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Ross J, Anastos K, Hill S, Remera E, Rwibasira GN, Ingabire C, Umwiza F, Munyaneza A, Muhoza B, Zhang C, Nash D, Yotebieng M, Murenzi G. Reducing time to differentiated service delivery for newly-diagnosed people living with HIV in Kigali, Rwanda: a pilot, unblinded, randomized controlled trial. BMC Health Serv Res 2024; 24:555. [PMID: 38693537 PMCID: PMC11062003 DOI: 10.1186/s12913-024-10950-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/04/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Differentiated service delivery (DSD) programs for people living with HIV (PWH) limit eligibility to patients established on antiretroviral therapy (ART), yet uncertainty exists regarding the duration on ART necessary for newly-diagnosed PWH to be considered established. We aimed to determine the feasibility, acceptability, and preliminary impact of entry into DSD at six months after ART initiation for newly-diagnosed PWH. METHODS We conducted a pilot randomized controlled trial in three health facilities in Rwanda. Participants were randomized to: (1) entry into DSD at six months after ART initiation after one suppressed viral load (DSD-1VL); (2) entry into DSD at six months after ART initiation after two consecutive suppressed viral loads (DSD-2VL); (3) treatment as usual (TAU). We examined feasibility by examining the proportion of participants assigned to intervention arms who entered DSD, assessed acceptability through patient surveys and by examining instances when clinical staff overrode the study assignment, and evaluated preliminary effectiveness by comparing study arms with respect to 12-month viral suppression. RESULTS Among 90 participants, 31 were randomized to DSD-1VL, 31 to DSD-2VL, and 28 to TAU. Among 62 participants randomized to DSD-1VL or DSD-2VL, 37 (60%) entered DSD at 6 months while 21 (34%) did not enter DSD because they were not virally suppressed. Patient-level acceptability was high for both clinical (mean score: 3.8 out of 5) and non-clinical (mean score: 4.1) elements of care and did not differ significantly across study arms. Viral suppression at 12 months was 81%, 81% and 68% in DSD-1VL, DSD-2VL, and TAU, respectively (p = 0.41). CONCLUSIONS The majority of participants randomized to intervention arms entered DSD and had similar rates of viral suppression compared to TAU. Results suggest that early DSD at six months after ART initiation is feasible for newly-diagnosed PWH, and support current WHO guidelines on DSD. TRIAL REGISTRATION Clinicaltrials.gov NCT04567693; first registered on September 28, 2020.
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Affiliation(s)
- Jonathan Ross
- Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
| | - Kathryn Anastos
- Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Sarah Hill
- Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Eric Remera
- Division of HIV, STIs and Viral Hepatitis, Rwanda Biomedical Center, Kigali, Rwanda
| | - Gallican N Rwibasira
- Division of HIV, STIs and Viral Hepatitis, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | | | | | - Chenshu Zhang
- Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, 10027, USA
| | - Marcel Yotebieng
- Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Gad Murenzi
- Research for Development (RD Rwanda), Kigali, Rwanda
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Magoulas PL. Supporting Parents Throughout the Genetic Testing Process and New Diagnosis. Pediatr Clin North Am 2023; 70:917-928. [PMID: 37704350 DOI: 10.1016/j.pcl.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Receiving a genetic diagnosis can be challenging for parents as they learn to cope and adapt to this news. They often experience a myriad of emotions ranging from shock to relief. Yet overwhelmingly, parents report a negative experience with this process. Factors that improve parental satisfaction include being provided written information, emotional and psychosocial support, and connections with other parents. Genetics care providers are particularly equipped to solicit parental needs and provide support before, during, and after receiving a diagnosis. This review will provide suggestions and recommendations for supporting parents throughout the diagnostic testing experience and receiving a genetic diagnosis.
