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Variation in Intensive Pediatric Physical Therapy Practice in the United States: Results From a National Survey.
No full textPURPOSE: Intensive pediatric physical therapy (PT) programs are increasingly common yet lack a clear definition. This study aimed to examine current practice patterns of intensive pediatric PT in the United States.
METHODS: A survey was developed and administered using the FITT (frequency, intensity, time, type) model and Knowledge to Action Cycle for pediatric physical therapists providing intensive PT. Survey respondents included pediatric physical therapists providing intensive physical therapy in outpatient, non-acute settings. Data analysis used descriptive statistics and cluster analysis.
RESULTS: Eighty pediatric physical therapists reported intensive programs involved children aged 4-6 years with cerebral palsy (90%), neuromuscular (78%), and neuromotor (44%) disorders. Greatest dose often-always ranged from 2-5 visits per week, ≤60-120 minute sessions over 3-8 weeks. Top interventions included locomotor training (80%), task-specific training (78%), and progressive resistive exercise (76%). Two clusters were identified based on therapist organization and dose.
CONCLUSIONS: This first study of intensive pediatric PT revealed marked variability, underscoring the need for a standardized definition to improve clinical care
Sustained improvements in spinal pain, morning stiffness, fatigue, sleep, physical function and overall health-related quality of life with bimekizumab in patients with axial spondyloarthritis: 2-year results from two phase 3 studies.
No full textObjective: To assess the long-term effect of bimekizumab, a dual inhibitor of IL-17A and IL-17F, on patient-reported symptoms, function and health-related quality of life (HRQoL) in patients with axial spondyloarthritis (axSpA) from phase 3 studies and their open-label extension.
Methods: BE MOBILE 1 (non-radiographic-axSpA) and 2 (radiographic-axSpA) comprised 16-week double-blind placebo-controlled and 36-week maintenance periods. From week 16, all patients received subcutaneous bimekizumab 160 mg every 4 weeks. At week 52, eligible patients could enrol in the open-label extension BE MOVING and continue bimekizumab treatment. Spinal pain (rated on a numerical rating scale from 0 (no pain) to 10 (maximum pain)), morning stiffness (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) average of Q5/6), fatigue (BASDAI Q1; Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue subscale), sleep quality (Medical Outcomes Study (MOS) Sleep Scale Index II), physical function (Bath Ankylosing Spondylitis Functional Index (BASFI)) and HRQoL (36-Item Short Form Survey (SF-36) physical component summary (PCS)/mental component summary (MCS); Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire) were reported to week 104.
Results: In total, 494/586 (84.3%) patients entered BE MOVING at week 52; 456 completed week 104. Patients reported substantial changes from baseline to week 104 in total spinal pain (-4.3), nocturnal spinal pain (-4.3), morning stiffness (-4.3) and fatigue (BASDAI Q1: -3.4; FACIT-Fatigue: +9.9). Over half reported total and nocturnal spinal pain scores ≤3 at week 104. Similar improvements to week 104 were shown in sleep (MOS-Sleep Scale: +10.2), physical function (BASFI: -2.9) and HRQoL (SF-36 PCS: +12.4; ASQoL: -5.6).
Conclusions: Bimekizumab treatment resulted in sustained improvements in patient-reported symptoms and their impacts across the full disease spectrum of axSpA over 2 years, underscoring its long-term potential for improving patients\u27 daily lives.
Trial registration numbers: NCT03928704, NCT03928743, NCT04436640
Consensus Guidelines on Diagnostic Brain and Spine Imaging of Spontaneous Intracranial Hypotension.
No full textDiagnostic imaging of the brain and spine in spontaneous intracranial hypotension (SIH) has evolved rapidly in the past several years, presenting challenges for practitioners seeking to stay current on the optimal methods for investigating and localizing spinal CSF leaks. We established a Guidelines Working Group with representation from experts in diagnostic imaging as well as external experts in the clinical management of SIH. Recommendations and statements addressing the selection and performance of diagnostic imaging in patients with known or suspected SIH were developed by using a modified Delphi process. The intent was to provide guidance across a variety of practice settings in North American health care systems to implement current best practices in the diagnostic evaluation of SIH
A multi-modal medical management and lifestyle intervention increase cerebral blood flow and lowers diabetic risk in persons with early Alzheimer\u27s disease: Mid-trial results from the PREVENTION trial.
