RESUMEN
Stoma-forming surgery can have extensive, negative impacts on a patient's psychological wellbeing. Although this has been known for several decades, little progress has been made in addressing the issue. Several areas of concern have been repeatedly identified in the literature: loss of control; reduced self-esteem; psychosexual issues; and the impact of enhanced recovery on psychological outcomes. While these issues have the potential to significantly affect patients undergoing stoma-forming surgery, they can be mitigated against. While identifying and addressing psychological morbidity at an early stage is the most effective approach, additional interventions can also be useful. The promotion of self-care and independence can minimise the feeling of loss of control, the selection of discreet, leak-proof products can help address self-esteem issues, and open, honest conversation can significantly improve a patient's feelings regarding sexuality and intimacy.
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Estomas Quirúrgicos , Humanos , Autoimagen , Sobrevivientes/psicología , Autocuidado/psicologíaRESUMEN
Since the 1990s, cases of serious violence and abuse, particularly sexual abuse in educational and social institutions of the Catholic Church, have been reported in numerous countries, including Ireland, the United States, and Australia. In many countries, commissions have been set up to investigate the widespread cases of abuse that could not be prosecuted under criminal law. The testimonies of survivors and other witnesses are used by the commissions of inquiry in their work. Since 2016 the Independent Inquiry into Child Sexual Abuse in Germany has collected more than 2,500 reports from survivors of child sexual abuse. Forty-four testimonies were analyzed in a study seeking to understand more about lifetime abuse. In an explorative analysis, aspects of time as a key category in the reports were identified using the structured content analysis method. The results highlight the importance of time in the reports and during all phases of the survivors' lives. Overall, four themes are relevant: (a) the identification of turning points, (b) time to make sense of what happened, (c) the practice of waiting, and (d) time-bound experiences of testifying.
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Adultos Sobrevivientes del Maltrato a los Niños , Abuso Sexual Infantil , Humanos , Abuso Sexual Infantil/estadística & datos numéricos , Femenino , Niño , Masculino , Adulto , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Sobrevivientes/psicología , Alemania , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVES: Disaster experiences have long-term effects on disaster preparedness. This study examined the long-term (10-y) effect of disaster severity of the 2008 Wenchuan earthquake on survivors' disaster preparedness and the moderating effects of household vulnerability. METHODS: The data were collected in January 2018 covering 30 counties in Wenchuan earthquake-stricken areas. The dependent variable was survivors' disaster preparedness (including overall, material, knowledge and awareness, and action preparedness) in 2018. Disaster severity included survivors' housing damage and county death rate caused by the earthquake in 2008. Household vulnerability is a set of conditions that negatively affects the ability of people to prepare for and withstand disaster, proxied by households' per-capita income and the highest years of schooling of household members. We performed multivariable linear regression models to answer the research questions. RESULTS: A higher county death rate was associated with better overall preparedness (ß = 0.043; P < 0.05) and knowledge and awareness preparedness (ß = 0.018; P < 0.05), but housing damage was not significantly associated with disaster preparedness. The positive association of county death rate with overall preparedness (ß = -0.065; P < 0.05) becomes weaker when a household has a higher per-capita income. Also, with the household per-capita income increasing, the associations of county death rate with material preparedness (ß = -0.037; P < 0.05) and action preparedness (ß = -0.034; P < 0.01) become weaker. CONCLUSIONS: Disaster severity has positive and long-term effects on survivors' disaster preparedness. Also, the positive and long-term effects are affected by household vulnerability. Specifically, the positive and long-term effects of disaster severity on disaster preparedness are more substantial when a household is more vulnerable.
