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1.
Leona Bannon Jennifer McGaughey Mike Clarke Daniel F. McAuley Bronagh Blackwood 《Australian critical care》2018,31(3):174-179
Background
Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation.Objective
The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation.Methods
Nine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework.Results
Overall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation.Conclusion
Generally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients. 相似文献2.
Elena Barahona Rita Pinhao Victoria Galindo Antonio Noguera 《Journal of pain and symptom management》2018,55(3):968-972
Background
Although Memorial Delirium Assessment Scale (MDAS) is a successful tool for delirium evaluation and monitoring, it is nevertheless important to determine whether cutoff scores vary according to the studied population. The main objective of this study was to evaluate the diagnostic sensitivity of the recently validated Spanish version of the MDAS. The secondary objective was to analyze possible diagnostic differences when used in a hospice or general hospital setting.Methodology
A prospective study was conducted with advanced cancer patients in two settings (hospice and general hospital). A diagnosis of delirium was established according to clinical criteria and the Confusion Assessment Method. Sensitivity (S), specificity (Sp), positive predictive value, and negative predictive value were determined according to the receiver operating characteristics curve. The MDAS values for different centers were studied using nonparametric tests (Mann-Whitney).Results
A total of 67 patients were included, 28 of whom had been diagnosed with delirium (15/40 hospice and 13/27 general hospital). The mean MDAS scores were 13.6 and 5.5 for the delirium and nondelirium groups, respectively. A cutoff score of 7 gave the optimal screening diagnosis balance (S 92.6%, Sp 71.8%, positive predictive value 70.1%, and negative predictive value 93.3%). Diagnoses of anxiety and depression were not related with delirium (P ≤ 0.44). A diagnosis of dementia was related to delirium (P ≤ 0.052) but did not influence the diagnostic sensitivity of MDAS (P ≤ 0.26). No differences were found between hospice and general hospital settings as regards the diagnostic sensitivity of MDAS.Conclusion
A screening cutoff of 7 appears to be optimal for MDAS Spanish version. No differences were found between advanced cancer patients cared for in a hospice or general hospital. However, more research is required to define the MDAS cutoff for patients with advanced cancer and dementia. 相似文献3.
Fangyi Li Minggen Zhou Zijun Zou Weichao Li Canxia Huang Zhijie He 《Asian nursing research.》2018,12(4):299-303
Purpose
Developing a risk prediction model for invasive fungal disease based on an analysis of the disease-related risk factors in critically ill patients in the intensive care unit (ICU) to diagnose the invasive fungal disease in the early stages and determine the time of initiating early antifungal treatment.Methods
Data were collected retrospectively from 141 critically ill adult patients with at least 4 days of general ICU stay at Sun Yat-sen Memorial Hospital, Sun Yat-sen University during the period from February 2015 to February 2016. Logistic regression was used to develop the risk prediction model. Discriminative power was evaluated by the area under the receiver operating characteristics (ROC) curve (AUC).Results
Sequential organ failure assessment (SOFA) score, antibiotic treatment period, and positive culture of Candida albicans other than normally sterile sites are the three predictors of invasive fungal disease in critically ill patients in the ICU. The model performs well with an ROC-AUC of .73.Conclusion
The risk prediction model performs well to discriminate between critically ill patients with or without invasive fungal disease. Physicians could use this prediction model for early diagnosis of invasive fungal disease and determination of the time to start early antifungal treatment of critically ill patients in the ICU. 相似文献4.
Hui-Shan Shen Szu-Yin Chen Denise Shuk Ting Cheung Shu-Yi Wang Jung Jae Lee Chia-Chin Lin 《Journal of pain and symptom management》2018,55(6):1531-1539
Context
No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings.Objectives
To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs).Methods
A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU. Data were collected on their concerns regarding PST during recruitment. Grief levels were assessed at three days and one month after the patient's death with the Texas Revised Inventory of Grief.Results
Families' major concern about sedated patients in the PCU was that “there might be other ways to relieve symptoms” (90.2%), whereas families of ICU sedated patients gave the highest ratings to “feeling they still had something more to do” (93.55%), and “the patient's sleeping condition was not dignified” (93.55%). Family members recruited from the ICU tended to experience more grief than those from the PCU (P = 0.005 at Day 3 and < 0.001 at Month 1). PST use predicted higher levels of grief in family members recruited from the PCU (P < 0.001 at Day 3 and Month 1).Conclusion
Family experiences with the use of PST in terminally ill patients varied in different settings. Supportive care should address family concerns about PST use, and regular attention should be paid to the grief of individuals at higher risk. 相似文献5.
