Volume 37, Issue 2 ,2015

Aggressive surgical interventions for severe stroke: Impact on quality of life, caregiver burden and family outcomes
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By Theresa Green, RN, PhD


Introduction: Decompressive hemicraniectomy, clot evacuation, and aneurysmal interventions are considered aggressive surgical therapeutic options for treatment of massive cerebral artery infarction (MCA), intracerebral hemorrhage (ICH), and severe subarachnoid hemorrhage (SAH) respectively. Although these procedures are saving lives, little is actually known about the impact on outcomes other than short-term survival and functional status. The purpose of this study was to gain a better understanding of personal and social consequences of surviving these aggressive surgical interventions in order to aid acute care clinicians in helping family members make difficult decisions about undertaking such interventions.

Methods: An exploratory mixed method study using a convergent parallel design was conducted to examine functional recovery (NIHSS, mRS & BI), cognitive status (Montreal Cognitive Assessment Scale, MoCA), quality of life (Euroqol 5-D), and caregiver outcomes (Bakas Caregiver Outcome Scale, BCOS) in a cohort of patients and families who had undergone aggressive surgical intervention for severe stroke between the years 2000–2007.

Data were analyzed using descriptive statistics, univariate and multivariate analysis of variance, and multivariate logistic regression. Content analysis was used to analyze the qualitative interviews conducted with stroke survivors and family members.

Results: Twenty-seven patients and 13 spouses participated in this study. Based on patient MOCA scores, overall cognitive status was 25.18 (range 23.4-26.9); current functional outcomes scores: NIHSS 2.22, mRS 1.74, and BI 88.5. EQ-5D scores revealed no significant differences between patients and caregivers (p=0.585) and caregiver outcomes revealed no significant differences between male/female caregivers or patient diagnostic group (MCA, SAH, ICH; p=""0.103).<"/span><"/span>



Factors that influence the decision-making of an interdisciplinary rehabilitation team when choosing a discharge destination for stroke survivors
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This study explored the culture of one interdisciplinary rehabilitation team in British Columbia (BC), Canada, to identify the specific client, clinical, and family factors considered by team members when determining post-hospital discharge placement. The study took the form of an ethnography of a health care team on a stroke unit of a Canadian hospital using observations of the interdisciplinary rehabilitation team meetings and follow-up interviews with team members.

The findings from the study indicate post-hospital discharge destination decisions were influenced by specific social, economic, and policy factors; specific types of interactions among members of the team; and the condition of stroke survivors, and the ability and willingness of the patient’s family to contribute to home care.

Key words: decision-making, interdisciplinary team, rehabilitation, stroke



Collaborative research teams: It is amazing what you can accomplish if you do not care who gets the credit
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By Diane Duff, RN, PhD


Abstract

This article focuses on working as a collaborative in conducting research. A common recommendation for those who want to get started in scholarly work is to collaborate with a team of likeminded individuals as part of an interest group. As researchers, we all have personal agendas in undertaking research. We need to reflect on the following: our own agendas; being honest with ourselves, and our research teammates; ensuring that our aims are not mutually exclusive or detrimental to the aspirations of our colleagues and students; and on the ethical conduct of the research work itself.



Pseudoprogression: Patient experience and nursing in uncertainty
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By Catherine-Anne Miller, BScN, MHSc, Winner of 2015 Brain Tumour Foundation Award


Abstract

Glioblastoma Multiforme (GBM) is the most common primary brain malignancy in humans and has a limited survival (median of 14.6 months). The goal of treatment is supportive rather than curative. Patients with a GBM struggle with uncertainty related to the illness trajectory. This uncertainty is compounded when possible progression is noted on imaging. Pseudoprogression (PsP) is an early treatment-related effect where there are apparent imaging changes suggesting progression, which then improve or stabilize through time. This paper provides a review of the literature on PsP in patients with high-grade gliomas. Insights in the patient and family experience of PsP will be informed by Mishel’s Uncertainty in Illness Theory, research on patients’ and families’ neurooncology experience, and the author’s nursing practice. Nursing implications will be proposed.

Key words: pseudoprogression, neuro-oncology, glioblastoma multiforme, uncertainty, cancer nursing



Early detection of cognitive disorders: Follow-up study
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By Antonio Galán Cabrera, Milagrosa Casares Peña, Khaled Mahmoud Abd Elaziz, and Mohamed Farouk Allam


Abstract

Background. Recently, a new test (Cuetos-Vega) was developed to detect patients with early symptoms of Alzheimer’s disease (AD). This test is rapid, simple and could diagnose patients at early phases of cognitive disorders. The aim of our follow-up study is to evaluate the sensitivity, specificity and predictive values of this test in primary health care (PHC) facilities.

Methods. We obtained from our database of La Rambla (village with +/- 8,000 habitants at South Cordoba Health District) the list of asymptomatic independent patients between 66 and 75 years old. A pilot study was conducted with 20 users of La Rambla PHC Centre. This test was modified and adapted for application to our study population. All participants were selected randomly and assigned a date by telephone for the nursing outpatient clinic where the nurse proceeded to administer the screening test. All participants were invited to repeat the same test, together with Pfeiffer test (a short mental status questionnaire), 32 months after the pilot study.

Results. The average age of participants was 71.5 + 2.9 years and 10 (50%) were men. The sensitivity of the new test after 32 months was 50% and the specificity 90.9%. The test had a positive predictive value of 75% and a negative predictive value of 76.9%. The overall accuracy of the test was 76.4%.

Conclusion. We present a new test designed to detect patients with mild cognitive impairment and/or early symptoms of AD. A larger cohort is needed to improve the internal validity.

Key words: primary health care, South Cordoba Health District, dementia, cognitive impairment, Alzheimer, early detection