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Terremotos , Sobrevivientes , Humanos , China/epidemiología , Sobrevivientes/estadística & datos numéricos , Sobrevivientes/psicología , Terremotos/estadística & datos numéricos , Encuestas y Cuestionarios , Masculino , Femenino , Persona de Mediana Edad , Adulto , Defensa Civil/estadística & datos numéricos , Defensa Civil/métodos , Defensa Civil/normas , Planificación en Desastres/métodos , Planificación en Desastres/estadística & datos numéricosRESUMEN
Immune profiling of Nipah virus (NiV) infection survivors is essential for advancing our understanding of NiV pathogenesis, improving diagnostic and therapeutic strategies, and guiding public health efforts to prevent future outbreaks. There is currently limited data available on the immune response to NiV infection. We aimed to elucidate the specific immune mechanisms involved in protection against NiV infection by analyzing the immune profiles of survivors of the Nipah outbreak in Kerala, India 2023. Immune cell populations were quantified and compared between survivors (up to 4 months post onset day of illness) and healthy controls. Statistical analysis was performed to explore associations between immune profiles and clinical outcomes. Immune signatures common to all three cases were: a heretofore undescribed persistent lymphopenia including the CD4+ Treg compartment with the relative expansion of memory Tregs; trends indicative of global leukopenic modulation were observed in monocytes and granulocytes including an expansion of putatively immunosuppressive low-density granulocytes described recently in the context of severe COVID-19; altered mucosal homing with respect to integrin beta-7 (ITGB7) expressing subsets; increased mobilization of activated T-cells (CD4+ and CD8+) and plasmablasts in the early phase of infection. Comparative analysis based on clinical presentation and outcome yielded lower initial viremia, increased activated T-cell responses, expanded plasmablasts, and restoration of ITGB7 expressing CD8+ T-cells as possible protective signatures. This longitudinal study delineates putative protective signatures associated with milder NiV disease. It emphasizes the need for the development of immunotherapeutic interventions such as monoclonal antibodies to blunt early viremia and ameliorate pathogenesis.
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Brotes de Enfermedades , Infecciones por Henipavirus , Virus Nipah , Humanos , India/epidemiología , Virus Nipah/inmunología , Infecciones por Henipavirus/inmunología , Infecciones por Henipavirus/epidemiología , Masculino , Adulto , Femenino , Sobrevivientes , Linfocitos T CD8-positivos/inmunología , Persona de Mediana EdadRESUMEN
AIM: To the determinants and the underlying mechanism of health literacy, social support, and resilience on the health-related quality of life (HRQoL) among older stroke survivors. DESIGN: A cross-sectional design was applied at four comprehensive hospitals in Chongqing via convenience sampling from January 2020 to June 2021. METHODS: Health literacy, social support, and resilience were designed as independent variables, and HRQoL was measured as a dependent variable. Structural equation modelling with the bootstrap method was used to test the hypotheses. RESULTS: The theoretically derived model exhibited a good fit (χ2/df ratio = 2.830, GFI = 0.987, CFI = 0.978, RMSEA = 0.066). Health literacy (ß = 0.12, p < 0.05) and social support (ß = 0.14, p < 0.05) directly affect HRQoL. Resilience (ß = 0.40, p < 0.01) also mediated the relationship between health literacy, social support, and HRQoL. The three variables explaining 29.0% of HRQoL variance. PATIENT OR PUBLIC CONTRIBUTION: There was no direct patient or public involvement in the design, conduct, or reporting of this study. Participants were recruited through convenience sampling from four comprehensive hospitals in Chongqing, and their perspectives or contributions were not explicitly sought. The study focused on examining the determinants and underlying mechanism of health literacy, social support, and resilience on the health-related quality of life among older stroke survivors. Nonetheless, the findings of this research may inform the development of interventions aimed at improving the health-related quality of life in post-stroke older patients.
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Alfabetización en Salud , Calidad de Vida , Resiliencia Psicológica , Apoyo Social , Accidente Cerebrovascular , Sobrevivientes , Humanos , Calidad de Vida/psicología , Femenino , Masculino , Anciano , Estudios Transversales , Accidente Cerebrovascular/psicología , Sobrevivientes/psicología , Análisis de Clases Latentes , Anciano de 80 o más Años , Encuestas y Cuestionarios , China , Persona de Mediana EdadRESUMEN
Introduction: In post-COVID survivors, transforming growth factor-beta-1 (TGF-ß1) might mediate fibroblast activation, resulting in persistent fibrosis. Methods: In this study, 82 survivors of COVID-19-associated ARDS were examined at 6- and 24-months post-ICU discharge. At 6-months, quantitative CT analysis of lung attenuation was performed and active TGF-ß1 was measured in blood and exhaled breath condensate (EBC). Results: At 6-months of ICU-discharge, patients with reduced DmCO/alveolar volume ratio exhibited higher plasma and EBC levels of active TGF-ß1. Plasma TGF-ß1 levels were elevated in dyspneic survivors and directly related to the high-attenuation lung volume. In vitro, plasma and EBC from survivors induced profibrotic changes in human primary fibroblasts in a TGF-ß receptor-dependent manner. Finally, at 6-months, plasma and EBC active TGF-ß1 levels discriminated patients who, 24-months post-ICU-discharge, developed gas exchange impairment. Discussion: TGF-ß1 pathway plays a pivotal role in the early-phase fibrotic abnormalities in COVID-19-induced ARDS survivors, with significant implications for long-term functional impairment.
