Burden and attitude to resistant and refractory migraine: a survey from the European Headache Federation with the endorsement of the European Migraine & Headache Alliance

Abstract Background New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts). The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. Methods We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. Conclusions This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities.

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Burden and Attitude to Resistant and Refractory Migraine A Survey From the European Headache Federation With the Endorsement of the European Migraine & Headache Alliance

10.21203/rs.3.rs-317819/v1 ◽

2021 ◽

Author(s):

Simona Sacco ◽

Christian Lampl ◽

Antoinette Maassen van den Brink ◽

Valeria Caponnetto ◽

Mark Braschinsky ◽

...

Keyword(s):

International Study ◽

Level Of Care ◽

Cross Sectional ◽

Consensus Document ◽

Organization Of Care ◽

Number Of Patients ◽

Refractory Migraine ◽

European Headache Federation ◽

New Treatments ◽

Treatment Escalation

Abstract BackgroundNew treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts). The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. MethodsWe conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. ResultsThere were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. ConclusionsThis report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities.

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What are Hidden Facts behind Intestinal Parasitic Infections in Ilam City?

Infectious Disorders - Drug Targets ◽

10.2174/1871526518666180508125418 ◽

2019 ◽

Vol 19 (3) ◽

pp. 284-287

Author(s):

S. Viesy ◽

J. Abdi ◽

Z. Rezaei

Keyword(s):

Public Health ◽

Intestinal Parasites ◽

Parasitic Infection ◽

Public Health Education ◽

Health Problems ◽

Parasitic Infections ◽

Blastocystis Hominis ◽

Cross Sectional ◽

Intestinal Parasitic Infections ◽

Number Of Patients

Background: Intestinal parasitic infections are the one of the most common health problems in developing countries. Objective: A number of patients die annually due to complications caused by these parasites.Therefore, the aim of this study was to investigate the rate and type of parasitic infections, determine the factors affecting them in Ilam city and also provide strategies to prevent them.In this descriptive cross-sectional study conducted in one of the Ilam labs in 2016, 417 stool specimens were randomly collected. All specimens were examined using direct and ethanol formaldehyde.Suspect specimens were examined using Trichrom staining. Demographic information was also recorded in a questionnaire, and finally the results were analyzed using statistical software SPSS 20.The data were then compared with Chi-square test. Results: Out of the 417 patients examined, 59 (14.1%) were infected with intestinal parasites. The type of parasitic infection in 9.4% was Blastocystis hominis, 3.6% Entamoeba coli, 0.5% Entamoeba histolytica, 0.5% Giardia and 0.2% Trichomonas hominis. Conclusion: Despite the improvement of public health, parasitic infections are still considered as one of the health problems in the city of Ilam. Therefore, proper planning, public health education, raising the level of health in the area and the provision of safe drinking water are some of the ways to reduce parasitic infections in the region.

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Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

Simulation & Gaming ◽

10.1177/1046878120904984 ◽

2020 ◽

Vol 51 (4) ◽

pp. 550-570

Author(s):

Cindy Luu ◽

Thomas B. Talbot ◽

Cha Chi Fung ◽

Eyal Ben-Isaac ◽

Juan Espinoza ◽

...

Keyword(s):

Emergency Department ◽

Diagnostic Accuracy ◽

Patient Care ◽

Skill Acquisition ◽

Video Game ◽

Rank Correlation ◽

Fixed Time ◽

Serious Game ◽

Cross Sectional ◽

Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

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Adverse Events in Home-Care Nursing Agencies and Related Factors: A Nationwide Survey in Japan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052546 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2546

Author(s):

Noriko Morioka ◽

Masayo Kashiwagi

Keyword(s):

Adverse Event ◽

Patient Safety ◽

Adverse Events ◽

Home Care ◽

Process Of Care ◽

Related Factors ◽

Cross Sectional ◽

Home Care Nursing ◽

Number Of Patients ◽

Care Nursing

Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients’ homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients’ higher care-need levels affected the higher number of adverse events in home-care nursing agencies.

