Perampanel as first add-on antiseizure medication: Italian consensus clinical practice statements

Abstract Background When use of a single antiseizure medication (ASM) fails to induce seizure remission, add-on therapy is justified. Perampanel (PER) is approved in Europe as adjunctive therapy for focal, focal to bilateral tonic-clonic seizures and generalized tonic-clonic seizures. Aim of the study was to establish whether PER is suitable for first add-on use. Methods A Delphi methodology was adopted to assess consensus on a list of 39 statements produced by an Expert Board of 5 epileptologists. Using an iterative process, statements were finalized by a Delphi Panel of 84 Italian pediatric and adult neurologists. Each statement was rated anonymously to determine level of agreement on a 9-point Likert scale. Consensus was established as agreement by at least 80% of the panelists. The relevance of each statement was also assessed on a 3-point scale. Results Consensus was achieved for 37 statements. Characteristics of PER considered to justify its use as first add-on include evidence of a positive impact on quality of life based on long term retention data, efficacy, tolerability, and ease of use; no worsening of cognitive functions and sleep quality; a low potential for drug interactions; a unique mechanism of action. Potential unfavorable factors are the need for a relatively slow dose titration; the potential occurrence of behavioral adverse effects; lack of information on safety when used in pregnancy; limited access to plasma PER levels. Conclusion Perampanel has many features which justify its use as a first add-on. Choice of an ASM as first add-on should be tailored to individual characteristics.

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Clinical Practice Recommendations for Improving Life Participation for People With Aphasia in Long-Term Care

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00136 ◽

2020 ◽

Vol 5 (2) ◽

pp. 384-396

Author(s):

Jamie H. Azios ◽

Jack S. Damico

Keyword(s):

Social Relationships ◽

Long Term Care ◽

Positive Impact ◽

Emotional Health ◽

Therapeutic Process ◽

Term Care ◽

Clinical Tools ◽

Practical Recommendations

Purpose The purpose of this clinical focus article is to present an overview of the Life Participation Approach to Aphasia as it relates to issues in long-term care (LTC) and provide practical recommendations for implementing the approach in this setting. The Framework for Living With Aphasia is used as a guide to (a) highlight specific challenges to life participation for residents with aphasia in LTC and (b) propose clinical tools that might help clinicians move through the therapeutic process when implementing the Life Participation Approach to Aphasia. Recommendations Clinicians in LTC facilities have the responsibility of delivering services that have a positive impact on communication, social relationships, emotional health, and quality of life. Clinical tools and approaches most appropriate for LTC settings are identified that help to address these goals. Approaches are discussed across several stages representing the therapeutic process, which is ultimately aimed at moving a resident toward recovery and increased independence. Case demonstrations are provided to illustrate approaches.

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An Eight-year Follow-up to a Randomized Clinical Trial of Participant Satisfaction with Three Types of Mandibular Implant-retained Overdentures

Journal of Dental Research ◽

10.1177/154405910408300809 ◽

2004 ◽

Vol 83 (8) ◽

pp. 630-633 ◽

Cited By ~ 89

Author(s):

R. Timmerman ◽

G.T. Stoker ◽

D. Wismeijer ◽

P. Oosterveld ◽

J.I.J.F. Vermeeren ◽

...

Keyword(s):

Positive Impact ◽

Controlled Trial ◽

Long Term Results ◽

Participant Satisfaction ◽

Chewing Ability ◽

Almost All ◽

Mandibular Overdenture

Studies have shown that mandibular implant overdentures significantly increase satisfaction and quality of life of edentulous elders. Improved chewing ability appears to have a positive impact on nutritional state. Therefore, it is important to determine the best design of this prosthesis over the long term. In this randomized controlled trial, three groups of edentulous participants with atrophic mandibles wore 3 types of implant overdentures. During an eight-year follow-up, only seven of the 110 participants had dropped out of this study. Almost all participants were still satisfied with their overdentures. Participant satisfaction concerning retention and stability of the mandibular overdenture had decreased significantly in the two-implant ball attachment group, whereas the opinion of participants in the single- and triple-bar groups was still at the same level. The long-term results suggest that a mandibular overdenture retained by 2 implants with a single bar may be the best treatment strategy for edentulous people with atrophic ridges.