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COVID-19 , SARS-CoV-2 , Sobrevivientes , Factor de Crecimiento Transformador beta1 , Humanos , COVID-19/inmunología , COVID-19/complicaciones , COVID-19/patología , Factor de Crecimiento Transformador beta1/metabolismo , Factor de Crecimiento Transformador beta1/sangre , Masculino , Femenino , Persona de Mediana Edad , Anciano , Pulmón/patología , Pulmón/metabolismo , Fibroblastos/metabolismo , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/metabolismo , FibrosisRESUMEN
OBJECTIVE: We aimed to evaluate the frequency of Post Traumatic Stress Disorder (PTSD), to determine the risk factors, and to monitor the change of symptoms after 6 months among individuals who survived the avalanche disaster in Van. METHOD: Face-to-face interviews were conducted with 35 people who were rescued from two consecutive avalanche disasters in Van 2 months and 6 months after the avalanche disaster. The socio-demographic and clinical data of the cases were evaluated. The Post Traumatic Stress Disorder Symptom Scale-Self Report version (PSS-SR) and clinical interviews were used for PTSD diagnosis. The level of trauma was assessed by using the Impact of Event Scale (IES). RESULTS: All participants were rescuers who went to the avalanche site for rescue mission. Of the cases, 16 were volunteers from the local community and 19 were professional rescuers. The frequency of PTSD was 71.4% in the early assessment, and 57.1% in the long term. Staying in avalanche for more than 30 minutes, the absence of a history of disaster exposure and being in the group of volunteers were found to increase the risk for PTSD development. CONCLUSION: There is a high risk of developing PTSD as a result of an avalanche. People who will intervene with the disasters should be educated and prepared in terms of preventing negative psychological consequences of the disaster. The relationship between the severity of trauma and PTSD was replicated in our study.
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Avalanchas , Trastornos por Estrés Postraumático , Sobrevivientes , Humanos , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/epidemiología , Masculino , Femenino , Adulto , Sobrevivientes/psicología , Estudios de Seguimiento , Persona de Mediana Edad , Factores de Riesgo , Turquía/epidemiología , Desastres , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
BACKGROUND: Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system. METHODS: We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory. FINDINGS: We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships. CONCLUSIONS: Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.
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Violencia de Pareja , Sobrevivientes , Humanos , Femenino , Adulto , Violencia de Pareja/psicología , Persona de Mediana Edad , Sobrevivientes/psicología , Adolescente , Adulto Joven , Atención a la Salud , San FranciscoRESUMEN
Health equity is a fast emerging priority for most healthcare systems around the world. Factors impacting health equity include education level, geographical location, age, gender, employment status and income. However, research examining the effect of these demographic variables on health service utilisation among mid-aged and older post-stroke adults is limited. Data was obtained from a sub-study of the Sax Institute's 45 and Up Study, which is conducted in Australia. The sub-study survey collected demographic, health service utilisation and health status information from 576 participants who had a previous stroke diagnosis. Poisson regression was used to examine the association between demographic characteristics and number of consultations with a doctor and/or an allied health practitioner over a 12 month period. All demographic measures were significantly associated with the number of consultations with doctors and/or allied health practitioners. The number of doctor consultations increased for those who struggled to live on their available income (IRR = 1.41), but decreased for females (IRR = 0.81), those who reside in an inner regional area (IRR = 0.83), those who were separated, divorced or widowed (IRR = 0.61), and for those who completed a trade, apprenticeship or diploma (IRR = 0.83). The number of allied health practitioner consultations increased for those who completed a trade, apprenticeship or diploma (IRR = 1.27), and for those who struggled to live on their available income (IRR = 1.38), but decreased for increasing age (IRR = 0.87), females (IRR = 0.78), and for those who reside in an outer regional or remote area (IRR = 0.49). We identified several demographic factors associated with a lower frequency and type of health care services used by post-stroke adults. These possible barriers need to be explored further, as reduced use of healthcare services may lead to poorer stroke outcomes in these demographics. Specifically, researching strategies to best support individuals facing these additional challenges is necessary to ensure equitable healthcare for all Australians.
