4 results
Why Should ACT Work When CBT Has Failed? a Study Assessing Acceptability and Feasibility of Acceptance and Commitment Therapy (ACT) for Paediatric Patients With Chronic Fatigue Syndrome/myalgic Encephalomyelitis (CFS/ME)
- Jamie Leveret, Jen Starbuck, Kate Chapple, Sam Gubb, Hannah Kwuo, Sarah Burge, Morain Li, Philippa Clery, Esther Crawley
-
- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S58
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) effects 0.5–3.28% of children. NICE guidance recommends Activity Management, Graded Exercise Therapy or Cognitive Behavioural Therapy for fatigue (CBT-f). Approximately 15% of patients do not achieve full recovery within one year with current treatments. Acceptance and Commitment Therapy (ACT) is an effective treatment in many chronic illnesses. There are no studies investigating ACT for paediatric CFS/ME. This feasability study aimed to assess if ACT is a feasible and acceptable alternative treatment when current treatment has not led to recovery.
MethodsThis feasability cohort study aimed to enrol a minimum of 12 participants aged 11–18 yearswith CFS/ME attending the Royal United Hospitals Bath NHS Foundation Trust Specialist Paediatric CFS/ME Service, who were still symptomatic after 12 months or 12 sessions of standard treatment and were offered six to 12 sessions of ACT. Retention and recruitment data were analysed. Participants were asked to complete questionnaires before, during and after treatment. A selection of participants and their parents were interviewed about their experience of the study. Interviews were analysed using thematic analysis.
Results19 participants (95% of those approached) were recruited. Only 4 participants of this hard-to-reach group did not complete treatment.
In almost all sessions participants reported that they felt ‘totally’ listened to in post session questionnaires (31/33 sessions).
Preliminary interviews (n = 12) indicate acceptability of ACT, with all young people and their parents stating that they thought ACT should be offered to this population. Participants particularly commented that the absence of thought challenging (used in CBT-f) was a positive element of ACT. Participant's openness to try new approaches and altruistic desire to be in a study was noted.
ConclusionRecruitment data indicate that it is feasible to recruit and retain 11–18-year-olds with CFS/ME to a study offering ACT. Interviews with participants and parents were broadly positive suggesting ACT is an acceptable treatment in this population.
Results indicated that it is both feasible and acceptable to offer ACT to 11–18-year-olds with CFS/ME using this protocol, supporting the prospect of an RCT in this area.
Indications for and Utility of Tracheal Aspirate Cultures for the Diagnosis of VAI
- Kathleen Chiotos, Giyoung Lee, Guy Sydney, Heather Wolfe, Jennifer Blumenthal, Hannah Stinson, Julie Harab, Danielle Traynor, Joseph Piccione, Ashlee Doll, Garrett Keim, Charlotte Woods-Hill, Megan Jennings, Rebecca Harris, Jeffrey Gerber, Aaditya Dudhia, Nancy McGowan, Jennalyn Burke
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, pp. s60-s61
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Background: Tracheal aspirate bacterial cultures are routinely collected in mechanically ventilated children for the evaluation of ventilator-associated infections (VAIs). However, frequent bacterial colonization of endotracheal and tracheostomy tubes contribute to the marginal performance characteristics of the test for diagnosing VAI. Published literature characterizing drivers of culture collection and the predictive value of positive cultures are limited. Methods: This single-center, retrospective cohort study included children admitted to the pediatric intensive care unit who were receiving mechanical ventilation for at least 48 hours and had 1 or more semiquantitative tracheal aspirate cultures collected between September 1, 2019, and August 31, 2020. Indications for culture collection were determined through medical record review and included fever, hypothermia, tracheal secretion changes, radiographic pneumonia, increased oxygen requirement, and/or increased positive end-expiratory pressure (PEEP). A positive culture was defined as moderate or heavy growth of a noncommensal bacterial organism. A purulent Gram stain was defined as detection of moderate or many white blood cells. Diagnosis of VAI was based on treating-clinician documentation and was ascertained through medical record review. Logistic regression accounting for clustering by patient was performed to estimate the association between indications for culture collection and (1) culture positivity, (2) purulent Gram stain, and (3) diagnosis of VAI. Results: In total, 625 tracheal aspirate cultures were performed in 261 unique patients. Common indications for culture collection included isolated fever or hypothermia (n = 124, 20%), fever with an increase in oxygen requirement or PEEP (n = 71, 11%), isolated increase in oxygen requirement or PEEP (n = 67, 11%), or isolated secretion change (n = 54, 9%) (Figure 1). Overall, 230 cultures (37%) were positive and 218 (35%) Gram stains were purulent. There were no associations between culture indications and a positive culture. Presence of isolated fever was negatively associated with a purulent Gram stain (odds ratio [OR], 0.49; 95% CI, 0.30–0.81; P = .005); otherwise, there were no associations between indication and purulent Gram stain. Finally, in a multivariable model, odds of VAI diagnosis increased with both the number of indications for culture collection and purulent Gram stain, but not with positive culture (Figure 2). Conclusions: Number and type of clinical signs were not associated with tracheal aspirate culture positivity or purulence on Gram stain, but they were associated with a clinical diagnosis of VAI. These findings suggest that positive tracheal aspirate cultures may not aid clinicians in the diagnosis of VAI, and they highlight the opportunity for improved diagnostic stewardship.
Funding: No
Disclosures: None
Figure 1.
