Adapted group yoga intervention, An: the lived experience of individuals with chronic traumatic brain injury

2017 Summer.Includes bibliographical references.The purpose of this qualitative phenomenological study was to explore the experiences of individuals with chronic traumatic brain injury (TBI) who participated in an adapted group yoga intervention. Participants attended one-hour yoga sessions twice a week for eight weeks and described their experiences through focus groups and individual interviews. Data accumulated were analysed using a coding process to generate themes of what experiences occurred, how experiences occurred, and why experiences occurred. Participants described experiencing the yoga intervention as a progression from initially expecting physical benefits from yoga to feeling safe and comfortable in the yoga intervention classes and among fellow participants, and to experiencing physical, emotional, and cognitive changes. Participants stated that these experiences carried over into their daily lives, positively impacting their health maintenance and social participation. Participants attributed their experiences to various structural strategies of the intervention including commonalities among participants, the instructor's dual knowledge of yoga and therapeutic rehabilitation, as well as the adaptability of yoga to their personal needs. Additionally, participant experiences were attributed to a re-conceptualization of what yoga should look and feel like, enhanced body awareness, and feeling supported. The fact that the participants generally expressed beneficial outcomes indicates the need to further research adapted yoga interventions for the population of individuals with chronic TBI

Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with e coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: A randomized clinical trial

IMPORTANCE Extended-spectrum β-lactamases mediate resistance to third-generation cephalosporins (eg, ceftriaxone) in Escherichia coli and Klebsiella pneumoniae. Significant infections caused by these strains are usually treated with carbapenems, potentially selecting for carbapenem resistance. Piperacillin-tazobactam may be an effective “carbapenem-sparing” option to treat extended-spectrum β-lactamase producers. OBJECTIVES To determine whether definitive therapy with piperacillin-tazobactam is noninferior to meropenem (a carbapenem) in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or K pneumoniae. DESIGN, SETTING, AND PARTICIPANTS Noninferiority, parallel group, randomized clinical trial included hospitalized patients enrolled from 26 sites in 9 countries from February 2014 to July 2017. Adult patients were eligible if they had at least 1 positive blood culture with E coli or Klebsiella spp testing nonsusceptible to ceftriaxone but susceptible to piperacillin-tazobactam. Of 1646 patients screened, 391 were included in the study. INTERVENTIONS Patients were randomly assigned 1:1 to intravenous piperacillin-tazobactam, 4.5 g, every 6 hours (n = 188 participants) or meropenem, 1 g, every 8 hours (n = 191 participants) for a minimum of 4 days, up to a maximum of 14 days, with the total duration determined by the treating clinician. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 30 days after randomization. A noninferiority margin of 5% was used. RESULTS Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the primary analysis population, 378 (99.7%) completed the trial and were assessed for the primary outcome. A total of 23 of 187 patients (12.3%) randomized to piperacillin-tazobactam met the primary outcome of mortality at 30 days compared with 7 of 191 (3.7%) randomized to meropenem (risk difference, 8.6% [1-sided 97.5% CI, − to 14.5%]; P = .90 for noninferiority). Effects were consistent in an analysis of the per-protocol population. Nonfatal serious adverse events occurred in 5 of 188 patients (2.7%) in the piperacillin-tazobactam group and 3 of 191 (1.6%) in the meropenem group. CONCLUSIONS AND RELEVANCE Among patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a noninferior 30-day mortality. These findings do not support use of piperacillin-tazobactam in this setting.</p