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Aceptación de la Atención de Salud , Accidente Cerebrovascular , Humanos , Femenino , Masculino , Australia , Persona de Mediana Edad , Anciano , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Sobrevivientes , Demografía , Factores Socioeconómicos , Anciano de 80 o más AñosRESUMEN
Intimate partner violence affects 20-30% of women in the United States. Disparities in routine cervical cancer surveillance have been demonstrated in certain populations, including victims of intimate partner violence (IPV). This study examined and assessed the acceptability of high-risk HPV (hrHPV) self-collection among individuals who have experienced IPV. We conducted an observational study using qualitative data collection and analysis. We interviewed individuals with a history of IPV and who currently reside in Oregon. This study identified key themes describing knowledge and attitudes towards cervical cancer screening for individuals who have experienced IPV. They include: guideline knowledge, prior office-based cervical cancer screening experience, barriers to cervical cancer screening, at-home hrHPV self-collection experience, and testing confidence. Participants experienced fewer barriers and expressed increased comfort and control with hrHPV self-collection process. Individuals with a history of IPV have lower rates of cervical cancer screening adherence and higher rates of cervical dysplasia and cancer than other populations. The patient-centered approach of hrHPV self-collection for cervical cancer screening can reduce barriers related to the pelvic exam and empower patients to reduce their risks of developing cervical cancer by enabling greater control of the testing process.
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Detección Precoz del Cáncer , Investigación Cualitativa , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/psicología , Persona de Mediana Edad , Infecciones por Papillomavirus/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Violencia de Pareja/psicología , Violencia de Pareja/estadística & datos numéricos , Manejo de Especímenes/métodos , Oregon , Autocuidado/métodos , Autocuidado/psicología , Sobrevivientes/psicología , Frotis Vaginal/métodos , Frotis Vaginal/psicología , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto JovenRESUMEN
CONTEXT.: As the Covid-19 pandemic continues into its 4th year, reports of long-term morbidity and mortality are now attracting attention. Recent studies suggest that Covid-19 survivors are at increased risk of common illnesses, such as myocardial infarction, diabetes mellitus and autoimmune disorders. Mortality may also be increased. This article will review the evidence that supports some of these observations and provide an opinion about their validity and their relevance to insured cohorts.
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COVID-19 , Humanos , COVID-19/mortalidad , COVID-19/complicaciones , COVID-19/epidemiología , SARS-CoV-2 , Diabetes Mellitus/epidemiología , Infarto del Miocardio , Enfermedades Autoinmunes/complicaciones , Sobrevivientes , PandemiasRESUMEN
PURPOSE: This study aims to explore the experiences of care, psychosocial support, and psychosocial wellbeing among patients treated for COVID-19 in intensive care 12 to 18 months after discharge. METHODS: This study used a qualitative approach with a descriptive design. Semi-structured interviews were performed with 20 adult patients treated for COVID-19 12 to 18 months after being discharged from a university hospital in Sweden. Data were analysed using qualitative content analysis. FINDINGS: The participants were severely affected by COVID-19 both during the hospital stay and afterwards. They experienced overwhelming fears and uncertainties related to their wellbeing and possibility to recover. The care was described chaotic with staff that were stressed; however, the efforts of the staff during this strenuous circumstance were still positively acknowledged. Difficulties to stay in touch with family and friends due to visiting restrictions affected the patient's psychosocial wellbeing. CONCLUSION: Contracting COVID-19 in the beginning of the pandemic was a stressful event. Being seen and heard is of importance as it has the possibility to create a feeling of security and being cared for despite unclarities about treatment and illness trajectory. Accordingly, healthcare staff play an important role for the psychosocial wellbeing of patients treated for COVID-19.
