scholarly journals Neutropenic Enterocolitis: Clinical Features and Outcomes

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5984-5984
Author(s):  
Delphine Lebon ◽  
Emmanuel Canet ◽  
Lucie Biard ◽  
David Schnell ◽  
Camille Roussel ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Early Recognition ◽  
Abdominal Distension ◽  
Outcome Data ◽  
Cancer Center ◽  
Neutropenic Enterocolitis ◽  
Non Hodgkin Lymphoma ◽  
Gastric Aspiration ◽  
Microbiological Infection

Abstract Background. Little attention has been given to patients with neutropenic enterocolitis (NEC or typhlitis). However, as significant advances have been made in both hematology, oncology and critical care management, updating outcome data on these patients is timely. Patients and methods. We conducted here a retrospective hospital-based cohort from patients admitted to the intensive care unit (ICU) from a cancer center that includes 10 wards of oncology and hematology (a 650-bed public hospital with 330 beds for treatment of malignancies). Patients with NEC were compared to patients with other digestive complications. We used the NEC definition suggested by Gorschlüter based on presence of neutropenia and at least one major criteria (bowel thickening and fever) with one or several minor criteria (abdominal aches, diarrhea, abdominal distension, abdominal cramps and low digestive bleedings), after exclusion of other intestinal affections listed above. Results. Among the 171 patients admitted for acute digestive complications over a 15-y study period (1997-2011), 54 (33%) presented with NEC. Median age was 48 years (IQR: 38-60y) and there were 34 men and 20 women. Hematological malignancies were more common (87% versus 13% solid tumors), mainly non hodgkin lymphoma (41%) and among them 5 undergoing autologous SCT. Abdominal pains were present in 74% of the patients. Vomiting, diarrhea and mucositis were present in 91%, 76% and 39%, respectively. All patients were treated with fasting, naso-gastric aspiration, hydroelectrolytic equilibration, large spectrum antibiotics and parenteral nutrition. Eight (15%) patients were operated. Vasopressive drugs were used for 31 patients (57%), mechanical ventilation for 22 (41%) and renal replacement for 14 (26%). Microbiological infection was documented for 32 patients: 1 fungal infection (Candida), 16 Escherichia coli, 7 Clostridium difficile (2 toxinogen), 6 Pseudomonas aeruginosae, 2 other enterobacteria. Twelve (22%) patients died. Compared to non-NEC patients, patients with NEC were sickest (median Simplified Acute Physiology II score was 54.5 (IQR 42.5-62.5) vs. 48 (IQR 35.5-61.5). Also, NEC was associated with more exposure to cytosine arabinoside (46% vs 20%, p=0.0008), anthracyclines (37% vs 13%, p=0.0008), vinca-alkaloids (28% vs 8%, p=0.002) and VP16 (24% vs 12%, p=0.0067). Steroids were not associated with incidence of NEC (19% vs 21%, p=0.84). Clinical symptoms that were significantly different in patients with NEC were vomiting (91% vs 70%, p=0.003), diarrhea (76% vs 53%, p=0.006) and mucositis (39% vs 17%, p=0.004). However, digestive bleedings were less common (11% vs 30%, p=0.01). CT findings helped to differentiate NEC and non-NEC patients with, colic (57% vs 33%, p=0.033) and small intestine (35% vs 14%, p=0.023) thickening, occlusive findings (51% vs 19%, p=0.002). Pneumatosis and pneumoperitoneum were not significantly different in the two groups (8% vs 4%, and 8% vs 12%, respectively). Need for surgery was non significantly higher in non-NEC patients (25% vs. 15%, p=0.22). However, mortality was significantly lower in NEC patients (22% vs 41%, p=0.023). Median time hospitalization in ICU was 7 days (IQR: 6.5-23.5d) vs 4d (IQR: 3-10d) for non-NEC patients. Conclusion: Neutropenic enterocolitis is a clinical entity that has its own clinical, radiological and management peculiarities that translate into different outcomes. Early recognition of the syndrome may help in setting prompt appropriate treatment and monitoring. Disclosures No relevant conflicts of interest to declare.

