE To explore the profile and clinical factors of quality of life after aneurysmal subarachnoid hemorrhage using the data we obtained from the recently completed Intravenous Magnesium Sulphate After Aneurysmal Subarachnoid Hemorrhage (IMASH) trial. METHODS This study was registered at www.strokecenter.org/trials and www.ClinicalTrials.gov (NCT00124150). Data from a patient cohort obtained with the Short Form-36 questionnaire completed at 6 months were used for analysis. RESULTS Patients with aneurysmal subarachnoid hemorrhage demonstrated a decrease in quality of life according to the Short Form-36 at 6 months. The physical and mental health scores correlated with the Extended Glasgow Outcome Scale and had the potential to avoid the ceiling effect. Multiple regression analyses showed that the physical component scores were related to age, World Federation of Neurological Surgeons grade, and chronic hydrocephalus and that the mental component scores were not related to the traditional prognostic factors. CONCLUSION Subarachnoid hemorrhage caused a decrease in quality of life. Chronic hydrocephalus is related to a decrease in physical health quality of life.
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Affiliation(s)
- George K C Wong
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.
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Baisch SB, Schenk T, Noble AJ. What is the cause of post-traumatic stress disorder following subarachnoid haemorrhage? Post-ictal events are key. Acta Neurochir (Wien) 2011; 153:913-22. [PMID: 20963450 DOI: 10.1007/s00701-010-0843-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 10/08/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is common after subarachnoid haemorrhage (SAH) and causes poor outcome. Knowing which SAH events cause the stress leading to PTSD development could allow for their severity, and so the chances of PTSD, to be reduced. The dramatic nature of SAH onset has meant ictal events have been the presumed cause. Frequent loss of consciousness (LOC) at ictus, and presumed resultant amnesia, however, means this might not be correct. We examined two hypotheses for how SAH patients develop PTSD despite frequent LOC. Firstly, has the frequency of amnesia for ictal events subsequent to LOC been overestimated? Secondly, is it the stress of post-ictal events, rather than ictal events, which causes PTSD? METHOD Sixty SAH patients, 18 months post-ictus, were assessed for PTSD, LOC at ictus, memory for ictal events, as well as which aspects of their SAH, ictal and post-ictal, were psychologically stressful. Patients also underwent neuropsychological examination. FINDINGS Of patients, 36.7% had PTSD. Memory overall for ictal events was more common than expected: 50% reported LOC, and only 18% reported no memory. However, memory was not associated with PTSD development. Rather, the key predictor of PTSD was the stress of post-ictal events. The stress of ictal events, cognitive impairment and clinical characteristics were unrelated to PTSD development. Post-ictal events included realizing that their life could have/had changed, that they may have been left with long-term problems, that they could have died and that they had little memory for some SAH events and regaining consciousness. CONCLUSIONS The traumatic quality of an SAH lies in post-ictal events, rather than ictal events. These events are related to the patients' adjustment to the experience of having had an SAH. Reducing the traumatic severity of these events could potentially reduce the likelihood of PTSD in SAH patients and so improve their outcome.
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Neuner B, von Mackensen S, Krümpel A, Manner D, Friefeld S, Nixdorf S, Frühwald M, deVeber G, Nowak-Göttl U. Health-related quality of life in children and adolescents with stroke, self-reports, and parent/proxies reports: Cross-sectional investigation. Ann Neurol 2011; 70:70-8. [DOI: 10.1002/ana.22381] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/17/2010] [Accepted: 01/14/2011] [Indexed: 11/06/2022]
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Martins EF, De Sousa PHC, De Araujo Barbosa PHF, De Menezes LT, Souza Costa A. A Brazilian experience to describe functioning and disability profiles provided by combined use of ICD and ICF in chronic stroke patients at home-care. Disabil Rehabil 2011; 33:2064-74. [DOI: 10.3109/09638288.2011.560332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lin KC, Fu T, Wu CY, Hsieh CJ. Assessing the stroke-specific quality of life for outcome measurement in stroke rehabilitation: minimal detectable change and clinically important difference. Health Qual Life Outcomes 2011; 9:5. [PMID: 21247433 PMCID: PMC3034658 DOI: 10.1186/1477-7525-9-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 01/19/2011] [Indexed: 11/26/2022] Open
Abstract
Background This study was conducted to establish the minimal detectable change (MDC) and clinically important differences (CIDs) of the physical category of the Stroke-Specific Quality of Life Scale in patients with stroke. Methods MDC and CIDs scores were calculated from the data of 74 participants enrolled in randomized controlled trials investigating the effects of two rehabilitation programs in patients with stroke. These participants received treatments for 3 weeks and underwent clinical assessment before and after treatment. To obtain test-retest reliability for calculating MDC, another 25 patients with chronic stroke were recruited. The MDC was calculated from the standard error of measurement (SEM) to indicate a real change with 95% confidence for individual patients (MDC95). Distribution-based and anchor-based methods were adopted to triangulate the ranges of minimal CIDs. The percentage of scale width was calculated by dividing the MDC and CIDs by the total score range of each physical category. The percentage of patients exceeding MDC95 and minimal CIDs was also reported. Results The MDC95 of the mobility, self-care, and upper extremity (UE) function subscales were 5.9, 4.0, and 5.3 respectively. The minimal CID ranges for these 3 subscales were 1.5 to 2.4, 1.2 to 1.9, and 1.2 to 1.8. The percentage of patients exceeding MDC95 and minimal CIDs of the mobility, self-care, and UE function subscales were 9.5% to 28.4%, 6.8% to 28.4%, and 12.2% to 33.8%, respectively. Conclusions The change score of an individual patient has to reach 5.9, 4.0, and 5.3 on the 3 subscales to indicate a true change. The mean change scores of a group of patients with stroke on these subscales should reach the lower bound of CID ranges of 1.5 (6.3% scale width), 1.2 (6.0% scale width), and 1.2 (6.0% scale width) to be regarded as clinically important change. This information may facilitate interpretations of patient-reported outcomes after stroke rehabilitation. Future research is warranted to validate these findings.
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Affiliation(s)
- Keh-chung Lin
- Department of Occupational Therapy, College of Medicine, National Taiwan University, and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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