No full textBackgroundMedical and lifestyle management are crucial for Alzheimer\u27s disease (AD). Cerebral blood flow (CBF), vital for brain health, and influenced by modifiable risk factors, is reduced in AD and may become uncoupled from metabolism due to neurovascular dysfunction in later stages.ObjectiveThis mid-trial analysis tested the hypothesis that a coached, multi-modal intervention (PREVENTION) improved ASL-MRI-measured CBF and diabetic risk (QUICKI) in patients with early AD.MethodsThe control arm received recommendations and medical management for one year; the active arm additionally received coaching, exercise training, and supplementation. We hypothesized that those in (1) the active arm and (2) with higher intervention adherence would have improved post-trial QUICKI and CBF, particularly in regions relevant to exercise, cardiovascular, diabetic, and AD risk. Post-trial CBF was analyzed using a linear model including arm, baseline CBF, adherence, age, education, and depressive symptoms. Change in QUICKI was analyzed using mixed effects general linear models, including arm, adherence, time, and interactions between time and treatment group and time and adherence, controlling for age.ResultsThe active arm (n = 18) showed greater post-trial CBF in regions related to exercise, cardiovascular, diabetic, and AD risk, compared to control (n = 20), but did not differ in global CBF, QUICKI, or adherence. Higher adherence scores were associated with greater regional post-trial CBF and improvement in QUICKI, but not global CBF.ConclusionsIn this small sample, we found evidence that a multi-modal intervention focused on medical management, exercise, and a carbohydrate-restricted diet improved diabetic risk and CBF in patients with AD
Medicine for a Changing Planet: Online Clinical Cases in Planetary Health and Infectious Diseases.
No full textPlanetary health and One Health have become key concepts in public health, scientific, and veterinary training, yet these concepts remain incompletely integrated into clinical medical education. Recognizing this gap, we created a free online curriculum called Medicine for a Changing Planet, geared toward training the next generation of health professionals in clinical skills to detect and manage the impacts of global and local environmental change on their patients. Using a case conference-style format familiar to medical trainees, we created 11 clinical case studies teaching both planetary health concepts and clinical competencies, leveraging Bloom\u27s Taxonomy. Here, we describe the creation of these clinical cases, highlighting those centered on emerging infectious diseases that teach clinical skills related to the human-animal interface, globalization, and climate change. The online cases have been visited by more than 4000 unique users from 99 countries, piloted with residency and medical school programs, and made available for CME credit
Adherence to CheckMate 577 Within a Community Health Care System in the First 2 Years After Approval.
No full textBACKGROUND: CheckMate 577 demonstrated a significant benefit with adjuvant nivolumab for those with residual disease after esophagectomy following chemoradiation, resulting in subsequent Food and Drug Administration approval and guideline inclusion. We analyzed adherence to this recommendation in a nontrial setting and assessed for factors associated with noncompliance within our health care system.
METHODS: We performed a cross-sectional analysis of patients with esophageal cancer within a multistate community health care system between February 2021 and December 2022. Patients with resected residual disease following induction chemoradiation were included. Patients were assigned to categories of those offered nivolumab and those not, then assessed for demographic, socioeconomic, or clinical factors associated with nonadherence. Area Deprivation Index was used as surrogate for socioeconomic status. Patients completing year-long nivolumab were then compared with those discontinuing prematurely for factors associated with noncompletion.
RESULTS: Of the 73 patients eligible for nivolumab, 67 (92%) were offered therapy. Not being offered nivolumab was associated with receiving care from medical oncologists located in more disadvantaged communities. Of patients offered nivolumab, 57 of 67 (85%) initiated treatment. Year-long immunotherapy was completed by 25 (48%) patients. Patients with node-positive disease were more likely to have completed year-long nivolumab.
CONCLUSIONS: In the first 2 years after CheckMate 577, results within our health care system suggest high clinician adherence to and patient acceptance of adjuvant immunotherapy with decreased adoption in more socioeconomically challenged oncology offices. In addition, compliance with the year-long adjuvant regimen mirrored clinical trial results. These results warrant further validation in a more diverse, less affluent population
Fine Motor Development Growth Curves for Down Syndrome.
No full textThis study seeks to develop fine motor development growth curves for children with Down syndrome, specifically related to grasping and visual motor integration skills. A cross-sectional retrospective chart review was completed on a large cohort of children with Down syndrome from birth to 6 years of age who completed the Peabody Developmental Motor Scales-2nd Edition (PDMS-2). Although both fine motor and visual motor development were delayed in children with Down syndrome compared with typically developing peers, and a negative association between fine motor quotient and age was observed, grasping and visual motor integration raw scores increased with age. The Down syndrome-specific percentile curves developed here may enable providers to identify individuals requiring further investigation, and will be useful in future studies of factors that may influence fine motor development in Down syndrome. These data will also help parents better understand their children\u27s development and interpret developmental test results
Impact of Obesity on Postoperative Outcomes in Transanal Total Mesorectal Excision for Rectal Cancer.