Hodgkin Lymphoma in Jordan; A Retrospective Analysis of 477 Cases in King Hussein Cancer Centre

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4862-4862 ◽  
Author(s):  
Alaa Addasi
Keyword(s):  
Retrospective Analysis ◽  
Hodgkin Lymphoma ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Hodgkin's Lymphoma ◽  
Cancer Center ◽  
Pathological Features ◽  
Female Ratio ◽  
Non Hodgkin Lymphoma ◽  
Paraffin Block

Abstract Abstract 4862 BACKGROUND Jordan is a small country with an estimated mid year population in 2008 of 5 850 000, 3015000 of whom are males and 2 835 000 are females (male: female ratio 1.06: 1). (Department of Statistics Jordan, 2008). About 12.7 % of the population is under 5 years old, and 37.3 % under 15 years old. 11%if the population are 15–19 year old, with a M:F ratio 1.06:1 as well) Only 3.3 % of the total population is above the age of 65 years old (sex ratio of 1.01 male per 1 female in this age group). According to the Jordan Cancer Registry Report for 2008, Lymphoma is the fourth most common Cancer in the country. A total of (4606 ) new cases of cancer were recorded among Jordanians in the year 2008, 333 (7.2%) of whom had a diagnosis of lymphoma.111 (2.4%) were diagnosed as Hodgkin's lymphoma (HL), and 222 (4.8%) as Non Hodgkin Lymphoma(NHL). OBJECTIVE In this study, we aim to characterize some of the clinico-pathological features of Hodgkin lymphoma in Jordan by analyzing the data available for patients referred to King Hussein Cancer Center over a seven year period. PATIENTS AND METHODS A retrospective analysis was conducted of adults (>18 years) lymphoma patients referred to KHCC, between 1/1/2003 and 31/12/2010. Clinical features and histological subtypes were prospectively established for all patients registered in the Lymphoma Service Database. Pathology review and original paraffin block were mandated for all patients. RESULTS Over the 8 year period of 2003–2010,1329 lymphoma patients were referred to KHCC and registered in the Lymphoma Service Database, of whom 477 (35.9%) were diagnosed with Hodgkin's lymphoma. Among this group all 477 patients were adults 18 years or older (100%), as children are treated in a different department. The median age was 35 years, (with an age range of 18–77), and 5% of patients were above the age of 60. 290 (61 %) of the patients were males, 187 (39%) were females, with a male to female (M:F) ratio of 1.55:1. 276 (57.8%) of the HL cases had a diagnosis of nodular sclerosis Hodgkin lymphoma (HDNS), making it the most common histological subtype. 120(25.2%) had mixed cellularity Hodgkin lymphoma (HDMC), 9 (1.9%) had lymphocyte-rich Hodgkin lymphoma (HDLR), and 6 (1.2%) had lymphocyte-depleted Hodgkin (HDLD). Nodular lymphocyte predominance Hodgkin lymphoma (NLPHD) cases were 33, and constituted 6.9% of the HL cohort. CONCLUSION Hodgkin lymphoma appears to constitute a bigger share of the lymphoma burden in Jordan, as opposed to Europe and the US. Clinico-pathological features, however, appear to be closer to those described in Western countries, with similar incidence of HDNS, and HDMC subtypes, but possibly with less incidence of HDLR and HDLD subtypes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Survival Improvement in Therapy Related Myeloid Neosplasm ? a Single Center Analysis of 428 Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4006-4006
Author(s):  
Khalil Saleh ◽  
Christophe Willekens ◽  
Jean Edouard Martin ◽  
Myriam Kossai ◽  
Nadine Khalifé-Saleh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Best Supportive Care ◽  
Primary Diagnosis ◽  
Study Data ◽  
Cancer Center ◽  
Complex Karyotype ◽  
Non Hodgkin Lymphoma ◽  
Radiotherapy Alone

