Support after brain tumor means different things: Family caregivers\u27 experiences of support and relationship changes

Shorter hospital stays and greater emphasis on outpatient care means that family members have the primary responsibility for supporting a person with brain tumor to manage the physical, cognitive, behavioral, and emotional effects of the illness and its treatment. Given the integral role of family caregivers, it is essential to understand their experience of the impact of brain tumor and their own support needs. Accordingly, this qualitative study aimed to investigate family caregivers\u27 experiences of support and relationship changes in the context of brain tumor. In-depth interviews were conducted with 11 family caregivers (8 spouse/partner, 3 parents) of people with malignant or benign tumor. A thematic analysis of interview transcripts identified two major themes, namely, Meanings of Support and Relationship Impacts. The Meanings of Support theme was characterized by intertwined and distinct support needs, varied expectations of support and factors influencing support expectations. The Relationship Impacts theme depicted mixed experiences of strengthened, maintained, and strained relations with the person with brain tumor. Overall, the findings highlight that there is considerable variability in caregivers\u27 experiences and expectations of support and the impact of brain tumor on relationships. The implications of these findings for the provision of caregiver support are discussed

Evaluation of brief interventions for managing depression and anxiety symptoms during early discharge period after stroke: a pilot randomized controlled trial

Background: Prevalence estimates for depression and anxiety in individuals post-stroke are approximately 33 and 29%, yet there are few effective preventive interventions. Interventions which commence pre-discharge and continue during the early post-discharge period may support individuals during the critical transition to home adjustment period. This study aimed to evaluate the efficacy of a self-management intervention and a coping skills intervention, compared to usual care, on anxiety and depression post-stroke.Methods: A pilot, three-arm randomized trial involving 33 stroke patients (coping skills: n=11, self-management: n=12, usual care: n=10) recruited from an Australian stroke unit. Both interventions were eight 1-hour weekly sessions, with the first two pre-discharge and the remainder at home; targeted both anxiety and depression; and tailored content to individuals. Primary outcome was severity of depressive and anxiety symptoms (measured using Montgomery andAsberg Depression Rating Scale and Hospital Anxiety and Depression Scale). Secondary measures were: self-efficacy, stroke knowledge, basic and extended activities of daily living, and quality of life. Outcome measures were administered at baseline, one week post-intervention, and at a three month follow-up by a blinded assessor.Results: Thirty (91%) participants completed the trial. Immediately post-intervention there was a small improvement in stroke knowledge and a small increase in depression symptoms (on one of the two measures of depression symptoms) in the coping skills group compared to usual care. These differences did not remain significant at the 3-month follow-up, nor were there any other significant differences.Conclusion: Neither a coping skills nor self-management intervention reduced anxiety nor depression symptoms early post-stroke more than usual care. Lack of statistical power may have contributed to the non-significant findings in this pilot study

A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: A single-case experimental design

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home: and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional Outcome in real life settings

Feasibility and initial efficacy of project-based treatment for people with ABI

Background: Communication impairments are common and pervasive for people a long time following acquired brain injury (ABI). These impairments have a significant impact on a person's quality of life (QOL) post‐injury. Project‐based treatment is a treatment approach that could have an impact on communication skills and QOL for people with ABI a long‐term post‐injury. This treatment is embedded in a context of meaningful activities chosen by people with ABI, whereby, as a group, they work collaboratively to achieve a tangible end product. Aims: To evaluate the feasibility and initial efficacy of project‐based treatment on improving the communication skills and QOL for people with ABI. Methods & Procedures: An exploratory controlled trial with alternate allocation of groups, and follow‐up at 6–8 weeks, was completed. Twenty‐one people with chronic ABI were recruited in groups of two to three from community settings, allocated to either a TREATMENT (n = 11) or WAITLIST group (n = 10). Participants attended a 20‐h group‐based treatment over 6 weeks where they worked towards achieving a project that helped others. To determine feasibility, four criteria were used: demand, implementation, practicality and acceptability. A range of communication and QOL outcomes was used to determine a fifth feasibility criterion, initial efficacy. Some of these criteria were additionally used to evaluate the feasibility of the outcomes. Outcomes & Results: All participants received the treatment as allocated with high attendance and no dropouts. The treatment was feasible to deliver as intended and was highly acceptable to participants. Medium and large effect sizes were found from pre‐ to post‐treatment, and from pre‐treatment to follow‐up for measures of conversation, perceived communicative ability and QOL. Conclusions & Implications: Project‐based treatment is feasible with indications of initial efficacy for both communication skills and QOL. The treatment provides a promising new approach for improving communication skills and QOL in people with chronic acquired brain injuries in the community setting