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COVID-19 , Cuidados Críticos , Investigación Cualitativa , Sobrevivientes , Humanos , COVID-19/psicología , Masculino , Femenino , Persona de Mediana Edad , Suecia , Sobrevivientes/psicología , Anciano , Cuidados Críticos/psicología , Adulto , SARS-CoV-2 , Unidades de Cuidados Intensivos , Apoyo Social , Miedo , Estrés Psicológico , Anciano de 80 o más AñosRESUMEN
INTRODUCTION: Burn survivors often experience a plethora of post-burn residual needs following their discharge including psychological issues and poor sleep. These needs are often overlooked with a significant focus on resolving physical issues. Aftercare support is particularly limited. The emergence of the Coronavirus pandemic worsened the situation as burn survivors were unable to return to utilise available services outpatient basis. Thus, an innovative nurse-led aftercare programme was developed and delivered via WeChat social medial platform. The current study sought to examine the effects of the intervention on anxiety, depression, and sleep pattern among adult burn survivors. METHODS: This is a randomised controlled trial. Sixty adult burn survivors were randomly assigned to intervention and control groups. Participants in the intervention group received the nurse-led aftercare programme which involved pre-discharge support and active follow-up on WeChat over an 8-week period and an additional 4 weeks to examine the sustained effects of the intervention. Data were collected at three timepoints: baseline (T0), post-intervention (T1), and follow-up (T2). Generalised estimating equation was employed to ascertain the group, time, and interaction effects. RESULTS: Using Bonferroni corrected p value (0.017), Anxiety and depression improved at T1 and sustained at T2 with mean scores demonstrating a reduction in both variables and total score. No statistically significant improvement was however observed regarding sleep. CONCLUSION: Continuous, comprehensive support is required by burn survivors following discharge to improve psychological outcomes. Delivering aftercare via WeChat should be considered a feasible option to supporting burn survivors following discharge.
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Cuidados Posteriores , Quemaduras , Sobrevivientes , Telemedicina , Humanos , Femenino , Masculino , Adulto , Quemaduras/psicología , Quemaduras/enfermería , Sobrevivientes/psicología , Cuidados Posteriores/métodos , Persona de Mediana Edad , Ansiedad , COVID-19/enfermería , COVID-19/psicología , Sueño , Trastornos del Sueño-VigiliaRESUMEN
PURPOSE OF REVIEW: For augmented intelligence (AI) tools to realize their potential, critical care clinicians must ensure they are designed to improve long-term outcomes. This overview is intended to align professionals with the state-of-the art of AI. RECENT FINDINGS: Many AI tools are undergoing preliminary assessment of their ability to support the care of survivors and their caregivers at multiple time points after intensive care unit (ICU) discharge. The domains being studied include early identification of deterioration (physiological, mental), management of impaired physical functioning, pain, sleep and sexual dysfunction, improving nutrition and communication, and screening and treatment of cognitive impairment and mental health disorders.Several technologies are already being marketed and many more are in various stages of development. These technologies mostly still require clinical trials outcome testing. However, lacking a formal regulatory approval process, some are already in use. SUMMARY: Plans for long-term management of ICU survivors must account for the development of a holistic follow-up system that incorporates AI across multiple platforms. A tiered post-ICU screening program may be established wherein AI tools managed by ICU follow-up clinics provide appropriate assistance without human intervention in cases with less pathology and refer severe cases to expert treatment.
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Inteligencia Artificial , Humanos , Cuidados Críticos/métodos , Unidades de Cuidados Intensivos , Enfermedad Crítica/terapia , Sobrevivientes/psicologíaRESUMEN
PURPOSE OF REVIEW: Survivors of cardiac arrest often have increased long-term risks of mortality and disability that are primarily associated with hypoxic-ischemic brain injury (HIBI). This review aims to examine health-related long-term outcomes after cardiac arrest. RECENT FINDINGS: A notable portion of cardiac arrest survivors face a decline in their quality of life, encountering persistent physical, cognitive, and mental health challenges emerging years after the initial event. Within the first-year postarrest, survivors are at elevated risk for stroke, epilepsy, and psychiatric conditions, along with a heightened susceptibility to developing dementia. Addressing these challenges necessitates establishing comprehensive, multidisciplinary care systems tailored to the needs of these individuals. SUMMARY: HIBI remains the leading cause of disability among cardiac arrest survivors. No single strategy is likely to improve long term outcomes after cardiac arrest. A multimodal neuroprognostication approach (clinical examination, imaging, neurophysiology, and biomarkers) is recommended by guidelines, but fails to predict long-term outcomes. Cardiac arrest survivors often experience long-term disabilities that negatively impact their quality of life. The likelihood of such outcomes implements a multidisciplinary care an integral part of long-term recovery.
