"This takes a toll on me too"-a qualitative interview study on experiences of informal caregivers to patients who have had aneurysmal subarachnoid haemorrhage

PURPOSE

To describe life as an informal caregiver to someone affected by an aneurysmal subarachnoid haemorrhage (aSAH) in the first year after the event.

METHODS

A qualitative descriptive study in which informal caregivers (n = 16) to patients treated for aSAH were interviewed one year after the event. An interview guide was used and an inductive, conventional content analysis was applied.

RESULTS

Expressions of missing the previous person were evident, as she/he had changed after the aSAH. The informants described an impact on their social life, with limited time for social activities, social interactions, and hobbies. Their working lives were also affected. Findings further indicated that professional support for informal caregivers, if offered, was fragmented, person-dependent, or offered at the wrong time.

CONCLUSION

A journey with frustration and hope, impacting on relationships, social life, and working life, was evident. As few studies have focused on the perspective of informal caregivers to someone affected by aSAH, the findings are important both for research purposes and the healthcare sector. The results could form the basis for a larger exploration of support needs and how both patients and informal caregivers would like to help design and develop such support.

Applied convolutional neural network framework for tagging healthcare systems in crowd protest environment

Healthcare systems constitute a significant portion of smart cities infrastructure. The aim of smart healthcare is two folds. The internal healthcare system has a sole focus on monitoring vital parameters of patients. The external systems provide proactive health care measures by the surveillance mechanism. This system utilizes the surveillance mechanism giving impetus to healthcare tagging requirements on the general public. The work exclusively deals with the mass gatherings and crowded places scenarios. Crowd gatherings and public places management is a vital challenge in any smart city environment. Protests and dissent are commonly observed crowd behavior. This behavior has the inherent capacity to transform into violent behavior. The paper explores a novel and deep learning-based method to provide an Internet of Things (IoT) environment-based decision support system for tagging healthcare systems for the people who are injured in crowd protests and violence. The proposed system is intelligent enough to classify protests into normal, medium and severe protest categories. The level of the protests is directly tagged to the nearest healthcare systems and generates the need for specialist healthcare professionals. The proposed system is an optimized solution for the people who are either participating in protests or stranded in such a protest environment. The proposed solution allows complete tagging of specialist healthcare professionals for all types of emergency response in specialized crowd gatherings. Experimental results are encouraging and have shown the proposed system has a fairly promising accuracy of more than eight one percent in classifying protest attributes and more than ninety percent accuracy for differentiating protests and violent actions. The numerical results are motivating enough for and it can be extended beyond proof of the concept into real time external surveillance and healthcare tagging.

Cognitive Impairments and Risk Factors After Ruptured Anterior Communicating Artery Aneurysm Treatment in Low-Grade Patients Without Severe Complications: A Multicenter Retrospective Study

Background: Cognitive impairment is the main factor affecting quality of life in patients with low-grade aneurysmal subarachnoid hemorrhage. Objective: We explored cognitive impairments and risk factors after treatment for ruptured anterior communicating artery (AComA) aneurysms in low-grade (Hunt-Hess grade of 1-3) patients without severe complications. Methods: One-hundred-twenty-six patients with a Hunt-Hess grade of 1-3 who underwent microsurgical clipping or endovascular embolization for ruptured AComA aneurysm treatment at three academic institutions in China from January 2015 to December 2017 were assessed with the modified Telephone Interview for Cognitive Status (TICS-m), the modified Rankin Scale (mRS), and the instrumental activities of daily living (IADL) scale 2 or more years after microsurgical clipping or endovascular coiling. Multiple cox-regression analysis was used to identify variables independently associated with cognitive impairment. Results: Of the total of 126 patients, 115 (91.3%) achieved good clinical outcomes (mRS score 0-2) and 109 (86.5%) had excellent quality of life (IADL score 8). Twenty-eight (22.2%) patients showed cognitive impairments (TICS-m≤27). The multivariate COX regression analysis showed that the female patients and longer duration of loss of consciousness at onset of subarachnoid hemorrhage (SAH) were independently associated with cognitive impairment. Cognitive outcome at the latest follow-up was not significantly different between patients treated after surgical clipping and coiling. Conclusion: About one in five patients showed cognitive impairments after treatment for ruptured AComA aneurysms. Patients who are of the female sex, and who have a longer duration of a loss of consciousness at the onset of SAH may be at risk of cognitive impairment.

Clipping versus Coiling: Neuropsychological Follow up After Aneurysmal Subarachnoid Haemorrhage (SAH)

Patients treated with microsurgical clipping of ruptured intracranial aneurysms often suffer from neuropsychological deficits in spite of a good neurological outcome. The purpose of this study was to explore if the deficits are related to the type of therapy. Two groups of 16 patients each suffering from aneurysmal SAH, matched for sex, age, aneurysm-site and Hunt and Hess score, and 16 control subjects were examined with a battery of neuropsychological tests including memory, attention, and executive function. Depression, mood, and quality of life were also assessed. One patient group had been treated with surgical clipping, the other with endovascular coiling. Both patient groups showed deficits in verbal and visual memory. Clipped patients were slightly more impaired than coiled patients, especially on measures of affect and on a self-assessment measure of executive function. The pattern of results suggests that the neuropsychological outcome after aneurysmal SAH is affected by both the severity of the bleeding and the type of therapy.