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Jeffares I, Merriman NA, Doyle F, Horgan F, Hickey A. Designing stroke services for the delivery of cognitive rehabilitation: A qualitative study with stroke rehabilitation professionals. Neuropsychol Rehabil 2023; 33:24-47. [PMID: 34648412 DOI: 10.1080/09602011.2021.1977155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This qualitative study explored the potential to deliver cognitive rehabilitation for post-stroke cognitive impairment (PSCI), with a specific focus on barriers and facilitators to its delivery from the perspective of Irish stroke rehabilitation professionals. Sixteen semi-structured interviews were completed with healthcare professionals in both hospital and community settings. The sample comprised physiotherapists, occupational therapists, nurses, a stroke physician, a psychologist, a neuropsychologist, a speech and language therapist, a dietician, and a public health nurse. Interviews were audio-recorded and analysed in NVivo using inductive Thematic Analysis. Barriers and facilitators to the delivery of cognitive rehabilitation were identified and described under four key themes: (i) Cognitive screening; (ii) Cognitive rehabilitation: no one size fits all; (iii) Psychology: the lost dimension of stroke rehabilitation; and (iv) Joining the dots in the community. Staffing required to deliver cognitive rehabilitation for PSCI was highlighted as under-resourced in the Republic of Ireland. Inadequate resourcing of neuropsychology and stroke-related psychological services, in particular, has had negative implications for the delivery of cognitive rehabilitation. Stroke-specific cognitive rehabilitation expertise is virtually inaccessible in the community, highlighting an urgent need for investment in specialist rehabilitation teams to deliver cognitive rehabilitation in this setting.
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Affiliation(s)
- Isabelle Jeffares
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh A Merriman
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Moran CN, Jeffares I, Merriman NA, McCormack J, Harbison J, Sexton E, Williams D, Kelly PJ, Horgan F, Collins R, Bhreacáin MN, Byrne E, Thornton J, Tully C, Hickey A. 119 ENHANCING THE QUALITY OF STROKE CARE IN IRELAND - DEVELOPMENT OF AN IRISH NATIONAL STROKE AUDIT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Population ageing, stroke treatment advances, changing models of care, and between-hospital heterogeneity in stroke outcomes demonstrate the necessity of continual audit of stroke care to support quality improvement at local and national levels, and to enhance patient recovery and wellbeing. This project aims to identify the core minimum datasets for acute and non-acute stroke care, and Patient-Reported Outcome Measures (PROMs), for integration in to the newly-developed Irish National Audit of Stroke (INAS), in addition to identifying resourcing needs and implementation procedures.
Methods
In Phase 1, a minimum dataset for acute stroke care was identified based on a scoping review of international practice and available guidelines. Phase 2 (ongoing) involves identifying datasets for non-acute rehabilitative and follow-up care based on a scoping review of international practice, iterative cycles of qualitative stakeholder engagement, and systematic review of PROMs. In Phase 3, a review of resourcing and data collection procedures used in stroke audits internationally will be used to produce an implementation strategy for data collection, contextualised to the Irish healthcare system.
Results
Twenty-one eligible international stroke registries were identified from the scoping review. Within Phase 1, core clinical and thrombectomy items in the Irish registry were benchmarked against internationally-collected items to identify common items and to generate an inventory of items that other registries collect that Ireland does not. Based on consensus agreement on the most frequently-occurring international items, as reviewed by key stakeholders, a core minimum dataset for audit of acute stroke care was delivered.
Conclusion
These minimum datasets shall act as the “gold standard” for evaluating stroke care in Ireland, by not only incorporating structure, process, and care quality outcome indicators, but also PROMs. The resultant datasets may inform policy and quality improvement initiatives, and shape health service delivery across the trajectory of stroke care, from hyper-acute care, to rehabilitation, and return to the community.
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Affiliation(s)
- CN Moran
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - I Jeffares
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - NA Merriman
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - J McCormack
- National Office of Clinical Audit , Dublin, Ireland
| | - J Harbison
- National Office of Clinical Audit , Dublin, Ireland
| | - E Sexton
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - D Williams
- Beaumont Hospital Dept. of Geriatric and Stroke Medicine, , Dublin, Ireland
- RCSI Dept. of Geriatric and Stroke Medicine, , Dublin, Ireland
| | - PJ Kelly
- Mater Misericordiae University Hospital Dept. of Neurology, , Dublin, Ireland
- University College Dublin Neurovascular Clinical Science Unit, , Dublin, Ireland
| | - F Horgan
- School of Physiotherapy, RCSI , Dublin, Ireland
| | - R Collins
- Tallaght University Hospital Dept. of Geriatric and Stroke Medicine, , Dublin, Ireland
| | | | - E Byrne
- Institute of Leadership, RCSI , Dublin, Ireland
| | - J Thornton
- Beaumont Hospital Dept. of Radiology, , Dublin, Ireland
| | - C Tully
- National Office of Clinical Audit , Dublin, Ireland
| | - A Hickey
- RCSI Dept. of Health Psychology, , Dublin, Ireland
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Merriman NA, Roudaia E, Ondřej J, Romagnoli M, Orvieto I, O’Sullivan C, Newell FN. “CityQuest,” A Custom-Designed Serious Game, Enhances Spatial Memory Performance in Older Adults. Front Aging Neurosci 2022; 14:806418. [PMID: 35356302 PMCID: PMC8959141 DOI: 10.3389/fnagi.2022.806418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
Spatial cognition is known to decline with aging. However, little is known about whether training can reduce or eliminate age-related deficits in spatial memory. We investigated whether a custom-designed video game involving spatial navigation, obstacle avoidance, and balance control would improve spatial memory in older adults. Specifically, 56 healthy adults aged 65 to 84 years received 10 sessions of multicomponent video game training, based on a virtual cityscape, over 5 weeks. Participants were allocated to one of three training conditions: the main intervention, the “CityQuest” group (n = 19), and two control groups, spatial navigation without obstacle avoidance (“Spatial Navigation-only” group, n = 21) and obstacle avoidance without spatial navigation (“Obstacles-only” group, n = 15). Performance on object recognition, egocentric and allocentric spatial memory (incorporating direction judgment tasks and landmark location tasks, respectively), navigation strategy preference, and executive functioning was assessed in pre- and post-intervention sessions. The results showed an overall benefit on performance in a number of spatial memory measures and executive function for participants who received spatial navigation training, particularly the CityQuest group, who also showed significant improvement on the landmark location task. However, there was no evidence of a shift from egocentric to allocentric strategy preference. We conclude that spatial memory in healthy older participants is amenable to improvement with training over a short term. Moreover, technology based on age-appropriate, multicomponent video games may play a key role in cognitive training in older adults.