Abstract Therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) arise after cytotoxic chemotherapy and/or radiotherapy administered for a prior neoplasm and have a dismal outcome (median survival of 8 months in the largest series published including 306 patients (pts), Smith, Blood 2003). Recent registry data suggested a continued increase in survival in AML (Derolf, Blood 2009) and we wondered whether this was also observed in the setting of t-AML/ MDS. All pts with a t-AML/MDS diagnosed and/or treated for their prior neoplasm at Gustave Roussy Cancer Center between July 1986 and 2016 were included in this retrospective study. Data regarding pts' demographics, primary diagnosis and treatment, latency time, cytogenetic, treatment and outcome were collected. The diagnosis of t-AML/MDS was based on the WHO 2016 classification. t-AML were classified based on cytogenetic results as favorable, intermediate and adverse according to international classification, t-MDS based on IPSS score as favorable (Low, Int-1) and adverse (Int-2 and High). 428 pts were analyzed. The median age at diagnosis of t-AML/MDS was 56.4 years with a female predominance (60%). 224/428 (52.3%) pts had t-AML, 204/428 (47.7%) t-MDS. The most common primary malignancies were breast cancer (24%), non-Hodgkin lymphoma (15%), Hodgkin lymphoma (HL) (9%) and ovarian cancer (9%). Occurrence of t-AML/MDS following HL represented 26.6% of t-AML/MDS cases between 1986-96 comparing to 4 % between 2006-16 whereas breast cancer rose from 16% to 45%. Prior treatments included chemotherapy alone in 137/428 pts (32%), radiotherapy alone in 61 pts (14%) and both in 230 pts (54%). At diagnosis of t-AML/MDS, 295 pts (69%) were in complete remission (CR) of their prior neoplasm, 29 (7%) had a stable and 104 (24%) a progressive disease. Median interval between primary cancer and t-AML/MDS was 5 years (4.3 and 5.7 years for t-AML and t-MDS respectively, (p=0.03)). Furthermore, delay to develop t-AML/MDS after radiotherapy alone was longer compare to chemotherapy or both (6.1, 5.1 and 4.3 years, respectively (p=0.0087)). In the t-AML subgroup, 47% of pts presented unfavorable cytogenetic (including complex karyotype (20%) and 11q23 abnormalities (16.9%)), 26% intermediate and 26% favorable cytogenetic (core binding factor mutations (12.7%), t(15;17) (13.3%)). In the t-MDS subgroup, 78% of pts were considered adverse; complex karyotype, chromosome 7 and 5 abnormalities were found in 40.8%, 46.7% and 28.9% respectively. Pts received intensive chemotherapy (including 41 allografts), low dose chemotherapy (including 74 treatments with hypomethylating agents) and best supportive care in 42%, 24% and 34% respectively. The median overall survival (OS) was 10.6 months and the 5-year survival was 19.1% (Figure 1A). The 5-year OS of patients in CR of their prior neoplasm was 25.5% compared to 3.65 and 0% for pts with progressive and stable disease, respectively (p<0.001). 5-year OS was not statistically different between t-AML and t-MDS subgroups (23.3% vs 13.5%) and between hematologic or oncologic malignancies as primary diagnosis (12.6% vs 21.1%). Pts with favorable risk t-AML had better 5-year survival compared with patients with intermediate or unfavorable risk disease (55.5% vs 20% vs 12.1% respectively, p<0.001). In addition, favorable t-MDS was associated with better 5-year OS compared to adverse t-MDS (34.9% vs 6.6%, p<0.001). We next compared OS of pts diagnosed for their t-AML/MDS after or before July 2001. A trend for better OS for pts diagnosed in the last 15 years was observed (21.5% vs 15.1%, p=0.39). Interestingly outcome of t-AML patients with favorable subtype significantly improved over the last 15 years (68.8% vs 25%, p=0.03, Figure 1B) which was not the case for other cytogenetic subgroups and for t-MDS, especially pts with adverse prognosis (4.6% vs 3.9%, p=0.92). Pts who received allograft had a trend for better OS in the last 15 years (52.8% vs 21.5% p=0.2). t-AML/MDS are still associated with a low 5-year OS (19.1%) but our results are upper than previous publications. However, a significant improvement of survival in favorable t-AML was observed during the past 30-years, with a trend for pts who benefit from allograft. In addition to improve treatment for t-MDS pts, detection of the disease at the earliest stage is a real challenge to improve their survival. Disclosures No relevant conflicts of interest to declare.

