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Using Multivariate Statistics

Basics of qualitative research: Grounded theory procedures and techniques

Data Mining Practical Machine Learning Tools and Techniques

Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read "60 mg"instead of "60 mg (use with caution in 'supranormal' renal function)."In the above-indicated cell, a footnote has also been added to state: "Edoxaban should be used in patients with high creatinine clearance only after a careful evaluation of the individual thromboembolic and bleeding risk."Supplementary Table 9, column 'Edoxaban', row 'Dose reduction in selected patients' (page 16). The cell should read "Edoxaban 60 mg reduced to 30 mg once daily if any of the following: creatinine clearance 15-50 mL/min, body weight <60 kg, concomitant use of dronedarone, erythromycin, ciclosporine or ketokonazole"instead of "Edoxaban 60 mg reduced to 30 mg once daily, and edoxaban 30 mg reduced to 15mg once daily, if any of the following: creatinine clearance of 30-50 mL/min, body weight <60 kg, concomitant us of verapamil or quinidine or dronedarone."

/pdf/2020-esc-guidelines-for-the-diagnosis-and-management-of-38dpic1xu8.pdf

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).

The detection of psychiatric illness by questionnaire

Objective: There is continuing controversy regarding predictors of poor outcome following mildtraumatic brain injury (mTBI). This study aimed to prospectively examine the influence of preinjuryfactors, injury-related factors, and postinjury factors on outcome following mTBI. Method: Participantswere 123 patients with mTBI and 100 trauma patient controls recruited and assessed in the emergencydepartment and followed up 1 week and 3 months postinjury. Outcome was measured in terms ofreported postconcussional symptoms. Measures included the ImPACT Post-Concussional SymptomScale and cognitive concussion battery, including Attention, Verbal and Visual memory, ProcessingSpeed and Reaction Time modules, pre- and postinjury SF-36 and MINI Psychiatric status ratings, VASPain Inventory, Hospital Anxiety and Depression Scale, PTSD ChecklistSpecific, and Revised SocialReadjustment Scale. Results: Presence of mTBI predicted postconcussional symptoms 1 week postin-jury, along with being female and premorbid psychiatric history, with elevated HADS anxiety aconcurrent indicator. However, at 3 months, preinjury physical or psychiatric problems but not mTBImost strongly predicted continuing symptoms, with concurrent indicators including HADS anxiety,PTSD symptoms, other life stressors and pain. HADS anxiety and age predicted 3-month PCS in themTBI group, whereas PTSD symptoms and other life stressors were most significant for the controls.Cognitive measures were not predictive of PCS at 1 week or 3 months. Conclusions: Given the evidentinfluence of both premorbid and concurrent psychiatric problems, especially anxiety, on postinjurysymptoms, managing the anxiety response in vulnerable individuals with mTBI may be important tominimize ongoing sequelae.Keywords: traumatic brain injury, concussion, outcome assessment

Predictors of postconcussive symptoms 3 months after mild traumatic brain injury.

Objectives: To evaluate the impact on outcome of the provision of information, measured in terms of reported symptoms, cognitive performance, and psychological adjustment three months postinjury. 

Methods: 202 adults with mild head injury were studied: 79 were assigned to an intervention group and were assessed one week and three months after injury; 123 were assigned to a non-intervention control group and were seen at three months only. Participants completed measures of preinjury psychological adjustment, concurrent life stresses, post-concussion symptoms, and tests of attention, speed of information processing, and memory. Subjects seen at one week were given an information booklet outlining the symptoms associated with mild head injury and suggested coping strategies. Those seen only at three months after injury did not receive this booklet. 

Results: Patients in the intervention group who were seen at one week and given the information booklet reported fewer symptoms overall and were significantly less stressed at three months after the injury. 