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Affiliation(s)
- Niamh A. Merriman
- School of Psychology, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Eugenie Roudaia
- School of Psychology, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Jan Ondřej
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | | | | | - Carol O’Sullivan
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Fiona N. Newell
- School of Psychology, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Fiona N. Newell,
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Sexton E, Donnelly NA, Merriman NA, Hickey A, Wren MA, O'Flaherty M, Bandosz P, Guzman-Castillo M, Williams DJ, Horgan F, Pender N, Feeney J, de Looze C, Kenny RA, Kelly P, Bennett K. StrokeCog Markov Model: Projected Prevalent and Incident Cases of Stroke and Poststroke Cognitive Impairment to 2035 in Ireland. Stroke 2021; 52:3961-3969. [PMID: 34496624 DOI: 10.1161/strokeaha.121.034005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Cognitive impairment no dementia (CIND) and dementia are common stroke outcomes, with significant health and societal implications for aging populations. These outcomes are not included in current epidemiological models. We aimed to develop an epidemiological model to project incidence and prevalence of stroke, poststroke CIND and dementia, and life expectancy, in Ireland to 2035, informing policy and service planning. METHODS We developed a probabilistic Markov model (the StrokeCog model) applied to the Irish population aged 40 to 89 years to 2035. Data sources included official population and hospital-episode statistics, longitudinal cohort studies, and published estimates. Key assumptions were varied in sensitivity analysis. Results were externally validated against independent sources. The model tracks poststroke progression into health states characterized by no cognitive impairment, CIND, dementia, disability, stroke recurrence, and death. RESULTS We projected 69 051 people with prevalent stroke in Ireland in 2035 (22.0 per 1000 population [95% CI, 20.8-23.1]), with 25 274 (8.0 per 1000 population [95% CI, 7.1-9.0]) of those projected to have poststroke CIND, and 12 442 having poststroke dementia (4.0 per 1000 population [95% CI, 3.2-4.8]). We projected 8725 annual incident strokes in 2035 (2.8 per 1000 population [95% CI, 2.7-2.9]), with 3832 of these having CIND (1.2 per 1000 population [95% CI, 1.1-1.3]), and 1715 with dementia (0.5 per 1000 population [95% CI, 0.5-0.6]). Life expectancy for stroke survivors at age 50 was 23.4 years (95% CI, 22.3-24.5) for women and 20.7 (95% CI, 19.5-21.9) for men. CONCLUSIONS This novel epidemiological model of stroke, poststroke CIND, and dementia draws on the best available evidence. Sensitivity analysis indicated that findings were robust to assumptions, and where there was uncertainty a conservative approach was taken. The StrokeCog model is a useful tool for service planning and cost-effectiveness analysis and is available for adaptation to other national contexts.
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Affiliation(s)
- Eithne Sexton
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland (E.S., N.A.M., A.H., N.P., K.B.)
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland (N.A.D., M.A.W.)
| | - Niamh A Merriman
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland (E.S., N.A.M., A.H., N.P., K.B.)
| | - Anne Hickey
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland (E.S., N.A.M., A.H., N.P., K.B.)
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland (N.A.D., M.A.W.)
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, United Kingdom (M.O., P.B., M.G.-C.)
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, United Kingdom (M.O., P.B., M.G.-C.).,Department of Prevention and Medical Education, Medical University of Gdansk, Poland (P.B.)
| | - Maria Guzman-Castillo
- Department of Public Health and Policy, University of Liverpool, United Kingdom (M.O., P.B., M.G.-C.).,Department of Social Sciences, University of Helsinki, Finaland (M.G.-C.)
| | - David J Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland (D.W.)
| | - Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland (F.H.)
| | - Niall Pender
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland (E.S., N.A.M., A.H., N.P., K.B.).,Department of Psychology, Beaumont Hospital, Dublin, Ireland (N.P.)
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Ireland (J.F., C.d.L., R.A.K.)
| | - Céline de Looze
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Ireland (J.F., C.d.L., R.A.K.)
