Background Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC). Methods Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed. Results In this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS. Conclusions The rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures. Trial registration ClinicalTrials.gov ID: NCT04139239; Registered 24 October 2019 - Retrospectively registered.

Primary Objective: This study aims to validate the Chinese version of the Coma Recovery Scale-Revised (CRS-R). Methods: One hundred sixty-nine patients were assessed with both the CRS-R and the Glasgow Coma Scale (GCS), diagnosed as being in unresponsive wakefulness syndrome (UWS, formerly known as vegetative state), minimally conscious state (MCS), or emergence from MCS (EMCS). A subgroup of 50 patients has been assessed twice by the same rater, within 24 h. Patient outcome was documented six months after assessment. Results: The internal consistency for the CRS-R total score was excellent (Cronbach's α = 0.84). Good test-retest reliability was obtained for CRS-R total score and subscale scores (intra-class correlation coefficient [ICC] = 0.87 and ICC = 0.66-0.84, respectively). Inter-rater reliability was high (ICC = 0.719; p < 0.01). Concurrent validity was good between CRS-R total scale and GCS total scale. Diagnostic validity was excellent compared with GCS (emerged from UWS: 24%; emerged from MCS: 28%). When considering patient outcome, diagnostic validity was good. In addition, false-positive rates have been detected for both diagnoses. Conclusion: The Chinese version of the CRS-R is a reliable and sensitive tool and can discriminate patients in UWS, MCS, and EMCS successfully.

Fiber-based pressure/temperature sensors are highly desired in wearable electronics because of their natural advantages of good breathability and easy integrability. However, it is still a great challenge to fabricate reliable and highly sensitive fiber-based pressure/temperature sensors via a scalable and facile strategy. Herein, a novel fiber-based iontronic sensor with excellent pressure-and temperature-sensing capabilities is designed by assembling two crossed hollow and porous ionogel fibers filled with liquid metal. Serving as a pressure sensor, a high detection resolution (1.16 Pa), a high sensitivity of 13.30 kPa −1 (0−2 kPa), and a wide detection range (∼207 kPa) are realized owing to its novel hierarchical structure and the selection of deformable liquid electrodes. As a temperature sensor, it exhibits a high temperature sensitivity of 25.99% °C−1 (35−40 °C), high resolution of 0.02 °C, and good repeatability and reliability. On the basis of these excellent sensing capabilities, the as-prepared sensor can detect not only pressure signals varied from weak pulse to large joint movements but also the proximity of different objects. Furthermore, a large-area fiber array can be easily woven for acquiring the pressure mapping to intuitively distinguish the location, magnitude, and shape of the loaded object. This work provides a universal strategy to design fiber-shaped iontronic sensors for wearable electronics.

Background Burnout is more common among healthcare professionals, that is an important problem of professional distress that can seriously affect healthcare professionals’ emotional state, health, medical quality and doctor-patient relationship. However, only few studies researched the burnout status of healthcare professionals who care for patients with prolonged disorders of consciousness. The aim of this study was to evaluate the level of burnout and related contributing personal and environment factors in healthcare professionals managing these patients. Methods Institution-based cross-sectional study. Maslach Burnout Inventory-Human Services Survey was used to evaluate burnout in professionals who specially care for patients with prolonged disorders of consciousness in the neurorehabilitation department. Results A total of 200 questionnaires were distributed, 121 were collected, among them 93 questionnaires could be used for further analysis. In this study, 61 participants (65.6%) showed burnout (55.2% physicians and 82.9% nurses). For the risks and Maslach Burnout Inventory scores, emotional exhaustion and depersonalization were correlated with age, gender, occupation, marital status, years of practice, and education level. Reduced personal accomplishment was correlated with marital status. The variables of age (< 29 years old), occupation (nurses), marital status (unmarried), years of practice (< 5 years), and educational level (≤ Undergraduate) were associated with high levels of burnout. Conclusions Healthcare professionals who care for patients with disorders of consciousness experienced high levels of burnout. Especially those who were younger, nurse, unmarried, less practice experience or lower educational levels were more likely to experience high burnout.

BackgroundBehavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients. The item “Functional Object Use” in the motor function sub-scale in the Coma Recovery Scale-Revised (CRS-R) is a key item in differentiating between minimally conscious state (MCS) and emergence from MCS (EMCS). However, previous studies suggested that certain specific stimuli, especially something self-relevant can affect DOC patients’ scores of behavioral assessment scale. So, we attempted to find out if personalized objects can improve the diagnosis of EMCS in the assessment of Functional Object Use by comparing the use of patients’ favorite objects and other common objects in MCS patients.MethodsTwenty-one post-comatose patients diagnosed as MCS were prospectively included. The item “Functional Object Use” was assessed by using personalized objects (e.g., cigarette, paper) and non-personalized objects, which were presented in a random order. The rest assessments were performed following the standard protocol of the CRS-R. The differences between functional uses of the two types of objects were analyzed by the McNemar test.ResultsThe incidence of Functional Object Use was significantly higher using personalized objects than non-personalized objects in the CRS-R. Five out of the 21 MCS studied patients, who were assessed with non-personalized objects, were re-diagnosed as EMCS with personalized objects (χ2 = 5, df = 1, p < 0.05).ConclusionsPersonalized objects employed here seem to be more effective to elicit patients’ responses as compared to non-personalized objects during the assessment of Functional Object Use in DOC patients.Trial registrationClinical Trials.gov: NCT02988206; Date of registration: 2016/12/12.Electronic supplementary materialThe online version of this article (10.1186/s12883-018-1040-5) contains supplementary material, which is available to authorized users.