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Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Care beyond the hospital ward: understanding the socio-medical trajectory of herpes simplex virus encephalitis

Authors: Jessie Cooper, Ciara Kierans, Sylviane Defres, Ava Easton, Rachel Kneen, Tom Solomon, on behalf of ENCEPH-UK study group

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

Herpes simplex virus (HSV) encephalitis is a life-threatening infection of the brain, which has significant physical, cognitive and social consequences for survivors. Despite increasing recognition of the long-term effects of encephalitis, research and policy remains largely focused on its acute management, meaning there is little understanding of the difficulties people face after discharge from acute care. This paper aims to chart the problems and challenges which people encounter when they return home after treatment for HSV encephalitis.

Methods

The paper reports on data from 30 narrative interviews with 45 people affected by HSV encephalitis and their significant others. The study was conducted as part of the ENCEPH-UK programme grant on Understanding and Improving the Outcome of Encephalitis.

Results

The findings show the diverse challenges which are experienced by people after treatment for HSV encephalitis. We first chart how peoples’ everyday lives are fragmented following their discharge from hospital. Second, we document the social consequences which result from the longer-term effects of encephalitis. Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, and describe how people are consequently forced to devise their own care routines and strategies for managing their problems.

Conclusion

The paper argues that in order to improve long-term outcomes in encephalitis, it is vital that we develop pathways of support for the condition beyond the acute hospital setting. We conclude by making recommendations to enhance communication and care for the post-acute consequences of encephalitis, to ensure those affected are fully supported through the chronic effects of this devastating disease.
Literature
1.
go back to reference Granerod J, Cousens S, Davies NWS, Crowcroft NS, Thomas SL. New estimates of incidence of encephalitis in England. Emerg Infect Dis. 2013;19:1455–62.CrossRefPubMedCentral Granerod J, Cousens S, Davies NWS, Crowcroft NS, Thomas SL. New estimates of incidence of encephalitis in England. Emerg Infect Dis. 2013;19:1455–62.CrossRefPubMedCentral
2.
go back to reference Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10:835–44.CrossRefPubMed Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10:835–44.CrossRefPubMed
3.
go back to reference Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ, et al. Management of suspected viral encephalitis in adults – Association of British Neurologists and British Infection Association National Guidelines. J Inf Secur. 2012;64:347–73. Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ, et al. Management of suspected viral encephalitis in adults – Association of British Neurologists and British Infection Association National Guidelines. J Inf Secur. 2012;64:347–73.
4.
go back to reference Raschilas F, Wolff M, Delatour F, Chaffaut C, De Broucker T, Chevret S, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicentre study. Clin Infect Dis. 2002;35:254–60.CrossRefPubMed Raschilas F, Wolff M, Delatour F, Chaffaut C, De Broucker T, Chevret S, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicentre study. Clin Infect Dis. 2002;35:254–60.CrossRefPubMed
5.
go back to reference Whitley RJ, Alford CA, Hirsch MS, Schooley RT, Luby JP, Aoki FY, et al. Vidarabine versus aciclovir therapy in herpes simplex encephalitis. N Engl J Med. 1986;314:144–9.CrossRefPubMed Whitley RJ, Alford CA, Hirsch MS, Schooley RT, Luby JP, Aoki FY, et al. Vidarabine versus aciclovir therapy in herpes simplex encephalitis. N Engl J Med. 1986;314:144–9.CrossRefPubMed
6.
go back to reference Atkin K, Stapley S, Easton A. No one listens to me, nobody believes me: self management and the experience of living with encephalitis. Soc Sci Med. 2010;71:386–93.CrossRefPubMed Atkin K, Stapley S, Easton A. No one listens to me, nobody believes me: self management and the experience of living with encephalitis. Soc Sci Med. 2010;71:386–93.CrossRefPubMed