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Ireland (J.F., C.d.L., R.A.K.).,Department of Medical Gerontology, St James Hospital, Dublin, Ireland (R.A.K.)
| | - Peter Kelly
- Mater University Hospital/University College Dublin, Ireland (P.K.)
| | - Kathleen Bennett
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland (E.S., N.A.M., A.H., N.P., K.B.)
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Bruen C, Merriman NA, Murphy PJ, McCormack J, Sexton E, Harbison J, Williams D, Kelly PJ, Horgan F, Collins R, Ní Bhreacáin M, Byrne E, Thornton J, Tully C, Hickey A. Development of a national stroke audit in Ireland: scoping review protocol. HRB Open Res 2021; 4:31. [PMID: 36330536 PMCID: PMC9607932 DOI: 10.12688/hrbopenres.13244.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction
Recent advances in stroke management and care have resulted in improved survival and outcomes. However, providing equitable access to acute care, rehabilitation and longer-term stroke care is challenging. Recent Irish evidence indicates variation in stroke outcomes across hospitals, and a need for continuous audit of stroke care to support quality improvement. The aim of this project is to develop a core minimum dataset for use in the new Irish National Audit of Stroke (INAS), which aims to improve the standard of stroke care in Ireland. This paper outlines the protocol for conducting a scoping review of international practice and guidelines in auditing acute and non-acute stroke care.
Objective
Identify data items that are currently collected by stroke audits internationally, and identify audit guidelines that exist for recommending inclusion of content in stroke audit datasets.
Methods and analysis
This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Grey literature will also be searched for relevant materials, as will relevant websites. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third. Data charting and synthesis will involve sub-dividing relevant sources of evidence, and synthesising data into three categories: i) acute stroke care; ii) non-acute stroke care; and iii) audit data collection procedures and resourcing. Data will be charted using a standardised form specific to each category. Consultation with knowledge users will be conducted at all stages of the scoping review.
Discussion
This scoping review will contribute to a larger project aimed at developing an internationally benchmarked stroke audit tool that will be used prospectively to collect data on all stroke admissions in Ireland, encompassing both acute and non-acute data items.
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Affiliation(s)
- Carlos Bruen
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A. Merriman
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul J. Murphy
- Library Services, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Eithne Sexton
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joseph Harbison
- National Office of Clinical Audit, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Dept of Geriatric and Stroke Medicine, St. James' Hospital, Dublin, Ireland
| | - David Williams
- Dept of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
- Dept of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter J. Kelly
- Dept of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
- Neurovascular Clinical Science Unit, University College Dublin, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rónán Collins
- Dept of Geriatric and Stroke Medicine, Tallaght University Hospital, Dublin, Ireland
| | | | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Thornton
- Dept. of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Anne Hickey
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Jeffares I, Merriman NA, Doyle F, Horgan F, Hickey A. Inclusion of stroke patients in expanded cardiac rehabilitation services: a cross-national qualitative study with cardiac and stroke rehabilitation professionals. Disabil Rehabil 2021; 44:3610-3622. [PMID: 33529535 DOI: 10.1080/09638288.2021.1874548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This qualitative study explored healthcare professionals' views in relation to the potential expansion of cardiac rehabilitation services to include stroke patients, thereby becoming a cardiovascular rehabilitation model. DESIGN AND METHODS 23 semi-structured interviews were completed with hospital and community-based stroke and cardiac rehabilitation professionals in Switzerland (n = 7) and Ireland (n = 19). The sample comprised physiotherapists, occupational therapists, speech and language therapists, stroke physicians, cardiologists, psychologists, dieticians and nurses. Interviews were audio-recorded and the transcripts were analysed in NVivo using inductive Thematic Analysis. RESULTS Barriers and facilitators to cardiovascular rehabilitation were captured under four broad themes; (i) Cardiac rehabilitation as "low-hanging fruit," (ii) Cognitive impairment ("the elephant in the room"), (iii) Adapted cardiac rehabilitation for mild stroke, and (iv) Resistance to change. CONCLUSIONS Hybrid cardiac rehabilitation programmes could be tailored to deliver stroke-specific education, exercises and multidisciplinary expertise. Post-stroke cognitive impairment was identified as a key barrier to participation in cardiac rehabilitation. A cognitive rehabilitation intervention could potentially be delivered as part of cardiac rehabilitation, to address the cognitive needs of stroke and cardiac patients.Implications for rehabilitationThe cardiac rehabilitation model has the potential to be expanded to include mild stroke patients given the commonality of secondary prevention needs.Up to half of stroke survivors are affected by post-stroke cognitive impairment, consequently mild stroke patients may not be such an "easy fit" for cardiac rehabilitation.A cardiovascular programme which includes common rehabilitation modules, in addition to stroke- and cardiac-specific content is recommended.A cognitive rehabilitation module could potentially be added as part of the cardiac rehabilitation programme to address the cognitive needs of stroke and cardiac patients.