Lisa M. Daniels Sarah B. Nelson Ryan D. Frank John G. Park 《Mayo Clinic proceedings. Mayo Clinic》2018,93(12):1739-1748
Objective
To determine whether treatment of delirium affects outcomes.Patients and Methods
A retrospective cohort study of patients admitted to the medical intensive care unit (ICU) from July 1, 2015, through June 30, 2016, was conducted. Patients with ICU delirium, defined by a positive Confusion Assessment Method for the ICU score, were included. Patients were stratified into 4 treatment groups based on exposure to melatonin and antipsychotic agents during ICU stay: no pharmacologic treatment, melatonin only, antipsychotics only, and both melatonin and antipsychotics. A time-dependent cause-specific hazards model with death as a competing risk was used to evaluate the effect of melatonin or antipsychotic drug use for delirium on duration of ICU delirium, length of ICU stay, and length of hospitalization. A logistic regression was used to evaluate 28-day mortality. Covariates significantly associated with exposure to melatonin and antipsychotics were included in the minimally adjusted model. Covariates significantly associated in the minimally adjusted model were included in a final adjusted model.Results
A total of 449 admissions to the medical ICU were included in the analysis. Exposure to melatonin or antipsychotic agents did not reduce the duration of ICU delirium, ICU/hospital length of stay, or 28-day mortality. However, antipsychotic use only was associated with longer hospitalization.Conclusion
Antipsychotic drugs for the treatment ICU delirium may not provide the benefit documented in earlier literature. Further investigation on patient selection, type of antipsychotic, and dosing is needed. 相似文献6.
Amanda Su Lindsay Lief David Berlin Zara Cooper Daniel Ouyang John Holmes Renee Maciejewski Paul K. Maciejewski Holly G. Prigerson 《Journal of pain and symptom management》2018,55(6):1591-1598.e1
Context
Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU.Objectives
The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity.Methods
From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care.Results
The patient sample was 61% males, 70.2% whites, and on average 66.9 (SD 15.1) years old. Nurses reported that 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n = 9) remained significantly (P < 0.05) associated with suffering, after adjusting for physical pain, including fever/chills, fatigue, and edema. Most patients received vasopressors and mechanical ventilation. Renal replacement therapy was significantly (<0.05) associated with severe suffering (adjusted odds ratio [AOR] 2.53) and loss of dignity (AOR 3.15). Use of feeding tube was associated with severe loss of dignity (AOR 3.12).Conclusion
Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU. 相似文献7.
Objective
To develop a formalized comprehensive placenta accreta (PA) program to improve maternal and neonatal outcomes associated with a PA birth.Design
To develop a clinically innovative PA program, goals were identified and teams were created to collaboratively address best practices in each phase of clinical patient care, along with the financial and marketing aspects necessary for a sustainable program.Setting/Local Problem
A Level 3 perinatal center in the Southwestern United States.Implementation
A diverse multidisciplinary team addressed each aspect of care associated with a PA birth, including team members from the main operating room; trauma surgery; blood bank; interventional radiology unit; NICU; and gynecology-oncology, anesthesia, and urology departments.Measurements
Pre- and postprogram clinical outcome measures were examined including estimated blood loss at birth, postbirth ICU transfers and length of stay, and postpartum length of stay.Results
Clinical outcomes after program implementation showed decreased blood loss at birth (from an estimated 6,350 ml to 1,300–1,400 ml), reduced postbirth ICU length of stay (from approximately 3 days to less than 1 day, with many women bypassing ICU transfer altogether), and shortened postpartum length of stay (from 8 days to 4 days).Conclusion
With implementation of this PA program, women receive a proactive approach to care that includes education, holistic care, and an organized team approach to birth made possible by the innovative care delivery model, structures, and processes. Standardized checklists and workflows help each clinician understand his or her role in the process, and resources are directed effectively and efficiently. Multidisciplinary, multispecialty collaboration results in decreased variation in care with associated improved patient outcomes. 相似文献8.