Conclusions: The provision of an information booklet reduces anxiety and reporting of ongoing problems.

https://jnnp.bmj.com/content/jnnp/73/3/330.full.pdf

Impact of early intervention on outcome following mild head injury in adults

Objectives. The impact of mild head injury or mild traumatic brain injury (TBI) in children is variable, and determinants of outcome remain poorly understood. There have been no previous attempts to evaluate the impact of interventions to improve outcome. Results of previous intervention studies in adults have been mixed. This study aimed to evaluate the impact of providing information on outcome measured in terms of reported symptoms, cognitive performance, and psychological adjustment in children 3 months after injury. Methods. A total of 61 children with mild TBI were assessed 1 week and 3 months after injury, and 58 children with mild TBI were assessed 3 months after injury only. They were compared with 2 control groups (N = 45 and 47) of children with minor injuries not involving the head. Participants completed measures of preinjury behavior and psychological adjustment, postconcussion symptoms, and tests of attention, speed of information processing, and memory. Children with mild TBI seen at 1 week were also given an information booklet outlining symptoms associated with mild TBI and suggested coping strategies. Those seen 3 months after injury only did not receive this booklet. Results. Children with mild TBI reported more symptoms than controls at 1 week but demonstrated no impairment on neuropsychological measures. Initial symptoms had resolved for most children by 3 months after injury, but a small group of children who had previous head injury or a history of learning or behavioral difficulties reported ongoing problems. The group not seen at 1 week and not given the information booklet reported more symptoms overall and was more stressed 3 months after injury. Conclusions. Providing an information booklet reduces anxiety and thereby lowers the incidence of ongoing problems.

Impact of early intervention on outcome after mild traumatic brain injury in children.

A group of 175 traumatic brain injury (TBI) patients who had undergone intensive rehabilitation at Bethesda Hospital attended a follow-up interview 2 years after injury. The majority of patients had suffered severe TBI. Outcome was documented in ten areas: medical/physical, mobility, activities of daily living (ADLs) accommodation, marital status, leisure and recreation, employment/study, communication, cognition and behaviour. Whilst most patients were physically independent and competent in personal and domestic activities of daily living, a third of the group were still reliant on assistance with community skills and transport, and more than half of those who previously had a job, were not working at 2 years post-injury. Around two-thirds of the sample reported cognitive, behavioural and emotional changes. There is clearly a need for ongoing community-based support and assistance in dealing with practical difficulties and psychological problems as they are experienced after return to the community.

A profile of outcome: 2 years after traumatic brain injury

OBJECTIVES To retrospectively establish the nature and frequency of Axis I psychiatric disorders pre- and post-TBI. PARTICIPANTS One hundred participants who were 0.5 to 5.5 years post mild to severe TBI and 87 informants, each evaluated at a single time point. MAIN MEASURE The Structured Clinical Interview for DSM-IV Disorders (SCID-I). RESULTS Preinjury, 52% received a psychiatric diagnosis, most commonly substance use disorder (41%), followed by major depressive disorder (17%) and anxiety (13%). Postinjury, 65% received a diagnosis, of which major depression became the most common (45%), followed by anxiety (38%) and substance use disorder (21%). Frequency of depression, generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and phobias rose from preinjury to postinjury. More than two-thirds of postinjury depression and anxiety cases were novel and showed poor resolution rates. Few novel cases of substance use disorder were noted. Psychotic disorders, somatoform disorders, and eating disorders occurred at frequencies similar to those in the general population. CONCLUSIONS A high frequency of postinjury psychiatric disorders was evident up to 5.5 years postinjury, with many novel cases of depression and anxiety. Individuals with TBI should be screened for psychiatric disorders at various time points post-injury without reliance on history of psychiatric problems to predict who is at risk, so that appropriate intervention can be offered.

Jennie Ponsford

Papers

Predictors of postconcussive symptoms 3 months after mild traumatic brain injury.

Impact of early intervention on outcome following mild head injury in adults

Impact of early intervention on outcome after mild traumatic brain injury in children.

A profile of outcome: 2 years after traumatic brain injury

Psychiatric disorders following traumatic brain injury: their nature and frequency.