1,721,070 research outputs found
Effect of neo-adjuvant chemotherapy on long-term health state and behaviour in the PNET3 RCT of treatment for primitive neuroectodermal tumour (PNET)
No full textThe addition of chemotherapy to craniospinal irradiation (CSI) for treatment of PNET is currently considered ‘the standard of care’ to improve both rate and quality of survival (QoS), but its effect on QoS has not been systematically assessed. We assessed QoS in UK children previously enrolled in the SIOP PNET3 RCT of CSI (35 Gy plus 20 Gy boost to posterior fossa) vs. CSI plus neo-adjuvant chemotherapy (Vincristine, Carboplatin, Etoposide, and Cyclophosphamide) using a cross-sectional multi-informant questionnaire design. Total scores on the two core measures, the Health Utilities Index mark 3 (HUI3) and the Strengths and Difficulties Questionnaire (SDQ), were compared between the two treatment arms using the Mann-Whitney U test. Information was obtained from patients, parents, and health professionals on 103/169 (61%) of survivors at a mean (SD) of 15.4 (4.0) years of age and 7.0 (2.25) years from diagnosis. Median {interquartile range} HUI scores and mean (SD) SDQ total difficulties scores were: HUI3 SDQ Respondent Parent Self* Parent Self** n 44 vs. 55 38 vs. 44 33 vs. 43 27 vs. 35 CSI 0.71 {0.52} 0.92 {0.37} 11.4 (5.21) 10.6 (4.59) CSI + Chemo 0.72 {0.48} 0.65 {0.45} 13.7 (5.90) 11.4 (5.90) *: aged over 11 years; **: aged 11–17 years Self-complete HUI3 scores were lower (Z = -2.263, p = 0.024, two-tailed) and parent-complete SDQ scores tended to be higher (Z = -1.559, p = 0.119, two-tailed) in the ‘CSI plus chemotherapy’ group. Parent-/child-complete SDQ scores were abnormally high in 14.0/2.9% and 33.3/7.4% of children in the ‘CSI’ and the ‘CSI plus chemotherapy’ arms, respectively. Patients in the two treatment arms will also be compared with respect to subscale scores on these measures, responses to quality of life questionnaires, and information from health professionals. These findings suggest that differences between self- and proxy-assessment are important and that the addition of chemotherapy to ‘standard dose’ CSI may adversely affect health status and behaviour. The effect on these measures of reducing the dose of CSI and simultaneously adding chemotherapy requires further investigation
The growth pattern of medulloblastoma affects short-term neurological impairments after surgery: results from the prospective multi-center HIT-SIOP PNET 4 study
No full textObjective: extensive resection of a tumor in the posterior fossa in children is associated with risk of neurological deficits. The objective of this study was to prospectively evaluate the short-term neurological morbidity in children after medulloblastoma (MB) surgery and relate this to the tumor´s growth pattern and to the extent of resection.Methods: in 160 patients taking part in the HIT-SIOP PNET 4 trial neurosurgeons prospectively responded to questions concerning the growth pattern of the tumor they had operated on. The extent of resection, i.e. gross-, near- or sub-total, was evaluated by MRI. The patients’ neurological status before resection and around 30 days after resection was recorded. Results: invasive tumor growth, defined as local invasion in the brain or meninges, in a cranial nerve or major vessel, was reported in 58% of the patients. After surgery almost 70% of all patients were affected by one or several neurological impairments e.g. impaired vision, impaired extraocular movements and ataxia. However, this figure was very similar to the preoperative findings. Invasive tumor growth implied a significantly higher number of impairments after surgery (p=0.03) as well as deterioration regarding extraocular movements, facial weakness (p= 0.012, 0.048) and ataxia in arms and trunk (p= 0.014, 0.025) compared to non-invasive tumor growth. This deterioration was not dependent on the extent of resection performed. PFS at 5 years was 80±4% and 76±5%, respectively, for patients with invasive and non-invasive tumor growth with no difference in the 5 years PFS for extent of resection. Conclusions: preoperative neurological impairments and invasive tumor growth were strong predictors for deterioration in short-term neurological outcome after MB neurosurgery whereas the extent of resection was not. Neither tumor invasiveness nor extent of resection influenced PFS. These findings support to continue maximal safe resection in MB surgery where functional risks are not taken in areas with tumor invasion.<br/
The diagnosis of death by neurological criteria in infants less than two months old
No full textThis NICE accredited evidence-based clinical guideline provides recommendations on the diagnosis of death by neurological criteria (DNC) in infants from 37 weeks corrected gestation (post menstrual) to two months of age (post term). It is for all UK paediatric and neonatal health care practitioners and other groups involved in the regulation or practice of the health care of critically ill neonates and young infants
Modified constraint-induced movement therapy as a home-based intervention for children with cerebral palsy
No full textPurpose: This study was designed to investigate the benefit to upper limb function of a home-based version of pediatric constraint-induced movement therapy, which was delivered across 2 months.Methods: Nine children (mean age: 6 years, 9 months) with hemiplegic cerebral palsy participated in this A1-B-C-A2 design, where A1 and A2 were nonintervention phases. In phases B and C, participants wore a splint on the unaffected hand. In phase C, motivating feedback through a computer game was added.Results: The Melbourne Assessment of Unilateral Upper Limb Function and the Quality of Upper Extremity Skills Test scores were significantly higher at the end of phases B (P = .037 and P = .006, respectively) and C (P = .001 and P = .001, respectively). Melbourne scores remained higher at the end of phase A2 (P = .001).Conclusions: A nonintensive form of home-based constraint-induced movement therapy was found to be effective. Improvements were larger after the second month of intervention.<br/
The impact of early identification of permanent childhood hearing impairment on speech and language outcomes
No full textIt is well established that permanent childhood hearing impairment (PCHI) has a detrimental impact on speech and language development. The past two decades have seen the gradual introduction of universal newborn hearing screening (UNHS) programmes coupled with early intervention programmes. We review studies that have capitalised on the advent of newborn hearing screening to assess the impact of early identification of PCHI on language outcomes in deaf children. The research supports the conclusion that, in children with PCHI, newborn hearing screening and early identification lead to beneficial effects on language development, with the most consistent evidence provided for links between early identification of PCHI and positive language outcomes. Future research needs to encompass a wider range of outcomes and to assess the impact of UNHS in adolescents and young adult
In reply to Genc et al
No full textRefers to Genc Mine, Aylin F. Korcum, Gamze M. Aksu, Melek N. Yavuz, In Regard to Kennedy et al, International Journal of Radiation Oncology*Biology*Physics, Volume 89, Issue 4, 15 July 2014, Pages 928
Forced use as a home-based intervention in children with congenital hemiplegic cerebral palsy: choosing the appropriate constraint
No full textPurpose: The purpose of this study was (1) to identify the most appropriate splint from children's and parents' perspective as reflected by effectiveness and adherence to home-based forced use therapy (FUT). (2) To provide guidance in the development of a practical and effective protocol based on forced use principles. Method: A crossover design with a convenience sample of children with hemiplegic cerebral palsy and their parents was used to test three types of splint (mitt, short splint and long splint) during home-based FUT. Children wore the splints for a minimum of 1 h/ day during physical activity. Outcome measures included a daily log and a questionnaire (completed by parents), an actometer worn on the affected hand to quantify movement and video recordings to inform quality of movement. Results: The short splint was found to be the most effective and acceptable restraining device. Wearing devices for more than 1 h per day was not considered acceptable by either parents or children. Conclusion: A short splint, worn for 1 h per day was found to be the most acceptable protocol.<br/
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