Seelwan Sathitratanacheewin Ruth A. Engelberg Lois Downey Robert Y. Lee James A. Fausto Helene Starks Ben Dunlap James Sibley William Lober Elizabeth T. Loggers Nita Khandelwal J. Randall Curtis 《Journal of pain and symptom management》2018,55(1):75-81
Context
Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age.Objectives
To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 vs. ≥65 years) who received care in a large healthcare system.Methods
Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression.Results
The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = ?0.026; CI = ?0.041, ?0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = ?0.023; CI = ?0.039, ?0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU.Conclusion
From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions. 相似文献9.
Katy Meeker Susan K. Brown Michele Lamping Michael R. Moyer M. Joyce Dienger 《Nursing for Women's Health》2018,22(6):454-462
Objective
To use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies.Design
Quality improvement initiative.Setting/Local Problem
The labor and delivery team at a large suburban Level 2 facility in the Midwestern United States sought to apply evidence and use simulation to improve communication and teamwork.Participants
Approximately 170 maternity care staff members, including nurses, anesthesia providers, and pediatric and obstetric physicians.Intervention/Measurements
During each simulation, there were two scenarios with a debriefing session at the end of each. Teamwork and communication were evaluated using participant surveys.Results
Participants reported improved communication (p = .031) and teamwork (p = .041) after simulation. Additionally, 81% of respondents believed that their ability to perform clinical skills improved.Conclusion
Use of high-fidelity human patient simulation was associated with improved teamwork and communication for a maternity care team. Simulation has been incorporated into standard education. We hope to sustain successful outcomes by providing ongoing simulation experiences for labor and delivery staff annually. 相似文献10.
Hiroaki Watanabe Takuya Odagiri Yasuyuki Asai 《Journal of pain and symptom management》2018,55(6):1546-1549
Context
Acute suppurative sialadenitis (hereafter referred to as sialadenitis) is accompanied by pain and fever and can diminish the quality of life in end-stage cancer patients; however, its incidence is not clear.Objectives
We conducted this study to elucidate the incidence of sialadenitis in end-stage cancer patients.Methods
Retrospective review and observational study based on patients' medical records.Subjects
About 726 consecutive cancer patients who died on the palliative care unit of our hospital between April 2012 and November 2016 were included.Measurements
Median duration between sialadenitis onset and death, concomitant treatment, average infusion volume per day, site of onset, symptoms, effectiveness of antibiotic treatment, and mean duration until symptomatic relief.Results
The incidence of sialadenitis was 2.9% (21 of 726 cases). The median duration from onset to death was 20 days (range 2–112); concomitant treatment included opioids in 11 patients (55%), anticholinergic drugs in six patients (28%), steroids in three patients (14%), and oxygen inhalation in five patients (23%); average infusion volume per day was 588 ± 307 mL; site of onset was submandibular gland in 12 patients (57%) and parotid gland in nine patients (42%); and symptoms were pain in 18 patients (85%) and fever in 13 patients (61%). Antibiotic treatment was administered in 18 patients (85%), and the mean duration until symptomatic relief was 4.0 ± 1.5 days.Conclusion
Sialadenitis is a rare complication in end-stage cancer patients; however, it is important to recognize that it can be associated with severe symptoms, including fever and pain. 相似文献11.
12.
Marcos Eduardo Scheicher Ligia Cristiane Santos Fonseca Tiago Buso Bortolloto Isabela Feitosa de Carvalho 《Journal of bodywork and movement therapies》2018,22(2):482-486
Background
The deterioration in the somatosensory and motor systems observed with increasing age can cause balance problems. Studies have shown that the use of infrapatellar bandages can enhance proprioception and improve postural balance.Aims
To evaluate the effect of an infrapatellar bandage on static balance and mobility in elderly female fallers and non-fallers.Methods
Forty older women (20 fallers and 20 non-fallers) were evaluated. Mobility (Timed Up and Go test) and balance (force platform) were measured in the presence and absence of additional sensory information (elastic infrapatellar bandage).Results
Mobility differed in fallers (p = 0.0001), but not in non-fallers (p = 0.27), when the patellar bandage was applied. Additional sensory information did not improve static balance in either group (p > 0.05), but a trend towards improvement was observed in fallers.Conclusion
Additional sensory input from an infrapatellar bandage improves mobility but not bipedal stance in elderly fallers. 相似文献13.
