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BACKGROUND: People with acquired brain injury (ABI) may be more susceptible to scams owing to postinjury cognitive and psychosocial consequences. Cyberscams result in financial loss and debilitating psychological impacts such as shame and mistrust, interference with neurorehabilitation, and reduced independence. Despite these significant consequences, there are no psychological treatments to support cyberscam survivors. There is limited evidence regarding how the current workforce is addressing post-ABI cyberscams. OBJECTIVE: This study aims to understand the perspectives and needs of clinicians and service providers in addressing post-ABI cyberscams. METHODS: Overall, 20 multidisciplinary clinicians and service providers were recruited through purposive sampling across Australia. Semistructured interviews explored post-ABI scam experiences and vulnerabilities, treatments and their efficacy, and recommendations for future cybersafety recovery interventions. Reflexive thematic analysis was used. RESULTS: In total, 8 themes encompassing a biopsychosocial understanding of scam vulnerabilities and impacts were identified: "genuine lack of awareness: cognitive-executive difficulties"; "not coping with the loss of it all"; "needing trust and connection"; "strong reactions of trusted others"; "nothing structured to do"; "financial stress and independence"; "cyberability"; and "scammer persuasion." Each theme informed clinical recommendations including the need to provide psychological and cognitive support, enhance financial and cybersafety skills, promote meaningful social engagement, and foster collaboration between families and clinical support teams. CONCLUSIONS: The multifaceted range of scam vulnerabilities and impacts highlighted the need for individualized, comprehensive, and targeted treatments using a biopsychosocial approach to enable cyberscam recovery among people with ABI. These findings will guide the development of a co-designed intervention.
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Lesiones Encefálicas , Humanos , Australia , Lesiones Encefálicas/terapia , Habilidades de Afrontamiento , Estrés Financiero , Estudios InterdisciplinariosRESUMEN
OBJECTIVE: To characterize trajectories of emotional distress across the first decade after moderate-severe traumatic brain injury (TBI) and explore relations with personal and injury-related factors. DESIGN: Cohort study with follow-ups at 1, 2, 3, 5, and 10 years post-injury. SETTING: Community. PARTICIPANTS: Participants were sampled from a larger longitudinal study of 4300 individuals recruited from consecutive inpatient TBI admissions to a rehabilitation hospital between 1985 and 2021 (N=4300). We analyzed data from 596 unique individuals (13.86% of total dataset; 70.81% male; Mage=40.11 years, SDage=17.49 years; 7.59% non-English-speaking background) with moderate-severe TBI who had complete data on all personal and injury-related variables (collected on admission) and emotional data at 3 or more time-points. There were 464 participants at the 1-year post-injury time-point, 485 at 2 years, 454 at 3 years, 450 at 5 years, and 248 at 10 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Hospital Anxiety and Depression Scale (HADS). RESULTS: Visualization of the individual HADS symptoms (line graph) showed that the most highly endorsed symptoms at each time-point were feeling slowed down and restlessness. On average, each symptom reduced across the first decade post-TBI, with an overall mild level of emotional distress at 10 years. However, visualization of participants' individual trajectories based on the HADS total score (Sankey diagram) revealed significant heterogeneity. Using latent class analysis, we identified 5 distinct trajectory types based on the HADS total score: "Gradual Improving" (38.93%), "Resilience" (36.41%), "Gradual Worsening" (10.40%), and 2 non-linear trajectories of "Worsening-Remitting" (8.22%) and "Improving-Relapsing" (6.04%). Middle age at injury, lower Glasgow Coma Scale score, comorbid spinal and limb injuries, and receipt of pre-injury mental health treatment predicted earlier and/or worsening post-injury emotional distress. CONCLUSIONS: Emotional distress across the first decade after moderate-severe TBI is dynamic, heterogeneous, and often chronic, underscoring a need for ongoing monitoring and responsive treatment.