No full textBACKGROUND: Transanal total mesorectal excision (taTME) has been increasingly adopted in the curative resection of low rectal cancer. Obesity is a known risk factor for conversion and morbidity during laparoscopic and robotic TME.
OBJECTIVE: We sought to compare short-term postoperative and pathologic outcomes and long-term oncologic outcomes of transanal total mesorectal excision between non-obese vs. obese patients across high-volume rectal cancer centers in the United States.
DESIGN: Retrospective cohort study.
SETTINGS: Eight tertiary centers in the United States of America.
PATIENTS: Eligible patients underwent transanal total mesorectal excision for curative resection of primary rectal adenocarcinoma between November 2011 and June 2020.
MAIN OUTCOME MEASURES: Intraoperative complications, 30-day postoperative complications, local recurrence, distant recurrence, overall survival, disease-free survival.
RESULTS: A total of 390 transanal total mesorectal excision procedures were performed in 271 (69.5%) non-obese (BMI \u3c 30 kg/m2) and 120 (30.5%) obese (BMI ≥ 30 kg/m2) patients with a median BMI of 27.4 kg/m2 (IQR 24.1-31.0). The median follow-up was 29 months (IQR 14-44 months). There were no significant differences in tumor stage or neoadjuvant treatment across groups. Tumors were located ≤ 6cm from the anal verge in 60.6% of patients. Operative time was longer in the obese group, with no significant differences in conversion rates or intraoperative complications. No significant differences in postoperative complications, including Clavien-Dindo grade ≥3 complications, anastomotic complications or reoperation rates were noted between non-obese and obese cohorts. At a median follow-up of 29 months, local recurrence, overall survival, and disease-free survival were comparable between the groups, while obese patients had a significantly lower rate of distant recurrence than non-obese patients.
LIMITATIONS: Retrospective design, short median follow up time.
CONCLUSIONS: In this multicenter retrospective study, transanal total mesorectal excision resulted in similar conversion and morbidity rates among obese and non-obese patients. Obesity was associated with a significantly lower 3-year distant recurrence with no differences in other mid-term oncologic outcomes
Trends in Catheter-Directed Therapy and In-Hospital Outcomes Among Patients with Acute Pulmonary Embolism: Insights from a Multicenter National Quality Assurance Database Registry.
No full textBackground: Multidisciplinary pulmonary embolism response teams (PERT) are being established in hospitals worldwide to address the increasing complexity in acute PE management.
Aim: To identify recent trends in PERT decisions regarding advanced treatment of acute severe PE.
Methods: We analysed data from the prospective multicentre PERTTM Consortium registry (years 2018-2024), focusing on catheter-directed treatment (CDT) and including systemic thrombolysis, surgical embolectomy, and extracorporeal membrane oxygenation (ECMO). An age-, sex-, and PE risk-matched population from the US Nationwide Inpatient Sample (NIS) was used for comparison.
Results: Among 11,436 patients enrolled at 51 sites (median age, 65 years; 13.7% high-risk and 62.5% intermediate-risk PE), 2,639 (23.1%) underwent CDT. Of those, 140 (5.3%) underwent catheter-directed thrombolysis without ultrasound, 851 (32.2%) ultrasound-assisted catheter thrombolysis, and 1,534 (58.1%) mechanical thrombectomy/aspiration. Systemic thrombolysis was used in 5.6%, surgical embolectomy in 1.1%, and ECMO in 1.6% of all patients. Trends of CDT increased over time (+0.36% quarterly by linear regression; P=0.002), with increase in mechanical thrombectomy (+0.83%; P\u3c 0.001) and decrease in catheter-directed thrombolysis (-0.4%; P=0.001). Matching 10,883 patients from the PERTTM Consortium registry to the NIS population, we found a 22% (95% CI, 21-23%) standardized mean difference in CDT use, 1.3% (0.6-2.0%) lower in-hospital mortality, and 0.75 (0.2-1.3) less days of hospital stay among PERTTM Consortium registry patients.
Conclusion: In a national quality assurance database of patients with PE included in the PERT registry, the use of catheter-directed treatment increased over time. Compared with a nationwide NIS sample, these patients had lower in-hospital mortality and shorter hospital length of stay.
Keywords: advanced therapies; catheter directed treatment; pulmonary embolism; pulmonary embolism response team; systemic thrombolysis