Daniel S.J. Costa Vanessa Loh Damian P. Birney Haryana M. Dhillon Joanna E. Fardell Danielle Gessler Janette L. Vardy 《Journal of pain and symptom management》2018,55(4):1173-1178
Context
The Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) version 3 questionnaire is designed to assess perceived cognitive function and impact on quality of life in cancer patients.Objectives
We examined the factor structure of the FACT-Cog version 3 in samples of cancer patients, older adults, and students.Methods
Data from three populations were sourced. Cancer patient data (N = 158) came from two studies, one evaluating a web-based cognitive training program, and the other evaluating symptoms in patients receiving chemotherapy. The older adult sample (N = 477) was commercial brain training users in the general population. The student sample (N = 154) came from a study examining the relation between cognitive test performance and perceived cognitive function.Results
The patient sample conformed to the traditional four-factor structure (impairments, abilities, noticeability, and quality of life), with some support for separating the broad impairment/ability factors into specific cognitive domains. The older adult sample was best described using both impairments/abilities and specific cognitive domains. The student sample suggested two impairment/ability factors but separation of concentration/acuity and memory/verbal impairment items.Conclusion
The FACT-Cog can be used in populations other than cancer patients, with modifications to the scoring system. Even when used with cancer patients, it is worth considering scoring specific cognitive domains separately. 相似文献14.
Igor Jeroukhimov Yehuda Hershkovitz Itay Wiser Boris Kessel Mohammed Ayyad Inbar Gatot Zahar Shapira Svetlana Jeoravlev Ariel Halevy Ron Lavy 《The Journal of emergency medicine》2017,52(5):609-614
Background
Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the “gold standard” examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%–40%.Objective
The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures.Methods
Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI.Results
Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1–16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1–13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2–4.8; p = 0.016) as independent risk factors for the presence of IAI.Conclusions
Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission. 相似文献15.
Andrea R.S. Huebner Amy Cassedy Tanya M. Brown H. Gerry Taylor Terry Stancin Michael W. Kirkwood Shari L. Wade 《PM & R》2018,10(5):462-471
Background
Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.Objective
To examine adolescents’ use of mental health services after TBI.Design
Secondary analysis from multicenter prospective randomized controlled trial.Setting
Five level 1 U.S. trauma centers.Participants
Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).Methods
Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.Main Outcome Measurements
Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.Results
Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.Conclusions
Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.Level of Evidence
II 相似文献16.
Cameron J.B. Cunningham Heather C. Finlayson William R. Henderson Russell J. O’Connor Andrew Travlos 《PM & R》2018,10(5):494-500
Background
Critical illness polyneuromyopathy (CIPNM) increasingly is recognized as a source of disability in patients requiring intensive care unit (ICU) admission. The prevalence and impact of CIPNM on patients in the rehabilitation setting has not been established.Objectives
To determine the proportion of at-risk rehabilitation inpatients with evidence of CIPNM and the functional sequelae of this disorder.Design
Prospective observational study.Setting
Tertiary academic rehabilitation hospital.Patients
Rehabilitation inpatients with a history of ICU admission for at least 72 hours.Methods
Electrodiagnostic studies were performed to evaluate for axonal neuropathy and/or myopathy in at least one upper and one lower limb.Main Outcome Measurements
The primary outcome was prevalence of CIPNM. Secondary outcomes included Functional Independence Measure (FIM) scores, rehabilitation length of stay (RLOS), and discharge disposition.Results
A total of 33 participants were enrolled; 70% had evidence of CIPNM. Admission FIM score, discharge FIM, FIM gain, and FIM efficiency were 64.1, 89.9, 25.5, and 0.31 in those with CIPNM versus 78.4, 94.6, 16.1, and 0.33 in those without CIPNM, respectively. Average RLOS was 123 days versus 76 days and discharge to home was 57% versus 90% in the CIPNM and non-CIPNM groups, respectively.Conclusions
CIPNM is very common in rehabilitation inpatients with a history of ICU admission. It was associated with a lower functional status at rehabilitation admission, but functional improvement was at a similar rate to those without CIPNM. Longer RLOS stay may be required to achieve the same functional level.Level of Evidence
III 相似文献17.