scholarly journals Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Tommy Ivanics ◽  
Semeret Munie ◽  
Hassan Nasser ◽  
Shravan Leonard-Murali ◽  
Atsushi Yoshida ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Enteral Feeding ◽  
Early Recognition ◽  
Medium Chain Triglyceride ◽  
Serum Triglyceride ◽  
Chylous Ascites ◽  
Abdominal Distension ◽  
Invasive Treatment ◽  
Management Options ◽  
Early Enteral Feeding

Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.

scholarly journals Maintaining an Adult Hematology/Oncology Service at a Tertiary Care Center during the SARS-CoV-2 Pandemic: An Eight-Week-Experience with a Newly Implemented Procedural Plan

2021 ◽  
pp. 1-6
Author(s):  
Philipp G. Hemmati ◽  
Dorothea Fischer ◽  
Frank Breywisch ◽  
Sabine Wohlfarth ◽  
Matthias Kramer ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Care Center ◽  
Tertiary Care ◽  
Cancer Center ◽  
Staff Members ◽  
Oncology Service ◽  
Containment Measures ◽  
Vulnerable Patient ◽  
Set Up ◽  
Oncology Unit

Treatment of cancer patients has become challenging when large parts of hospital services need to be shut down as a consequence of a local COVID-19 outbreak that requires rapid containment measures, in conjunction with the shifting of priorities to vital services. Reports providing conceptual frameworks and first experiences on how to maintain a clinical hematology/oncology service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are scarce. Here, we report our first 8 weeks of experience after implementing a procedural plan at a hematology/oncology unit with its associated cancer center at a large academic teaching hospital in Germany. By strictly separating team workflows and implementing vigorous testing for SARS-CoV-2 infections for all patients and staff members irrespective of clinical symptoms, we were successful in maintaining a comprehensive hematology/oncology service to allow for the continuation of treatment for our patients. Notably, this was achieved without introducing or further transmitting SARS-CoV-2 infections within the unit and the entire center. Although challenging, our approach appears safe and feasible and may help others to set up or optimize their procedures for cancer treatment or for other exceedingly vulnerable patient cohorts.

scholarly journals A Rare Cause of Intestinal Obstruction in Infants: Ileum Duplication Cyst and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Mehmet Serif Arslan ◽  
Erol Basuguy ◽  
Hikmet Zeytun ◽  
Serkan Arslan ◽  
Bahattin Aydogdu ◽  
...  
Keyword(s):  
Literature Review ◽  
Intestinal Obstruction ◽  
Male Patient ◽  
Pediatric Surgery ◽  
Clinical Symptoms ◽  
Abdominal Distension ◽  
Duplication Cyst ◽  
Oral Feeding ◽  
Imaging Method ◽  
History Of

Cases of neonatal gastrointestinal system (GIS) obstruction are quite complex for pediatric surgery clinics. A rare cause of intestinal obstruction is the duplication cyst (DC). A three-day-old male patient presented at our clinic with a history of abdominal distension and bilious vomiting on the second day following birth. Although pathology had not yet been determined from observation and examination, surgery was performed when the patient could not tolerate oral feeding. An ileal DC forming an incomplete obstruction was observed. Ileoileal anastomosis was performed on the patient. Because DCs can present with different clinical symptoms, it is quite difficult to diagnose them in neonate patients. Lacking an imaging method that can provide an exact diagnosis, the diagnostic laparotomy is a suitable approach for both diagnosis and treatment to avoid delays in treatment.