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Affiliation(s)
- Pilar L Magoulas
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
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Zhou Q, Xu F, Wen J, Yue J, Zhang Y, Su J, Liu Y. Efficacy and safety analysis of bortezomib-based triplet regimens sequential lenalidomide in newly diagnosed multiple myeloma patients. Clin Exp Med 2023; 23:1573-1580. [PMID: 36094683 PMCID: PMC10460706 DOI: 10.1007/s10238-022-00879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Abstract
The aim of this study is to analyze the efficacy and safety of sequential therapy with bortezomib-based triplet regimens without lenalidomide (PXD, including VTD, PAD, and VCD) followed by continuous lenalidomide and dexamethasone (Rd) or bortezomib and dexamethasone (Vd) treatment. The main objective is to evaluate the advantages of PXD followed by Rd compared to the combinations of bortezomib-lenalidomide-dexamethasone (VRd) in newly diagnosed multiple myeloma (NDMM). Fifty-eight nontransplant NDMM patients who were admitted to our department from 2017 to 2019 were included in this study. Bortezomib-based triplet regimens were initially selected and followed by Rd or Vd as continuous treatment once the patients achieved partial remission (PR) or better response. The efficacy and safety of the patients were observed. The Rd continuous treatment cohort was compared with historical data from the EVOLUTION trial on continuous VRd treatment. In our cohort, the overall survival rate was 100%, and progression-free survival (PFS) was 38.5% after a median of 19 (4-36) cycles of Rd continuous therapy was applied. During the follow-up period, the best outcome assessments achieved were 53.8% complete response (CR) and 84.6% excellent partial response (VGPR). A total of 23.1% had grade 3-4 or higher drug-related adverse reactions, mainly hematological toxicity, and no patients died of adverse reactions. Compared with the Vd group, the Rd group had a better PFS and VGPR rate (2-year PFS: 92.3% vs. 56.3%, P = 0.002; 3-year PFS: 69.2% vs. 8.0%, P < 0.001; VGPR: 84.6% vs. 69.2%, P = 0.02). No significant differences were found in ORR (100% vs. 92.3%) or CR (53.8% vs. 35.7%, P = 0.082). Compared with the EVOLUTION study, patients in the Rd group had a more advanced disease stage (stage III rate of 40% vs. 19%, P = 0.039) and worse physical status (KPS 50-60 rate of 25.0% vs. 2.0%, P = 0.000). However, a higher proportion of ORR (100% vs. 73.0%, P < 0.001), VGPR or better (75.0% vs. 32.0%, P < 0.001), and PFS at 12 months (90.0% vs. 68%, P = 0.011) were achieved. Sequential administration of bortezomib-based triplet regimens without lenalidomide as an initial therapy followed by Rd as a continuous treatment may not be inferior to VRd for first-line treatment in NDMM patients.
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Affiliation(s)
- Qiaolin Zhou
- Hematology Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Fang Xu
- Hematology Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China.
| | - Jingjing Wen
- Hematology Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Jing Yue
- Hematology Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Ya Zhang
- Hematology Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Jing Su
- Hematology Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Yiping Liu
- Hematology Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No 12. Changjia Alley, Jingzhong Street, Fucheng District, Mianyang, 621000, China
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Chepulis L, Mellsop-Kupe J, Moorhouse S, Keenan R, Norman K, Paul R. Newly diagnosed type 2 diabetes - does New Zealand General Practice adequately prepare patients to self-manage their Condition? BMC Prim Care 2023; 24:162. [PMID: 37605190 PMCID: PMC10441743 DOI: 10.1186/s12875-023-02118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) is predominantly managed in primary care, and patients need to be provided with appropriate knowledge and education to understand how to best self-manage their condition. For optimal T2D self-management, primary care teams should share this information from the time of diagnosis. Little is currently known about how and when these resources are being provided to patients with T2D in New Zealand. METHODS An online survey was carried out between Oct 2022 and Feb 2023. Patients diagnosed with T2D after Jan 2020 were invited to participate, with recruitment occurring via primary care and social media. Questions included information about demographics, diagnosis, provision of education resources and/or referral services as well as about current diabetes management. All responses were analysed with chi square tests. Free-text comments were summarised only. RESULTS A total of 203 participants from across New Zealand completed the survey, but 18 were excluded due to being diagnosed more than 3 years ago, or self-reporting with type 1 diabetes rather than T2D. Nearly three quarters (70.7%) of participants reported that they were given appropriate resources to understand and manage their T2D, though half of these would have like more information. Overall, family and friends, self-led research and healthcare-provided education were equally useful, though this differed by ethnic groups. Similarly, approx. 70% of patients thought that medications had been well explained. Free text comments suggested a need for more targeted information around food choice and insulin use as well as a need for empathy and appropriate language from healthcare providers. CONCLUSIONS Primary care appears to be providing most newly diagnosed patients with appropriate resources to understand and manage their T2D, but there is room for improvement with up to a third of participants not understanding how to manage foods, medication and lifestyle choices to optimise health outcomes. Further work is required to address this gap and should include the use of culturally-appropriate materials to meet the multi-ethnic population needs.