Figure 2.
eleven - Migration and nutrition
- Edited by Alan Walker, The University of Sheffield
-
- Book:
- The New Dynamics of Ageing Volume 2
- Published by:
- Bristol University Press
- Published online:
- 13 April 2022
- Print publication:
- 25 July 2018, pp 197-216
-
- Chapter
- Export citation
-
Summary
Introduction
The Bangladeshi population is one of the fastest growing ethnic groups within the UK. In 2011 the Bangladeshi population resident in England and Wales was 447,201, or 0.8 per cent of the total UK population; this is an increase of just over 50 per cent from the previous census in 2001 (ONS, 2012). Additionally, this group is reported to be one of the most deprived populations in the UK, having high rates of unemployment, social deprivation and low rates of education (Brice, 2008; Alexander et al, 2010). This group also has poorer self-reported and measured health status indicated by higher rates of disability, centralised obesity and chronic diseases such as type 2 diabetes and cardiovascular disease (Sproston and Mindell, 2006). Older Bangladeshi women are particularly affected as they play a lead role in caretaking for multiple generations within relatively large extended families, and many struggle to cope with the complex challenges of ageing, poverty, racism and social exclusion.
The migration of Bangladeshis to the UK has a long history, with the majority of those migrating originating from the Sylhet region in northeast Bangladesh (Gardner, 2002). Research has been dedicated to understanding how to improve the health of Bangladeshi residents in the UK; however, the majority of this research has concentrated on the Tower Hamlets region of London, limiting the amount of knowledge about those communities living outside of the London area (Brice, 2008). Findings from these studies may not be generalisable to other UK communities, so more research is needed to expand our understanding of this minority ethnic group and how to improve their health and wellbeing and reduce existing health inequalities.
MINA was a three-year project that examined ageing, migration and nutrition across two generations of Bangladeshi women living in Cardiff, UK and Sylhet, Bangladesh. The 2011 Census indicates that the Bangladeshi population living in Cardiff is 4,838, or approximately 45 per cent of the Bangladeshis living in Wales (ONS, 2012). This research builds on the existing literature focusing on migration and ageing among UK Bangladeshis (Gardner, 2002; Phillipson et al, 2003), providing new insights into specifically food, nutrition and their interactions with ageing and migration among UK Bangladeshi families who are living in communities outside of Tower Hamlets, London.
Contributors
-
- By Ghazi Al-Rawas, Vazken Andréassian, Tianqi Ao, Stacey A. Archfield, Berit Arheimer, András Bárdossy, Trent Biggs, Günter Blöschl, Theresa Blume, Marco Borga, Helge Bormann, Gianluca Botter, Tom Brown, Donald H. Burn, Sean K. Carey, Attilio Castellarin, Francis Chiew, François Colin, Paulin Coulibaly, Armand Crabit, Barry Croke, Siegfried Demuth, Qingyun Duan, Giuliano Di Baldassarre, Thomas Dunne, Ying Fan, Xing Fang, Boris Gartsman, Alexander Gelfan, Mikhail Georgievski, Nick van de Giesen, David C. Goodrich, Hoshin V. Gupta, Khaled Haddad, David M. Hannah, H. A. P. Hapuarachchi, Hege Hisdal, Kamila Hlavčová, Markus Hrachowitz, Denis A. Hughes, Günter Humer, Ruud Hurkmans, Vito Iacobellis, Elena Ilyichyova, Hiroshi Ishidaira, Graham Jewitt, Shaofeng Jia, Jeffrey R. Kennedy, Anthony S. Kiem, Robert Kirnbauer, Thomas R. Kjeldsen, Jürgen Komma, Leonid M. Korytny, Charles N. Kroll, George Kuczera, Gregor Laaha, Henny A. J. van Lanen, Hjalmar Laudon, Jens Liebe, Shijun Lin, Göran Lindström, Suxia Liu, Jun Magome, Danny G. Marks, Dominic Mazvimavi, Jeffrey J. McDonnell, Brian L. McGlynn, Kevin J. McGuire, Neil McIntyre, Thomas A. McMahon, Ralf Merz, Robert A. Metcalfe, Alberto Montanari, David Morris, Roger Moussa, Lakshman Nandagiri, Thomas Nester, Taha B. M. J. Ouarda, Ludovic Oudin, Juraj Parajka, Charles S. Pearson, Murray C. Peel, Charles Perrin, John W. Pomeroy, David A. Post, Ataur Rahman, Liliang Ren, Magdalena Rogger, Dan Rosbjerg, José Luis Salinas, Jos Samuel, Eric Sauquet, Hubert H. G. Savenije, Takahiro Sayama, John C. Schaake, Kevin Shook, Murugesu Sivapalan, Jon Olav Skøien, Chris Soulsby, Christopher Spence, R. ‘Sri’ Srikanthan, Tammo S. Steenhuis, Jan Szolgay, Yasuto Tachikawa, Kuniyoshi Takeuchi, Lena M. Tallaksen, Dörthe Tetzlaff, Sally E. Thompson, Elena Toth, Peter A. Troch, Remko Uijlenhoet, Carl L. Unkrich, Alberto Viglione, Neil R. Viney, Richard M. Vogel, Thorsten Wagener, M. Todd Walter, Guoqiang Wang, Markus Weiler, Rolf Weingartner, Erwin Weinmann, Hessel Winsemius, Ross A. Woods, Dawen Yang, Chihiro Yoshimura, Andy Young, Gordon Young, Erwin Zehe, Yongqiang Zhang, Maichun C. Zhou
- Edited by Günter Blöschl, Technische Universität Wien, Austria, Murugesu Sivapalan, University of Illinois, Urbana-Champaign, Thorsten Wagener, University of Bristol, Alberto Viglione, Technische Universität Wien, Austria, Hubert Savenije, Technische Universiteit Delft, The Netherlands
-
- Book:
- Runoff Prediction in Ungauged Basins
- Published online:
- 05 April 2013
- Print publication:
- 18 April 2013, pp ix-xiv
-
- Chapter
- Export citation