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Affiliation(s)
- Isabelle Jeffares
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Donnelly NA, Sexton E, Merriman NA, Bennett KE, Williams DJ, Horgan F, Gillespie P, Hickey A, Wren MA. The Prevalence of Cognitive Impairment on Admission to Nursing Home among Residents with and without Stroke: A Cross-Sectional Survey of Nursing Homes in Ireland. Int J Environ Res Public Health 2020; 17:E7203. [PMID: 33019730 PMCID: PMC7579486 DOI: 10.3390/ijerph17197203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022]
Abstract
Post-stroke cognitive impairment (PSCI) is a common consequence of stroke. Epidemiological evidence indicates that, with an ageing population, stroke and PSCI are likely to increase in the coming decades. This may have considerable implications for the demand for nursing home placement. As prevalence estimates of both cognitive impairment and dementia on admission to nursing home among residents with and without stroke have not yet been compared, they were estimated and compared in this study. We performed a cross-sectional survey to establish the admission characteristics of 643 residents in 13 randomly selected nursing homes in Ireland. The survey collected data on resident's stroke and cognitive status at the time of nursing home admission. The survey found, among nursing home residents that experienced stroke prior to admission, prevalence estimates for cognitive impairment (83.8%; 95% CI = 76.9-90.6%) and dementia (66.7%; 95% CI = 57.9-75.4%) were significantly higher compared to residents that had not experienced stroke prior to admission (cognitive impairment: 56.6%; 95% CI = 52.4-60.8%; X2 (1) = 28.64; p < 0.001; dementia: 49.8%; 95% CI = 45.6-54.1%; X2 (1) = 10.47; p < 0.01). Since the prevalence of PSCI is likely to increase in the coming decades, the findings highlight an urgent need for health service planning for this increased demand for nursing home care to meet the care needs of these stroke survivors.
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Affiliation(s)
- Nora-Ann Donnelly
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
- Social Research Division, Economic and Social Research Institute, D02 K138, Ireland;
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - Niamh A. Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - Kathleen E. Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, D02 P796, Ireland;
| | - Frances Horgan
- Department Physiotherapy, Royal College of Surgeons in Ireland, D02 P796, Ireland;
| | - Paddy Gillespie
- Health Economics & Policy Analysis Centre (HEPAC), Department of Economics, NUI Galway, H91 TK33, Ireland;
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, D02 K138, Ireland;
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Merriman NA, Gillan D, Pender N, Williams DJ, Horgan F, Sexton E, Johnston M, Bennett KE, Donnelly NA, Wren MA, Hickey A. The StrokeCog study: development and description of a cognition-focused psychological intervention to address cognitive impairment following stroke. Psychol Health 2020; 36:792-809. [PMID: 32924891 DOI: 10.1080/08870446.2020.1820009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the process of developing a cognitive rehabilitation intervention for patients with post-stroke cognitive impairment (PSCI) and to describe the intervention prior to evaluation in a pilot randomised controlled trial (RCT). Method: The Medical Research Council framework, 'Developing and evaluating complex interventions', was used to develop the cognitive rehabilitation intervention. We conducted a combined analysis of the existing evidence base for PSCI rehabilitation alongside qualitative exploration of the perspectives of stroke survivors, their families, and healthcare professionals providing stroke care, on the necessary components for a cognitive rehabilitation intervention for PSCI. The Template for Intervention Description and Replication checklist was used as a structural framework for the description of the intervention. Results: The intervention comprises a five-week intervention integrating group-based activities, supported by a clinical neuropsychologist, with home-based activities to encourage self-efficacy through the practice of adjustment and compensatory strategies learned in the group format to achieve the patients' identified goals in managing their PSCI. Conclusion: A cognitive rehabilitation intervention for patients with PSCI has been developed and described. We are in the process of developing a structured intervention manual to standardise the content and delivery of the intervention for further testing in a pilot RCT.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Diane Gillan
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Johnston
- Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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9
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Sexton E, Merriman NA, Donnelly NA, Wren MA, Hickey A, Bennett KE. Poststroke Cognitive Impairment in Model-Based Economic Evaluation: A Systematic Review. Dement Geriatr Cogn Disord 2020; 48:234-240. [PMID: 32187606 DOI: 10.1159/000506283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cognitive impairment (CI) is a frequent consequence of stroke and is associated with increased costs and reduced quality of life. However, its inclusion in model-based economic evaluation for stroke is limited. OBJECTIVE To identify, review, and critically appraise current models of stroke for use in economic evaluation, and to identify applicability to modeling poststroke CI. METHODS PubMed, EMBASE, and the NHS Economic Evaluations Database (NHS EED) were systematically searched for papers published from January 2008 to August 2018. Studies that described the development or design of a model of stroke progression intended for use in economic evaluation were included. Abstracts were screened, followed by full text review of potentially relevant articles. Models that included CI were retained for data extraction, and among the remainder, models that included both stroke recurrence and disability were also retained. Relevance and potential for adaptation for modeling CI were assessed using a standard questionnaire. RESULTS Forty modeling studies were identified and categorized into 4 groups: Markov disability/recurrence (k = 29); CI (k = 2); discrete event simulation (k = 4), and other (k = 5). Only 2 modeling studies included CI as an outcome, and both focused on narrow populations at risk of intracranial aneurysm. None of the models allowed for disease progression in the absence of a stroke recurrence. None of the included studies carried out any sensitivity analysis in relation to model design or structure. CONCLUSIONS Current stroke models used in economic evaluation are not adequate to model poststroke CI or dementia, and will require adaptation to be used for this purpose.