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Lesiones Traumáticas del Encéfalo , Lesiones Encefálicas , Distrés Psicológico , Persona de Mediana Edad , Humanos , Masculino , Femenino , Estudios de Cohortes , Estudios Longitudinales , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Encefálicas/rehabilitaciónRESUMEN
Challenging behaviours are distressing sequelae for people with acquired brain injury (ABI) and their families. Positive Behaviour Support (PBS) is a collaborative approach focussing on improving quality of life for individuals with ABI presenting with challenging behaviours. This qualitative study explored clinicians' experiences of a 12-month intervention (PBS+PLUS) for adults with ABI and their family/carers. Semi-structured interviews were conducted with eight clinicians trained in neuropsychology (n = 5), occupational therapy (n = 3), speech pathology (n = 2), with two clinicians trained in two of these disciplines. Interviews were analysed through reflexive thematic analysis. Three themes were identified: Shifting clinical identity; Working as equals; Adapting to the environment. Participants experienced PBS+PLUS as a difficult approach to learn but one which enhanced overt client communication and comfort with their clinical fallibility. PBS+PLUS involved giving clients equal status in the clinician-client relationship which for some clients and families was challenging. Finally, PBS+PLUS was perceived as problematic to implement in some work settings (e.g., involving high staff turnover). Clinicians' recommendations for future implementation included thorough training and supervision and early setting of client expectations. With increasing interest in PBS to address challenging behaviours after ABI, these findings will guide PBS+PLUS translation for community clinicians.
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Lesiones Encefálicas , Calidad de Vida , Adulto , Humanos , Calidad de Vida/psicología , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/psicología , Terapia Conductista , Cuidadores/psicología , Comunicación , Investigación CualitativaRESUMEN
Individuals with acquired brain injury (ABI) may be vulnerable to cyberscams due to their cognitive and psychosocial impairments. However, the lived experiences of cyberscam survivors with ABI and their close others is not understood, and no effective intervention has been identified. This qualitative study aimed to explore the perspectives of cyberscam survivors with ABI (n = 7) and their close others (n = 6). Semi-structured interviews explored the scam experience, impacts, vulnerabilities and interventions. Reflexive thematic analysis of interview transcripts identified seven themes: "who is at the helm?: vulnerabilities," "the lure: scammer tactics," "scammers aboard: scam experience," "the discovery," "sinking in: impacts," "responding to the mayday: responses from others," and "lifesavers: suggestions for intervention." The journey towards scam victimisation was complex, and complicated by the ABI. Cyberscams contributed to substantial financial disadvantage, loss of trust and shame. ABI related impairments and social isolation reportedly increased scam vulnerability and interfered with intervention attempts by family and professionals. Confusion, denial and disbelief created further barriers to discovery. The practical and emotional impacts on both cyberscam survivors with ABI and their family members, and a lack of effective intervention, highlight the need for increased education and awareness in order to improve online safety for those with ABI.
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Lesiones Encefálicas , Humanos , Lesiones Encefálicas/complicaciones , Emociones , Familia , Aislamiento Social , Sobrevivientes/psicología , Investigación CualitativaRESUMEN
BACKGROUND: Challenging behaviours after acquired brain injury (ABI) cause distress and reduce community participation. Evidence-based and effective interventions are needed. Positive Behaviour Support (PBS) interventions, such as PBS + PLUS, are person-driven and context-sensitive approaches which aim to improve quality of life and enhance behavioural self-regulation. This study aimed to expand the empirical outcomes of a recent waitlist-controlled trial of PBS + PLUS by examining individualized goal attainment. METHOD: Participants were 44 adults with severe ABI sustained on average nine years previously (Range = 0.6-26) from the combined trial cohort who completed the intervention. Using Goal Attainment Scaling, trial therapists developed and reviewed goals collaboratively with the person with ABI and their natural supports. RESULTS: The 182 goals in the sample focussed on psychological wellbeing, interpersonal relationships, routines and self-care. By the end of 12-month intervention, 84.6% of goals were achieved and 53.3% exceeded their expected outcome. CONCLUSIONS: These findings indicate high levels of personally meaningful outcomes in a broad range of life-domains can be obtained for participants with severe ABI using PBS + PLUS. Whilst these results should be considered in combination with the findings of the waitlist-controlled trial, they contribute to the growing literature regarding benefits of PBS in enhancing quality of life post-ABI. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry identifier: ACTRN12616001704482.