Paraneoplastic movement disorders

2018 ◽  
Vol 29 (7) ◽  
pp. 745-755 ◽  
Author(s):  
Karolina Popławska-Domaszewicz ◽  
Jolanta Florczak-Wyspiańska ◽  
Wojciech Kozubski ◽  
Sławomir Michalak
Keyword(s):  
T Cell ◽  
Cell Surface ◽  
Movement Disorders ◽  
Clinical Symptoms ◽  
Early Recognition ◽  
Neuronal Loss ◽  
Synaptic Proteins ◽  
Malignant Neoplasms ◽  
Cell Surface Antigens ◽  
Opsoclonus Myoclonus Syndrome

Abstract Paraneoplastic movement disorders are rare, autoimmune-mediated, nonmetastatic complications of malignant neoplasms. Common paraneoplastic movement disorders include paraneoplastic chorea, dystonia, cerebellar degeneration, different types of encephalitis, opsoclonus-myoclonus syndrome, stiff person syndrome, and neuromyotonia. Syndromes usually develop before tumor diagnosis, have subacute onset, and are associated with serum or cerebrospinal fluid antibodies. Two types of antibodies can be distinguished: antibodies against nuclear and cytoplasmic neuronal antigens (anti-Hu, anti-Ri, anti-Yo, anti-Ma, anti-CV2/CRMP5, anti-Gephrin, and anti-GABATRAP) and antibodies recently identified against cell surface and synaptic proteins (anti-NMDAR, anti-LGI1, and anti-Caspr2). These two types differ from each other in a few important aspects. Antibodies against cell surface and synaptic protein disrupt cell-surface antigens. Clinical symptoms are related to the disruption of antigens and potentially can be reversed by immunotherapy. The association between these antibodies and malignancy is much less consistent. On the other hand, antibodies against nuclear and cytoplasmic neuronal antigens seem to be not pathogenic; however, they most likely indicate a T-cell-mediated immune response against neurons. Due to T-cell-mediated neuronal loss, response to immunotherapy is generally disappointing. Early recognition of all these diseases is crucial because it may lead to the disclosure of occult cancer. This review is focused on paraneoplastic movement disorders with emphasis on clinical presentations, investigational findings, and therapeutic results.

scholarly journals Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481877825 ◽  
Author(s):  
Luis Miguel Juárez-Salcedo ◽  
Lubomir Sokol ◽  
Julio C. Chavez ◽  
Samir Dalia
Keyword(s):  
Malt Lymphoma ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Wide Spectrum ◽  
Gastric Lymphoma ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
Predisposing Factor ◽  
Primary Gastric Lymphoma ◽  
Non Hodgkin Lymphoma

Primary gastric lymphoma (PGL) is the most common extranodal non-Hodgkin lymphoma and represents a wide spectrum of disease, ranging from indolent low-grade marginal zone lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma to aggressive diffuse large B-cell lymphoma. The PGL is a relatively rare cancer and easily misdiagnosed due to its unspecific symptoms of the digestive tract. The medical literature and ongoing clinical trials were reviewed on the clinical presentation, diagnosis, prognosis, prevention, and treatment of PGL. Primary gastric lymphoma is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis. Chronic gastritis secondary to Helicobacter pylori ( H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Magnetic resonance imaging and endoscopic ultrasonography have helped in staging of these cancers. The clinical course and prognosis of this disease are dependent on histopathological subtype and stage at the time of diagnosis. A global therapeutic approach to the cure of PGL has completely changed over the past 10 years, including innovative and conservative options to reduce treatment toxicity. Due to the rarity of PGL, many aspects of this neoplasm are still controversial. The incidence of this disease is increasing, making it necessary for clinicians to understand the clinical symptoms, workup, and treatment of these lymphomas.