Star formation and the evolution of massive galaxies across cosmic time

This thesis investigates the evolution of massive galaxies throughout the last 11 billion years using measured stellar masses and star formation rates. Firstly, we present a study of the resolved star-forming properties of a sample of distant massive (M > 10{11} M) galaxies in the GOODS NICMOS Survey (GNS) within the redshift range 1.5 < z < 3 in order to measure the spatial location of ongoing star formation (SF). We find that the SFRs present in different regions of a galaxy reflect the already existent stellar mass density, i.e. high density regions have higher SFRs than lower density regions, on average. We find that these massive galaxies fall into three broad classifications of SF distributions. These different SF distributions increase the effective radii to z=0, by ~16 plus-minus 5 % , with little change in the Sersic index (n), with an average delta n = -0.9 plus-minus 0.9, after evolution. These results are not in agreement with the observed change in the effective radius and n between z ~2.5 and z ~0. We conclude that SF and stellar migration alone cannot account for the observed change in structural parameters for this galaxy population, implying that other mechanisms must additionally be at work to produce the evolution, such as merging. In Chapter 2, we present a study of the stellar mass growth of the progenitors of local massive galaxies at number densities of n 1.5 SF is the dominant form of stellar mass growth, while at z<1.5 mergers become the dominant form with minor mergers the dominant form of growth at z<1.0. We also explore the implication of these results on other galaxy formation processes such as the cold gas accretion rate of the progenitors of most massive galaxies over the same redshift range. We find that the gas accretion rate decreases with redshift with an average gas accretion rate of ~65 M yr{-1} over the redshift range of 1.5<z<3.0. Finally, we investigate the evolution of the properties of local massive galaxies over the redshift range 0.31.7 and transitioning to high n objects at z2.5 are passive low n systems, possibly implying that local massive galaxies were passive disk-like systems at early cosmic times

Comparison of individual, group and combined intervention formats in a randomized controlled trial for facilitating goal attainment and improving psychosocial function following acquired brain injury

To compare individual, group and combined intervention formats for improving goal attainment and psychosocial function following acquired brain injury. Design: Randomized controlled trial, waiting list controls. Participants: Thirty-five participants with a mean time of 5.29 years (standard deviation = 3.9) since acquired brain injury were randomly allocated into 6 groups involving an intervention or waiting list control condition for 1 of 3 intervention formats. Methods: Interventions were 3 h/week for 8 weeks. Formats included: group-based support (n = 12), individual occupation-based support (n = 11), and a combined group and individual support intervention (n = 12). Participant outcomes were examined at pre-, post-, and 3-month follow-up assessment on the Canadian Occupational Performance Measure, Patient Competency Rating Scale, and Brain Injury Community Rehabilitation Outcome 39 Scales. Results: Overall, the findings indicated that the individual intervention component appeared to contribute particularly to gains in performance in goal-specific areas. The combined intervention was associated with maintained gains in performance and satisfaction. However, gains in behavioural competency and psychological well-being were more likely to occur after the group and individual interventions. Conclusion: These findings generally support the efficacy of brief intervention formats following acquired brain injury, although further research is needed to examine clients’ suitability for particular interventions. Authors