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Reanimación Cardiopulmonar , Paro Cardíaco , Hipoxia-Isquemia Encefálica , Calidad de Vida , Humanos , Paro Cardíaco/terapia , Hipoxia-Isquemia Encefálica/terapia , Privación de Tratamiento , SobrevivientesRESUMEN
PURPOSE OF REVIEW: To highlight the emerging crisis of critically ill elderly patients and review the unique burden of multidimensional morbidity faced by these patients and caregivers and potential interventions. RECENT FINDINGS: Physical, psychological, and cognitive sequelae after critical illness are frequent, durable, and robust across the international ICU outcome literature. Elderly patients are more vulnerable to the multisystem sequelae of critical illness and its treatment and the resultant multidimensional morbidity may be profound, chronic, and significantly affect functional independence, transition to the community, and quality of life for patients and families. Recent data reinforce the importance of baseline functional status, health trajectory, and chronic illness as key determinants of long-term functional disability after ICU. These risks are even more pronounced in older patients. SUMMARY: The current article is an overview of the outcomes of older survivors of critical illness, putative interventions to mitigate the long-term morbidity of patients, and the consequences for families and caregivers. A multimodal longitudinal approach designed to follow patients for one or more years may foster a better understanding of multidimensional morbidity faced by vulnerable older patients and families and provides a detailed understanding of recovery trajectories in this unique population to optimize outcome, goals of care directives, and ongoing informed consent to ICU treatment.
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Cuidadores , Enfermedad Crítica , Calidad de Vida , Humanos , Enfermedad Crítica/psicología , Anciano , Cuidadores/psicología , Unidades de Cuidados Intensivos , Cuidados Críticos/psicología , Familia/psicología , Sobrevivientes/psicología , Anciano de 80 o más Años , Enfermedad Crónica/psicologíaRESUMEN
OBJECTIVE: Primary intracerebral hemorrhage (ICH) accounts for 85â¯% of ICH and is associated with high morbidity and mortality. Identification of prognostic factors is critical to its management. However, previous studies showed conflicting results in whether diabetes mellitus (DM) is associated with outcomes among ICH patients. The present study examined the association between DM and long-term functional outcomes prospectively after ICH. DESIGN: This prospective study examined the functional outcomes in primary ICH patients. This study excluded patients who died before discharge and those with ICH related to aneurysm, arteriovenous malformation, or trauma. Patients were followed up for 1 year after ICH. Functional outcome was based on the Barthel Index (BI). Severe dependency in ADL was defined by a BI of ≤60, and functional independence was defined by a BI of >90. RESULTS: A total of 100 patients completed the 1-year follow-up, and 24 patients had DM. DM was significantly associated with worse functional outcomes 1 year post-ICH. The association remained significant after adjusting for baseline characteristics, comorbidities, and ICH score. CONCLUSION: DM was an independent predictor of worse functional outcomes 1 year post-ICH. This study is the first to examine the effect of DM on long-term functional outcomes after ICH.
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Hemorragia Cerebral , Diabetes Mellitus , Humanos , Masculino , Femenino , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/mortalidad , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Diabetes Mellitus/epidemiología , Sobrevivientes , Recuperación de la Función , Estudios de Seguimiento , Pronóstico , Resultado del Tratamiento , Anciano de 80 o más Años , AdultoRESUMEN
OBJECTIVE: The aim was to examine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in cohorts of working age stroke survivors, before and after inpatient rehabilitation. METHODS: Stroke patients aged 18-66 years registered in the national quality register WebRehab Sweden were included in the study at hospital admission (n = 256), discharge (n = 223), and 1-year follow-up (n = 313). Classical and modern (Rasch) methods were used for psychometric evaluation. RESULTS: The two-factor HADS model measuring anxiety and depression showed better fit than a single factor measuring emotional distress. The instrument's psychometric stability before and after rehabilitation was satisfactory. The anxiety scale showed good psychometric properties, except for item 7, which is not anxiety-specific. Some concerns were observed for the depression items showing weaker discriminant validity, and item 8 performing poorly as a measure of depression. Cronbach's alpha and McDonald's omega coefficients showed satisfactory internal consistency reliability, whereas Rasch person reliability coefficients indicated weaker reliability, especially for the depression scale. Effect size of change between hospital admission and discharge showed a reduction in anxiety and depression symptoms. CONCLUSIONS: HADS showed a stable two-factor structure over the rehabilitation period. Patients' perception of items was not affected by the recovery, allowing relevant comparison of HADS scores between different phases of the rehabilitation process. Measures of responsiveness suggest that HADS is sensitive to capturing improvements in emotional distress following rehabilitation interventions. Overall, despite minor psychometric weaknesses, HADS is a suitable instrument for assessing anxiety and depresssion symptoms in stroke patients aged 18-66 years.
