Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care.Parent-adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11-17) had experienced primary pain for >3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention.Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5-9 and Hybrid-PIPP median 8.5, range 5-10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported.The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications.ANZTR(ACTRN2614000489695).
Abstract Objective To evaluate the accuracy, reliability, clinical utility, and usability of HeraBEAT, a wireless fetal and maternal heart rate monitor (HBM) when used by clinicians and pregnant women to monitor fetal heart rate (FHR). Methods We recruited women aged 18 years or older with a singleton pregnancy of ≥12 weeks gestation. FHR recordings were performed using the HBM and cardiotocography (CTG) to determine comparative accuracy. The HBM was then used by clinicians and participants in the antenatal clinic with the latter then using the device unassisted to record at home. The women rated the HBM using the System Usability Scale (SUS). Results A total of 81 participants provided 126 recordings for analysis. The accuracy of the HBM was excellent compared with CTG, with limits of agreement (95%) between −1.5 and +0.9 beats per minute (bpm) and a mean difference of −0.29 bpm. The FHR was detected on 100% of occasions by clinicians (52 recordings) and participants when used in the clinic (42 recordings) and at home (32 recordings). Home users took an average of 1.1 minutes to detect the FHR and recorded a continuous trace of >1 minute in 94% of occasions, with an average total trace time of 4.4 minutes. The FHR trace was deemed to be clinically useful in 100% of clinician recordings and 97% of home recordings. There was no effect from body mass index, gestational age, pregnancy history, or placental position. The HBM ranked in the 96–100th percentile on the SUS for usability and learnability. Conclusions The HBM was accurate and easy for clinicians and participants to use. The data recorded at home was equivalent to that obtained in the clinic using current assessment protocols for low-risk pregnancies, allowing the device to be used in telehealth consultations. Clinical Trial Registration Australian New Zealand Clinical Trial Registry, https://www.anzctr.org.au ACTRN12620000739910.
Objective: There is evidence that mood disorders are associated with impaired parasympathetic nervous system function and consequently increased morbidity and mortality. Our study addresses whether this impairment persists into remission in unipolar and bipolar disorders. Methods: Heart Rate Variability was measured in groups of subjects during remission, with Bipolar Affective Disorder I ( n = 29), recurrent Major Depressive Disorder ( n = 41) and a healthy control group ( n = 38), during the bedtime period. Results: Heart Rate Variability was found to be lower in the bipolar and depression groups, compared with control subjects, using the Root Mean Square of Successive Distances variable, and lower in the depression group using the Standard Deviation of Normal to Normal variable and the Standard Deviation, Poincare Plot variable. Conclusion: Autonomic function during bedtime was impaired in subjects with Bipolar I and recurrent Major Depressive Disorder, despite clinical remission. This has significant implications for the morbidity and mortality of patients with major mood disorders.
Abstract Background Autologous hematopoietic stem cell transplantation (aHSCT) using hematopoietic progenitor cells (HPCs) has become an important therapeutic modality for patients with high‐risk malignancies. Current literature on standardized method for HPC apheresis in children is sparse and failure rate reported as high as 30%. Patients/Methods A retrospective study of 125 pediatric patients with high‐risk malignancies undergoing aHSCT in Western Australia between 1997 and 2016 was conducted. Results Mobilization was achieved by means of chemotherapy and granulocyte colony‐stimulating factor (G‐CSF). Patients underwent apheresis the day after CD34 + counts reached ≥20/µL and an additional dose of G‐CSF. Peripheral arterial and intravenous lines were inserted in pediatric intensive care unit under local anesthetic and/or sedation, omitting the need for general anesthesia as well as facilitating an uninterrupted apheresis flow. Larger apheresis total blood volumes were processed in patients weighing ≤20 kg. The minimal dose of ≥2 × 10 6 CD34 + cells/kg was successfully collected in 98.4% of all patients. The optimal dose of 3‐5 × 10 6 CD34 + cells/kg was collected in 96% of patients scheduled for a single aHSCT, 87.5% for tandem, and 100% for triple aHSCT. All HPC collections were completed in one apheresis session. Mobilization after ≤3 chemotherapy cycles and cycles including cyclophosphamide resulted in a significantly higher yield of CD34 + cells. Conclusion Our approach to HPC mobilization by means of chemotherapy and single myeloid growth factor combined with optimal collection timing facilitated by continuous apheresis flow resulted in highly effective HPC harvest in children and adolescents with high‐risk cancers.