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Affiliation(s)
- Lynne Chepulis
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand.
| | - Jessie Mellsop-Kupe
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | | | - Rawiri Keenan
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Kimberley Norman
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Ryan Paul
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
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Esteban-Fernández A, Gómez-Otero I, López-Fernández S, Santamarta MR, Pastor-Pérez FJ, Fluvià-Brugués P, Pérez-Rivera JÁ, López López A, García-Pinilla JM, Palomas JLB, Bonet LA, Cobo-Marcos M, Mateo VM, Llergo JT, Fernández VA, Vives CG, de Juan Bagudá J, Benedicto AM, de Polavieja JIM, Solla-Ruiz I, Solé-González E, Cardona M, Olaetxea JR, Cortés CO, Dosantos VM, López AG, Amao E, Sánchez BC, Torres EA, Carrillo VG, García-Fuertes D, Ridocci-Soriano F. Influence of the medical treatment schedule in new diagnoses patients with heart failure and reduced ejection fraction. Clin Res Cardiol 2023:10.1007/s00392-023-02241-0. [PMID: 37341769 DOI: 10.1007/s00392-023-02241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/30/2023] [Indexed: 06/22/2023]
Abstract
AIMS Heart failure (HF) guidelines recommend treating all patients with HF and reduced ejection fraction (HFrEF) with quadruple therapy, although they do not establish how to start it. This study aimed to evaluate the implementation of these recommendations, analyzing the efficacy and safety of the different therapeutic schedules. METHODS AND RESULTS Prospective, observational, and multicenter registry that evaluated the treatment initiated in patients with newly diagnosed HFrEF and its evolution at 3 months. Clinical and analytical data were collected, as well as adverse reactions and events during follow-up. Five hundred and thirty-three patients were included, selecting four hundred and ninety-seven, aged 65.5 ± 12.9 years (72% male). The most frequent etiologies were ischemic (25.5%) and idiopathic (21.1%), with a left ventricular ejection fraction of 28.7 ± 7.4%. Quadruple therapy was started in 314 (63.2%) patients, triple in 120 (24.1%), and double in 63 (12.7%). Follow-up was 112 days [IQI 91; 154], with 10 (2%) patients dying. At 3 months, 78.5% had quadruple therapy (p < 0.001). There were no differences in achieving maximum doses or reducing or withdrawing drugs (< 6%) depending on the starting scheme. Twenty-seven (5.7%) patients had any emergency room visits or admission for HF, less frequent in those with quadruple therapy (p = 0.02). CONCLUSION It is possible to achieve quadruple therapy in patients with newly diagnosed HFrEF early. This strategy makes it possible to reduce admissions and visits to the emergency room for HF without associating a more significant reduction or withdrawal of drugs or significant difficulty in achieving the target doses.
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Affiliation(s)
- Alberto Esteban-Fernández
- Cardiology Service, Hospital Universitario Severo Ochoa, Universidad Internacional de Valencia, Madrid, Spain.
- Valencian Internacional University, Valencia, Spain.