7.
go back to reference Easton A. Life after encephalitis: a narrative approach. London: Routledge; 2016. Easton A. Life after encephalitis: a narrative approach. London: Routledge; 2016.
8.
go back to reference Elbers JM, Bitnun A, Richardson SE, Ford-Jones EL, Tellier R, Wald RM, et al. A 12-year prospective study of childhood herpes simplex encephalitis: is there a broader spectrum of disease? Pediatrics. 2007;119:e399.CrossRefPubMed Elbers JM, Bitnun A, Richardson SE, Ford-Jones EL, Tellier R, Wald RM, et al. A 12-year prospective study of childhood herpes simplex encephalitis: is there a broader spectrum of disease? Pediatrics. 2007;119:e399.CrossRefPubMed
9.
go back to reference Fazekas C, Enzinger C, Wallner M, Kischa U, Greimel E, Kapeller P, et al. Depressive symptoms following herpes simplex encephalitis – an underestimated phenomenon? Gen Hosp Psychiatry. 2006;28:403.CrossRefPubMed Fazekas C, Enzinger C, Wallner M, Kischa U, Greimel E, Kapeller P, et al. Depressive symptoms following herpes simplex encephalitis – an underestimated phenomenon? Gen Hosp Psychiatry. 2006;28:403.CrossRefPubMed
10.
go back to reference Granerod J, Davies NW, Ramanuj PP, Easton A, Brown DWG. Increased rates of sequelae post-encephalitis in individuals attending primary care practices in the United Kingdom: a population-based retrospective cohort study. J Neurol. 2016; Granerod J, Davies NW, Ramanuj PP, Easton A, Brown DWG. Increased rates of sequelae post-encephalitis in individuals attending primary care practices in the United Kingdom: a population-based retrospective cohort study. J Neurol. 2016;
11.
go back to reference Hokkanen L, Launes J. Neuropsychological sequelae of acute-onset sporadic viral encephalitis. Neuropsychol Rehabil. 2007;17:450–77.CrossRefPubMed Hokkanen L, Launes J. Neuropsychological sequelae of acute-onset sporadic viral encephalitis. Neuropsychol Rehabil. 2007;17:450–77.CrossRefPubMed
12.
go back to reference Dewar BK, Gracey F. ‘Am not was’: cognitive-behavioural therapy for adjustment and identity change following herpes simplex encephalitis. Neuropsychol Rehabil. 2007;17:602–20.CrossRefPubMed Dewar BK, Gracey F. ‘Am not was’: cognitive-behavioural therapy for adjustment and identity change following herpes simplex encephalitis. Neuropsychol Rehabil. 2007;17:602–20.CrossRefPubMed
13.
go back to reference Ramanuj PR, Granerod J, Davies NWS, Conti S, Brown DWG, Crowcroft NS. Quality of life and associated socio-clinical factors after encephalitis in children and adults in England: a population-based, prospective cohort study. PLoS One. 2014;9:e103496.CrossRefPubMedPubMedCentral Ramanuj PR, Granerod J, Davies NWS, Conti S, Brown DWG, Crowcroft NS. Quality of life and associated socio-clinical factors after encephalitis in children and adults in England: a population-based, prospective cohort study. PLoS One. 2014;9:e103496.CrossRefPubMedPubMedCentral
14.
go back to reference Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemmingway C, et al. Management of suspected viral encephalitis in children – Association of British Neurologists and British Paediatric Allergy, immunology and infection group national guidelines. J Inf Secur. 2012;64:449–77. Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemmingway C, et al. Management of suspected viral encephalitis in children – Association of British Neurologists and British Paediatric Allergy, immunology and infection group national guidelines. J Inf Secur. 2012;64:449–77.
16.
go back to reference Riessman CK. Narrative methods for the human sciences. London: Sage; 2008. Riessman CK. Narrative methods for the human sciences. London: Sage; 2008.
17.
18.
go back to reference Mattingly C, Garro LC. Narrative and the cultural construction of illness and healing. Berkley: University of California Press; 2000. Mattingly C, Garro LC. Narrative and the cultural construction of illness and healing. Berkley: University of California Press; 2000.
19.
go back to reference Kleinman A. The illness narratives: suffering, healing and the human condition. New York: Basic Books; 1988. Kleinman A. The illness narratives: suffering, healing and the human condition. New York: Basic Books; 1988.
