Translational Research For Successful Treatment Of Post Stroke Depression

Describe about the Translational Research For the Facilitate Success.

Statement of the problem

Statement of the problem- Post stroke depression can be described as a feeling of hopelessness that interferes with the quality of life and functioning of life. Thus, if it is not treated well than the post-depression can slow down the process of recovery. Depression can set in weeks of months after the occurrence of stroke and it can prevent the process of rehabilitation and recovery and it impacts the way of life. There is a combination of factors that all together can all together have a life changing impact on the patient. Damage to the brain after stroke is common and it has a life changing effects on the social factors, genetics that all together contributes to depression.

Background of the Problem- Post stroke depression occurs in one in every 3 patients or stroke survivors. The stroke survivors are associated with reduced recovery, like after the occurrence of myocardial infarction depression follows. The post stroke depression is associated with the increased healthcare utilization, increased mortality, and subsequent events of cardiovascular events. Post stroke depression is a disabling and is a prevalent disorder and yet the several evidences of effectiveness of the treatment procedures of post stroke depression are all inconclusive.

Aim- The main objective of the study is to determine the effectiveness of the care management programme called the Activate-Initiate-Monitor care management for the treatment of the patients that are suffering from the post stroke depression.

Knowledge creation- knowledge is created through the different previously conducted studies and such studies included the controlled clinical trials, randomized control trials and their evaluation. A Cochrane meta-analysis was also conducted which concluded the previously suggested treatments were insufficient

Identification of the problem/determination of the gap- The problem identified by the authors emphasized mostly on the lack of proper treatment options for the post stroke depression patients. All the previously conducted studies were unable to provide a comprehensive method of treating post stroke depression and the efficacy of the process were not up to the mark. Furthermore, a Cochrane meta-analysis on the post stroke depression treatment trials showed that the treatment procedures were insufficient and the remission of the depression after stroke.

Adapt to the local knowledge-  The study is designed so that it can help the patients with post stroke depression. The previous studies lacked the proper care management plans or the proper intervention plan. The local knowledge pertaining to the previous practices that were previously applied on such patients are used in the study.

Assessment of the facilitators of the knowledge use- The authors emphasized on the intervention plan of Activate-Initiate-Monitor intervention was found to be effective within the patients regardless of the gender or the age and it affected the white and the black subjects similarly.

Implementation of the intervention- The intervention chosen for the patients suffering from the post stroke depression is the Activate-Initiate-Monitor intervention. This intervention was conducted by the nurse care managers that are under the supervision of the study physicians. The intervention consisted of the three main steps: 1) the stroke survivors and their families were activated and were made understand of the depression treatment and diagnosis; 2) initiation of the antidepressant medication; 3) monitoring the effectiveness of the medication.

Background of the problem

Evaluation of the outcomes- The usual care group and the intervention differed on the major baseline measures. The results of the study indicated that post stroke depression can be treated effectively by the standard antidepressant medications for the treatment of depression.

Translational methods- The strategy employed in the search approach includes survivors of the stroke that received the care management for post stroke depression.

Anticipated challenges and strategies to facilitate success- The challenges of the study can be unwillingness of the patients to take up the medication at the proper time intervals. The medications might not work in some of the patients. The strategy can be to promote the benefits of having the medicine at the proper time. While complication with the certain type of medicine in some patient can be altered with a different medicine.

Anticipated result- The usual care model is less effective in comparison to the Activate-Initiate-Monitor intervention.

Potential impact- The providers must first consider the screening of the active depression among the high risk groups and along with it must also provide guidelines based on the treatment of depression. 

Second article- Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability 

Statement of the problem- The burden of stroke is increasing at a rapid pace and due to it disability and morbidity is also rising. Majority of the morbidity occurs due to the depression, although is treatable but if left untreated and unidentified can be fatal.