| | - Inés Gómez-Otero
- Cardiology Service, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia López-Fernández
- Cardiology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | | | - Francisco J Pastor-Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Paula Fluvià-Brugués
- Cardiology Service, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - José-Ángel Pérez-Rivera
- Cardiology Service, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de La Salud, Universidad Isabel I, Burgos, Spain
| | | | - José Manuel García-Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Service, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | | | | | - Marta Cobo-Marcos
- Cardiology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Virgilio Martínez Mateo
- Cardiology Service, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | | | - Cristina Goena Vives
- Cardiology Service, Hospital de Mendaro, Mendaro, Gipuzkoa, Spain
- Instituto de Investigación Biodonostia, Donostia, Gipuzkoa, Spain
| | - Javier de Juan Bagudá
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Service, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
- Departamento de Medicina, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain
| | - Alba Maestro Benedicto
- Cardiology Service, Hospital de la Santa Creu I Sant Pau, IIB SANT PAU, Barcelona, Spain
| | | | - Itziar Solla-Ruiz
- Cardiology Service, Hospital Universitario de Donostia, San Sebastián, Spain
| | | | - Montserrat Cardona
- Cardiology Service, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | - Victor Martínez Dosantos
- Cardiology Service, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Antonio Gámez López
- Cardiology Service, Hospital General de Valdepeñas, Valdepeñas, Ciudad Real, Spain
| | - Elvis Amao
- Cardiology Service, Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
| | - Borja Casas Sánchez
- Cardiology Service, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | | | - Francisco Ridocci-Soriano
- Cardiology Service, Hospital General Universitario de Valencia, Valencia, Spain
- Departamento de Medicina, Universitat de Valencia, Valencia, Spain
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Alschuler KN, Whibley D, Kratz AL, Jensen MP, Wundes A, von Geldern G, Qian P, Bombardier CH, Ehde DM. Quality of life in individuals newly diagnosed with multiple sclerosis or clinically isolated syndrome. J Neurol 2021. [PMID: 34665331 DOI: 10.1007/s00415-021-10842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Little is known about quality of life (QOL) at the time of multiple sclerosis (MS) or clinically isolated syndrome (CIS) diagnosis and how it evolves in the critical adjustment period immediately following a new diagnosis. OBJECTIVES To (1) describe QOL trajectory in the first year post-MS/CIS diagnosis and (2) examine associations of demographic and biopsychosocial factors with QOL at baseline and as it evolves over the first year post-MS/CIS diagnosis. METHODS Participants were N = 250 individuals newly diagnosed with MS or CIS. Participants completed self-report assessments of QOL, demographics, and biopsychosocial factors at 1, 2, 3, 6, 9, and 12 months post-diagnosis using validated measures. RESULTS At 1-month post-diagnosis, QOL M = 75.2/100 with subsequent assessments revealing consistent ratings on average. Modelling revealed a small number of variables that were predictive of QOL at baseline and/or change in QOL over time. CONCLUSION QOL in the first year post-MS/CIS diagnosis was, on average, high and stable. A subset of modifiable factors across the biopsychosocial spectrum was associated with baseline level of QOL and change in QOL over time. The stability in QOL suggests that patients can be assessed early after diagnosis for key variables that are predictive of both current and future QOL.
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Lin C, Shen H, Zhou S, Liu M, Xu A, Huang S, Shen C, Zhou F. Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics. BMC Infect Dis 2020; 20:699. [PMID: 32972385 PMCID: PMC7517606 DOI: 10.1186/s12879-020-05412-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Infection is a leading cause of morbidity and death in patients with multiple myeloma (MM). The increased susceptibility to infection is complicated and multifactorial. However, no studies have explored the spectrum and risk factors of infections in newly diagnosed MM patients at the first admission. This cross-sectional study aimed to provide ideas for the assessment, prevention and treatment of infection in newly diagnosed MM patients when admitted for the first time. Methods Retrospectively, the data from electronic medical records for 161 patients newly diagnosed with MM from May 2013 to December 2018 were analysed. All the information was collected at the time of admission, and the patients had received no antineoplastic therapy previously. Independent risk factors of infection in multiple myeloma were determined by univariate and multivariate analysis. Results Newly diagnosed patients with MM were highly susceptible to viruses (43.9%), especially Epstein-Barr virus (EBV) (24.4%) and hepatitis B virus (HBV) (17.1%). Advanced stage (ISS stage III, P = 0.040), more severe anaemia (Hb < 90 g/L, P = 0.044) and elevated CRP (> 10 mg/L, P = 0.006) were independent risk factors for infection. Moreover, infections represented a major survival threat to patients with newly diagnosed MM (P = 0.033), and the existence of risk factors for infection was significantly correlated with poor prognosis (P = 0.011), especially ISS stage III (P = 0.008) and lower haemoglobin level (P = 0.039). Conclusions Newly diagnosed MM patients are highly susceptible to viruses. Advanced ISS stage, more severe anaemia and the elevation of CRP are independent risk factors of infection, which also have a strong impact on prognosis. Our results suggest that viral infection should be taken into account if antibacterial drugs are not effective, and the prevention of infection and improvement of prognosis should be paid more attention in newly diagnosed patents with advanced stage and more severe anaemia.
