Navigating Patients and Families through the Neuro-ICU

项目总结/摘要 每天在世界各地的医院里，严重的急性脑损伤都会使患者及其家属 家庭和挑战临床医生与一组独特的临床护理问题。由于这些患者 中风或创伤性脑损伤表现为急性和神经破坏性损伤， 结果取决于早期的治疗决定，这些决定几乎都是通过 与代理决策者进行讨论，并由重症监护、神经外科或 不认识这些病人的神经科医生。尽管最近在这方面取得了显著进展， 急性神经系统护理、发病率和死亡率仍然很高。随着姑息治疗越来越多 被认为是针对重病患者的专门医疗护理， 关于护理目标和生活质量的沟通，在理解方面仍然存在重大差距 针对严重急性脑损伤患者及其家属的姑息治疗需求。很长的- 这个职业发展奖的长期目标是促进Creutzfeldt博士的发展成为一个 独立的医生-科学家，致力于了解和提高护理质量， 严重急性脑损伤Creutzfeldt博士将进行前瞻性队列研究， 在我们的神经重症监护室中，已建立的姑息治疗需要检查表 （神经ICU）。该项目的目的是确定那些风险最高的患者和家庭， 结果不佳，最需要姑息治疗干预，并测试 多方面的沟通干预，以满足这一独特患者的姑息治疗需求 人口及其家庭。为了支持她的职业发展，Creutzfeldt博士提出了 综合课程包括设计、实施和出版的实践经验 临床研究;流行病学、生物统计学和卫生服务研究课程;以及 由姑息治疗、神经病学和重症监护领域的专家提供密集指导。此外，委员会认为， 她将发展基于调查的成果评估、集群和纵向评估方面的专业知识， 统计方法以及定性数据收集和分析。这一建议具有重要意义 对严重急性脑损伤患者及其家属的影响。了解 具体的姑息治疗需求以及它们如何影响长期结果将为发展提供信息 姑息治疗干预，以减少痛苦，改善这些患者的结果， 家人

PROJECT SUMMARY/ABSTRACT Every day in hospitals across the world, severe acute brain injury devastates patients and their families and challenges clinicians with a unique set of clinical care issues. As these patients with stroke or traumatic brain injury present with acute and neurologically devastating injury, their outcomes rely on early treatment decisions, and these decisions are virtually all made through discussions with surrogate decision makers and organized by critical care, neurosurgery or neurology clinicians who do not know these patients. Despite the remarkable recent advances in acute neurological care, morbidity and mortality remain high. With palliative care increasingly recognized as specialized medical care for patients with serious illness that focuses on improving communication about goals of care and quality of life, there remains a critical gap in understanding palliative care needs specific to patients with severe acute brain injury and their families. The long- term goal of this career development award is to promote Dr. Creutzfeldt's development into an independent physician-scientist working to understand and improve the quality of care early after severe acute brain injury. Dr. Creutzfeldt will conduct a prospective cohort study employing an established palliative care needs checklist that is in daily use in our neurological intensive care unit (neuro-ICU). The aims of this project are to identify those patients and families at highest risk for poor outcome and at highest need for a palliative care intervention, and to test the feasibility of a multifaceted communication intervention to meet the palliative care needs of this unique patient population and their families. To support her career development, Dr. Creutzfeldt proposes an integrated curriculum consisting of practical experience in designing, conducting and publishing clinical research; coursework in epidemiology, biostatistics and health services research; and intensive mentoring by experts in the fields of palliative care, neurology and critical care. Moreover, she will develop expertise in survey-based outcome assessment, clustered and longitudinal statistical methods, and qualitative data collection and analysis. This proposal has important implications for patients with severe acute brain injury and their families. Understanding the specific palliative care needs and how they affect long-term outcomes will inform the development of palliative care interventions to reduce distress and improve outcomes for these patients and their families.