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Affiliation(s)
- Eithne Sexton
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland,
| | - Niamh A Merriman
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hickey A, Merriman NA, Bruen C, Mellon L, Bennett K, Williams D, Pender N, Doyle F. Psychological interventions for managing cognitive impairment after stroke. Hippokratia 2019. [DOI: 10.1002/14651858.cd013406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Anne Hickey
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Niamh A Merriman
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Carlos Bruen
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Lisa Mellon
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
| | - Kathleen Bennett
- Royal College of Surgeons in Ireland; Division of Population Health Sciences; Dublin Ireland
| | - David Williams
- Royal College of Surgeons in Ireland; RCSI Geriatric Medicine - Beaumont Hospital; Dublin Ireland
| | - Niall Pender
- Beaumont Hospital; Department of Psychology; Dublin Ireland 9
| | - Frank Doyle
- Royal College of Surgeons in Ireland; Department of Psychology; 123 St Stephen's Green Dublin Ireland
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Jeffares I, Merriman NA, Rohde D, McLoughlin A, Scally B, Doyle F, Horgan F, Hickey A. A systematic review and meta-analysis of the effects of cardiac rehabilitation interventions on cognitive impairment following stroke. Disabil Rehabil 2019; 43:773-788. [PMID: 31339368 DOI: 10.1080/09638288.2019.1641850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The cardiac rehabilitation model has potential as an approach to providing rehabilitation following stroke. This review aims to identify evidence for the participation of stroke patients in cardiac/cardiovascular rehabilitation programs internationally, whether or not such programs offer a cognitive intervention as part of treatment, and the impact of rehabilitation on post-stroke cognitive function. METHOD Five electronic databases were searched from inception to 1 May 2019, namely: MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials, and the Web of Science. Eligible studies included both randomized and non-randomized studies of cardiac rehabilitation-type interventions which measured cognitive function in patients with transient ischemic attack (TIA) or stroke. RESULTS Of 14,153 records reviewed, nine studies which delivered cardiac rehabilitation-type interventions to stroke patients were finally included. Only three of these studies delivered cognitive rehabilitation as part of the intervention. Cardiac rehabilitation had no statistically significant effect on cognitive function in five randomized controlled trials (standardized mean difference= 0.28, 95% CI= -0.16 to 0.73) or in three one group pre-post studies (standardized mean difference= 0.15, 95% CI= -0.03 to 0.33). CONCLUSIONS This review highlights that there are very few studies of delivery of cardiac rehabilitation to stroke patients and that the inclusion of cognitive interventions is even less common, despite the high prevalence of post-stroke cognitive impairment.IMPLICATIONS FOR REHABILITATIONThe cardiac rehabilitation model has the potential to be expanded to include patients post-stroke given the commonality of secondary prevention needs, thereby becoming a cardiovascular rehabilitation model.Up to half of patients experience cognitive impairment after stroke; suggesting that a post-stroke cardiovascular rehabilitation model should incorporate specific cognitive strategies for patients.This systematic review identified three cardiovascular rehabilitation programmes which delivered cognitive rehabilitation as part of treatment; however, evidence for efficacy is weak.
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Affiliation(s)
- Isabelle Jeffares
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Affraic McLoughlin
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brendan Scally
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Merriman NA, Bruen C, Gorman A, Horgan F, Williams DJ, Pender N, Byrne E, Hickey A. "I'm just not a Sudoku person": analysis of stroke survivor, carer, and healthcare professional perspectives for the design of a cognitive rehabilitation intervention. Disabil Rehabil 2019; 42:3359-3369. [PMID: 30971135 DOI: 10.1080/09638288.2019.1594400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Exploring the views of those impacted by stroke is key to the design of an effective and appropriate cognitive rehabilitation intervention for post-stroke cognitive impairment. This qualitative study examined the perspectives and preferences of stroke survivors, carers, and healthcare professionals to inform the design of a cognitive rehabilitation intervention.Design and methods: The research employed a qualitative study design and thematic analysis of data. In-depth semi-structured interviews were conducted with stroke survivors (n = 14), carers (n = 11), and healthcare professionals involved in providing stroke care (n = 19). Interviews were audio-recorded and transcribed. Coding was conducted and themes were developed both inductively and deductively.Results: Themes address five broad areas relevant for the design and implementation of the intervention: (i) activities to include; (ii) when it takes place; (iii) location; (vi) format; (v) who the intervention should include.Conclusions: Qualitative work with stroke survivors, carers and healthcare professionals provided vital information for the intervention design. Issues identified by participants as being key to intervention development included: (i) implications of post-stroke cognitive impairment survivors' confidence; (ii) their individual capacity in terms of fatigue and metacognition; and (iii) practical issues such as intervention location. The inclusion of psychoeducation regarding consequences of stroke was recommended.Implications for rehabilitationStroke survivors, carers, and rehabilitation professionals who provide stroke care can provide valuable insights and ideas to inform the development of a cognitive rehabilitation intervention.A cognitive rehabilitation intervention should be tailored to patient-specified goals, incorporating both group and individualized activities.Information, education, and communication are required to help stroke survivors and carers understand the cognitive, emotional, and behavioral consequences of stroke.Intervention content should be considerate of stroke survivors' capacity in terms of cognitive impairment and fatigue levels.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carlos Bruen
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Merriman NA, Sexton E, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Donnelly NA, Pender N, Williams DJ, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Addressing cognitive impairment following stroke: systematic review and meta-analysis of non-randomised controlled studies of psychological interventions. BMJ Open 2019; 9:e024429. [PMID: 30819706 PMCID: PMC6398645 DOI: 10.1136/bmjopen-2018-024429] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy. DESIGN Systematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment. DATA SOURCES Electronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017. ELIGIBILITY CRITERIA All non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life. METHODS The current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre-post studies. RESULTS Results indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre-post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions. CONCLUSIONS This review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grainne McCabe
- Library, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Sexton E, McLoughlin A, Williams DJ, Merriman NA, Donnelly N, Rohde D, Hickey A, Wren MA, Bennett K. Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke. Eur Stroke J 2019; 4:160-171. [PMID: 31259264 DOI: 10.1177/2396987318825484] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/20/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke. Patients and methods Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995-2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1-12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I2 statistic. Results A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI = 32-43%] (I2=92.5%, p < 0.01). Study quality emerged as one source of heterogeneity. The five studies with the highest quality scores had no heterogeneity (I2=0%, p = 0.99), with a similar pooled prevalence (39%, 95%CI = 35-42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time.Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.
