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Surrogate Satisfaction with Decision Making After Intracerebral Hemorrhage.

脑出血后决策的替代满意度。

  • 影响因子:2.83
  • DOI:10.1007/s12028-020-01018-x
  • 作者列表:"Sahgal S","Yande A","Thompson BB","Chen EP","Fagerlin A","Morgenstern LB","Zahuranec DB
  • 发表时间:2020-06-15
Abstract

BACKGROUND/OBJECTIVE:Surrogate decision makers for patients with intracerebral hemorrhage (ICH) are frequently asked to make difficult decisions on use of life-sustaining treatments. We explored ICH surrogate satisfaction with decision making and experience of decision regret using validated measures in a prospective multicenter study. METHODS:Cases of non-traumatic ICH were enrolled from three hospitals (September 2015-December 2016), and surrogate decision makers were invited to complete a self-administered survey. The primary outcome was the 10-item decision-making subscale of the Family Satisfaction in the Intensive Care Unit scale (FSICU-DM, range 0-100, higher is greater satisfaction), and the secondary outcome was the decision regret scale (range 0-100, higher is greater regret). Linear regression models were used to assess the association between satisfaction with decision making and pre-specified covariates using manual backward selection. RESULTS:A total of 73 surrogates were approached for participation (in person or mail), with 48 surrogates returning a completed survey (median surrogate age 60.5 years, 63% female, 77% white). Patients had a median age of 72.5, 54% were female, with a median admission Glasgow coma scale of 10, in-hospital mortality of 31%, and 56% with an in-hospital DNR order. Physicians commonly made treatment recommendation (> 50%) regarding brain surgery or transitions to comfort measures, but rarely made recommendations (< 20%) regarding DNR orders. Surrogate satisfaction with decision making was generally high (median FSICU-DM 85, IQR 57.5-95). Factors associated with higher satisfaction on multivariable analysis included greater use of shared decision making (P < 0.0001), younger patient age (p = 0.02), ICH score of 3 or higher (p = 0.03), and surrogate relationship (spouse vs. other, p = 0.02). Timing of DNR orders was not associated with satisfaction (P > 0.25). Decision regret scores were generally low (median 12.5, IQR 0-31.3). CONCLUSIONS:Considering the severity and abruptness of ICH, it is reassuring that surrogate satisfaction with decision making was generally high and regret was generally low. However, more work is needed to define the appropriate outcome measures and optimal methods of recruitment for studies of surrogate decision makers of ICH patients.

摘要

背景/目的: 脑出血 (ICH) 患者的替代决策者经常被要求对使用维持生命治疗做出艰难的决定。我们在一项前瞻性多中心研究中,使用经验证的措施探讨了 ICH 替代决策满意度和决策后悔体验。 方法: 从三家医院 (2015 年 9 月-2016 年 12 月) 招募非创伤性 ICH 病例,并邀请替代决策者完成自我管理调查。主要结局为重症监护病房量表中家庭满意度的 10 项决策分量表 (FSICU-DM,范围 0-100,更高是更大的满意度),次要结局为决定后悔量表 (范围 0-100,越高则后悔越大)。使用线性回归模型评估决策满意度与使用手动向后选择预先指定的协变量之间的关联。 结果: 共联系了 73 名代理人 (亲自或邮寄),48 名代理人返回了一份完成的调查 (中位代理人年龄 60.5 岁,63% 为女性,77% 为白人)。患者的中位年龄为 72.5 岁,54% 为女性,中位入院格拉斯哥昏迷量表为 10,住院死亡率为 31%,住院 DNR 顺序为 56%。医生通常就脑部手术或过渡到舒适措施提出治疗建议 (> 50%),但很少就 DNR 医嘱提出建议 (<20%)。替代决策满意度普遍较高 (中位 FSICU-DM 85,IQR 57.5-95)。多变量分析满意度较高的相关因素包括更多地使用共同决策 (p <0.0001) 、患者年龄较小 (p = 0.02) 、 ICH 评分 ≥ 3 分 (p = 0.03),代理关系 (配偶 vs.其他,p = 0.02)。DNR 订单的时间与满意度无关 (p> 0.25)。决策后悔评分普遍较低 (中位数 12.5,IQR 0-31.3)。 结论: 考虑到 ICH 的严重程度和突发性,令人放心的是,代理人对决策的满意度普遍较高,遗憾普遍较低。然而,对于 ICH 患者的替代决策者的研究,需要做更多的工作来定义适当的结局指标和最佳的招募方法。

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影响因子:2.57
发表时间:2020-01-06
DOI:10.1007/s12031-019-01474-x
作者列表:["Cheng, Xiao","Yang, Ying-Lin","Li, Wei-Han","Liu, Man","Zhang, Shan-Shan","Wang, Yue-Hua","Du, Guan-Hua"]

METHODS:Cerebral ischemia-reperfusion (I/R) is characterized by initial transient cerebral ischemia followed by reperfusion. Various pathophysiological processes are involved in brain injury and functional recovery during cerebral I/R. There are few studies on dynamic metabolic process after cerebral I/R. The present study was to observe dynamic alteration of brain injury, functional recovery, and metabolites after cerebral I/R in rats and discover potential metabolic markers. The cerebral I/R model was established by middle cerebral artery occlusion (MCAO) for 90 min, following reperfusion in rats. The results of cerebral infarction area, cerebral edema, and behavior test showed that there were dynamic changes in brain injury and functional recovery at different periods after cerebral I/R. Further analysis showed that the brain injury was severe on the first day of cerebral I/R, and there was a significant functional recovery from the 7th day of cerebral I/R, followed by an aggravation trend of brain injury from the days 7 to 28. Furthermore, Matrix-assisted laser desorption ionization mass spectrometry imaging analysis showed that the expression of ATP, glucose, and citric acid on 7th day was the highest during cerebral I/R, which indicated that energy metabolism and oxidative phosphorylation played important roles during cerebral I/R. In addition, the untargeted metabolomic results showed that the level of isocitric acid, the ratio of oxyglutaric acid/glutamic acid, and the level of pyruvic acid associated with the TCA cycle were also the highest on the 7th day during cerebral I/R, which indicated that the transient spontaneous recovery of ischemic brain on the 7th day after ischemia-reperfusion might be related to oxidative phosphorylation and energy metabolism in the brain in this period. In conclusion, the results suggest that some small molecule metabolites participate in the brain injury and functional recovery during cerebral I/R, which is of great significance to the development of therapeutic drugs and diagnostic markers.

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影响因子:2.75
发表时间:2020-01-01
DOI:10.1007/s00702-019-02124-7
作者列表:["Wang, Xiaodong","Shi, Cunxian","Pan, Hongxia","Meng, Xiaowen","Ji, Fuhai"]

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