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Marketing Channels and Underwriting Service Quality of Life Insurance

International Review of Financial Consumers ◽

10.36544/irfc.2016.1.2 ◽

2016 ◽

Vol 1 (No. 1 Oct 2016) ◽

pp. 9-24

Author(s):

Chen Tsai-Jyh

Keyword(s):

Service Quality ◽

Empirical Result ◽

Life Insurance ◽

Positive Impact ◽

Marketing Channels ◽

Competitive Advantages ◽

Competitive Strategies ◽

Cost Efficient

This paper investigates the relationship between marketing channels and underwriting service quality with focus on two major channels: salesperson and bancassurance. Based on the data of life insurance in Taiwan, the empirical analysis shows that the traditional salesperson channel has competitive advantages in underwriting service quality. This result supports the coexistence of salesperson and bancassurance because previous literature indicated bancassurance more cost-efficient than a salesperson. The empirical result shows that insurers with more dependence on salesperson channel present lower complaint ratio and higher contract persistency due to better service quality. The empirical result also indicates that service quality has a significantly positive impact on insurer’s reputation. This finding implies that the insurers with more dependence on bancassurance should take additional competitive strategies to maintain the long-term customer relation.

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Personalization of the use of non-steroidal anti-inflammatory drugs for musculoskeletal diseases. Resolution on the results of the Meeting of Experts of December 13, 2017

Medical Council ◽

10.21518/2079-701x-2018-18-76-84 ◽

2018 ◽

pp. 76-84 ◽

Cited By ~ 1

Author(s):

A. E. Karateev ◽

A. M. Lila ◽

I. S. Dydykina ◽

P. R. Kamchatnov ◽

S. O. Mazurenko ◽

...

Keyword(s):

Musculoskeletal Diseases ◽

Modern Medicine ◽

Individual Characteristics ◽

Analgesic Therapy ◽

Acute Pain Therapy ◽

Inflammatory Drugs ◽

The Individual ◽

Key Aspects

The personalization of therapy is one of the innovative approaches gaining an increasingly strong foothold in modern medicine, implying an individual approach to each patient, taking into account the individual characteristics of the patient and the specific clinical case. This same standpoint of personified therapy should be used to plan rational analgesic therapy, the most important component of managing patients with the most common and socially significant diseases, with conditions that have a significant impact on the patient’s quality of life and worsen the course of concomitant diseases. The Meeting of Experts of different specialties such as rheumatologists, neurologists, cardiologists and clinical pharmacologists considered the key aspects of the prescription of NSAIDs, the most widely used class of painkillers, including those used for the relief of musculoskeletal pain. It was noted that when choosing NSAIDs, the practitioner should take into account the diagnosis, the planned duration of analgesic therapy, the intensity of pain, medical history data, the presence of comorbid diseases and risk factors for drug complications. There are different types of NSAIDs, some of which are most useful for urgent acute pain therapy (eg, ketoprofen), while others are most suitable for long-term pain management in chronic diseases (eg, etoricoxib). In any case, the practitioner should take into account the priority of patient safety and pay the utmost attention to the prevention of NSAIDassociated complications, and also keep in mind the duration of the specific drug administration permitted by the patient information leaflet. It was also noted that the launch of a new generic etoricoxib (Kostarox®) expands the possibilities of analgesic therapy for the Russian practitioners.

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CPAP after endoscopic procedures as add-on therapy for the treatment of tracheal stenosis: a case series

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2019.1121 ◽

2019 ◽

Vol 89 (3) ◽

Author(s):

Adriano Gesuele ◽

Simone Gambazza ◽

Marta Lazzeri ◽

Serena Conforti

Keyword(s):

Tracheal Stenosis ◽

Positive Airway Pressure ◽

Positive Impact ◽

Case Series ◽

Long Term Results ◽

Tracheal Resection ◽

Endoscopic Procedures ◽

Frequent Relapses

Tracheal stenosis represents a possible complication in intubated or tracheotomised patients. Tracheal resection is currently the gold standard for the treatment of complex stenosis while granulomas and simple stenosis (e.g., web-like) are often treated by endoscopic procedures, which do not consistently give satisfactory long-term results, due to frequent relapses. Administering continuous positive airway pressure (CPAP) after endoscopic procedures might represent a new add-on option for the treatment of this complication. In this case series are presented two patients with tracheal stenosis showed after the removal of tracheostomy tube, both treated with CPAP. The results were straightforward: CPAP treatment helped to keep stable the tracheal lumen, without adverse effects. No further endoscopic dilations were necessary thereafter, with a likely positive impact on patients’ quality of life and on health expenditure.

