The experience of PTSD symptoms in individuals with traumatic brain injury

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Evaluation of depression in patients with heart failure

Background: Despite advances in medical therapy heart failure consists a prevalent debilitating disease of poor prognosis, strongly associated with high mortality and morbidity rates. On the same time, depression rates are higher in patients with heart failure than in the general population. Depression may be underdiagnosed and consequently undertreated in the patients, as symptoms can often be similar in the two disease states. Purpose: The purpose of the present study was to explore the frequency of occurrence of depression in patients with heart failure and to evaluate possible precipitating factors. Method and material : Study sample consisted of 139 patients with heart failure, who were hospitalized or visited outpatients’ clinics in two major hospitals in Athens. Collection of data was performed using the Zung Self-Rating Depression Scale. Statistical analyses (Student’s t-test, One-way ANOVA) were conducted using the Statistical Package for Social Sciences 13.0 (SPSS, Chicago, Il, USA). Results: 110 patients (79.1%) were male and only 29 patients were female, over the age of 40. 71.9% were outpatients, 20.2% were hospitalized in the departments of cardiology, while 7.9% were I.C.U. patients. Analysis of data showed that 34.6% of patients scored lower than 40 in Zung Self-Rating Scale, indicating absence of depression, 27.3% scored 40 to 47, indicating mild depression, 20.9% scored 48 to 55, indicating moderate depression, and 17.2% scored over 56, indicating severe depression. More specifically, it was found that, regarding patients’ gender and age, women (p=0.001) and patients over the age of 60 (p=0.001) experienced higher levels of depression, while regarding educational background patients who received only basic education may have been more prone to depression (p=0.05, non-significant). In addition, higher levels of depression were observed for those retired (p=0.028), those living in metropolitan areas (p=0.021), patients at 2nd or 3rd stage of heart failure p<0.001), patients who had been diagnosed for over 1 year (p=0.032), as well as those who reported that were less informed about the extent of their condition (p=0.001). Conclusions: The majority of patients with heart failure experience various levels of depression. The main precipitating factors are age, gender , educational and economic status, place of residence, amount of receiving information as well as the stage and the onset of the disease. Nurses and physicians must act towards id entification, assessment and management of depression in this clinical population

What Greek mothers know about evaluation and treatment of fever in children: An interview study

Background Fever is one of the most common symptoms in childhood. Mothers’ insufficient knowledge about its evaluation and treatment frequently leads to excessive fear and anxiety. Objectives To explore mothers’ knowledge concerning management of fever in their children, at home. Design Descriptive, correlational. Settings An emergency department of a pediatric hospital. Participants A total of 327 mothers with febrile children randomly selected in the waiting room. Methods Data collection was based on interviews by using a questionnaire which was specifically developed for this study. Results Almost one out of three mothers (32.4%) evaluated fever as a temperature between 37–38 °C and the 38.1% of them considered that side effects could be a result of these temperatures. The majority of the mothers (73.7%) administered antipyretics at body temperatures of 37–38.5 °C, usually without a medical instruction (49.2%). Younger mothers with lower education levels and those who admitted to hospital for the first time with children less than 12 months of age showed the poorest level of Knowledge about fever evaluation and treatment. Conclusions Educational interventions by health care professionals aiming at educating young mothers with a low educational level and those with a child younger than 12 months old who seek medical attention at hospital, for the first time, are needed to dispel misconceptions about fever and to promote the appropriate management of the febrile child

Ring block with levobupivacaine 0.25% and paracetamol vs. paracetamol alone in children submitted to three different surgical techniques of circumcision: A prospective randomized study

Background: circumcision in children is a painful procedure. We aim compare the intraoperative and postoperative efficacy of three different surgical procedures of the ring block using levobupivacaine 0.25% combined with rectal paracetamol as opposed to rectal paracetamol alone. Methods: the study included 106 boys scheduled to undergo circumcision. The patients were randomly assigned within two groups to receive either ring block with levobupivacaine 0.25% and rectal paracetamol 30 mg/kg, or rectal paracetamol 30 mg/kg alone. The following surgical procedures were performed: sutureless proctoplasty, preputial plasty, and conventional circumcision. The efficacy of intraoperative analgesia was estimated on the basis of increases in heart rate and mean arterial pressure. Postoperatively, children were assessed for pain, pain-free (PF) period, and the total doses of analgesics administered during hospitalization, on the day after discharge, and on the first and second postoperative days. Results: all children remained stable during anesthesia. Postoperatively, the mean pain score did not show statistical differences between the groups. Children who received combined analgesia had a longer PF period (P < 0.001). However, the total doses of paracetamol administered during the observational period showed no differences. Children undergoing sutureless prepuceplasty received lower doses of paracetamol postoperatively (P < 0.001). Conclusion: subcutaneous ring block either with levobupivacaine 0.25% plus rectal paracetamol or rectal paracetamol alone provides adequate intraoperative and postoperative analgesia in circumcised children. However, combined analgesia allows a longer PF period. The need for less analgesic administration in children undergoing sutureless prepuceplasty could mean that the circumcision techniques might be a mitigating factor in terms of pain

Making sense of teacher agency for change with social and epistemic network analysis

Reference to teachers as agents of change has become commonplace in the education literature, including change toward more inclusive practice in response to the changing demographic of schooling. Yet, little is known about how teacher agency relates to (1) their understanding of, and commitment to any given change agenda and (2) the institutional and social structures through which they are able to access knowledge and resources within and beyond their schools. This study combined social and epistemic network analysis to examine teachers’ understanding of change and their sense of agency as they use their social networks to mobilise support for furthering change that matters to them. Our study is the first to apply this learning analytic approach in a real setting context. We used theories of teacher agency and inclusive pedagogy to interpret teachers’ social interactions in light of the extent to which they seek to make a difference toward greater inclusion. We collected data with an online log completed by teachers and other staff in two schools in Sweden over 6 months. The findings suggest that teachers understanding of change is embedded in their day-to-day activities such as student support, lesson planning, improvement of programs, and working conditions. Teachers tend to exercise agency toward inclusion when they seek to support student learning and well-being. When teachers act as agents of change, their social networks are bigger, more diverse and more collaborative than in situations in which they act as role implementers. We discuss substantive and methodological implications of these findings

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

Purpose To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.status: publishe

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed