What to Measure in Aneurysmal Subarachnoid Haemorrhage Research-An International Delphi Survey.

Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating condition with high mortality and morbidity. The outcome measures used in aSAH clinical research vary making it challenging to compare and combine different studies. Additionally, there may be a mismatch between the outcomes prioritized by patients, caregivers, and health care providers and those selected by researchers. We conducted an international, online, multiple round Delphi study to develop consensus on domains (where a domain is a health concept or aspect) prioritized by key stakeholders including those with lived experience of aSAH, health care providers, and researchers, funders, or industry professionals. One hundred seventy-five people participated in the survey, 59% of whom had lived experience of aSAH. Over three rounds, 32 domains reached the consensus threshold pre-defined as 70% of participants rating the domain as being critically important. During the fourth round, participants ranked the importance of each of these 32 domains. The top ten domains ranked highest to lowest were (1) Cognition and executive function, (2) Aneurysm obliteration, (3) Cerebral infarction, (4) Functional outcomes including ability to walk, (5) Delayed cerebral ischemia, (6) The overall quality of life as reported by the SAH survivor, (7) Changes to emotions or mood (including depression), (8) The basic activities of daily living, (9) Vasospasm, and (10) ICU complications. Our findings confirm that there is a mismatch between domains prioritized by stakeholders and outcomes used in clinical research. Our future work aims to address this mismatch through the development of a core outcome set in aSAH research.

Patient Relevance of the Modified Rankin Scale in Subarachnoid Hemorrhage Research: An International Cross-sectional Survey.

BACKGROUND AND OBJECTIVES: There is significant heterogeneity in the reporting of outcome measures in aneurysmal subarachnoid hemorrhage (aSAH) research. The modified Rankin scale (mRS) is the most commonly reported functional outcome measure. The mRS focuses on physical disability; however, many aSAH survivors experience sequalae in other domains, and the mRS may therefore not capture outcomes important to aSAH survivors. The objective of this study was to assess the clinical relevance of the mRS as a research outcome measure to people with lived aSAH experience. METHODS: We conducted an international cross-sectional survey of 355 aSAH survivors, family members, and caregivers to evaluate patient-perceived outcomes in relation to the mRS. The mRS was assessed using a previously validated web-based tool. RESULTS: Response rate was 60%; respondents from 7 continents were composed of 86% aSAH survivors and 14% family members/caregivers. Agreement between self-assessed outcome and the mRS was poor (Kappa 0.26 [CI 0.14-0.39]). Of the 172 respondents who self-assessed as having had a good aSAH outcome, 122 (71%) had a score of 0-2 on the mRS. Approximately 19% of respondents with a good outcome, based on a measured mRS score of 0-2, self-assessed as having had a poor aSAH outcome. When the mRS score was dichotomized as 0-3 corresponding to a good outcome, agreement between the score and self-assessed outcome remained poor with a Kappa score of 0.40 (CI 0.20-0.60). Approximately 30% of respondents believed that the mRS should not be used as an outcome measure in future aSAH trials. DISCUSSION: The findings suggest that there is poor agreement between aSAH survivors' self-assessed outcome, their actual mRS score, and the dichotomization of the mRS score into good/poor outcomes. Patient-centered and patient-informed outcome measurement tools are needed to guide the aSAH research agenda.

Does Passion mediate the Effectof Character Strengths on the Resilience of Athletes? / ¿Media la pasión los efectos delas fortalezasdel carácter en la resiliencia de atletas apasionados? / A paixão medeia os efeitos das forças de caráter sobre a resiliência de atletas apaixonados?

