Patient Reported Experience Following Ambulatory Procedures of the Nervous System

2018 ◽  
Vol 44 (9) ◽  
pp. 557-560
Author(s):  
Mohamad Bydon ◽  
Panagiotis Kerezoudis ◽  
Kristine T. Hanson ◽  
Mohammed Ali Alvi ◽  
Elizabeth B. Habermann
Keyword(s):  
Nervous System ◽  
Patient Reported ◽  
Ambulatory Procedures

EPID-24. TRANSCRIPT: A cenTRAl NERVOUS SYSTEM CANCER CLINICAL tRIals PostmorTem

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi91-vi91
Author(s):  
Yeonju Kim ◽  
Terri Armstrong ◽  
Mark Gilbert ◽  
Orieta Celiku
Keyword(s):  
Central Nervous System ◽  
Overall Survival ◽  
Clinical Trials ◽  
Nervous System ◽  
Brain Tumor ◽  
Objective Response ◽  
Survival Rates ◽  
Maximum Tolerated Dose ◽  
Secondary Outcome ◽  
Patient Reported

Abstract BACKGROUND Despite the growing number of neuro-oncology clinical trials, there have been limited advances in the treatment of malignant primary central nervous system tumors. We surveyed the landscape of past, ongoing, and planned trials to assess trends in their interventions, outcomes, and design considerations to guide future studies. METHODS Data on interventional trials on ClinicalTrials.gov were accessed programmatically using AACT and R. Neuro-oncology trials were isolated using primary malignant brain tumor classification terms. Instrument names from PROQOLID were used to identify clinical outcome assessment (COA) use. Linear regression was used to assess chronological trends; power analyses utilized CBTRUS survival rates among trials investigating overall survival. RESULTS We identified 3039 interventional brain tumor trials that started between 1966 and 2025. Trials were most frequently phase II (43%), completed (40%), non-blinded (92%), single-group assignment (65%), non-randomized (51%) studies targeting glioblastoma (45%). Planned outcomes were reported by 93% of trials; this included adverse event or toxicity (54%), overall/x-year survival (44%), progression free survival (43%), maximum tolerated dose (16%), and objective response rate (14%). Evaluating the anticipated and actual trial enrollment, we estimate that only 10% and 8% of trial arms, respectively, were sufficiently powered to assess overall survival endpoints. 21% of trials mentioned the use of a COA (first trial initiated in 1992), majority of which were patient-reported outcomes. Among these, 25% and 58% reported COA as a primary or secondary outcome, respectively. The rate of COA use increased linearly over time at 1.1%/year but remained less than 5 trials per year until 2003. Ongoing work is investigating treatment mechanisms of actions and evidence of preclinical efficacy among brain tumor studies. CONCLUSIONS Low randomization rates and underpowered trial design may impede interpretability of efficacy. Increasing trends in COA use suggests cumulative influence of advocacy efforts to holistically evaluate net clinical benefit of interventions.

NCOG-42. SYMPTOM ONSET TO TIME OF DIAGNOSIS IN PRIMARY CENTRAL NERVOUS SYSTEM TUMOR PATIENTS: A REVIEW OF FINDINGS FROM THE NOB-NHS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi161-vi161
Author(s):  
Matthew Lindsley ◽  
Elizabeth Vera ◽  
Alvina Acquaye ◽  
Nicole Briceno ◽  
Anna Choi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Healthcare Providers ◽  
Healthcare Setting ◽  
Tumor Location ◽  
Low Grade ◽  
Central Nervous System Tumor ◽  
Tumor Patients ◽  
Patient Reported ◽  
Reported Data

Abstract Prior reports suggest the low prevalence of primary central nervous system (PCNS) tumors and the healthcare setting where patients seek care can contribute to diagnostic delays, potentially affecting prognosis. This descriptive report highlights findings from patient-reported data at presentation collected from a sample of 623 PCNS tumor patients. Participants were White (88%), males (56%), median age at diagnosis 41 (2-79) with high grade (HG) (66%) brain tumors (BT) (89%). Among BT patients, 30% reported ≥ 3 concurrent symptoms at presentation including headaches (40%), seizures (30%), and memory problems or difficulty with balance/walking (20% each). Over half (57%) had symptoms for < 6 months before diagnosis and 60% presented to the Emergency Room. Sixty-five percent of HG BT patients had symptoms for < 6 months prior to diagnosis compared to low grade (LG) tumors (40%) and had surgery in < 1 month from presentation (68% vs 51%, p < 0.01). More HG BT patients presented with weakness in the arms/legs than LG BT (14% vs 8%). Among spine tumor (ST) patients, 45% reported ≥ 3 concurrent symptoms at presentation including back pain (65%), sensory changes (45%), and weakness (40%). Almost half (46%) were symptomatic for > 1 year before diagnosis, presented in an outpatient clinic (64%) with 41% having surgery < 1 month from presentation. Younger (40% vs 16%) and HG ST patients (56% vs 21%) more often reported symptoms for < 6 months before diagnosis. HG ST patients more often presented to Emergency Rooms (67% vs 25%) and had surgery < 1 month from presentation (60% vs 36%). Further analysis of symptom presentation and clinical course is ongoing. Tumor location, grade, patient age and healthcare setting were associated with the time from clinical presentation to diagnosis. Development of aids providing guidance on diagnostic evaluation/treatment to front-line healthcare providers is warranted.

