Sleep difficulties and sustained attention following traumatic brain injury and research portfolio

Objectives: The audit sought to investigate and characterise general practitioner referrals to the Riverside locality Direct Access Clinical Psychology Service, in the West of Scotland. The audit aimed to describe any variations in general practice referral rates, and to consider why such variation might be occurring in terms of practice characteristics (primary care CPN support and single-handed practices) and referral characteristics (demographic and referral problem of patients). Design: A retrospective analysis of general practice referrals to the Riverside Direct Access Clinical Psychology Service was conducted. Setting: An out-patient Direct Access Clinical Psychology Department in the West Sector of Glasgow, which covers three localities. One of these localities, Riverside, was the focus of this audit. Cases: Four hundred and eighty patients consecutively referred from GPs to the Riverside locality Direct Access Clinical Psychology Department between the 1st of January 2004 - 31st of December 2004. Results: Four hundred and eighty referrals were received by the psychology department from 51 general practices. Of these practices, 23 were members of the two locality LHCCs and accounted for 79.3% (n=381) of referrals. There was a high degree of variation in the number and rate of referrals by individual practices. There were no significant differences between practice characteristics in groups of practices that referred more or less frequently. Fifty five percent (n=266) of all general practice referrals were female, and forty five percent (n=214) were male. The median age of referrals was 35 years (the mean age was 36.1). According to Carstairs deprivation categories clients most frequently fell into category four (n= 126, 29.4%) which is an area of no deprivation and band six (n=119, 27.7%) which is an area of medium deprivation (McLoone, 2001). The referral reasons most frequently used in GPs letters were the general categories of anxiety (n=143, 29.8%), and depression / low mood (n=143, 29.8%). Where more specific categories were described, the most frequent primary problems were stress/ coping difficulties (n=23, 4.8%) and panic (n= 20, 4.2%). There were no obvious differences in these referral characteristics between groups of practices that referred higher and lower than the median referral rate. Conclusions: The majority of referrals came from practices within the Riverside locality. There was a wide variation of referral rates. This variation in referral rates was not explained by the presence of the practice characteristics examined in this audit. In line with the results of other audits the broad referral categories of anxiety and depression/low mood were utilised most frequently by referring GPs. However, looking at more specific problems that were frequently referred may be more useful in terms of future service provision. Implications for future service delivery, allocation of resources and staff training, which take account of and meet the needs of general practice referrals, were discussed. Limitations of this study and ideas for further investigation were also discussed along with a dissemination strategy for these data

Do sleep difficulties exacerbate deficits in sustained attention following traumatic brain injury?

Sustained attention has been shown to be vulnerable following traumatic brain injury (TBI). Sleep restriction and disturbances have been shown to negatively affect sustained attention. Sleep disorders are common but under-diagnosed after TBI. Thus, it seems possible that sleep disturbances may exacerbate neuropsychological deficits for a proportion of individuals who have sustained a TBI. The aim of this prospective study was to examine whether poor sleepers post-TBI had poorer sustained and general attentional functioning than good sleepers post-TBI. Retrospective subjective, prospective subjective, and objective measures were used to assess participants’ sleep. The results showed that the poor sleep group had significantly poorer sustained attention ability than the good sleep group. The differences on other measures of attention were not significant. This study supports the use of measures that capture specific components of attention rather than global measures of attention, and highlights the importance of assessing and treating sleep problems in brain injury rehabilitation