Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements

Dataset

The curated set of data used to run the study's analyses, taken from the larger longitudinal NHATs dataset

Do​es Chronic Illness Diagnosis Alter Sense of Purpose in Older Adults?

Maintenance of a sense of purpose serves as a psychological resource for late-life health. A strong sense of purpose in older adulthood is associated with a reduction in health incidents (Kim et al., 2013) and mortality, and lower psychological distress (Musich et al., 2018). Limited research has examined whether one’s purpose is threatened by chronic illness diagnoses. This study leverages data from the National Health and Aging Trends Study (NHATs; N = 831) to establish trajectories of purpose across three such diagnoses (i.e., dementia, heart disease, no diagnosis) using three-year (pre-diagnosis, year of diagnosis, post-diagnosis) timespans. Results demonstrate a decrease in purpose following a dementia diagnosis (F=9.18, p\u3e.001, n2=.05) which deviates from trajectories of those who received a heart disease diagnosis (F=3.04, p=.05, n2=.006) or no diagnosis (F=1.29, p=.24, n2=.001), where purpose did not change over time. Findings suggest that older adults who receive a dementia diagnosis are vulnerable to a threatened sense of purpose. Interventions that support health priorities navigation and pursuit of purpose despite diagnosis appear to be a priority for dementia care

A Mixed-Method Examination of Emerging and Young Adult Cancer Caregivers’ Experiences during the COVID-19 Pandemic

Advanced cancer caregivers in emerging and young adulthood (EYACs; ages 18–35) are an understudied yet vulnerable caregiving population. The COVID-19 pandemic created new challenges for advanced cancer caregivers but also created unique contexts from which caregivers sometimes benefited. To understand how the pandemic may have positively and negatively impacted their caregiving and bereavement experiences, we examined EYACs’ experiences of caring for and losing a parent with advanced cancer during the pandemic in comparison to those of EYACs with a parent who died outside the context of the pandemic. Eligible EYACs completed an online survey and semi-structured interview. Quantitative analyses compared responses for pre-pandemic EYACS (n = 14) and pandemic EYACs (n = 26). A thematic analysis of the interview transcripts of pandemic EYACS (n = 14) was conducted. Pandemic EYACs experienced non-significant but higher communal coping, benefit finding, negative emotional experiences, and caregiver strain than pre-pandemic EYACs. Thematic analysis revealed that the pandemic negatively affected EYACs’ caregiving efficacy, personal well-being, interpersonal dynamics, and bereavement; shifts to remote work and schooling were reported as benefits. The findings can inform the design of resources to support EYACs whose parents died during the pandemic and who are navigating the healthcare system today

Former dementia caregivers’ high and low point narratives: what is remembered, and how is it shared?

Objectives: To characterize core themes conveyed by caregivers when sharing narratives of high and low caregiving points and to describe how caregivers structured these narratives. Methods: Using consensual qualitative research and thematic analysis, high and low point narratives from 32 former caregivers of persons living with dementia were examined. Results: High point narrative themes involved strengthening relationships with care partners, fulfillment derived from care, lighthearted moments, and fostering the care partners’ joy and dignity. Low point narratives involved family conflict and lack of support, personal deficiencies, loss of the caregivers’ ‘pre-caregiving’ life, health system failures, and alienation from their care partner. Across high and low points, caregivers’ narratives were structured by three types of narrative elaborations; details unnecessary for factual recall but which enriched narrative sharing. Conclusion: Themes across high and low point narratives encompassed relational issues, how caregiving shaped the caregiver’s self-efficacy, and factors that made navigating caregiving easier or more difficult. Both high point and low point narration often involved describing positive aspects of caregiving (PAC). Narrative elaborations may be used by former caregivers to engage in deeper evaluation of their caregiving experiences. We consider how psychotherapeutic techniques can help former caregivers reframe maladaptive narratives, supporting their mental health

Personal Health Planning in Adult-Child Former Caregivers of Parents Living With Dementia

Purpose: To examine how former caregivers for parents living with dementia engage in personal health planning. Design: An inductive, qualitative study. Setting: Virtual, audio-recorded, semi-structured interviews. Participants: Thirty-two midlife former primary caregivers for parents who died following advanced dementia 3 months to 3 years prior. Method: Participants responded to a series of open-ended interview prompts. Interview recordings were transcribed and evaluated by a trained, diverse team to generate Consensual Qualitative Research (CQR) domains and categories. Results: Caregivers developed health planning outlooks (ie, mindsets regarding willingness and ability to engage in personal health planning) that guided health planning activities (ie, engaging in a healthy lifestyle, initiating cognitive/genetic testing, maintaining independence and aging in place, ensuring financial and legal security). An agentic outlook involved feeling capable of engaging in health planning activities and arose when caregivers witnessed the impact and feasibility of their parents’ health planning. Anxiety-inducing and present-focused outlooks arose when caregivers faced barriers (eg, low self-efficacy, lack of social support, perception that parent’s health planning did not enhance quality of life) and concluded that personal health planning would not be valuable or feasible. Conclusion: Caregiving for a parent living with dementia (PLWD) shapes former caregivers’ personal health planning. Interventions should support former caregivers who have developed low self-efficacy or pessimistic views on healthy aging to support them in addressing health planning activities