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Management of Malignant Pleural Effusion with ASEPT® Pleural Catheter: Quality of Life, Feasibility, and Patient Satisfaction

Canadian Respiratory Journal ◽

10.1155/2016/4273480 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Inderdeep Dhaliwal ◽

Masoud Mahdavian ◽

Shabnam Asghari ◽

Benson Chun To Wong ◽

Rosalie Labelle ◽

...

Keyword(s):

Quality Of Life ◽

Time Management ◽

Cost Savings ◽

Ease Of Use ◽

Effective Option ◽

Eortc Qlq C30 ◽

Pleural Catheter ◽

Eortc Qlq

Objective. The PleurX® IPC system has been used extensively in the past. Over time, management of MPE with the PleurX system can be costly. The new ASEPT pleural catheter, through advantages in design, may ultimately show cost savings. The primary outcome of this study was to evaluate safety and efficacy of the ASEPT system.Method. This single centre, prospective study enrolled 50 patients with MPE, who were followed for as long as they were alive with a catheter. Quality of Life (QoL) was assessed before, at 2 weeks, and 6 weeks after ASEPT catheter insertion using the EORTC QLQ-C30 and LC13 questionnaires. Ease of catheter use and complications were reported by physician and community nurses.Results. 50 patients with MPE with a mean age of64.5±1.9, BDI of2.8±0.9, and ECOG score of3.0±0.7were recruited. No immediate or long-term complications were reported during the study period. Compared to precatheter insertion, global health status (−18,p<0.001), QLQ-C30 dyspnea (−39,p<0.00001), and LC13 dyspnea (−11,p<0.0005) significantly improved at 2 and 6 weeks after intervention. Provider surveys indicated favourable ease of use.Conclusion. The new ASEPT catheter offers a safe and effective option for the management of MPE.

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Penerapan Manajemen Mutu Terpadu di Perguruan Tinggi dengan Menggunakan Teknologi Informasi

10.31227/osf.io/t2rma ◽

2019 ◽

Author(s):

Puja Ningsih ◽

Rusdinal ◽

Hade Afriansyah

Keyword(s):

Information Technology ◽

Quality Management ◽

Positive Impact ◽

Educational Institutions ◽

Total Quality ◽

Quality Of Information ◽

World Information ◽

Fundamental Values

Integration of Management Total Quality and Information Technology has become very important for countries, businesses, and companies that hope to survive, including educational institutions. The demand for graduates of quality education institutions is increasingly urgent because of the increasing competition in employment, therefore competition in the labor market will be increasingly severe. Integrated Quality Management (Total Quality Management-TQM) is a system of fundamental values and competence in managing organizations with the aim of improving performance in the long term by paying special attention to achieving customer satisfaction while paying adequate attention to meeting the needs of all organizational stakeholders concerned. Quality problems in TQM require the involvement and responsibility of all parties in the organization. Its application in the world of education has had a positive impact, especially in universities. Where to support the implementation and implementation of TQM in an increasingly advanced world, information technology is needed. Information technology is a variety of facilities consisting of hardware and software to support and improve the quality of information for the community quickly and with quality.

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The Role of Individual Characteristics in Predicting Short- and Long-Term Cognitive and Psychological Benefits of Cognitive Stimulation Therapy for Mild-to-Moderate Dementia

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.811127 ◽

2022 ◽

Vol 13 ◽

Author(s):

Elena Carbone ◽

Federica Piras ◽

Massimiliano Pastore ◽

Erika Borella

Keyword(s):

Cognitive Functioning ◽

Individual Characteristics ◽

Cognitive Stimulation ◽

Older Age ◽

Everyday Functioning ◽

Moderate Dementia ◽

Short And Long Term

Introduction: This study examined the role of individual characteristics in predicting short- and long-term benefits of the Italian version of Cognitive Stimulation Therapy (CST-IT), an evidence-based intervention for people with mild-to-moderate dementia.Materials and Methods: Data were drawn from a sample (N = 123) of people with dementia (PwD) who took part in a multicenter controlled clinical trial of CST-IT. Assessments at pre-test, immediately after completing the treatment, and 3 months later investigated the following outcomes: general cognitive functioning and language, mood and behavior, everyday functioning, and quality of life. Age, education and baseline (pre-test) cognitive functioning, mood (depression) and behavioral and neuropsychiatric symptoms were considered as predictors of any short- and long-term benefits.Results: Linear mixed-effects models showed that different individual characteristics -particularly education and age- influenced the benefits of CST-IT, depending on the outcome measures considered. Higher education predicted larger gains in general cognitive functioning and, along with less severe depressive symptoms, in language (magnification effects). Older age was associated with positive changes in mood (compensation effects). Albeit very modestly, older age was also associated with larger gains in everyday functioning (compensation effects). Gains in quality of life were predicted by older age and lower education (compensation effects). Baseline cognitive functioning, mood and/or behavioral symptoms broadly influenced performance too, but their role again depended on the outcomes considered.Discussion: These findings underscore the importance of considering and further exploring how psychosocial interventions like CST are affected by individual characteristics in order to maximize their efficacy for PwD.