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How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients

BMJ Open ◽

10.1136/bmjopen-2020-041214 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041214

Author(s):

Kevin Glynn ◽

Frank McKenna ◽

Kevin Lally ◽

Muireann O’Donnell ◽

Sandeep Grover ◽

...

Keyword(s):

Palliative Care ◽

Rating Scale ◽

Symptom Burden ◽

Systemic Infection ◽

International Study ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Liaison Psychiatry ◽

Cross Sectional ◽

Hypoactive Delirium

ObjectivesTo investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.DesignCross-sectional study.SettingInternational study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measuresHyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.ResultsHypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).ConclusionsThis study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

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Evidence for diagnosis of early chronic pancreatitis after three episodes of acute pancreatitis: a cross-sectional multicentre international study with experimental animal model

Scientific Reports ◽

10.1038/s41598-020-80532-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Péter J. Hegyi ◽

Alexandra Soós ◽

Emese Tóth ◽

Attila Ébert ◽

Viktória Venglovecz ◽

...

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Morphological Changes ◽

International Study ◽

Study Data ◽

Cross Sectional ◽

Clinical Biomarkers ◽

Stage Disease ◽

Significant Difference ◽

End Stage

AbstractChronic pancreatitis (CP) is an end-stage disease with no specific therapy; therefore, an early diagnosis is of crucial importance. In this study, data from 1315 and 318 patients were analysed from acute pancreatitis (AP) and CP registries, respectively. The population from the AP registry was divided into AP (n = 983), recurrent AP (RAP, n = 270) and CP (n = 62) groups. The prevalence of CP in combination with AP, RAP2, RAP3, RAP4 and RAP5 + was 0%, 1%, 16%, 50% and 47%, respectively, suggesting that three or more episodes of AP is a strong risk factor for CP. Laboratory, imaging and clinical biomarkers highlighted that patients with RAP3 + do not show a significant difference between RAPs and CP. Data from CP registries showed 98% of patients had at least one AP and the average number of episodes was four. We mimicked the human RAPs in a mouse model and found that three or more episodes of AP cause early chronic-like morphological changes in the pancreas. We concluded that three or more attacks of AP with no morphological changes to the pancreas could be considered as early CP (ECP).The new diagnostic criteria for ECP allow the majority of CP patients to be diagnosed earlier. They can be used in hospitals with no additional costs in healthcare.

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POS1274 THERAPEUTIC MANAGEMENT OF RHEUMATOLOGISTS VERSUS OTORHINOLARYNGOLOGISTS OF CERVICOGENIC DIZZINESS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2230 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 921.2-922

Author(s):

M. Yasmine ◽

K. Maatallah ◽

H. Ferjani ◽

W. Triki ◽

D. Ben Nsib ◽

...

Keyword(s):

Physical Therapy ◽

Treatment Approach ◽

Cross Sectional Study ◽

Treatment Modalities ◽

Sectional Study ◽

Cross Sectional ◽

Standard Assessment ◽

Number Of Patients ◽

Cervicogenic Dizziness ◽

No Gold Standard

Background:The treatment of patients presenting with cervicogenic dizziness (CGD) may be challenging. Indeed, there is no consensual treatment approach for CGD, nor is there no gold-standard assessment for diagnosis.Objectives:Our study aimed to assess the management of CGD by rheumatologists versus otorhinolaryngologists.Methods:We conducted a cross-sectional study including Tunisian doctors dealing with CGD. Rheumatologists (RTO) and otorhinolaryngologists (ORL) were invited to answer a questionnaire via google form about CGD daily management. Outcomes of interest were treatment modalities.Results:The study included 30 RTO and 32 ORL. Most of the doctors (RTO, vs ORL) were females (88.3%, vs 56.3%), aged between 35 and 45 (43.3%, vs 62.5%), and worked at a private practice (33.3%, vs 59.4%). The number of patients diagnosed with CGD by RTO was as follows: 1-2 per year (33.3%), 1-2 per month (18.8%), 1-2 per week (20%), less than one patient a year (10%) and none in 3.3% of cases. The number of patients diagnosed with CGD by ORL was as follows: 1-2 per year (50%), 1-2 per month (33.3%), 1-2 per week (6.2%), less than one patient a year (15.7%) and none (9.4%). Most patients presenting with CGD were females in both groups (93.1%, vs 82.8% respectively) with a mean age between 36 and 65 (79.3%, vs 82.1%). Most of the respondents declared treating patients with CGD (93.1%, vs 79.1%). Regarding treatment modalities, physical therapy was the most prescribed in both specialties (81.5% and 48.3%, respectively). Only RTO (18.5%) prescribed manual therapy. Concerning medical treatment, anti-inflammatory were the most prescribed drugs in both groups (92.6, and 34.5%, respectively). Sixty-seven percent of RTO prescribed anti-vertigo medication. Interestingly, it was the least prescribed drug by ORL (6.9%). Only RTO (59.3%) prescribed Muscle relaxants.Conclusion:Despite the disparities in the management of CGD, physical therapy remains the first prescribed treatment by Tunisian doctors. Further studies are needed to establish a consensus to treat CGD.Disclosure of Interests:None declared

