The effect of injury diagnosis on illness perceptions and expected Postconcussion Syndrome and Posttraumatic Stress Disorder Symptoms

Objective: To determine if systematic variation of diagnostic terminology (i.e. concussion, minor head injury [MHI], mild traumatic brain injury [mTBI]) following a standardized injury description produced different expected symptoms and illness perceptions. We hypothesized that worse outcomes would be expected of mTBI, compared to other diagnoses, and that MHI would be perceived as worse than concussion. Method:108 volunteers were randomly allocated to conditions in which they read a vignette describing a motor vehicle accident-related mTBI followed by: a diagnosis of mTBI (n=27), MHI (n=24), concussion (n=31); or, no diagnosis (n=26). All groups rated: a) event ‘undesirability’; b) illness perception, and; c) expected Postconcussion Syndrome (PCS) and Posttraumatic Stress Disorder (PTSD) symptoms six months post injury. Results: On average, more PCS symptomatology was expected following mTBI compared to other diagnoses, but this difference was not statistically significant. There was a statistically significant group effect on undesirability (mTBI>concussion & MHI), PTSD symptomatology (mTBI & no diagnosis>concussion), and negative illness perception (mTBI & no diagnosis>concussion). Conclusion: In general, diagnostic terminology did not affect anticipated PCS symptoms six months post injury, but other outcomes were affected. Given that these diagnostic terms are used interchangeably, this study suggests that changing terminology can influence known contributors to poor mTBI outcome

A critical evaluation of written discharge advice for people with mild traumatic brain injury: What should we be looking for?

Objective: To formally evaluate the written discharge advice for people with mild traumatic brain injury (mTBI). Methods: Eleven publications met the inclusion criteria: (1) intended for adults; (2) ≤two A4 pages; (3) published in English; (4) freely accessible; and (5) currently used (or suitable for use) in Australian hospital emergency departments or similar settings. Two independent raters evaluated the content and style of each publication against established standards. The readability of the publication, the diagnostic term(s) contained in it and a modified Patient Literature Usefulness Index (mPLUI) were also evaluated. Results: The mean content score was 19.18 ± 8.53 (maximum = 31) and the mean style score was 6.8 ± 1.34 (maximum = 8). The mean Flesch-Kincaid reading ease score was 66.42 ± 4.3. The mean mPLUI score was 65.86 ± 14.97 (maximum = 100). Higher scores on these metrics indicate more desirable properties. Over 80% of the publications used mixed diagnostic terminology. One publication scored optimally on two of the four metrics and highly on the others. Discussion: The content, style, readability and usefulness of written mTBI discharge advice was highly variable. The provision of written information to patients with mTBI is advised, but this variability in materials highlights the need for evaluation before distribution. Areas are identified to guide the improvement of written mTBI discharge advice

The effect of varying diagnostic terminology within patient discharge information on expected mild traumatic brain injury outcome

This study aimed to determine if systematic variation of the diagnostic terminology embedded within written discharge information (i.e., concussion or mild traumatic brain injury, mTBI) would produce different expected symptoms and illness perceptions. We hypothesized that compared to concussion advice, mTBI advice would be associated with worse outcomes. Sixty-two volunteers with no history of brain injury or neurological disease were randomly allocated to one of two conditions in which they read a mTBI vignette followed by information that varied only by use of the embedded terms concussion (n = 28) or mTBI (n = 34). Both groups reported illness perceptions (timeline and consequences subscale of the Illness Perception Questionnaire-Revised) and expected Postconcussion Syndrome (PCS) symptoms 6 months post injury (Neurobehavioral Symptom Inventory, NSI). Statistically significant group differences due to terminology were found on selected NSI scores (i.e., total, cognitive and sensory symptom cluster scores (concussion > mTBI)), but there was no effect of terminology on illness perception. When embedded in discharge advice, diagnostic terminology affects some but not all expected outcomes. Given that such expectations are a known contributor to poor mTBI outcome, clinicians should consider the potential impact of varied terminology on their patients

Progardes Desmanthus - an update

Introduction: Some 35,000 ha has now been sown to ProgardesTM Desmanthus since its launch in 2012. It has been sown primarily across Queensland, but also into northern New South Wales and the Northern Territory. The targeted soil types have been Vertosols and related, mainly neutral to alkaline clay soils in semiarid environments. Progardes is a blend of typically 5 PBR registered varieties of Desmanthus (cv JCU 1-5). Update information: Four new cultivars, JCU 6-9, are in seed increase. Agrimix Pastures and James Cook University are evaluating and selecting new accessions of Desmanthus, particularly those that have persisted through drought and grazing. Many of these are being evaluated across inland northern Australia through a CRC supported project. Cultivar JCU 2 has recently been shown to access soil moisture to >1.2 m and be productive in NSW. A Desmanthus breeding program that includes intraspecific and interspecific crosses is well advanced, with crosses undergoing field evaluation. There is interest also in other species to complement Progardes including new varieties of Stylosanthes, Clitoria and Centrosema that show considerable promise. Research regarding new advanced strains of Rhizobia specifically for Progardes are also being undertaken, including isolating effective strains from the native legume Neptunia and from adventive and cultivated Desmanthus plants. Nodules from these plants have been collected from a wide geographic area across northern Queensland, particularly from semiarid neutral to alkaline soils. It’s expected that these new strains from the native environment will be resilient to both abiotic and edaphic environmental factors and particularly to heat and alkalinity. Already some new strains have scored better in terms of plant growth than the existing recommended commercial inoculant. Investigations regarding in vitro and in vivo antimethanogenic properties of JCU Desmanthus cultivars have or are currently being undertaken. Formal and informal producer paired paddock trials are investigating nutritive attributes and botanical composition of pastures with and without ProgardesTM . This work is expected to confirm liveweight gains in the order of an additional 40 kg/head per year over grass alone pastures and confirm the value of sown legumes for beef cattle production systems

Resilience and other possible outcomes after mild traumatic brain injury: A systematic review

The relation between resilience and mild traumatic brain injury (TBI) outcome has been theorized but empirical studies have been scarce. This systematic review aimed to describe the research in this area. Electronic databases (Medline, CINAHL, PsychINFO, SPORTdiscus, and PILOTS) were searched from inception to August 2015 for studies in which resilience was measured following TBI. The search terms included ‘TBI’ ‘concussion’ ‘postconcussion’ ‘resilience’ and ‘hardiness’. Inclusion criteria were peer reviewed original research reports published in English, human participants aged 18 years and over with brain injury, and an accepted definition of mild TBI. Hand searching of identified articles was also undertaken. Of the 71 studies identified, five studies were accepted for review. These studies were formally assessed for risk of bias by two independent reviewers. Each study carried a risk of bias, most commonly a detection bias, but none were excluded on this basis. A narrative interpretation of the findings was used because the studies reflected fundamental differences in the conceptualization of resilience. No studies employed a trajectory based approach to measure a resilient outcome. In most cases, the eligible studies assessed trait resilience with a scale and used it as a predictor of outcome (postconcussion symptoms). Three of these studies showed that greater trait resilience was associated with better mild TBI outcomes (fewer symptoms). Future research of the adult mild TBI response that predicts a resilient outcome is encouraged. These studies could yield empirical evidence for a resilient, and other possible mild TBI outcomes