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Affiliation(s)
- Eithne Sexton
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Affraic McLoughlin
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Merriman NA, Sexton E, Donnelly NA, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Pender N, Williams D, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Managing cognitive impairment following stroke: protocol for a systematic review of non-randomised controlled studies of psychological interventions. BMJ Open 2018; 8:e019001. [PMID: 29326188 PMCID: PMC5781105 DOI: 10.1136/bmjopen-2017-019001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Stroke is one of the primary causes of death and disability worldwide, leaving a considerable proportion of survivors with persistent cognitive and functional deficits. Despite the prevalence of poststroke cognitive impairment, there is no established treatment aimed at improving cognitive function following a stroke. Therefore, the aims of this systematic review are to identify psychological interventions intended to improve poststroke cognitive function and establish their efficacy. METHODS AND ANALYSIS A systematic review of non-randomised controlled studies that investigated the efficacy of psychological interventions aimed at improving cognitive function in stroke survivors will be conducted. Electronic searches will be performed in the PubMed, Embase and PsycINFO databases, the search dating from the beginning of the index to February 2017. Reference lists of all identified relevant articles will be reviewed to identify additional studies not previously identified by the electronic search. Potential grey literature will be reviewed using Google Scholar. Titles and abstracts will be assessed for eligibility by one reviewer, with a random sample of 50% independently double-screened by second reviewers. Any discrepancies will be resolved through discussion, with referral to a third reviewer where necessary. Risk of bias will be assessed with the Risk of Bias in Non-randomized Studies of Interventions tool. Meta-analyses will be performed if studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of the evidence regarding cognitive function will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This systematic review will collect secondary data only and as such ethical approval is not required. Findings will be disseminated through presentations and peer-reviewed publication. This review will provide information on the effectiveness of psychological interventions for poststroke cognitive impairment, identifying which psychological interventions are effective for improving poststroke cognitive function. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Grainne McCabe
- Royal College of Surgeons in Ireland Library, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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O’Callaghan G, O’Dowd A, Stapleton J, Merriman NA, Roudaia E, Newell FN. Changes in Regional Brain Grey-Matter Volume Following Successful Completion of a Sensori-Motor Intervention Targeted at Healthy and Fall-Prone Older Adults. Multisens Res 2018; 31:317-344. [DOI: 10.1163/22134808-00002604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/08/2017] [Indexed: 02/03/2023]
Abstract
Previous studies have suggested that discrete cross-sensory events could be incorrectly combined in the brain of older adults with a history of falls, possibly undermining motor and balance control. Based on previous findings that multisensory integration is modifiable with practice, even in an ageing population, we designed a serious game, named CityQuest, to train typical, everyday multisensory processes including sensori-motor control, spatial navigation, obstacle avoidance and balance control. Played over several sessions, this game was shown to improve these functions in older adults with and without a history of falls, depending on the specific condition of the game on which they were trained. Here, using voxel-based morphometry analysis of anatomical magnetic resonance imaging (MRI) data, we investigated structural changes in the brain of a smaller group of older adults from those who successfully completed this five-week intervention. A grey-matter (GM) volume increase in the precentral gyrus, and GM volume reduction in the inferior temporal and orbitofrontal gyri, was found for all participants. Changes in GM volume within regions of the cerebellum were differentially associated with fall-prone and healthy older adults. Furthermore, a greater GM volume increase in the precentral gyrus was observed in participants who performed the full CityQuest intervention relative to those required to avoid obstacles only. Our results support previous evidence that multisensory training can affect structural changes in the older brain and have implications for programmes designed for the successful rehabilitation of perceptual and cognitive functions.
