Background. Everything known about the roles, relationships, and repercussions of comorbidity in cardiovascular disease is shaped by how comorbidity is currently measured. Objectives. To critically examine how comorbidity is measured in randomized controlled trials or clinical trials and prospective observational studies in acute myocardial infarction (AMI), heart failure (HF), or stroke. Design. Systematic review of studies of hospitalized adults from MEDLINE CINAHL, PsychINFO, and ISI Web of Science Social Science databases. At least two reviewers screened and extracted all data. Results. From 1432 reviewed abstracts, 26 studies were included (AMI n = 8, HF n = 11, stroke n = 7). Five studies used an instrument to measure comorbidity while the remaining used the presence or absence of an unsubstantiated list of individual diseases. Comorbidity data were obtained from 1–4 different sources with 35% of studies not reporting the source. A year-by-year analysis showed no changes in measurement. Conclusions. The measurement of comorbidity remains limited to a list of conditions without stated rationale or standards increasing the likelihood that the true impact is underestimated.
Background: Although scientific statements and clinical guidelines are useful summaries of the evidence intended to guide practice, the identification of the gaps in knowledge can be just as informative. Purpose: The aims of this project were to (1) identify the contributions of nursing and rehabilitation professionals to the evidence summarized in comprehensive overviews of nursing and interdisciplinary care for stroke patients; and, (2) present the opportunities where research could be developed in practice by nursing and rehabilitation professionals in an effort to strengthen the evidence for the care delivered to stroke patients. Methods: We examined the 2009 and 2010 American Heart Association Scientific Statements intended to guide nursing and rehabilitation professionals in the care of stroke patients and reviewed each of the articles cited. The number of articles and studies cited were summarized. The credentials and institution for the first and last author of every unique article were sought and analyzed to identify professional affiliation and the profession’s contribution to specific clinical recommendations. The recommendations in these statements were then analyzed to identify clinical areas where additional studies are needed or where the standard of care would benefit from systematic investigation. Results: These two scientific statements summarized data and information from 893 unique sources (912 references in total that included 780 empirical studies). Of the 780 studies included in these comprehensive overviews, only 7% were led by nurses or persons affiliated with a nursing school or clinical department (N=51). Rehabilitation professionals or persons affiliated with allied health schools or clinical rehabilitation departments led 27% of the studies included (N=214). Over 300 recommendations for care of the stroke patient were made. The majority of the recommendations were either Class I Level of Evidence C or Class IIa/b Level of Evidence B or C. Conclusions: Nursing and rehabilitation professionals provide much of the care summarized in these documents but have led few of the studies used to develop the evidence for it. Significant advances in science and quality will continue to be made but the significant gaps in evidence could be addressed, at least in part, with systematic investigation at the point of care by mentored nursing and rehabilitation professionals.
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