This study investigates (a) the relationship between character strengths, passion and resilience in athletes in a sample of Spanish passionate athletes (elite, federated and recreational), and (b) if passion for sport mediates the relationship between character strengths and resilience. Using a cross-sectional design, participants (N = 480)completed measures of character strengths, passion, and resilience. Both Principal Components and Confirmatory Factor Analyses were conducted with character strengths, and five factors were extracted. All character strengths factors related positively to resilience. Harmonious passion (but not obsessive passion) partially mediated the relationship between all character strengths factors and resilience. Strengths and limitations of the study, as well as its implications are discussed. (AU)

Este estudio investiga (a) la relación entre las fortalezas del carácter, la pasión y la resiliencia de una muestra de atletas apasionados españoles (élite, federados y recreativos), y (b) si la pasión por el deporte media la relación entre las fortalezas del carácter y la resiliencia. Mediante un diseño transversal, los participantes (N = 480) completaron medidas de fortalezas del carácter, pasión y resiliencia. Se llevaron a cabo un análisis de componentes principales y un análisis factorial confirmatoriocon las fortalezas de carácter y se extrajeron cinco factores. Todos los factores de fortalezas del carácter se relacionaron positivamente con la resiliencia. La pasión armoniosa (pero no la pasión obsesiva) medió parcialmente la relación entre todos los factores de fortalezas del carácter y la resistencia. Finalmente, se discuten las fortalezas y limitaciones del estudio, así como sus implicaciones. (AU)

Este estudo investiga (a)a relação entre forças de caráter, paixão e resiliência de uma amostra de atletas espanhóis apaixonados (elite, federados e recreativos), e (b) se a paixão pelo esporte medeia a relação entre forças de caráter e resiliência. Usando um desenho transversal,os participantes (N = 480) completaram medidas de força de caráter, paixão e resiliência. Uma análise de componentes principais e uma análise fatorial confirmatória foram realizadas com forças de caráter e cinco fatores foram extraídos. Todos os fatores de força de caráter foram positivamente relacionados à resiliência. A paixão harmoniosa (mas não a paixão obsessiva) media parcialmente a relação entre todos os pontos fortes dos fatores de caráter e a resistência. Por fim, são discutidos os pontos fortes eas limitações do estudo, bem como suas implicações. (AU)

Character Strengths Predict an Increase in Mental Health and Subjective Well-Being Over a One-Month Period During the COVID-19 Pandemic Lockdown.

This study examines whether character strengths predict resilience (operationalized as stable or higher mental health and subjective well-being despite an adverse event) over a period of approximately 1 month during the COVID-19 pandemic lockdown in Spain. Using a longitudinal design, participants (N = 348 adults) completed online measures of sociodemographic data, information regarding their situation in relation to the COVID-19, character strengths, general mental health, life satisfaction, positive affect and negative affect. All variables were measured at Time 1 and Time 2, except for sociodemographic and most COVID-related information (Time 1 only). Time 1 data collection was conducted between March 21, 2020 and April 2, 2020, i.e., approximately the second week of lockdown in Spain. Time 2 data collection was conducted between April 24, 2020 and May 18, 2020, after the Spanish government announced its intention to progressively release the lockdown. A principal component analysis of character strengths was conducted. Five character strength factors were extracted: fortitude, goodness, intellectual, interpersonal, and restraint. Factor structures at Times 1 and 2 were highly consistent. All character strength factors at Time 1 correlated positively with life satisfaction and positive affect, and negatively with negative affect and mental health at T2 (higher scores in the mental health measure indicate poorer mental health). Fortitude strengths showed the highest correlations. We conducted a series of regression analyses with strength factors at Time 1 as predictors, and mental health, life satisfaction, and positive and negative affect as dependent variables, controlling for their baseline levels. To test the directionality of the relationship between strengths and the dependent variables, all analyses were reversed. All character strength factors predicted an increase in mental health. They also predicted positive affect, with the exception of strengths of restraint. Fortitude, intellectual, and interpersonal strengths predicted an increase in life satisfaction. Finally, fortitude strengths, interpersonal strengths, and strengths of restraint, predicted a decrease in negative affect. None of the reversed analyses yielded significant effects. Limitations, implications, and possible character strengths-based interventions aimed at promoting mental health in the COVID-19 pandemic are discussed.

Validation of the Mexican Spanish Version of the Scale of Positive and Negative Experience in a Sample of Medical and Psychology Students.