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Ansiedad , Depresión , Psicometría , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Persona de Mediana Edad , Adulto , Femenino , Masculino , Rehabilitación de Accidente Cerebrovascular/psicología , Depresión/psicología , Ansiedad/psicología , Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/complicaciones , Anciano , Adolescente , Adulto Joven , Suecia , Sobrevivientes/psicología , Pacientes Internos/psicología , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Sepsis survivors experience high morbidity and mortality. Though recommended best practices have been established to address the transition and early post hospital needs and promote recovery for sepsis survivors, few patients receive recommended post-sepsis care. Our team developed the Sepsis Transition and Recovery (STAR) program, a multicomponent transition intervention that leverages virtually-connected nurses to coordinate the application of evidence-based recommendations for post-sepsis care with additional clinical support from hospitalist and primary care physicians. In this paper, we present findings from a qualitative pre-implementation study, guided by the Consolidated Framework for Implementation Research (CFIR), of factors to inform successful STAR implementation at a large learning health system prior to effectiveness testing as part of a Type I Hybrid trial. METHODS: We conducted semi-structured qualitative interviews (n = 16) with 8 administrative leaders and 8 clinicians. Interviews were transcribed and analyzed in ATLAS.ti using a combination deductive/inductive strategy based on CFIR domains and constructs and the Constant Comparison Method. RESULTS: Six facilitators and five implementation barriers were identified spanning all five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals and Process). Facilitators of STAR included alignment with health system goals, fostering stakeholder engagement, sharing STAR outcomes data, good communication between STAR navigators and patient care teams/PCPs, clinician promotion of STAR with patients, and good rapport and effective communication between STAR navigators and patients, caregivers, and family members. Barriers of STAR included competing demands for staff time and resources, insufficient communication and education of STAR's value and effectiveness, underlying informational and technology gaps among patients, lack of patient access to community resources, and patient distrust of the program and/or health care. CONCLUSIONS: CFIR proved to be a robust framework for examining facilitators and barriers for pre-implementation planning of post-sepsis care programs within diverse hospital and community settings in a large LHS. Conducting a structured pre-implementation evaluation helps researchers design with implementation in mind prior to effectiveness studies and should be considered a key component of Type I hybrid trials when feasible. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04495946 . Registered August 3, 2020.
Asunto(s)
Aprendizaje del Sistema de Salud , Investigación Cualitativa , Sepsis , Femenino , Humanos , Masculino , Entrevistas como Asunto , Sepsis/terapia , Sobrevivientes/psicologíaRESUMEN
Background: Road traffic injuries (RTI) pose a global public health threat, especially in low- and middle-income nations. These injuries typically cause orthopaedic problems that may negatively impair a person's physical and mental health and quality of life. Our study examined the quality of life of road traffic orthopaedic injuries (RTOI) survivors. Methods: A cross-sectional study at five Rwandan referral hospitals, included 369 adult RTOI victims. Two years post-injury, participants completed the European Quality of life 5 Dimension 5 (EQ-5D-5L) and Visual Analogue Scale (VAS) Questionnaire between June 2 and August 31, 2022, with informed consent. Three EQ-5D-5L-VAS scores were used: low (0-40%), fair (41-60%), and excellent (61-100%). We used logistic regression analysis with a significance threshold of p < 0.05 to determine odds ratios (OR) and 95% CI. Results: The RTOI victims had a mean age of 37.5 ± 11.26 years with sex ratio M:F:3:1. Usual activities (66.8%) and mobility (54.8%) were the most affected EQ-5D-5L dimensions. Residence, hospital stay, rehabilitation, and return to work affected mobility, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L/VAS score showed 34.95% poor QoL (0-40%) and 35.50% good QoL. Factors affecting QoL include level of education (OR = 1.66, p < <0.01), type of intervention (OR = 1.22, p = 0.003), rehabilitation (OR = 2.41, p < 0.01) and level of disability (OR = 196.41, p < 0.01). Mobility, self-care, usual activities, pain, comfort, anxiety, and depression vary moderately on Shannon's index. Conclusion: The study highlights the significant impact of road traffic orthopaedic injuries (RTOI) on survivors' quality of life in Rwanda, revealing challenges in mobility and daily activities. Factors influencing quality of life include education level, medical intervention type, rehabilitation, and disability degree. The findings emphasize the need for tailored rehabilitation strategies and policy interventions to improve long-term outcomes for RTOI survivors.