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Exploring the Systematic Attributes Influencing Gerontechnology Adoption for Elderly Users Using a Meta-Analysis

Sustainability ◽

10.3390/su12072864 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2864 ◽

Cited By ~ 1

Author(s):

Jining Zhou ◽

Bo Zhang ◽

Runhua Tan ◽

Ming-Lang Tseng ◽

Yaya Zhang

Keyword(s):

Behavioral Intention ◽

Positive Impact ◽

Meta Analysis ◽

Empirical Studies ◽

Significant Negative Correlation ◽

Individual Characteristics ◽

Ease Of Use ◽

Perceived Usefulness ◽

Perceived Ease Of Use ◽

Positive Correlation

This study aims to explore the key systematic attributes influencing the acceptance of gerontechnology by seniors in response to global aging and rapid technological progress. A meta-analysis was carried out to quantitatively synthesize the results of 25 empirical studies published from 2010 to 2020. After standardized coding and descriptive statistics, as well as tests and analysis of main effects and heterogeneity, publication bias. The following results were obtained: Perceived usefulness and perceived ease of use have a significant positive impact on the user’s attitude and behavioral intention; performance expectancy, effort expectancy, trust, technical performance and subjective norm have a significant positive correlation with the user’s behavioral intention; social influence, facilitating conditions have a positive correlation with the user’s behavioral intention; anxiety has a significant negative correlation to the user’s behavioral intention. The key systematic influencing attributes are classified into three categories: (1) User individual characteristics; (2) product and technical characteristics; and (3) environmental characteristics. This study provides researchers and practitioners with a systematic evidence-based basis to reduce the gap in decision-making for gerontechnology practices.

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Non-technical skills: a review of training and evaluation in urology

World Journal of Urology ◽

10.1007/s00345-019-02920-6 ◽

2019 ◽

Vol 38 (7) ◽

pp. 1653-1661 ◽

Cited By ~ 4

Author(s):

Cora Griffin ◽

Abdullatif Aydın ◽

Oliver Brunckhorst ◽

Nicholas Raison ◽

Muhammad Shamim Khan ◽

...

Keyword(s):

Operating Room ◽

Simulation Training ◽

Positive Impact ◽

Distributed Simulation ◽

Technical Skills ◽

Training Methods ◽

Learning Techniques ◽

Training Courses

Abstract Purpose With non-technical skills (NTS) deficits being recognised as a major cause for error in surgery, there is an increasing interest in their training and evaluation. A growing number of training courses are emerging and some NTS curricula have also been created. Many different training methods are described in the literature but there is still uncertainty with regards to their optimum combination within a curriculum. Methods A literature review of the electronic database Medline was performed. All articles published before December 2018 were screened by abstract and included if deemed relevant by the author. The included articles’ reference lists were also screened for further relevant studies. Results Simulation training is accepted as the most effective way to train NTS. Within simulation training, it is shown that the ‘igloo’ full immersion/distributed simulation environment is appropriate for teaching NTS in urological scenarios where a designated operating room or space is not available. The use of multiple settings, for example wards and clinics as well as the operating room, is advantageous, as is training in an interprofessional team. Classroom teaching also plays a role in NTS training as an adjunct to simulation, with evidence that it improves some parameters of NTS. All levels, including qualified surgeons, benefit from NTS training; however, adaptation to both trainee level and specialty is important. Although less time consuming, training juniors and seniors together mainly benefits juniors, and training NTS at the same time as technical skills detracts from the quality of teaching. Debriefing is an important part of training and should be well structured; there are many debriefing models in existence, allowing for choice of method based on examiner preference and participant demographic. Furthermore, examiners should be well briefed in their task and trained in NTS assessment. Conclusion To move forward, studies should combine tried and tested learning techniques into a curriculum covering all training levels, which should then be validated and followed up long term to ensure a positive impact on patient safety.

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