Background of the problem- The recommendation for the diagnosis of the post stroke depression should be based on the examination of the semi mental state. The clinical criteria include the statistical manual of mental disorders and the diagnostic manual of mental disorders to diagnose stroke that have depressive or episodic features. There remains a difficulty in the identification of the appropriate method of screening the post stroke depression in the wide array of the tools.

Aim of the study- The optimal tool which is required for the identification of the depression after stroke is yet to be identified. The study presents a context specific screening tool for the identification of post stroke depression. The reliability and the validity of the screening test is conducted within the stroke survivors.

 Knowledge creation- Knowledge is created by conducting a systematic review on the 27 different tools that were used in the screening of the post stroke depression. It has been found that none of the measures were able to provide sufficient results among the stroke survivors because many of them were false positives. Tools were unable to meet the clinical and the psychometric utility criteria in the reviews. The tools are either no longer used in the test the post stroke depression or require the assistance of the specialists in conducting such tests.

Identification of the gap- The several systematic reviews conducted with the tools revealed that the post stroke depression is capable or sufficient enough to provide the desired results as required in the identification of the post stroke depression. The tools are found to be either very complicated requiring the assistance of a specialist or is no longer used in the screening process. This knowledge gap created an interest in the authors to conduct a study on the post stroke depression identification tool.

Aim of the study

Adaptation of knowledge to local context- The study is designed so that it can provide a comprehensive tool for the identification of the post stroke depression though a tool. It was found by the authors that a scale named Hospital Anxiety and Depression rating scale is psychometrically sufficient in identifying the post stroke depression within the stroke survivors. However, it is important to note that the acquisition cost of the tool is huge and thus has very limited usage. Thus, the optimal tool remains to be identified.

Assessment of the facilitators to knowledge use- The lack of a tool that can be widely used and have less acquisition cost led to the usage of knowledge and framing of a screening tool that will be used for post stroke depression. While the newly designed tool will facilitate its usage in a patient controlled, transnational, cross cultural sample and it will be a comprehensive model.

Implementation of the intervention- A new tool was used which is called “HRQOLISP-E” and it has been designed from the Health Related Quality of Life in Stroke patients (HRQOLISP-26). This tool will be used in the identification of the post stroke depression.

Evaluation of the outcomes- The evaluation of the outcomes will be based on the evaluation of the stroke survivors with the Health Related Quality of Life in Stroke patients scale.

Anticipated challenges and strategies to facilitate success- The challenges pertaining to the usage of the tools for the identification of post stroke depression involves the usage of tools that are either obsolete or are very expensive. The best strategy is to frame a tool that will be easy to handle and have less complexity.

Anticipated result- The study itself is based on devising a strategy or a tool which will surpass all the old and complex tools that were previously used in the diagnosing the stroke survivors. Thus the newly developed scale will perform in a better way in comparisons to all the previous tools and it will prove to be helpful in diagnosing the post stroke depression in stroke survivors.

Potential impact- The new HRQOLISP-26 is designed in an empirical way so that it can measure the stroke in a specific way and thus it will have a good construct validity. The new instrument will be much better in comparison to the old ones in diagnosing post stroke depression in stroke survivors. 

References

Ojagbemi, A., Owolabi, M., Akinyemi, J., & Ovbiagele, B. (2017). Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability. eNeurologicalSci, 9, 14-18. DOI: https://dx.doi.org/10.1016/j.ensci.2017.10.002

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2016). Translation of evidence into nursing and health care. Springer Publishing Company. Retrieved from: https://books.google.co.in/books?id=vDCoCwAAQBAJ&pg=PA354&lpg=PA354&dq=Part+V:+Translation+Exemplars.&source=bl&ots=ZZz5Zddr9I&sig=141Tc9jN9Y4SPBgdcKWzj3b24b8&hl=en&sa=X&redir_esc=y#v=onepage&q&f=false

Williams, L. S., Kroenke, K., Bakas, T., Plue, L. D., Brizendine, E., Tu, W., & Hendrie, H. (2007). Care management of poststroke depression: a randomized, controlled trial. Stroke, 38(3), 998-1003. DOI: 10.1161/01.STR.0000257319.14023.61

Statement of the problem- Post stroke depression can be described as a feeling of hopelessness that interferes with the quality of life and functioning of life. Thus, if it is not treated well than the post-depression can slow down the process of recovery. Depression can set in weeks of months after the occurrence of stroke and it can prevent the process of rehabilitation and recovery and it impacts the way of life. There is a combination of factors that all together can all together have a life changing impact on the patient. Damage to the brain after stroke is common and it has a life changing effects on the social factors, genetics that all together contributes to depression.