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Affiliation(s)
- Georgia O’Callaghan
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Alan O’Dowd
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - John Stapleton
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Niamh A. Merriman
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Eugenie Roudaia
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Fiona N. Newell
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Ireland
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Rohde D, Merriman NA, Doyle F, Bennett K, Williams D, Hickey A. Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke. PLoS One 2017; 12:e0189339. [PMID: 29220386 PMCID: PMC5722379 DOI: 10.1371/journal.pone.0189339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND While medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke. METHODS A systematic literature search of longitudinal and cross-sectional studies of adults with any stroke type, which reported on the association between any measure of non-adherence and cognitive impairment, was carried out according to PRISMA guidelines. Odds ratios and 95% confidence intervals were the primary measure of effect. Risk of bias was assessed using the Cochrane Bias Methods Group's Tool to Assess Risk of Bias in Cohort Studies, with evidence quality assessed according to the GRADE approach. We conducted sensitivity analyses according to measure of cognitive impairment, measure of medication adherence, population, risk of bias and adjustment for covariates. The protocol was registered with PROSPERO. RESULTS From 1,760 titles and abstracts, we identified 9 studies for inclusion. Measures of cognitive impairment varied from dementia diagnosis to standardised cognitive assessments. Medication adherence was assessed through self-report or administrative databases. The majority of studies were of medium risk of bias (n = 6); two studies had low risk of bias. Findings were mixed; when all studies were pooled, there was no evidence of an association between cognitive impairment and medication non-adherence post-stroke [OR (95% CI): 0.85 (0.66, 1.03)]. However, heterogeneity was substantial [I2 = 90.9%, p < .001], and the overall evidence quality was low. CONCLUSIONS Few studies have explored associations between cognitive impairment and medication adherence post-stroke, with substantial heterogeneity in study populations, and definitions and assessments of non-adherence and cognitive impairment. Further research using clear, standardised and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A. Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Merriman NA, Ondřej J, Rybicki A, Roudaia E, O’Sullivan C, Newell FN. Crowded environments reduce spatial memory in older but not younger adults. Psychological Research 2016; 82:407-428. [DOI: 10.1007/s00426-016-0819-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 10/18/2016] [Indexed: 12/16/2022]
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Merriman NA, Ondřej J, Roudaia E, O'Sullivan C, Newell FN. Familiar environments enhance object and spatial memory in both younger and older adults. Exp Brain Res 2016; 234:1555-74. [PMID: 26821318 DOI: 10.1007/s00221-016-4557-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/09/2016] [Indexed: 11/30/2022]
Abstract
Recent evidence suggests that familiarity with an environment may protect against spatial memory decline for familiar objects in older adults. We investigated whether a familiar context also reduces age-related decline in spatial memory for novel objects. Twenty-four younger and 23 older participants viewed a virtual rendering of a local environment along two different routes, each through a well-known (West) or lesser-known (East) area within the environment. Older and younger participants reported being more familiar with one (i.e. West) area than the other. In each trial, participants were presented with one route and were instructed to learn ten novel objects and their locations along the route. Following learning, participants immediately completed five test blocks: an object recognition task, an egocentric spatial processing (direction judgement) task, an allocentric spatial processing (proximity judgement) task and two pen-and-paper tests to measure cognitive mapping abilities. First we found an age effect with worse performance by older than younger adults in all spatial tasks, particularly in allocentric spatial processing. However, our results suggested better memory for objects and directions, but not proximity judgements, when the task was associated with more familiar than unfamiliar contexts, in both age groups. There was no benefit of context when a separate young adult group (N = 24) was tested, who reported being equally familiar with both areas. These results suggest an important facilitatory role of context familiarity on object recognition, and in particular egocentric spatial memory, and have implications for enhancing spatial memory in older adults.
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Affiliation(s)
- Niamh A Merriman
- School of Psychology and Institute of Neuroscience, Lloyd Building, Trinity College Dublin, Dublin 2, Ireland
| | - Jan Ondřej
- Graphics, Vision and Visualisation Group, School of Computer Science and Statistics, Trinity College Dublin, Dublin 2, Ireland
| | - Eugenie Roudaia
- School of Psychology and Institute of Neuroscience, Lloyd Building, Trinity College Dublin, Dublin 2, Ireland
| | - Carol O'Sullivan
- Graphics, Vision and Visualisation Group, School of Computer Science and Statistics, Trinity College Dublin, Dublin 2, Ireland
| | - Fiona N Newell
- School of Psychology and Institute of Neuroscience, Lloyd Building, Trinity College Dublin, Dublin 2, Ireland.
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Abstract
Background: Falls and fall-related injuries are symptomatic of an aging population. This study aimed to design, develop, and deliver a novel method of balance training, using an interactive game-based system to promote engagement, with the inclusion of older adults at both high and low risk of experiencing a fall. Study Design: Eighty-two older adults (65 years of age and older) were recruited from sheltered accommodation and local activity groups. Forty volunteers were randomly selected and received 5 weeks of balance game training (5 males, 35 females; mean, 77.18 ± 6.59 years), whereas the remaining control participants recorded levels of physical activity (20 males, 22 females; mean, 76.62 ± 7.28 years). The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments. Results: Balance game training had a significant effect on levels of functional balance and balance confidence (P < 0.05). This was further demonstrated in participants who were deemed at high risk of falls. The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls. Conclusions: Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population.
