Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221

Validation de données issues d’un réseau de capteurs sans fil : application à l’alerte anti-gel

International audienceRecent researches have shown the ability of Wireless Sensor Networks (WSN) to collect real-time data acquired by sensors distributed throughout a vineyard or a watershed area. Due to the emergence of new technologies, these researches focused on the technical and practical aspects of deployed solutions. They mainly focused on i) networks architecture, ii) communication protocols, iii) energy savings and iv) the ability to produce relevant real-time information. Few studies have focused on the quality of data collected by WSN. However, considering the cost of installation and the required maintenance for such devices, the deployment of a new WSN on a vineyard raises the question of data consistency and/or data redundancy. The objective of this study is to propose and test two methods of data processing coming from a WSN recently deployed over a commercial vineyard. The first method aims at testing data consistency in order to implement possible corrective actions on the sensors. The second method aims at identifying one or more representative sites of a more or less extensive area. Both methods have been implemented on temperature data acquired through a WSN set up in 2012 on a vineyard in the Bordeaux region. The WSN consisted of 54 temperature sensors. 51 sensors were positioned on a group of six contiguous fields with a total area of 11 ha. 3 sensors were positioned on three independent fields located at a distance of about 1 km from the main WSN. Each sensor records temperature every 10 min. A period of measurement stretching from April 4th to May 15th was considered. This period is interesting because frost can cause significant yield losses. This is also a time when preventive actions (water spray) can be quickly implemented. The study of WSN information aimed at i) analyzing the consistency of measured temperature by comparing it with a reference weather station (national french network) and ii) analyzing the covariance of 54 temperature measurements over time. The results showed that it is possible i) to identify and eliminate outliers corresponding to the logistical constraints of implementation during the installation of sensors, ii) to find different sets of fields corresponding to different climatic conditions iii) to identify homogeneous zones of reference for triggering a possible anti-frost alert.De récentes recherches ont montré la possibilité de proposer des Réseaux de Capteurs Sans Fil (RCSF) capables de collecter, en temps réel, des données acquises par des capteurs répartis sur tout un vignoble ou tout un bassin versant. S’agissant de technologies nouvelles et en constante évolution, ces recherches se sont focalisées sur les aspects techniques des solutions déployées. Elles portent en particulier sur i) l’architecture même des réseaux, ii) les protocoles de communication, iii) l’autonomie énergétique et iv) l’aptitude à produire une information en temps réel. Peu d’études se sont intéressées à la qualité des données renvoyées. Pourtant, compte-tenu du coût d’installation et des contraintes de maintenance, le déploiement d’un RCSF sur un nouveau domaine pose rapidement des questions relatives à la cohérence et/ou à la redondance des données collectées. L’objectif de cette étude est de proposer et tester deux méthodes de traitement de données issues d’un RCSF récemment mis en place. La première méthode vise à tester la cohérence des données afin de mettre en oeuvre d’éventuelles mesures correctives sur les capteurs. La deuxième méthode vise à identifier un ou plusieurs sites représentatifs d’une zone plus ou moins étendue. Ces deux méthodes ont été mises en oeuvre sur les données de température acquises par un RCSF installé en 2012 sur un domaine viticole de la région de Bordeaux. Le RCSF était constitué de 54 capteurs de température. 51 capteurs ont été positionnés sur un groupe de 6 parcelles contigües d’une surface de 11 ha. 3 capteurs ont été installés sur trois parcelles isolées situées à environ 2 km. Chaque capteur renvoie la mesure de température toutes les 10 min. Une période de mesure du 4 Avril au 15 mai a été considérée. Cette période est intéressante car le risque de gel y peut provoquer des pertes importantes de rendement. C’est une période où des mesures préventives (aspersion d’eau) peuvent rapidement être mises en oeuvre. L’analyse des données du réseau a consisté i) à analyser la cohérence des données avec une station de météo-France proche et ii) à analyser la covariance des 54 mesures de température dans le temps. Les résultats ont permis i) de mettre en évidence et d’éliminer des données « atypiques » correspondant à des contraintes logistiques de mise en oeuvre lors de l’installation des capteurs, ii) de retrouver les différents groupes de parcelles correspondant à des situations climatiques légèrement différentes, iii) de mettre en évidence des zones homogènes de référence pour le déclenchement d’une éventuelle alerte anti-gel

Is prolonged infusion of piperacillin/tazobactam and meropenem in critically ill patients associated with improved pharmacokinetic/pharmacodynamic and patient outcomes? An observation from the Defining Antibiotic Levels in Intensive care unit patients (DALI) cohort

Objectives: We utilized the database of the Defining Antibiotic Levels in Intensive care unit patients (DALI) study to statistically compare the pharmacokinetic/pharmacodynamic and clinical outcomes between prolonged- infusion and intermittent-bolus dosing of piperacillin/tazobactam and meropenem in critically ill patients using inclusion criteria similar to those used in previous prospective studies. Methods: This was a post hoc analysis of a prospective, multicentre pharmacokinetic point-prevalence study (DALI), which recruited a large cohort of critically ill patients from 68 ICUs across 10 countries. Results: Of the 211 patients receiving piperacillin/tazobactam and meropenem in the DALI study, 182 met inclusion criteria. Overall, 89.0% (162/182) of patients achieved the most conservative target of 50% fT 65MIC (time over which unbound or free drug concentration remains above the MIC). Decreasing creatinine clearance and the use of prolonged infusion significantly increased the PTA for most pharmacokinetic/pharmacodynamic targets. In the subgroup of patients who had respiratory infection, patients receiving \u3b2-lactams via prolonged infusion demonstrated significantly better 30 day survival when compared with intermittent-bolus patients [86.2% (25/29) versus 56.7% (17/30); P=0.012]. Additionally, in patients with a SOFA score of 65 9, administration by prolonged infusion compared with intermittent-bolus dosing demonstrated significantly better clinical cure [73.3% (11/15) versus 35.0% (7/20); P=0.035] and survival rates [73.3% (11/15) versus 25.0% (5/20); P=0.025]. Conclusions: Analysis of this large dataset has provided additional data on the niche benefits of administration of piperacillin/tazobactam and meropenem by prolonged infusion in critically ill patients, particularly for patients with respiratory infections. \ua9 The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

International audienceBackground: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221