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Lesiones Encefálicas , Calidad de Vida , Humanos , Adulto , Calidad de Vida/psicología , Objetivos , Australia , Relaciones InterpersonalesRESUMEN
Challenging behaviours are common following moderate to severe acquired brain injury (ABI). These behaviours cause relationship and community participation difficulties and are a significant source of stress for many individuals with ABI and their close others (COs). A Positive Behaviour Support intervention, PBS + PLUS, was implemented to assist individuals with ABI to collaboratively build meaningful lives and self-regulate their behaviour. This study explored the perspectives of individuals with ABI and COs (family members, friends, and carers) who had completed an individualized 12-month PBS + PLUS intervention. Fifty-two individuals participated in semi-structured interviews, and a thematic analysis of interview transcripts identified the interrelated themes of Openness to Change, Embeddedness, Clinician Connection, and Preparedness for the Future. Participant perceptions of, and engagement with, PBS + PLUS were influenced by an attitude of openness to new ideas and by the intervention itself. Achieving contextual relevance allowed the intervention to become embedded in participants' lives, and the client-clinician relationship was central to participants' positive experiences. While most participants felt better equipped to cope with the future, some experienced difficulties transitioning to post-intervention life. These results suggest PBS + PLUS may assist individuals with ABI to lead meaningful lives and more confidently overcome behavioural challenges, while encouraging supportive and empowered COs.
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Terapia Conductista , Familia , Humanos , Cuidadores , Emociones , Amigos , Investigación CualitativaRESUMEN
Challenging behaviours are a common and distressing consequence of acquired brain injury (ABI). There are no evidence-based guidelines for managing challenging behaviours after ABI, leaving clinicians with few resources to guide practice. Findings from case studies and single-subject experimental designs support the use of positive behaviour support (PBS) interventions for challenging behaviour post-ABI. This paper introduces PBS + PLUS: a multi-component and flexible PBS intervention using a person-driven collaborative approach to build a meaningful life and self-regulate behaviour after ABI. PBS + PLUS is currently being examined in a randomized controlled trial (RCT). Three detailed pilot case studies illustrate the highly individualized implementation of the programme, delivered to the individuals with ABI and carers over 12 months by a transdisciplinary team including neuropsychologists, occupational therapists, and psychiatrists. Objective behavioural outcomes are reported for participants using the Overt Behaviour Scale at baseline and four-monthly intervals for two years. Goal attainment scaling was used to measure personally meaningful goals. The qualitative appraisals of the intervention by participants, families and carers, and 12-month follow-up outcomes are described. The advantages and challenges of programme delivery are discussed. These case studies will assist clinicians and service providers to implement PBS + PLUS in anticipation of the results of the RCT.
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Lesiones Encefálicas , Terapia Conductista , Lesiones Encefálicas/complicaciones , Cuidadores , Humanos , Proyectos Piloto , Proyectos de InvestigaciónRESUMEN
Post-traumatic growth (PTG) can emerge following traumatic brain injury (TBI), however measures of PTG rely on the cognitive capacity to reflect on psychological growth. Positive associations between scores on PTG measures and behavioural and functional indicators of growth would help establish the clinical utility of measuring PTG after TBI. We examined the degree of association of the Post-traumatic Growth Inventory - Short form (PTGI-SF) and Changes in Outlook Questionnaire - Short form (CiOQ-S), with (1) PTG-consistent behaviours; (2) valued living (behaving in ways consistent with one's values); and (3) post-injury functional outcomes. Participants had moderate to severe TBI and were 1-5 years post-injury (n = 70). Participants with higher scores on the CiOP-S (the positive subscale of the CiOQ-S) reported more frequent PTG-consistent behaviours post-injury, such as showing care towards family and friends, and appreciation of life. Higher CiOP-S scores were also positively associated with valued living and return to work/study. There were fewer associations between PTGI-SF scores and behavioural and functional outcomes. PTG after TBI, as measured by the CiOQ-S, was associated with behavioural and functional indicators of positive growth, highlighting the strength and utility of this scale and the importance of measuring and fostering PTG in rehabilitation.
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Lesiones Traumáticas del Encéfalo/psicología , Crecimiento Psicológico Postraumático , Psicometría/instrumentación , Funcionamiento Psicosocial , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reinserción al Trabajo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Behaviours of Concern (BoC) are a debilitating consequence of Traumatic Brain Injury (TBI). Whilst perspectives of clinicians, carers and family members on BoC have been previously explored, few qualitative studies have included individuals with TBI. The aim of this study was to explore the lived experience of BoC in individuals with TBI, their close others and clinicians. METHOD: Eleven males with TBI and BoC were recruited and 25 semi-structured qualitative interviews were conducted (9 individuals with TBI, 9 close others, 7 clinicians). A six-phase thematic analysis approach was utilised. RESULTS: Frequent and persistent BoC were reported and the key themes identified included the brain injury, control, environment, mood, identity, social relationships, and meaningful participation. Whilst the brain injury contributed to BoC in all cases, the way the other themes manifested and interacted was variable. CONCLUSIONS: This study enriches our understanding of factors associated with BoC. Themes emerging from this study will inform interventions designed to reduce BoC and ultimately maximise quality of life for individuals with TBI and their families.