Abstract 193: Hemophagocytic lymphohistiocytosis following kawasaki disease:Differential Diagnosis in IVIG Refractory Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Hyun Ok Jun ◽  
Eun Kyung Cho ◽  
Jeong Jin Yu ◽  
So Yeon Kang ◽  
Chang Deok Seo ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Skin Rash ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Clinical Symptoms ◽  
Early Recognition ◽  
Cervical Lymphadenopathy ◽  
Inflammatory Disorder ◽  
Laboratory Findings

Introduction: Hemophagocytic lymphohistiocytosis(HLH) is a systemic inflammatory disorder characterized by uncontrolled histiocytic proliferation, hemophagocytosis and up-regulation of inflammatory cytokines. Thus, both HLH and Kawasaki disease(KD) are characterized by prolonged fever, and are diagnosed by a clinical and laboratory scoring system, concurrent manifestation of HLH and KD has been described in the literature. We describe two cases of children who diagnosed as KD initially, but after intravenous gamma globulin(IVIG) failed to produce clinical response, were found to have HLH. Case report: A 3-year-old boy who had previous KD history 5 months ago was admitted for 9day fever and skin rash. His symptoms were fulfilled KD criteria, and echocardiography showed dilated right coronary artery of 4.2mm. He was treated with 2 cycles of IVIG until fever subsided. However, 2 days later, he got fever again and cytopenia(Hb<9.0), hypertriglyceridemia, high level of ferritin was shown and had splenomegaly on physical examination. In the suspicion of HLH, bone marrow biopsy was done and revealed hemophagocytosis, consistent with HLH. A second case of 11-month-old boy admitted for 8-day fever with Kawasaki feature. Although, he showed incomplete feature(fever, skin rash, conjunctival injection, cervical lymphadenopathy), echocardiography showed dilated left main coronary artery(3.5mm) and treated with IVIG. However, 2days after IVIG administration, he was still pyrexial. The laboratory findings fulfilled 5 diagnostic criteria of HLH; bicytopenia(anemia, thrombocytopenia), hypofibrinogenemia, hyperferritinemia, hemophagocytosis in bone marrow, raised level of soluble IL-2 receptor. In both cases, the patients treated according to the HLH protocol 2004, and after that clinical symptoms and laboratory findings were improved. Several causes of febrile illness, EBV, CMV, rubella, parvo-viral infection, for example, were excluded. Comment: There is considerable overlap between the clinical syndromes of KD and HLH and early recognition and treatment of these two disease entity is imperative to avoid fatal outcomes in severe cases. Thus, these should both be considered and excluded in any child with unremitting fever and rash.

scholarly journals P21 Feasibility of the Learning and Exercise to Avert Pain (LEAP) programme: an evaluation of a group therapy intervention for young people with chronic musculoskeletal pain

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Hannah Wong ◽  
Margaret Wheeler ◽  
Jennifer Nisbet ◽  
Janet McDonagh ◽  
Verna Cuthbert
Keyword(s):  
Young People ◽  
Musculoskeletal Pain ◽  
Conflicts Of Interest ◽  
Outcome Data ◽  
Free Text ◽  
Electronic Patient Records ◽  
Structured Interviews ◽  
Group Setting ◽  
Adolescent Anxiety