Translational framework

Background of the Problem- Post stroke depression occurs in one in every 3 patients or stroke survivors. The stroke survivors are associated with reduced recovery, like after the occurrence of myocardial infarction depression follows. The post stroke depression is associated with the increased healthcare utilization, increased mortality, and subsequent events of cardiovascular events. Post stroke depression is a disabling and is a prevalent disorder and yet the several evidences of effectiveness of the treatment procedures of post stroke depression are all inconclusive.

Aim- The main objective of the study is to determine the effectiveness of the care management programme called the Activate-Initiate-Monitor care management for the treatment of the patients that are suffering from the post stroke depression.

Knowledge creation- knowledge is created through the different previously conducted studies and such studies included the controlled clinical trials, randomized control trials and their evaluation. A Cochrane meta-analysis was also conducted which concluded the previously suggested treatments were insufficient

Identification of the problem/determination of the gap- The problem identified by the authors emphasized mostly on the lack of proper treatment options for the post stroke depression patients. All the previously conducted studies were unable to provide a comprehensive method of treating post stroke depression and the efficacy of the process were not up to the mark. Furthermore, a Cochrane meta-analysis on the post stroke depression treatment trials showed that the treatment procedures were insufficient and the remission of the depression after stroke.

Adapt to the local knowledge-  The study is designed so that it can help the patients with post stroke depression. The previous studies lacked the proper care management plans or the proper intervention plan. The local knowledge pertaining to the previous practices that were previously applied on such patients are used in the study.

Assessment of the facilitators of the knowledge use- The authors emphasized on the intervention plan of Activate-Initiate-Monitor intervention was found to be effective within the patients regardless of the gender or the age and it affected the white and the black subjects similarly.

Implementation of the intervention- The intervention chosen for the patients suffering from the post stroke depression is the Activate-Initiate-Monitor intervention. This intervention was conducted by the nurse care managers that are under the supervision of the study physicians. The intervention consisted of the three main steps: 1) the stroke survivors and their families were activated and were made understand of the depression treatment and diagnosis; 2) initiation of the antidepressant medication; 3) monitoring the effectiveness of the medication.

Evaluation of the outcomes- The usual care group and the intervention differed on the major baseline measures. The results of the study indicated that post stroke depression can be treated effectively by the standard antidepressant medications for the treatment of depression.

Translational methods- The strategy employed in the search approach includes survivors of the stroke that received the care management for post stroke depression.

Anticipated challenges and strategies to facilitate success- The challenges of the study can be unwillingness of the patients to take up the medication at the proper time intervals. The medications might not work in some of the patients. The strategy can be to promote the benefits of having the medicine at the proper time. While complication with the certain type of medicine in some patient can be altered with a different medicine.

Anticipated challenges and strategies to facilitate success

Anticipated result- The usual care model is less effective in comparison to the Activate-Initiate-Monitor intervention.

Potential impact- The providers must first consider the screening of the active depression among the high risk groups and along with it must also provide guidelines based on the treatment of depression. 

Second article- Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability 

Statement of the problem- The burden of stroke is increasing at a rapid pace and due to it disability and morbidity is also rising. Majority of the morbidity occurs due to the depression, although is treatable but if left untreated and unidentified can be fatal.

Background of the problem- The recommendation for the diagnosis of the post stroke depression should be based on the examination of the semi mental state. The clinical criteria include the statistical manual of mental disorders and the diagnostic manual of mental disorders to diagnose stroke that have depressive or episodic features. There remains a difficulty in the identification of the appropriate method of screening the post stroke depression in the wide array of the tools.