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Affiliation(s)
- Chenyao Lin
- Department of Clinical Laboratory, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, P.R. China.,Genetic Diagnosis Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Hui Shen
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Shuimei Zhou
- Blood Transfusion Department, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Minghui Liu
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Anjie Xu
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China
| | - Shuang Huang
- Genetic Diagnosis Centre, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P.R. China
| | - Changxin Shen
- Blood Transfusion Department, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China.
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, P.R. China.
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Garabedian M, Perrone E, Pileggi C, Zimmerman V. Support Group Participation: Effect on Perceptions of Patients with Newly Diagnosed Multiple Sclerosis. Int J MS Care 2020; 22:115-121. [PMID: 32607073 DOI: 10.7224/1537-2073.2018-099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Patients newly diagnosed as having multiple sclerosis (MS) face an overwhelming number of questions about how it will affect their lives. Participation in a support group is one way to obtain information and receive support from others. However, existing support groups are often attended by patients with significant disability, resulting in newly diagnosed patients being hesitant to return. Methods This qualitative pilot study explored perceptions of patients with newly diagnosed MS before and after participation in two monthly meetings. A support group was conducted each month using nursing staff, a physician, and a social worker. Prior to the first meeting, participants were asked to complete a questionnaire with open-ended questions to share their thoughts about how MS may affect their lives. After the two meetings, they were asked to complete the same questionnaire again. Results Eight themes were identified: uncertain disease course; insecure future; physical, emotional, and cognitive impacts; effect on relationships with family and/or spouse/significant other; ability to develop future relationship with significant other; impact on career plans; impact on ability to achieve future goals; and impact on ability to care for self and family. Five of six participants who attended both meetings and one of four who attended only the first meeting expressed a change in their perception of how MS may affect their lives. Conclusions A support group dedicated exclusively to newly diagnosed patients may provide an opportunity for patients to experience a change in perceptions of MS.
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Abstract
Despite advances in diabetes technology and treatment, a majority of children and adolescents with type 1 diabetes (T1D) fail to meet hemoglobin A1c (HbA1c) targets. Among high-income nations, the United States has one of the highest mean HbA1c values. We tracked the HbA1c values of 261 patients diagnosed with T1D in our practice over a 2.5-year period to identify inflection points in the HbA1c trajectory. The HbA1c declined until 5 months postdiagnosis. There was a rise in the HbA1c between the fifth and sixth month postdiagnosis. The HbA1c continued to steadily rise and by 18 months postdiagnosis, the mean HbA1c was 8.2%, which is also our clinic mean. Understanding the HbA1c trajectory early in the course of diabetes has helped to identify opportunities for intensification of diabetes management to flatten the trajectory of HbA1c and improve clinical outcomes.
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Affiliation(s)
- Priya Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Address correspondence to: Priya Prahalad, MD, PhD, Division of Pediatric Endocrinology, Stanford University, 300 Pasteur Drive, Room G313, Stanford, CA 94305
| | - Jaden Yang
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, California
| | - David Scheinker
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Department of Management Science and Engineering, Stanford University, Stanford, California
| | - Manisha Desai
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford, California
| | - Korey Hood
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford, California
| | - David M. Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford, California
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Çelen Yoldaş T, Günbey C, Değerliyurt A, Erol N, Özmert E, Yalnızoğlu D. Behavioral problems of preschool children with new-onset epilepsy and one-year follow-up - A prospective study. Epilepsy Behav 2019; 92:171-175. [PMID: 30660968 DOI: 10.1016/j.yebeh.2018.