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Lesiones Traumáticas del Encéfalo/psicología , Problema de Conducta , Adulto , Lesiones Traumáticas del Encéfalo/rehabilitación , Familia/psicología , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación CualitativaRESUMEN
Bacterial regulatory small RNAs (sRNAs) play important roles in gene regulation and are frequently connected to the expression of virulence factors in diverse bacteria. Only a few sRNAs have been described for Pasteurellaceae pathogens and no in-depth analysis of sRNAs has been described for Actinobacillus pleuropneumoniae, the causative agent of porcine pleuropneumonia, responsible for considerable losses in the swine industry. To search for sRNAs in A. pleuropneumoniae, we developed a strategy for the computational analysis of the bacterial genome by using four algorithms with different approaches, followed by experimental validation. The coding strand and expression of 17 out of 23 RNA candidates were confirmed by Northern blotting, RT-PCR, and RNA sequencing. Among them, two are likely riboswitches, three are housekeeping regulatory RNAs, two are the widely studied GcvB and 6S sRNAs, and 10 are putative novel trans-acting sRNAs, never before described for any bacteria. The latter group has several potential mRNA targets, many of which are involved with virulence, stress resistance, or metabolism, and connect the sRNAs in a complex gene regulatory network. The sRNAs identified are well conserved among the Pasteurellaceae that are evolutionarily closer to A. pleuropneumoniae and/or share the same host. Our results show that the combination of newly developed computational programs can be successfully utilized for the discovery of novel sRNAs and indicate an intricate system of gene regulation through sRNAs in A. pleuropneumoniae and in other Pasteurellaceae, thus providing clues for novel aspects of virulence that will be explored in further studies.
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Actinobacillus pleuropneumoniae/genética , Algoritmos , ARN Pequeño no Traducido/genética , Análisis de Secuencia de ARN/métodos , Actinobacillus pleuropneumoniae/patogenicidad , Genoma Bacteriano , ARN Pequeño no Traducido/química , Programas Informáticos , TranscriptomaRESUMEN
This article outlines the epidemiology of psychiatric disorders in individuals with traumatic brain injury (TBI), with a focus on DSM axis I disorders diagnosed on the basis of structured clinical interview. The epidemiology of psychiatric disorders in the general population is described as a basis for understanding the disorders that occur before and after TBI. For each disorder category, including mood disorders, anxiety disorders, acute stress disorder, posttraumatic stress disorder (PTSD), substance use disorders, psychotic disorders, eating disorders, somatoform disorders, and adjustment disorders, the evidence from retrospective, cross-sectional and prospective studies is reviewed, showing the frequency, time course, and predictors of the disorders. Studies show elevated rates of depressive and anxiety disorders after TBI, most commonly major depressive disorder and PTSD, usually emerging in the first year postinjury but with delayed onset in severe injury cases. Although individuals with a preinjury history are more likely to develop these disorders, the nature of the disorders may change after injury, and novel psychiatric disorders are also common. Even though the frequency of anxiety disorders diminishes over the years postinjury, depressive disorders are more persistent during postinjury years. Substance use-while high before injury-declines after injury. The frequency of psychotic, eating, somatoform, and adjustment disorders do not exceed population rates.
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Trastornos de Ansiedad/epidemiología , Lesiones Traumáticas del Encéfalo/psicología , Trastorno Depresivo Mayor/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Australia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/psicología , Factores de TiempoRESUMEN
Antimicrobials have been in use for many thousands of years in a variety of formats. In this article, I trace how we have moved from ingenious use of agents available in the environment to chemically engineered agents.