Abstract Background Chronic idiopathic musculoskeletal pain (CIMSKP) has become increasingly recognised as a major cause of morbidity in adolescents. In view of increasing referrals to a paediatric rheumatology centre, the Learning and Exercise to Avert Pain (LEAP) intervention was designed as an approach to pain management within a group setting, led by an occupational therapist and a physiotherapist. It involves 2 hour weekly sessions for 6 weeks and includes education, gym activities and relaxation sessions with routine collection of Pain VAS, CHAQ, Bath Pain questionnaires (adolescent BAPQ and parent BAPQ-p forms) at baseline, end of LEAP and 3 months follow-up. We aim to assess the feasibility and impact of LEAP for adolescents with CIMSKP. Methods Young people who had been referred for the LEAP programme were identified (n = 46). Basic demographics and questionnaire scores were collected from electronic patient records and therapy notes. Feasibility was assessed by delivery of programme and percentage completion of questionnaires at three time-points. Semi-structured interviews were conducted with healthcare professionals involved in the programme and analysed using thematic analyses as were any free text comments on the BAPQ from adolescents and parents. Statistical analysis of the outcome data was performed using paired t-tests and SPSS software (v22). Results 46 adolescents were identified: 85% female, median age 16 years (range 10 to 19). 34 participated in LEAP, 12 received 1:1 therapy. Feasibility of programme delivery was achieved with completion of all six sessions. Completion rates for all 3 measures for adolescents/parents at baseline, end of programme review and follow up were 78.6/71.4%, 64.3/71.4%, and 45.5/36.4% respectively. Adolescent scores indicated a significant increase in impairment in the development subscale scores on BAPQ from baseline to programme end (p = 0.021) although not at follow up. Parent scores for adolescent anxiety and pain-specific anxiety on BAPQ-p increased significantly from end of programme to follow-up (p = 0.017, p = 0.034 respectively). Parents scored higher than adolescents for most outcomes. The qualitative data (available for 11 adolescents, 12 parents) revealed that parents and adolescents appreciated learning coping techniques and gaining a greater understanding of chronic pain. The intervention was perceived to be socially beneficial in particular but imperfect in terms of data collection by the professionals interviewed (n = 2). Conclusion Baseline demographics of the LEAP participants echoed current literature. Delivery of the programme was feasible and the programme was positively received by young people, their parents and professionals alike. The increase in adolescent development subscale scores following the programme could represent increased self-reflection and/or peer to peer observations as a result of the group setting but needs longer term follow-up data to clarify further. The increase in parental anxiety highlights the need for a concurrent session for parents. Routine collection of objective measures remains challenging in non-research setting. Conflicts of Interest The authors declare no conflicts of interest.

scholarly journals Overdiagnosis of Juvenile Thyroid Cancer

2019 ◽  
Vol 9 (3) ◽  
pp. 124-131 ◽  
Author(s):  
Toru Takano
Keyword(s):  
Thyroid Cancer ◽  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Steady Increase ◽  
Thyroid Ultrasound ◽  
Screening Programs ◽  
Incomplete Knowledge ◽  
Thyroid Screening ◽  
Future Harm ◽  
Cancer In Children

Overdiagnosis is the detection of a disease that does not do any harm to the patient throughout the lifetime. Thyroid cancer in children is a rare disease; however, since 2011, many children in Fukushima, Japan, have been diagnosed with it, and the number has shown a steady increase to over 200 cases at present. Some experts have stated that this phenomenon is due to overdiagnosis caused by thyroid ultrasound (US)-based thyroid screening detecting self-limiting thyroid cancer, which will not lead to clinical symptoms in the future. Harm caused by overdiagnosis of thyroid cancer is more serious in the young, since it is difficult to perform active surveillance and children diagnosed with cancer are likely to suffer from stigma. Thus, overdiagnosis of thyroid cancer in the young is not only a health problem but also a problem of human rights. Conflicts of interest among people related to screening programs and some experts with incomplete knowledge on overdiagnosis help to spread misleading opinions together with fear of radiation exposure among residents, which has led to their erroneous understanding of the nature of US-based thyroid screening. Scientific and honest discussions among experts to enhance education of residents and consideration of medical ethics are crucial to prevent the expansion of overdiagnosis.

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