Chlorambucil-Induced Myoclonus in a Cat With Lymphoma

2003 ◽  
Vol 39 (3) ◽  
pp. 283-287 ◽  
Author(s):  
Noémi Benitah ◽  
Louis-Philippe de Lorimier ◽  
Michele Gaspar ◽  
Barbara E. Kitchell
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Side Effect ◽  
Alkylating Agent ◽  
Laboratory Animals ◽  
Intestinal Lymphoma ◽  
Potential Side Effect ◽  
Patient Reported ◽  
Clonic Seizures

Chlorambucil is an alkylating agent commonly used in veterinary oncology for conditions including lymphoma. Chlorambucil neurotoxicity has been well recognized in human patients. Onsets of central nervous system signs, such as myoclonus, tremors, muscular twitching, agitation, and tonic-clonic seizures, have been reported in humans and laboratory animals treated with chlorambucil. This case of a cat with intestinal lymphoma represents the first veterinary patient reported to have chlorambucil-induced neurotoxicity. Neurotoxicity should be considered a potential side effect of chlorambucil therapy in veterinary patients.

scholarly journals Improved Central Nervous System Symptoms in People with HIV without Objective Neuropsychiatric Complaints Switching from Efavirenz to Rilpivirine Containing cART

2019 ◽  
Vol 9 (8) ◽  
pp. 195 ◽  
Author(s):  
Vera ◽  
Bracchi ◽  
Alagaratnam ◽  
Lwanga ◽  
Fox ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Tenofovir Disoproxil Fumarate ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
People Living With Hiv ◽  
White Ethnicity ◽  
Patient Reported ◽  
Switching Therapy ◽  
Living With Hiv

Objective: Occult central nervous system (CNS) symptoms not recognized by people living with HIV (PLWH) receiving efavirenz or their clinicians could occur and impact people’s quality of life. The aim of this study was to determine whether CNS parameters improve in PLWH when switching from efavirenz to rilpivirine. Methods: PLWH receiving tenofovir disoproxil fumarate, emtricitabine, efavirenz (Atripla™) with undetectable HIV RNA, and no CNS symptoms were switched cART to tenofovir disoproxil fumarate, emtricitabine, rilpivirine (Eviplera™). CNS parameters including sleep, anxiety, and depressive symptoms were evaluated using patient-reported outcome measures at baseline, 4, 12, and 24 weeks after switching therapy. A median CNS score was derived from the sum of CNS toxicities of all the grades collected in the study questionnaires. Cognitive function was assessed using a computerized test battery. Results: Of 41 participants, median age was 47 years, Interquartile range (IQR) 31, 92% were male and 80% were of white ethnicity. A significant reduction in total CNS score (10 to 7) was observed at 4 weeks (p = 0.028), but not thereafter. Significant improvements in sleep and anxiety were observed 4, 12 and 24 weeks after switching therapy (p < 0.05). No significant change in global cognitive scores was observed. Conclusions: Switching from efavirenz to rilpivirine based regimens in virologically suppressed PLWH without perceived CNS symptoms was well tolerated and slightly improved overall CNS symptoms.

scholarly journals Acute central nervous system infection by Trypanosoma cruzi and AIDS

1992 ◽  
Vol 50 (3) ◽  
pp. 375-377 ◽  
Author(s):  
Pasquale Gallo ◽  
Othello M. Fabião Neto ◽  
Juan M. Mira Suarez ◽  
Rover P. Borba
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Blood Transfusion ◽  
Trypanosoma Cruzi ◽  
Cellular Immunity ◽  
Acute Infection ◽  
Central Nervous System Infection ◽  
Patient Reported

The acute infection of the CNS by Trypanosoma cruzi acquired by blood transfusion is uncommon. The concomitance of AIDS in the patient reported shows the importance of cellular immunity in restriction of this parasite, and reinforces the problem of blood transfusion in endemic zones.

scholarly journals Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015927 ◽  
Author(s):  
Catriona McDaid ◽  
Debra Fayter ◽  
Alison Booth ◽  
Joanne O'Connor ◽  
Rocio Rodriguez-Lopez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Nervous System ◽  
Nervous System ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Neuromuscular Disorder ◽  
Knee Instability ◽  
Walking Ability ◽  
Orthotic Devices ◽  
Patient Reported

ObjectivesTo assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder.DesignA systematic review of primary studies.SettingCommunity.ParticipantsAdults with a neuromuscular disorder or central nervous system disorder and impaired walking ability due to instability of the knee.InterventionsOrthoses with the clinical aim of controlling knee instability, for example, knee-ankle-foot orthoses, ankle-foot orthoses and knee orthoses or mixed design with no restrictions in design or material.Primary and secondary outcome measuresCondition-specific or generic patient-reported outcome measures assessing function, disability, independence, activities of daily living, quality of life or psychosocial outcomes; pain; walking ability; functional assessments; biomechanical analysis; adverse effects; usage; patient satisfaction and the acceptability of a device; and resource utilisation data.ResultsTwenty-one studies including 478 patients were included. Orthotic devices were evaluated in patients with postpolio syndrome, poststroke syndrome, inclusion body myositis and spinal cord injury. The review included 2 randomised controlled trials (RCTs), 3 non-randomised controlled studies and 16 case series. Most were small, single-centre studies with only 6 of 21 following patients for 1 year or longer. They met between one and five of nine quality criteria and reported methods and results poorly. They mainly assessed outcomes related to gait analysis and energy consumption with limited use of standardised, validated, patient-reported outcome measures. There was an absence of evidence on outcomes of direct importance to patients such as reduction in pain and falls.ConclusionsThere is a need for high-quality research, particularly RCTs, of orthotic devices for knee instability related to neuromuscular and central nervous system conditions. This research should address outcomes important to patients. There may also be value in developing a national registry.Registration number systematic reviewPROSPERO (CRD42014010180).

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