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Antibacterianos/historia , Antibacterianos/uso terapéutico , Animales , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Historia Antigua , Historia Medieval , HumanosRESUMEN
BACKGROUND: This study prospectively examined the relationship between preinjury, injury-related, and postinjury factors and posttraumatic stress disorder (PTSD) following moderate to severe traumatic brain injury (TBI). METHOD: Two hundred and three participants were recruited during inpatient admission following moderate to severe TBI. Participants completed an initial assessment soon after injury and were reassessed at 3, 6, and 12 months, 2, 3, 4, and 5 years postinjury. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-fourth edition was used to diagnose pre- and postinjury PTSD and other psychiatric disorders. The Glasgow Outcome Scale-Extended (GOSE) and the Quality of Life Inventory (QOLI) were used to evaluate functional and psychosocial outcome from 6 months postinjury. RESULTS: The frequency of PTSD ranged between 0.5 and 9.4% during the 5-year period, increasing throughout the first 12 months and declining thereafter. After controlling for other predictors, shorter posttraumatic amnesia duration (odds ratio = 0.96, 95% CI = 0.92-1.00), other concurrent psychiatric disorder (odds ratio = 14.22, 95% CI = 2.68-75.38), and lower GOSE (odds ratio = 0.38, 95% CI = 0.20-0.72) and QOLI scores (odds ratio = 0.97, 95% CI = 0.95-0.97) were associated with greater odds of having injury-related PTSD. DISCUSSION: The results of this study indicate that while shorter posttraumatic amnesia duration is associated with PTSD, greater TBI severity does not prevent PTSD from evolving. Patients with PTSD experienced high rates of psychiatric comorbidity and poorer functional and quality of life outcomes after TBI. CONCLUSION: There is a need to direct clinical attention to early identification and treatment of PTSD following TBI to improve outcomes.
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Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Adolescente , Adulto , Anciano , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida/psicología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Adulto JovenRESUMEN
PURPOSE: This study aimed to delineate epidemiology of infecting microorganism genus in first-time revision knee arthroplasty for indication of periprosthetic joint infection in England and Wales using linked registry data. METHODS: From the National Joint Registry database for England and Wales, a consecutive series of primary knee arthroplasties performed between April 2003 and January 2014 that went on to have a revision for periprosthetic infection were identified (n = 2810). Each case was then linked to microbiology data held by Public Health England in order to identify infecting microorganism at time of revision surgery established from intra-operative cultures. Following data linkage, 403 culture results at time of revision surgery were identified in a group of 331 patients. The demographic characteristics of five microorganism groups were compared: pure staphylococcus (single genus), pure streptococcus (single genus), other gram-positive infections (single genus), gram-negative infections (single genus) and mixed genus infections. RESULTS: Staphylococcus species was the most common organism genus isolated after revision of a primary implant for infection and present in 72 % of cases overall (71.3 % of patients with a single-genus infection and 76.8 % of patients with mixed genus infection). A pure staphylococcal infection was present in 59 % of all cases. A single-genus infection was responsible for infection in 83.1 % of cases, and mixed genera were responsible in 16.9 % of cases. A significant difference was observed for mean age at primary procedure in the cohort of patients where there was an isolated pure streptococcal infection (73.2 years) when compared to gram-negative infections (65.0 years). No other significant differences were observed between microorganism groups in terms of BMI, gender, ASA grade, indication for primary procedure and primary implant characteristics. CONCLUSION: Staphylococci were the most commonly isolated organism species responsible for periprosthetic infection of primary arthroplasty in England and Wales. This information can be used by surgeons to benchmark and audit their own practice against national, publicly available data. Furthermore, this study has shown that even when using the largest national databases available, there is a substantial volume of missing data. Antimicrobial resistance represents a growing clinical problem with significant health and social costs. In order to counteract this threat, this study would advocate the consolidation of national microbial data in order to guide effective strategies towards targeting and combating the threat of antimicrobial resistance. LEVEL OF EVIDENCE: IV.
