A pilot feasibility study of a randomized controlled trial of goal setting using the values in action inventory of strengths following brain injury.

In a single-blind feasibility pilot randomized controlled trial design, brain injury (BI) participants were recruited from a community rehabilitation centre and randomized into goal-setting using the Values in Action Inventory of Strengths (VIA-IS), and goal-setting as usual. Outcomes included the feasibility and acceptability of the VIA-IS, and its use in setting goals in a BI rehabilitation context, and whether it affected types of goals set (International Classification of Functioning (ICF)). Memory for goals two weeks later was measured, and a sample size calculated for a full-scale trial. Twenty-six BI participants were recruited, and randomized to the VIA-IS (n = 13) and control group (n = 13). Two dropped out of the VIA-IS condition, leaving a total n = 24. The majority (92%) of participants rated the VIA-IS as acceptable; both groups described the goal-setting process as "easy". VIA-IS feedback varied; over two thirds (73%) of VIA-IS participants used their VIA-IS results to set goals and described it as "helpful". There were no major differences in ICF categories between groups. A sample size of 66 would be required for a full-scale trial. A full-scale trial with multi-centre design appears warranted though might be more clinically beneficial for difficult to engage BI clients.

Mortality in a cohort of patients with psychogenic non-epileptic seizures.

Some evidence suggests that psychogenic non-epileptic seizures (PNES) are associated with increased mortality. The authors obtained death certificate information in a cohort of 260 patients who presented with PNES between 1999 and 2004. The follow-up period averaged 7.92 years, during which 17 patients died, 12/17 were under the age of 75 years, giving a premature (<75 years) mortality rate of 0.58%, compared with a Scottish mortality rate for the 40-75 years age group of 0.41% per year. The main predictor of death was the patient age at presentation of PNES. There was no correlation with withdrawal of anticonvulsant medication, and death certificate information provided no evidence to suggest that the deaths were related to the seizure disorder. The population had a high mean deprivation rank, providing a possible explanation for a modest increase in premature death rate.

Head injury and mortality in the homeless.

Risk factors for head injury are also risk factors for becoming homeless but there is little research on this vulnerable group, who can be neglected by health services that specialize in acquired brain injury. This study investigates the prevalence of admissions to hospital with a head injury in the homeless and associations with later mortality. It compares homeless people with and without a record of hospitalized head injury (HHI) and the Glasgow population. Data were obtained from a U.K. National Health Service strategy to enhance care of the homeless. This included development and production of local registers of homeless people. In Glasgow, the initiative took place over a seven-year period (2004-2010) and comprised 40 general practitioner (family practice) services in the locality of 55 homeless hostels. The register was linked to hospital admissions with head injury recorded in Scottish Medical Records and to the General Register of Scotland, which records deaths. A total of 1590 homeless people was registered in general practitioner (family doctor) returns. The prevalence of admission to hospital with head injury in the homeless over a 30-year period (13.5%) was 5.4 times higher than in the Glasgow population. In the homeless with HHI, 33.6% died in the seven-year census period, compared with 13.9% in the homeless with no hospitalized HI (NHHI). The standardized mortality ratio for HHI (4.51) was more than twice that for NHHI (2.08). The standardized mortality ratio for HHI aged 15-34 (17.54) was particularly high. These findings suggest that HHI is common in the homeless relative to the general population and is a risk factor for late mortality in the homeless population.