Xue-Cheng Liu David Embrey Channing Tassone Kim Zvara Brenna Brandsma Roger Lyon Karin Goodfriend Sergey Tarima John Thometz 《PM & R》2018,10(3):269-275
Background
Orthoses commonly are prescribed to children with cerebral palsy (CP) to provide foot correction and to improve ambulatory function. Immediate effects of ankle foot orthosis (AFOs) have been investigated, but long-term kinematic effects are lacking clinical evidence.Objective
To determine changes in 3-dimensional ankle and foot segment motion in pediatric patients with CP between initial and follow-up visits (18-month average time differences) in both barefoot gait and gait with their AFO. We also investigated intravisit changes between barefoot and AFO gait.Design
A prospective cohort study.Setting
Children’s Hospital of Wisconsin, Department of Orthopaedic Surgery, Medical College of Wisconsin.Patients
A total of 23 children with CP, mean age 10.5 years (6.2-18.1 years) were clinically prescribed either a solid ankle foot orthotic (SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic.Methods
Holes were cut in the study orthoses so that electromagnetic markers could be directly placed on the skin. A 6-foot segment model was used.Outcome Measurements
Kinematic and kinetic data were recorded for each patient’s initial and follow-up visit (18-month follow-up average, 15-20 months range).Results
For the SAFO group (gait with AFO), a significant decrease in dorsiflexion was found between the initial and third visit (P = .008). Furthermore, the SAFO group (barefoot gait) had an increased eversion at the midfoot for most of the gait cycle (P < .008). Sagittal forefoot range of motion was reduced for all 3 groups between the barefoot and AFO groups.Conclusion
The use of AFOs long term either maintained or improved foot deformities or dysfunction.Level of Evidence
Level II. 相似文献18.
Yael Goverover Nancy D. Chiaravalloti Amanda R. O&#x;Brien John DeLuca 《Archives of physical medicine and rehabilitation》2018,99(2):390-407
Objective
To update the clinical recommendations for cognitive rehabilitation of people with multiple sclerosis (MS), based on a systematic review of the literature from 2007 through 2016.Data Sources
Searches of MEDLINE, PsycINFO, and CINAHL were conducted with a combination of the following terms: attention, awareness, cognition, cognitive, communication, executive, executive function, language, learning, memory, perception, problem solving, reasoning, rehabilitation, remediation, training, processing speed, and working memory. One hundred twenty-nine articles were identified and underwent initial screening.Study Selection
Fifty-nine articles were selected for inclusion after initial screening. Nineteen studies were excluded after further detailed review. Forty studies were fully reviewed and evaluated.Data Extraction
Articles were assigned to 1 of 6 categories: attention, learning and memory, processing speed and working memory, executive functioning, metacognition, or nonspecified/combined cognitive domains. Articles were abstracted and levels of evidence were decided using specific criteria.Data Synthesis
The current review yielded 6 class I studies, 10 class II studies, and 24 class III studies. One intervention in the area of verbal learning and memory received support for a practice standard, 2 computer programs received support as practice guidelines (in the area of attention and multicognitive domains), and several studies provided support for 5 practice options in the domains of attention and learning and memory.Conclusions
Substantial progress has been made since our previous review regarding the identification of effective treatments for cognitive impairments in persons with MS. However, much work remains to be done to optimize rehabilitation potential by applying the most methodologically rigorous research designs to provide class I evidence in support of a given treatment strategy. 相似文献19.
20.
Marion L. Mitchell David H.K. Shum Gabor Mihala Jenny E. Murfield Leanne M. Aitken 《Australian critical care》2018,31(4):204-211