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Artroplastia de Reemplazo de Rodilla , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Prótesis de la Rodilla/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Infecciones Relacionadas con Prótesis/epidemiología , Sistema de Registros , Gales/epidemiologíaRESUMEN
PURPOSE: This study examined a cohort of primary knee arthroplasties revised for peri-prosthetic infection to (1) determine whether the microorganisms isolated by sampling (up to 6 months pre-operatively) are representative of the microorganisms encountered at the time of knee revision, (2) determine whether the antibiotic sensitivity profiles of matching organisms correlate and (3) determine whether the proportion of organism and antibiotic sensitivity matches is influenced by the type of infection, timing of sample collection and the type of microorganism isolated. METHODS: From the National Joint Registry database for England and Wales, a consecutive series of primary knee arthroplasties performed between 2003 and 2014 that went on to have a revision for peri-prosthetic infection were identified. Each case was then linked to a national microbiology database held by Public Health England. Following data linkage, intra-operative and pre-operative cultures were identified and compared in a group of 75 patients. RESULTS: Pre-operative genus matched intra-operative genus in 56 of 75 cases (75 %). Of those 56, the corresponding antimicrobial sensitivities matched in 37 (66 % of cases). Overall, 37 of 75 cases (49 %) matched for both microorganism and antimicrobial sensitivity. The proportion of matches was highest in the pure Staphylococcal genus infections (genus match 88 %, sensitivity match 62 %, genus and sensitivity match 55 %) and lowest in those patients with mixed organism infections (genus match 29 %, sensitivity match 14 %). CONCLUSION: Pre-operative joint sampling obtained by either aspiration or tissue biopsy is advocated in cases where peri-prosthetic infection is suspected and provides the only means of determining infecting organism prior to revision. Overall, only half of all pre-operative cultures matched completely the findings of intra-operative samples in terms of both the microorganism(s) encountered and their corresponding antimicrobial sensitivity profile. Clinicians should be vigilant regarding the possibility of the patient acquiring further microorganisms or the development of new antibiotic resistance by the time of revision, especially in historic pre-operative cultures. Broad spectrum antibiotic therapies should therefore be employed until final microorganisms and antimicrobial sensitivities are confirmed from intra-operative samples. LEVEL OF EVIDENCE: IV.
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Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla/microbiología , Cuidados Preoperatorios , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Técnicas de Tipificación Bacteriana , Biopsia , Estudios de Cohortes , Femenino , Humanos , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/microbiología , Sistema de Registros , Reoperación , Estudios Retrospectivos , Succión , Reino UnidoRESUMEN
BACKGROUND: Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare. OBJECTIVES: We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP. METHODS: A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1ß), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination. RESULTS: Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p<0.001). The area under the receiver operator characteristic curve for IL-1ß was 0.81; IL-8, 0.74; MMP-8, 0.76; MMP-9, 0.79 and HNE, 0.78. A combination of IL-1ß and IL-8, at the optimal cut-point, excluded VAP with a sensitivity of 100%, a specificity of 44.3% and a post-test probability of 0% (95% CI 0% to 9.2%). CONCLUSIONS: Low BALF IL-1ß in combination with IL-8 confidently excludes VAP and could form a rapid biomarker-based rule-out test, with the potential to improve antibiotic stewardship.
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Líquido del Lavado Bronquioalveolar/química , Citocinas/metabolismo , Neumonía Asociada al Ventilador/diagnóstico , Biomarcadores/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neumonía Asociada al Ventilador/metabolismo , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: Most studies of quality-of-life (QoL) after traumatic brain injury (TBI) reveal a largely negative picture, yet some survivors show positive changes (PC). Understanding PC in QoL may assist clinicians in facilitating post-injury adjustment. This study aimed to prospectively explore changes in QoL from pre- to post-injury, identify those with PC and examine predictive and associated factors. METHODS: Ninety-five participants, recruited from consecutive admissions to a rehabilitation hospital, were prospectively assessed at least once over the first 4 years post-injury. Measures of QoL, psychiatric disorders, coping style and psychosocial outcome were administered at each assessment. RESULTS: Participants' mean QoL was in the average range pre-injury and at follow-up. A third demonstrated PC post-injury, which tended to remain stable. PC participants tended to rate their relatives as of greater importance than other participants, but did not rate their health as high. Group membership was not predicted by pre-injury demographic or injury factors, but it was significantly associated with psychosocial and functional outcome. CONCLUSIONS: Even after a significant brain injury, some individuals show sustained improved QoL. Factors such as lack of 'good old days' bias and increased value placed on family may have important clinical utility.