The Scale of Positive and Negative Experience (SPANE) aims to measure affect with high transcultural validity. The bifactor model is the best theoretical option to represent affective balance, although it is not typically used in validation studies. The objectives of this research were to test a bifactor model vis-à-vis the traditional model composed of two correlated factors, to prove its invariance across sexes, and to provide evidence of concurrent validity. A nonprobability sample composed of 600 Mexican students of psychology and medicine was recruit. One-group and multigroup confirmatory factor analyses were carried out. The SPANE and the scales selected to assess depression, perceived stress, and satisfaction with life were applied. The bifactor model showed better goodness-of-fit indices than the two correlated factors model: Δχ2(11) = 121.436, p < . 001, Δχ2/Δdf = 11.04 > 5, ΔGFI = .034, ΔNFI = .025, ΔNNFI = .022, and ΔCFI = .023 >.01. The internal consistency for the general factor as well as for the factor of positive affect was excellent, whereas it was good for the factor of negative affect. The measurement model was valid across sexes. The general factor of affective balance had a very high correlation with depression, high with perceived stress, and medium with satisfaction with life. It is concluded that SPANE is reliable and shows evidence of validity among Mexican student of psychology and medicine, and the bifactor model is adequate to represent affective balance.

Técnica del catéter de analgesia intraincisional. Una alternativa para el control del dolor postoperatorio en cirugía de la mama / Intraincisional analgesia catheter techniques. An alternative for managing postoperative pain in breast surgery

Objetivo: La analgesia postoperatoria en cirugía de la mama sigue siendo un reto. Presentamos la técnica de colocación de un catéter para la perfusión continua de anestésicos locales en cirugía de mama como alternativa a los métodos analgésicos actuales. Casos clínicos: Caso 1. Mujer de 59 años con un carcinoma en la mama derecha con ganglios axilares negativos. Se realizó mastectomía derecha y se colocó catéter de analgesia interpectoral. Caso 2. Mujer de 52 años con un carcinoma en la mama derecha y ganglios axilares positivos. Se realizó mastectomía tipo Madden y se colocó catéter de analgesia interpectoral y axilar derecho. Se retiró el catéter a las 48 horas sin complicaciones. Conclusiones: El uso de perfusión continua de anestésico local en la herida quirúrgica mediante catéter multiperforado es una alternativa eficaz para el control del dolor postoperatorio en cirugía de la mama, lo cual disminuye los requerimientos y los efectos secundarios de antiinflamatorios sistémicos y opioides(AU)

Introduction: Postoperative analgesia in breast surgery is still a challenge. We present a technique for continuous perfusion of anaesthetics through an "in situ" placed catheter, as an alternative to the current analgesic methods in breast surgery. Case reports: Case 1. A 59 year old woman with carcinoma in the right breast and negative axillary nodes had a right mastectomy and an interpectoral analgesia catheter was inserted. Case 2. A 52 year old woman with carcinoma in the right breast and positive axillary nodes. A right Madden mastectomy was performed and an interpectoral and right axillary analgesia catheter was inserted. The catheter was removed 48 hours later with no complications. Conclusions: The use of continuous perfusion in surgical wounds by means of a multiperforated catheter is an effective option for the treatment of post-surgical pain in breast surgery. This technique reduces the requirements, and potential side effects, of systemic anti-inflammatory drugs and opioids(AU)

The effects of counting blessings on subjective well-being: a gratitude intervention in a spanish sample

This study examined a gratitude intervention repeating Emmons and McCullough study (2003) in a Spanish sample. Participants were randomly assigned to one of three conditions (gratitude, hassles and any event) and kept daily records during 2 weeks of gratitude, affect, quality of relationships, physical and subjective well-being. We added design features to assess the intervention long-term impact (follow-up measures), and to improve the design control (pre-treatment measures). Following the cited authors’ analysis, i.e., comparing groups only in the post-test, we replicated their results, finding differences in positive affect and gratitude between the gratitude condition and the hassles condition. However, when including both the pre and the follow-up measures in the analysis, results were replicated only partially, as the difference in gratitude disappeared. Moreover, the difference in positive affect between groups in the post-test seemed to be influenced mainly by a decrease in positive affect in the hassles group. Post-test differences between groups in positive affect disappeared in the follow-up. Gratitude interventions may have an effect on well-being, but we consider other methods to promote gratitude besides gratitude journals should be tested (AU)