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A Comparison of Orally Administered Misoprostol With Vaginally Administered Misoprostol For Cervical Ripening And Labour Induction

KYAMC Journal ◽

10.3329/kyamcj.v7i1.33755 ◽

2017 ◽

Vol 7 (1) ◽

pp. 668-672 ◽

Cited By ~ 1

Author(s):

Sohana Siddique ◽

Muhammad Jahangir Howlader ◽

Joysree Saha ◽

Kazi Shahnaz Begum

Keyword(s):

Mode Of Delivery ◽

Cervical Ripening ◽

Labour Induction ◽

Efficacy And Safety ◽

Cross Sectional ◽

Oral Misoprostol ◽

Number Of Patients ◽

Oral Group ◽

Vaginal Misoprostol ◽

Duration Of Pregnancy

Objective: To compare efficacy and safety of oral misoprostol over vaginal misoprostol for labour induction.Materials and Methods: This is a cross sectional interventional hospital based comparative study which was carried in the department of Obstetrics and Gynecology in DMCH from 01.07.2008 to 31.12.2008.Results: Almost equal number of patients delivered vaginally spontaneously in both group, there is no association between route of administration and mode of delivery. Nausea,vomiting occurred more in oral group and uterine hypertonicity more in vaginal group.Conclusion: In this study, 50 patients were randomly selected for oral group and 50 patients for vaginal group. There were no significant differences regarding age, duration of pregnancy, Bishop's score and indication of induction of labour.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 668-672

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SAT0476 COMPLIANCE AND PERSISTENCE OF ANTI-OSTEOPOROTIC TREATMENTS IN PATIENTS WITH HIP FRACTURE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2633 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1194.2-1195

Author(s):

S. Paredes ◽

M. Guinovart ◽

A. Basco ◽

C. Llop

Keyword(s):