Background: Public health approaches to palliative and end-of-life care focus on enhancing the integration of services and providing a comprehensive approach that engages the assets of local communities. However, few studies have evaluated the relative costs and benefits of providing care using these service models. Objectives: To assess the effect on healthcare usage of a community-based palliative care program (‘Compassionate Communities Connectors’) where practical and social support was delivered by community volunteers to people living with advanced life-limiting illnesses in regional Western Australia. Design: Controlled before-and-after study/Cost-consequence analysis. Methods: A total of 43 community-based patients participated in the program during the period 2020–2022. A comparator population of 172 individuals with advanced life-limiting illnesses was randomly selected from usage data from the same set of health services. Results: Relative to controls, the intervention group had lower hospitalizations per month [Incidence rate ratio (IRR): 0.37; 95% CI: 0.18–0.77, p = 0.007], less hospital days per month (IRR: 0.23; 95% CI: 0.11–0.49, p < 0.001) and less emergency presentations (IRR: 0.56; 95% CI: 0.34–0.94, p = 0.028. The frequency of outpatient contacts overall was two times higher for the intervention group (IRR: 2.07; 95% CI: 1.11–3.86, p = 0.022), indicating the Connector program may have shifted individuals away from the hospital system and toward community-based care. Estimated net savings of $AUD 518,701 would be achieved from adopting the Connector program, assuming enrollment of 100 patients over an average 6-month participation period. Conclusion: This combined healthcare usage and economic analysis of the ‘Compassionate Communities Connectors’ program demonstrates the benefits of optimizing palliative care services using home-based and community-centered interventions, with gains for the health system through improved patient outcomes and reduced total healthcare costs (including fewer hospitalizations and readmissions). These findings, coupled with the other published results, suggest that investment in the Connectors program has the capacity to reduce net health sector expenditure while also improving outcomes for people with life-limiting illnesses. Trial Registration: Australian and New Zealand Clinical Trial Registry: ACTRN12620000326998.
Abstract Background The aim of this study is to contribute to the knowledge base on the long-term outcomes of evidence-based medical interventions used to improve gross motor function in children and adolescents with Cerebral Palsy. Method Prospective cohort study of children with Cerebral Palsy in the birth years 2000–2009 attending a tertiary level service for children with Cerebral Palsy who’s first recorded Gross Motor Function Classification System level was II. Results A total of 40 children were eligible for the study, of whom 28 (72.7%) enrolled. The Botulinum toxin A treatment for this cohort, (median and interquartile ranges) were: total number of lower limb Botulinum toxin A injections 11 (6.7, 5.5); total dose of Botulinum Toxin A per lower limb treatment 6.95 u/kg (4.5, 11); and dose of Botulinum Toxin u/kg/muscle 2.95 (2.2, 4). For all 28 subjects there was a median of 15 (8.5 to 22) Gross Motor Function Classification System level recordings: six of the 28 children (21.4%) improved from level II to level I, the remaining 22 children remained stable at level II (78.6%). In this highly treated population, the average 66 item Gross Motor Function Measure score for the 22 children in level II was 72.55, which is consistent with the mean of 68.5 reported in the original Ontario cohort. Conclusion This cohort study has confirmed that children with Cerebral Palsy, Gross Motor Function level II treated at a young age with repeated doses of Botulinum Toxin A within an integrated comprehensive service, maintain or improve their functional motor level at a later age.
dysmotility symptoms score.A multivariate linear regression revealed that the mean LCQ total score was independently associated with current smoker, fibrocavitary type, bilateral cavitary lesion, and FSSG total score (Table 2).Conclusions: Cough-and sputum-related QOL was impaired in NTM patients with current smoking, radiographical characteristics, and comorbid GERD being associated with the cough-specific QOL.
mucormycosis is an uncommon, life-threatening opportunistic fungal infection which affects immunocompromised patients such as diabetes, recipients of stem cell or organ transplant, and has worse outcomes in those with hematologic malignancy or neutropenia.Methods: A 35 years old male patient with uncontrolled type II Diabemellitus presented to casualty with complaints of cough associated with thick dark brownish sputum for 1 month, fever, loss of appetite and weight since 15 days.His vitals were stable at the time of admission.Chest auscultation revealed diminished vesicular breath sounds heard in right infraclavicular and suprascapular area.Complete blood count showed leucocytosis with neutrophilic predominance.He also had hyponatremia and hypokalaemia.Chest x-ray showed large irregular thick walled cavity in right mid and lower zone.CT thorax revealed central bronchopleural fistula involving right main bronchus with collapse and consolidation involving right middle and lower lobe.Patient underwent diagnostic bronchoscope which showed distorted right secondary carina and there was a large communication in right main bronchus extending to pleural space with thick brownish collection.Right upper lobe bronchial mucosa was unhealthy, covered with thick brownish slough.Results: Bronchoalveolar lavage KOH smear and Transbronchial lung biopsy showed fungal organisms with broad aseptate hyphae suggestive of mucormycosis and he was started on intravenous amphotericin deoxycholate 50mg.Right pneumonectomy was performed in view of large BPF. Conclusion:We evidenced a positive clinical outcome in a poorly controlled diabetic state with early surgical resection and a combination of antifungals.It highlights the importance of the early diagnosis, treatment and timely surgical debridement for the therapy of mucormycosis.
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