Aim of the study- The optimal tool which is required for the identification of the depression after stroke is yet to be identified. The study presents a context specific screening tool for the identification of post stroke depression. The reliability and the validity of the screening test is conducted within the stroke survivors.

 Knowledge creation- Knowledge is created by conducting a systematic review on the 27 different tools that were used in the screening of the post stroke depression. It has been found that none of the measures were able to provide sufficient results among the stroke survivors because many of them were false positives. Tools were unable to meet the clinical and the psychometric utility criteria in the reviews. The tools are either no longer used in the test the post stroke depression or require the assistance of the specialists in conducting such tests.

Identification of the gap- The several systematic reviews conducted with the tools revealed that the post stroke depression is capable or sufficient enough to provide the desired results as required in the identification of the post stroke depression. The tools are found to be either very complicated requiring the assistance of a specialist or is no longer used in the screening process. This knowledge gap created an interest in the authors to conduct a study on the post stroke depression identification tool.

Adaptation of knowledge to local context- The study is designed so that it can provide a comprehensive tool for the identification of the post stroke depression though a tool. It was found by the authors that a scale named Hospital Anxiety and Depression rating scale is psychometrically sufficient in identifying the post stroke depression within the stroke survivors. However, it is important to note that the acquisition cost of the tool is huge and thus has very limited usage. Thus, the optimal tool remains to be identified.

Assessment of the facilitators to knowledge use- The lack of a tool that can be widely used and have less acquisition cost led to the usage of knowledge and framing of a screening tool that will be used for post stroke depression. While the newly designed tool will facilitate its usage in a patient controlled, transnational, cross cultural sample and it will be a comprehensive model.

Implementation of the intervention- A new tool was used which is called “HRQOLISP-E” and it has been designed from the Health Related Quality of Life in Stroke patients (HRQOLISP-26). This tool will be used in the identification of the post stroke depression.

Evaluation of the outcomes- The evaluation of the outcomes will be based on the evaluation of the stroke survivors with the Health Related Quality of Life in Stroke patients scale.

Anticipated challenges and strategies to facilitate success- The challenges pertaining to the usage of the tools for the identification of post stroke depression involves the usage of tools that are either obsolete or are very expensive. The best strategy is to frame a tool that will be easy to handle and have less complexity.

Anticipated result- The study itself is based on devising a strategy or a tool which will surpass all the old and complex tools that were previously used in the diagnosing the stroke survivors. Thus the newly developed scale will perform in a better way in comparisons to all the previous tools and it will prove to be helpful in diagnosing the post stroke depression in stroke survivors.

Potential impact- The new HRQOLISP-26 is designed in an empirical way so that it can measure the stroke in a specific way and thus it will have a good construct validity. The new instrument will be much better in comparison to the old ones in diagnosing post stroke depression in stroke survivors. 

References

Ojagbemi, A., Owolabi, M., Akinyemi, J., & Ovbiagele, B. (2017). Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability. eNeurologicalSci, 9, 14-18. DOI: https://dx.doi.org/10.1016/j.ensci.2017.10.002

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2016). Translation of evidence into nursing and health care. Springer Publishing Company. Retrieved from: https://books.google.co.in/books?id=vDCoCwAAQBAJ&pg=PA354&lpg=PA354&dq=Part+V:+Translation+Exemplars.&source=bl&ots=ZZz5Zddr9I&sig=141Tc9jN9Y4SPBgdcKWzj3b24b8&hl=en&sa=X&redir_esc=y#v=onepage&q&f=false

Williams, L. S., Kroenke, K., Bakas, T., Plue, L. D., Brizendine, E., Tu, W., & Hendrie, H. (2007). Care management of poststroke depression: a randomized, controlled trial. Stroke, 38(3), 998-1003. DOI: 10.1161/01.STR.0000257319.14023.61