基于循证医学与研究的意识恢复（RECOVER）项目：推进神经预后评估的范例
The Recovery of Consciousness via Evidence-Based Medicine and Research (RECOVER) Program: A Paradigm for Advancing Neuroprognostication.
作者信息
Fischer David, Abella Benjamin S, Bass Geoffrey D, Charles Jeremy, Hampton Stephen, Kulick-Soper Catherine V, Mendlik Matthew T, Mitchell Oscar J, Narva Aliza M, Pino William, Sikandar Morgan L, Sinha Saurabh R, Waldman Genna J, Ware Jeffrey B, Levine Joshua M
机构信息
Division of Neurocritical Care (DF, JML), Department of Neurology; Department of Emergency Medicine (BSA); Division of Pulmonary, Allergy and Critical Care (GDB, OJM), Department of Medicine; Department of Physical Medicine and Rehabilitation (JC, SH); Division of Epilepsy (CVK-S, SRS, GJW), Department of Neurology; Department of Palliative Care (MTM); Ethics (AMN), Perelman School of Medicine, University of Pennsylvania; Physical Therapy (WP), Good Shepherd Penn Partners at the Hospital of the University of Pennsylvania; Clinical Resource Management and Social Work (MLS), Hospital of the University of Pennsylvania; and Division of Neuroradiology (JBW), Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
出版信息
Neurol Clin Pract. 2024 Dec;14(6):e200351. doi: 10.1212/CPJ.0000000000200351. Epub 2024 Aug 16.
BACKGROUND
Neuroprognostication for disorders of consciousness (DoC) after severe acute brain injury is a major challenge, and the conventional clinical approach struggles to keep pace with a rapidly evolving literature. Lacking specialization, and fragmented between providers, conventional neuroprognostication is variable, frequently incongruent with guidelines, and prone to error, contributing to avoidable mortality and morbidity.
RECENT FINDINGS
We review the limitations of the conventional approach to neuroprognostication and DoC care, and propose a paradigm entitled the Recovery of Consciousness Via Evidence-Based Medicine and Research (RECOVER) program to address them. The aim of the RECOVER program is to provide specialized, comprehensive, and longitudinal care that synthesizes interdisciplinary perspectives, provides continuity to patients and families, and improves the future of DoC care through research and education.
IMPLICATIONS FOR PRACTICE
This model, if broadly adopted, may help establish neuroprognostication as a new subspecialty that improves the care of this vulnerable patient population.
背景
严重急性脑损伤后意识障碍（DoC）的神经预后评估是一项重大挑战，传统的临床方法难以跟上快速发展的文献步伐。由于缺乏专业性，且提供者之间相互分散，传统的神经预后评估存在差异，常常与指南不一致，且容易出错，导致了可避免的死亡率和发病率。
最新发现
我们回顾了传统神经预后评估方法和DoC护理的局限性，并提出了一种名为“通过循证医学与研究实现意识恢复”（RECOVER）计划的模式来解决这些问题。RECOVER计划的目的是提供专业化、全面且纵向的护理，综合跨学科观点，为患者及其家庭提供连续性护理，并通过研究和教育改善DoC护理的未来。
对实践的启示
这种模式如果得到广泛采用，可能有助于将神经预后评估确立为一个新的亚专业，从而改善对这一脆弱患者群体的护理。
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