20.
go back to reference Greenhalgh T, Hurwitz B. Why study narrative? BMJ. 1999;318:7175. Greenhalgh T, Hurwitz B. Why study narrative? BMJ. 1999;318:7175.
21.
go back to reference Kleinman A, Benson T. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3:e249.CrossRef Kleinman A, Benson T. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3:e249.CrossRef
22.
go back to reference Farmer P. On suffering and structural violence: a view from below. Daedalus. 1996;125:261–83. Farmer P. On suffering and structural violence: a view from below. Daedalus. 1996;125:261–83.
23.
go back to reference Kierans C, Padilla-Altamira P, Garcia-Garcia G, Ibarra-Herandez M, Mercado FJ. When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients. PLoS One. 2013;8:e54380.CrossRefPubMedPubMedCentral Kierans C, Padilla-Altamira P, Garcia-Garcia G, Ibarra-Herandez M, Mercado FJ. When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients. PLoS One. 2013;8:e54380.CrossRefPubMedPubMedCentral
24.
go back to reference Cooper J, Kierans C, Defres S, Easton A, Kneen R, Solomon T. Diagnostic pathways as social and participatory practices: the case of herpes simplex encephalitis. PLoS One. 2016;11:e0151145.CrossRefPubMedPubMedCentral Cooper J, Kierans C, Defres S, Easton A, Kneen R, Solomon T. Diagnostic pathways as social and participatory practices: the case of herpes simplex encephalitis. PLoS One. 2016;11:e0151145.CrossRefPubMedPubMedCentral
25.
go back to reference Gelech JM, Desjardins M. I am many: the reconstruction of self following acquired brain injury. Qual Health Res. 2011;21:62–74.CrossRefPubMed Gelech JM, Desjardins M. I am many: the reconstruction of self following acquired brain injury. Qual Health Res. 2011;21:62–74.CrossRefPubMed
26.
go back to reference Howes H, Benton D, Edwards SS. Women’s Experience of brain injury: an interpretative phenomenological analysis. Psychol Health. 2005;20:129–42.CrossRef Howes H, Benton D, Edwards SS. Women’s Experience of brain injury: an interpretative phenomenological analysis. Psychol Health. 2005;20:129–42.CrossRef
27.
go back to reference Lorenz LS. Discovering a new identity after brain injury. Sociol Health Illn. 2010;13:862–79.CrossRef Lorenz LS. Discovering a new identity after brain injury. Sociol Health Illn. 2010;13:862–79.CrossRef
28.
go back to reference Livingston J. Improvising medicine: an African oncology ward in an emerging cancer epidemic. Durham: Duke University Press; 2012.CrossRef Livingston J. Improvising medicine: an African oncology ward in an emerging cancer epidemic. Durham: Duke University Press; 2012.CrossRef
29.
go back to reference Kierans C. Biopolitics and capital: poverty, mobility and the body-in-transplantation in Mexico. Body & Society. 2015;21:42–65.CrossRef Kierans C. Biopolitics and capital: poverty, mobility and the body-in-transplantation in Mexico. Body & Society. 2015;21:42–65.CrossRef
30.
go back to reference Corbin J, Strauss A. Managing chronic illness at home: three lines of work. Qual Sociol. 1985;8:224–47.CrossRef Corbin J, Strauss A. Managing chronic illness at home: three lines of work. Qual Sociol. 1985;8:224–47.CrossRef
31.
go back to reference Mattingly C, Gron L, Meinert L. Chronic homework in emerging borderlands of healthcare. Cult Med Psychiatry. 2011;35:347–75.CrossRefPubMed Mattingly C, Gron L, Meinert L. Chronic homework in emerging borderlands of healthcare. Cult Med Psychiatry. 2011;35:347–75.CrossRefPubMed
32.
go back to reference Mykhalovskiy E, McCoy L. Troubling ruling discourses of health: using institutional ethnography in community-based research. Crit Public Health. 2002;12:17–37.CrossRef Mykhalovskiy E, McCoy L. Troubling ruling discourses of health: using institutional ethnography in community-based research. Crit Public Health. 2002;12:17–37.CrossRef
Metadata
Title
Care beyond the hospital ward: understanding the socio-medical trajectory of herpes simplex virus encephalitis
Authors
Jessie Cooper
Ciara Kierans
Sylviane Defres
Ava Easton
Rachel Kneen
Tom Solomon
on behalf of ENCEPH-UK study group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2608-2

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