Hip Fracture ◽

Health Service ◽

Hospital Discharge ◽

Treatment Time ◽

Osteoporotic Fractures ◽

Main Diagnosis ◽

Pharmacological Treatments ◽

Cross Sectional ◽

Good Compliance ◽

Number Of Patients

Background:Osteoporotic fractures have a high health and economic impact. The best strategy to minimize the incidence of fractures is, certainly, the prevention of these that includes pharmacological treatments. However, long-term discontinuation treatment and sub-optimal compliance of the treatment are common.Objectives:The aim of the study is to quantify the therapeutic compliance and permanence of the osteoporosis pharmacological treatments for patients who were discharged from hospitals in Catalonia with hip fracture during 2017.Methods:From the Hospital Discharge Database of the Catalan Health Service, all patients who had been discharged during 2017 were selected with the main diagnosis of femur fracture, according to the coding CIM-9. The consumption of drugs to assess compliance and permanence was obtained from the Catalan Health Service pharmacy Database. The study period was 18 months from the date of hospital discharge. Patients who died, moved to other areas or switched their treatment were excluded from the study. Good compliance was considered when sufficient drug was obtained to cover 80% of the time since treatment was prescribed until the end of the study period. In the case of denosumab, good post-fracture compliance was considered when the treatment time was remained at least 12 months. Permanence was considered positive if a drug had been obtained during the last three months of the study period. To compare the differences in compliance and permanence between the patients treated with different drugs, the chi-square statistic was used, considering statistically significant differences if p<0.05.Results:8,354 patients were discharged with the main diagnosis of hip fracture. Of these, 1,712 patients (20.49%) were treated after been discharged. After applying the exclusion criteria, the final sample was made up of 1,327 patients. 81,54% were women, and the median age was 84,79 years.The most commonly used treatments were bisphosphonates (69%), denosumab (23%) and teriparatide (7%)The results of good compliance and permanence of treatment were those described in the table.nCompliancePermanenceAlendronate86363,27%64,77%Alendronate+colecalciferol2774,07%81,48%Ibandronate366,67%100%Risedronate2339,13%60,87%Raloxifene1100%100%Bazedoxifene10%0%Teriparatide9976,77% (*)73,74%Denosumab31076,77% (*)74,52% (*)(*) p<0.05 for total bisphosphonates and for alendronateConclusion:The results obtained suggest that a small number of patients were treated after a hip fracture (20.49%) in addition the instituted treatments are followed in a suboptimal way. It is necessary to investigate which factors may lead to the detection of potential non-compliant patients. It seems appropriate to consider drugs that facilitate compliance and permanence of treatment.Our results suggest that denosumab and teriparatide improve compliance compared with oral bisphosphonates.The introduction of specific plans and cross-sectional health structures between levels of care should lead to improve detection, treatment and compliance in patients with osteoporosis.Disclosure of Interests:SILVIA PAREDES Consultant of: Amgen, Lilly, Ferrer, Roche, Novartis; BMS, Maria Guinovart: None declared, Aida Basco: None declared, Carles Llop: None declared

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The status of integrated care on the chronic abuse of alcohol response - A cross-sectional study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1152 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Moreira de Sousa ◽

L Lopes ◽

P Costa ◽

G Martins-Coelho ◽

R Capucho

Keyword(s):

Alcohol Consumption ◽

Alcohol Abuse ◽

Negative Impact ◽

Cross Sectional Study ◽

Treatment Team ◽

Health Administration ◽

Sectional Study ◽

Cross Sectional ◽

Number Of Patients ◽

Index Value

Abstract Background In 2017, the risk-weighted prevalence of alcohol consumption was the health indicator with a more negative impact on the Institute for Health Metrics and Evaluation Sustainable Development Goals Health Index Value in Portugal. According to data from 2012-14, the Alto Tâmega and Barroso (ATB) had the highest value of Years of potential life lost (YPLL) in North Portugal - 4570,1/10.000 people. Liver chronic disease was the specific cause of death that contributed to the value of YPLL - 465,4/10.000 people. Methods A cross-sectional study was conducted with data from the Northern Health Administration and the General Directorate for Intervention on Addictive Behaviours and Dependencies. We compared the number of patients with chronic alcohol consumption (CAC) in 2018, the leading causes of death between 2012-14, the main morbidity causes according to data from primary healthcare (PHC) physicians in 2018 and the number of patients in specialized treatment team (STT) for alcohol abuse treatment in 2018 in ATB. Results In 2018, 2643 patients of ATB had a diagnosis of CAC; only 178 were followed by an STT. Although CAC had a massive influence on YPLL, this was only the 11º cause of morbidity in ATB according to the data from PHC. The number of women with CAC was stable between 2012 (n = 284) and 2018 (n = 291). In the same period, there was an increase of 52,86% of CAC on men (n = 1523 to n = 2348). Even though 18,4% of YPLL due to chronic liver disease happen in women, only 11,2%of the patients with CAC in the PHC are women. Conclusions There is a need for the improvement of CAC diagnosis in PHC, and the improvement of referral of patients to STT and hospital care. Besides, to reach the SDG3, there is the need to work intensely on SDG 17 (partnership for the goals). The Public Health Unit of ATB is organizing Operation PROMETEU to improve communication, institutional collaboration, and monitoring of the existing health activities that are tackling CAC. Key messages The need to integrate data from different healthcare sources for a better analysis on health problems. The urgent need to tackle the alcohol abuse problem in ATB.

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