Unexpected lucidity in dementia: application of qualitative methods to develop an informant-reported lucidity measure.

OBJECTIVES: Unexpected lucidity is a phenomenon of scientific, clinical, and psychological relevance to health professionals, to those who experience it, and their relatives. This paper describes qualitative methods used to develop an informant-based measure of lucidity episodes. METHODS: The approach was refinement of the operationalization of the construct; review of seminal items, modification, and purification; and confirmation of the feasibility of reporting methodology. Modified focus groups were conducted with 20 staff and 10 family members using a web-based survey. Themes included reaction when hearing the term; words that come to mind; description of and first reaction to referenced or observed 'lucidity' events. Semi-structured cognitive interviews were conducted with 10 health professionals working with older adults with cognitive impairment. Data were extracted from Qualtrics or Microsoft 365 Word® for analysis using NVivo. RESULTS: Conceptual issues, as well as issues regarding comprehension, interpretation, clarity, semantics, and standardization of definitions derived from an external advisory board, focus groups and cognitive interviews informed items' modification, and resulted in the final lucidity measure. CONCLUSIONS: An obstacle to understanding the mechanisms and estimating the prevalence of lucid events among individuals with dementia and other neurological conditions is the scarcity of reliable and valid measures. The substantive and varied data gathered from multiple methods including the collaborative work of an External Advisory Board, modified focus groups with staff and family caregivers, and structured cognitive interviews with health professionals were central in creating the revised version of the lucidity measure.

Reports About Paradoxical Lucidity from Health Care Professionals: A Pilot Study.

Although clinicians caring for persons at the end of life recognize the phenomenon of paradoxical/terminal lucidity, systematic evidence is scant. The current pilot study aimed to develop a structured interview instrument for health care professionals to report lucidity. A questionnaire measuring lucidity length, degree, content, coinciding circumstances, and time from episode to death was expanded to include time of day, expressive and receptive communication, and speech during the month prior to and during the event. Thirty-three interviews were conducted; 73% of participants reported ever witnessing paradoxical lucidity. Among 29 events reported, 31% lasted several days, 20.7% lasted 1 day, and 24.1% lasted <1 day. In 78.6% of events, the person engaged in unexpected activity; 22.2% died within 3 days, and 14.8% died within 3 months of the event. The phenomenological complexity of lucidity presents challenges to eliciting reports in a systematic fashion; however, staff respondents were able to report lucidity events and detailed descriptions of person-specific characteristics. [Journal of Gerontological Nursing, 49(1), 18-26.].

Activación de la coagulación y fibrinólisis inducida por un ejercicio de larga duración (carrera de maratón) / Coagulation and fibrinolysis activation induced by continued physical exercise (marathon race)

Introducción y objetivos. Durante el ejercicio físico aumentan tanto el potencial coagulante como el fibrinolítico. La realización de ejercicio físico regular y moderado está asociada a una disminución de los eventos trombóticos, por el contrario, el ejercicio físico extenuante parece ser un desencadenante de eventos trombóticos especialmente en sujetos no entrenados. El objetivo del estudio es valorar los efectos de una carrera de maratón sobre diferentes parámetros de la actividad coagulativa y de la actividad fibrinolítica en individuos entrenados. Material y métodos. Se han estudiado 31 deportistas amateurs que han seguido un programa de entrenamiento de 4 meses y a los que se ha tomado muestras de sangre preejercicio, postejercicio y a las 24 y 72 horas para analizar las variaciones de el tiempo de protrombina, actividad de protrombina, tiempo de tromboplastina parcial activada, fibrinógeno, antitrombina III y dímero D, en respuesta a una carrera de maratón. Resultados. Las muestras postejercicio muestran un aumento de la actividad coagulativa y un marcado incremento de los niveles de dímero D (marcador de actividad fibrinolítica) asociados a una disminución de los niveles de fibrinógeno, probablemente por consumo. Las muestras de 24h presentan una disminución de los niveles de antitrombina III, posiblemente como consecuencia de su consumo durante la fase de ejercicio. Conclusiones. Los resultados obtenidos sugieren que en sujetos que han seguido una preparación física se produce un equilibrio general de los mecanismos hemostáticos (activación de la coagulación y fibrinólisis) tras el ejercicio físico de larga duración (AU)

Introduction and objectives. During physical exercise coagulation and fibrinolytic activities are increased. Moderate and regular exercise is associated with a decrease on thrombotic episodes. On the other hand exhausting physical exercise seems to be a trigger of thrombotic events, especially on non-trained subjects. The objective of this study is to investigate the effect of a marathon race on coagulation and fibrinolytic parameters on trained subjects. Material and methods. We studied 31 amateur athletes who had followed a training program for 4 months. Blood samples were collected before and after exercise and at 24hours and 72hours to test the effects of a marathon race on prothrombin time, prothrombin activity, activated partial thromboplastin time, fibrinogen, antithrombin III (AT3) and D dimer. Results. There was an increase in coagulation activity and a marked increase in D dimmer (marker of fibrinolytic activity) in post-exercise samples. There was also a decrease in fibrinogen levels, probably due to it has been used up during the exercise period. The 24 hour hours samples showed a decrease in AT3 levels, also as a result of AT3 consumption during the physical exercise. Conclusions. These data, suggests that in trained subjects, a general balance in haemostatic mechanisms is achieved (coagulation and fibrinolysis activation) with continued physical exercise (AU)