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Adaptación Psicológica , Lesiones Encefálicas/psicología , Calidad de Vida , Sobrevivientes/psicología , Logro , Adolescente , Adulto , Anciano , Australia/epidemiología , Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Satisfacción Personal , Factores Socioeconómicos , Sobrevivientes/estadística & datos numéricosRESUMEN
A novel actinomycete, strain N1286(T), isolated from a lung transplant patient with a pulmonary infection, was provisionally assigned to the genus Nocardia. The strain had chemotaxonomic and morphological properties typical of members of the genus Nocardia and formed a distinct phyletic line in the Nocardia 16S rRNA gene tree. Isolate N1286(T) was most closely related to Nocardia farcinica DSM 43665(T) (99.8% gene sequence similarity) but could be distinguished from the latter by the low level of DNA-DNA relatedness. These strains were also distinguishable on the basis of a broad range of phenotypic properties. It is concluded that strain N1286(T) represents a novel species of the genus Nocardia for which the name Nocardia kroppenstedtii sp. nov. is proposed. The type strain is N1286(T) (â=âDSM 45810(T)â=âNCTC 13617(T)).
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Enfermedades Pulmonares/microbiología , Nocardia/clasificación , Filogenia , Técnicas de Tipificación Bacteriana , ADN Bacteriano/genética , Ácidos Grasos/química , Humanos , Trasplante de Pulmón , Datos de Secuencia Molecular , Nocardia/genética , Nocardia/aislamiento & purificación , Hibridación de Ácido Nucleico , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Vitamina K 2/análogos & derivados , Vitamina K 2/químicaRESUMEN
OBJECTIVE: To examine the influence of self-reported preinjury coping on postinjury coping, psychosocial functioning, emotional functioning, and quality of life at 1 year following traumatic brain injury (TBI). SETTING: Inpatient hospital and community. PARTICIPANTS: One hundred seventy-four participants with TBI. DESIGN: Prospective, longitudinal design. Participants were assessed at 5 time points: after emerging from posttraumatic amnesia, and at 6, 12, 24, and 36 months postinjury. MAIN MEASURES: Coping Scale for Adults-Short Version; Quality of Life Inventory; Sydney Psychosocial Reintegration Scale; Hospital Anxiety and Depression Scale. RESULTS: High preinjury use of nonproductive coping style predicted high use of nonproductive coping, more anxiety, and lower psychosocial functioning at 1 year postinjury. Increased use of nonproductive coping and decreased use of productive coping predicted poorer psychosocial outcome at 1 year post-TBI. Use of both productive and nonproductive coping decreased in the first 6 to 12 months post-TBI relative to preinjury. Unlike productive coping, nonproductive coping reached preinjury levels within 3 years postinjury. CONCLUSION: The findings support identification of individuals at risk of relying on nonproductive coping and poorer psychosocial outcome following TBI. In addition, the results emphasize the need to implement timely interventions to facilitate productive coping and reduce the use of nonproductive coping in order to maximize favorable long-term psychosocial outcome.
Asunto(s)
Adaptación Fisiológica , Adaptación Psicológica , Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/psicología , Calidad de Vida , Adulto , Ansiedad/epidemiología , Australia/epidemiología , Depresión/epidemiología , Femenino , Escala de Coma de Glasgow , Humanos , Acontecimientos que Cambian la Vida , Estudios Longitudinales , Masculino , Estudios Prospectivos , Análisis de Regresión , Autoinforme , Encuestas y CuestionariosRESUMEN
Background Although individuals with acquired brain injury (ABI) may be vulnerable to cyberscams, the lack of existing measures documenting cybersafety behaviours in people with ABI limits our understanding of ABI-specific risk factors, the frequency of this problem, and the ability to evaluate evidence-based interventions. The CyberABIlity Scale was developed to assess vulnerability in people with ABI via self-rated statements and practical scam-identification tasks. This study aimed to develop and refine The CyberABIlity Scale through feedback from clinicians and people with ABI. Methods Scale feedback was collected via three rounds of clinician surveys (n = 14) using Delphi methods and two rounds of cognitive interviews with participants with ABI (n = 8). Following each round, feedback was quantitatively and qualitatively summarised, and revisions were made accordingly. Results Key revisions included removing 12 items deemed irrelevant. Instructions and rating scales were revised to improve clarity. Cognitive interviews identified 15 comprehension errors, with further revisions made to support response clarity for participants with ABI. Clinicians and participants with ABI endorsed the content and face validities of The CyberABIlity Scale . Conclusions Following further validation, The CyberABIlity Scale has the potential to be an effective screening measure for online vulnerability for people with ABI within clinical and research settings.