Este estudio examina una intervención en gratitud repitiendo el estudio de Emmons y McCullough (2003) en una muestra española. Los participantes fueron asignados de manera aleatoria a una de tres posibles condiciones (gratitud, escollos y cualquier suceso) y evaluaron diariamente durante dos semanas la gratitud, el afecto, la calidad de las relaciones, el bienestar físico y el bienestar subjetivo. Añadimos nuevos aspectos al diseño para evaluar el impacto de la intervención a largo plazo (medidas de seguimiento) y para mejorar el control (medidas pretest). Al hacer los mismos análisis que los autores previamente citados, es decir, al comparar los grupos sólo en el postest, replicamos sus resultados, ya que encontramos diferencias en afecto positivo y en gratitud entre el grupo de gratitud y el grupo de los escollos. Sin embargo, cuando incluimos las medidas pretest y las de seguimiento en el análisis, replicamos los resultados sólo de manera parcial, ya que la diferencia en gratitud desapareció. Además, la diferencia en afecto positivo entre los grupos en el postest parecía estar influida principalmente por un descenso en afecto positivo en el grupo de escollos. Las diferencias entre los grupos en afecto positivo en el postest desaparecieron en el seguimiento. Las intervenciones basadas en la gratitud pueden tener un efecto sobre el bienestar, pero consideramos que se deberían investigar otros métodos aparte de los diarios de gratitud (AU)

The effects of counting blessings on subjective well-being: a gratitude intervention in a Spanish sample.

This study examined a gratitude intervention repeating Emmons and McCullough study (2003) in a Spanish sample, Participants were randomly assigned to one of three conditions (gratitude, hassles and any event) and kept daily records during 2 weeks of gratitude, affect, quality of relationships, physical and subjective well-being. We added design features to assess the intervention long-term impact (follow-up measures), and to improve the design control (pre-treatment measures). Following the cited authors' analysis, i.e., comparing groups only in the post-test, we replicated their results, finding differences in positive affect and gratitude between the gratitude condition and the hassles condition. However, when including both the pre and the follow-up measures in the analysis, results were replicated only partially, as the difference in gratitude disappeared. Moreover, the difference in positive affect between groups in the post-test seemed to be influenced mainly by a decrease in positive affect in the hassles group. Post-test differences between groups in positive affect disappeared in the follow-up. Gratitude interventions may have an effect on well-being, but we consider other methods to promote gratitude besides gratitude journals should be tested.

El estudio científico de las fortalezas trascendentales desde la psicología positiva / The scientific study of the transcendental strengths from the positive psychology perspective

Dentro del marco de la Psicología positiva existe una línea de investigación centrada en las virtudes y fortalezas del ser humano, entendidas como rasgos positivos de personalidad, que está elaborando una clasificación de ellas siguiendo un esquema similar al del Diagnostic and Statistical Manual of Mental Disorders (DSM). En este artículo se exponen algunos de los estudios que muestran los efectos beneficiosos de un grupo concreto de estas fortalezas, las trascendentales (espiritualidad, gratitud, esperanza, apreciación de la belleza y excelencia, humor), con la intención de promover su investigación

Within the framework of Positive Psychology there is a line of research focused on the virtues and strengths of human beings. Taking virtues and strengths as positive traits of personality, the Positive Psychology classifies them following a scheme similar to the Diagnostic and Statistical Manual of Mental Disorders (DSM). With the aim of promoting research, this article reviews some of the studies that show the beneficial effects of a subset of strengths, the transcendental strengths –i.e. spirituality, gratitude, hope, appreciation of beauty and excellence, and humor