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/27/2018] [Accepted: 12/24/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Childhood emotional/behavioral problems in children with epilepsy have been reported to be higher compared with those with typical development or with other nonneurologic health conditions. Increasing interest towards understanding these behavioral comorbidities is reflected in literature. However, longitudinal investigations regarding the course of behavioral problems in children with newly diagnosed epilepsy and normal development are rare, and majority of them involve school-aged children. We aimed to study the behavioral comorbidities of preschool children with newly diagnosed epilepsy and to explore the changes of behavioral problems after one year from the diagnosis in comparison with the healthy group and subsequently, to elucidate the potential developmental, neurologic, and social risk factors associated with these difficulties. METHODS Participants were 83 patients, aged between 18 and 59 months, 43 of them were children with new-onset epilepsy, and 40 of them were healthy children as the comparison group. The Child Behavior Check List-1 1/2-5 (CBCL) was used to evaluate emotional/behavioral problems of the children. Maternal anxiety was analyzed by The State-Trait Anxiety Inventory (STAI). The general development of children was evaluated by the Denver-II-Developmental Screening Test (D-II-DST). Sociodemographic characteristics were also collected for all participants. Each evaluation was repeated after one year from the diagnosis. RESULTS Internalizing, externalizing, and total problem scores were higher in children with epilepsy than the control group at baseline, and despite some reduction in several scales, the differences continued across groups after one year. The analysis for the course revealed that behavior problem scores reduced in children with new-onset epilepsy over a year, but it did not change in healthy children. Among the possible factors related to behavior problem scores, in correlation analysis, the duration of screen viewing, socioeconomic status, and maternal education were associated with behavior problem scores. There was no significant association between epilepsy-related variables and the behavior problem scores and the course. Among all possible risk factors in the regression analyses, maternal trait anxiety level was found to be significantly related to the total problems, internalizing, and externalizing scores in the group with epilepsy. CONCLUSION Behavioral comorbidities of epilepsy are present very early and can be seen at the time of the diagnosis, however, they do not worsen over time in preschool children. Maternal anxiety should be considered as a risk factor for behavioral problems in preschool children with epilepsy. Assisting children and parents and ensuring necessary guidance and support should be a crucial part of epilepsy treatment initiated as soon as the time of diagnosis.
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Affiliation(s)
- Tuba Çelen Yoldaş
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Sihhiye 06100, Ankara, Turkey.
| | - Ceren Günbey
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Sihhiye 06100, Ankara, Turkey
| | - Aydan Değerliyurt
- Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey
| | - Neşe Erol
- Ankara University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Elif Özmert
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Sihhiye 06100, Ankara, Turkey.
| | - Dilek Yalnızoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Sihhiye 06100, Ankara, Turkey.
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Maatman RC, Papen-Botterhuis NE, Scheltinga MRM, Roumen RMH. Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain. Scand J Pain 2017; 17:211-217. [PMID: 29111493 DOI: 10.1016/j.sjpain.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 09/30/2022]
Abstract
BACKGROUND AND AIMS Chronic abdominal pain may occasionally be due to terminal endings of intercostal nerves (ACNES, abdominal cutaneous nerve entrapment syndrome) that are entrapped in the abdominal wall. Spontaneous neuropathic flank pain may also be caused by involvement of branches of these intercostal nerves. Aim is to describe a series of patients with flank pain due to nerve entrapment and to increase awareness for an unknown condition coined Lateral Cutaneous Nerve Entrapment Syndrome (LACNES). METHODS Patients possibly having LACNES (constant area of flank tenderness, small point of maximal pain with neuropathic characteristics, locoregional altered skin sensation) presenting between January 2007 and May 2016 received a diagnostic 5-10mL 1% lidocaine injection. Pain levels were recorded using a numerical rating scale (0, no pain to 10, worst possible). A >50% pain reduction was defined as success. Long term effect of injections and alternative therapies were determined using a satisfaction scale (1, very satisfied, no pain - 5, pain worse). RESULTS 30 patients (21 women, median age 52, range 13-78) were diagnosed with LACNES. Pain following one injection dropped from 6.9±1.4 to 2.4±1.9 (mean, p<0.001) leading to an 83% immediate success rate. Repeated injection therapy was successful in 16 (pain free n=7, pain acceptable, n=9; median 42 months follow-up). The remaining 14 patients received (minimally invasive) surgery (n=5) or other treatments (medication, manual therapy or pulsed radiofrequency, n=9). Overall treatment satisfaction (scale 1 or 2) was attained in 79%. CONCLUSIONS AND IMPLICATIONS LACNES should be considered in patients with chronic flank pain. Injection therapy is long term effective in more than half of the population.
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Affiliation(s)
- Robbert C Maatman
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands.
| | | | - Marc R M Scheltinga
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands; SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
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