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Affiliation(s)
- Caroline Whyatt
- 1 School of Psychology, Queen's University Belfast , Belfast, United Kingdom
| | - Niamh A Merriman
- 2 School of Psychology and Institute of Neuroscience, Trinity College Dublin , Dublin, Ireland
| | - William R Young
- 3 The Institute of Environment, Health and Societies, Brunel University London , London, United Kingdom
| | - Fiona N Newell
- 2 School of Psychology and Institute of Neuroscience, Trinity College Dublin , Dublin, Ireland
| | - Cathy Craig
- 1 School of Psychology, Queen's University Belfast , Belfast, United Kingdom
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Merriman NA, Whyatt C, Setti A, Craig C, Newell FN. Successful balance training is associated with improved multisensory function in fall-prone older adults. Computers in Human Behavior 2015. [DOI: 10.1016/j.chb.2014.12.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mylonakis E, Merriman NA, Rich JD, Flanigan TP, Walters BC, Tashima KT, Mileno MD, van der Horst CM. Use of cerebrospinal fluid shunt for the management of elevated intracranial pressure in a patient with active AIDS-related cryptococcal meningitis. Diagn Microbiol Infect Dis 1999; 34:111-4. [PMID: 10354860 DOI: 10.1016/s0732-8893(99)00025-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Persistently elevated intracranial pressure (ICP) is one of the most accurate predictors of a poor prognosis in patients with AIDS-related cryptococcal meningitis. We present a severe case of persistent cryptococcal meningitis in a patient with advanced AIDS, complicated by elevation of ICP. A ventriculoperitoneal shunt was placed that successfully lowered the ICP and alleviated the associated symptoms. The elevated ICP secondary to AIDS-related cryptococcal meningitis should be treated aggressively. Despite the risk of shunt complications, cerebrospinal fluid shunts can be considered in these patients if they do not respond to other treatment.
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Affiliation(s)
- E Mylonakis
- Department of Medicine, Miriam Hospital, Brown University School of Medicine, Providence, RI 02906, USA
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Vigilante KC, Flynn MM, Affleck PC, Stunkle JC, Merriman NA, Flanigan TP, Mitty JA, Rich JD. Reduction in recidivism of incarcerated women through primary care, peer counseling, and discharge planning. J Womens Health (Larchmt) 1999; 8:409-15. [PMID: 10326995 DOI: 10.1089/jwh.1999.8.409] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Prior to release from the Rhode Island state prison, women at the highest risk for reincarceration and HIV infection are assigned to the Women's HIV/Prison Prevention Program (WHPPP), a discharge program designed to reduce the likelihood of reincarceration and HIV infection. Candidates for the WHPPP must meet at least one of three criteria: intravenous drug use or crack use, commercial sex work, or a history of prison recidivism with poor educational history and poor employment prospects. While incarcerated, the program participant develops a relationship with a physician and a social worker and establishes an individualized discharge plan. After release, the same physician and social worker continue to work with the client and assist an outreach worker in implementing the discharge plan. Data were collected from questionnaires administered to 78 women enrolled in the WHPPP between 1992 and 1995. The population in this program was primarily composed of ethnic minorities (55%), 25-35 years of age (55%), unmarried (90%), had children (72%), and displayed a variety of HIV risk behaviors. The WHPPP recidivism rates were compared with those of a mostly white (65%), similarly aged (51% were between 25 and 35 years of age) historical control group of all women incarcerated in Rhode Island in 1992. The intervention group demonstrated lower recidivism rates than the historical control group at 3 months (5% versus 18.5%, p = 0.0036) and at 12 months (33% versus 45%, p = 0.06). Assuming that recidivism is a marker for high-risk behavior, participation in the WHPPP was associated with a reduction in recidivism and in the risk of HIV disease in this very high risk group of women.
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Affiliation(s)
- K C Vigilante
- The Miriam Hospital, Brown University School of Medicine, Providence, Rhode Island 02906, USA
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Abstract
BACKGROUND The availability of sensitive assays for plasma HIV viral load and the trend toward earlier and more aggressive treatment of HIV infection has led to the inappropriate use of these assays as primary tools for the diagnosis of acute HIV infection. OBJECTIVE To describe limitations in the use of plasma viral load testing for the diagnosis of HIV infection. DESIGN Case series. SETTING Academic medical centers in Providence, Rhode Island, and Worcester, Massachusetts. PATIENTS Three persons in whom HIV infection was falsely diagnosed by plasma viral load testing. MEASUREMENTS Laboratory measures and clinical outcomes. RESULTS Two cases of false-positive results obtained by using branched-chain DNA plasma viral load assays and one case of a false-positive result obtained by using reverse transcriptase-polymerase chain reaction plasma viral load assay are reported. All three plasma viral load tests yielded positive results with low values (1254 copies/mL, 1574 copies/mL, and 1300 copies/mL). Infection with HIV was initially diagnosed in all three patients, but each patient subsequently tested negative by HIV-1 enzyme-linked immunosorbent assay and repeated plasma viral load testing. CONCLUSION Physicians should exercise caution when using plasma viral load assays to detect primary HIV infection, particularly when the pretest probability of infection is low.
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Affiliation(s)
- J D Rich
- Brown University School of Medicine, Providence, Rhode Island 02906, USA.
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Dickinson BP, Mitty JA, Mylonakis E, Rich JD, Merriman NA, Tashima KT, Carpenter CC, Flanigan TP. Predictors of undetectable HIV plasma viral load in 250 HIV-positive women receiving care. AIDS 1998; 12:2075-6. [PMID: 9814878 DOI: 10.1097/00002030-199815000-00021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rich JD, Dickinson BP, Merriman NA, Flanigan TP. Hepatitis C virus infection related to anabolic-androgenic steroid injection in a recreational weight lifter. Am J Gastroenterol 1998; 93:1598. [PMID: 9732964 DOI: 10.1111/j.1572-0241.1998.01598.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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