scholarly journals Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience

2017 ◽  
Vol 19 (3) ◽  
pp. 273-281 ◽  
Author(s):  
Sandi Lam ◽  
I-Wen Pan ◽  
Ben A. Strickland ◽  
Caroline Hadley ◽  
Bradley Daniels ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Treatment Recommendation ◽  
Sudden Infant ◽  
Multiple Gestation ◽  
Head Shape ◽  
Positional Plagiocephaly ◽  
Recommended Treatment ◽  
The Impact ◽  
Orthotic Treatment

OBJECTIVE Following institution of the Back to Sleep Campaign, the incidence of sudden infant death syndrome decreased while the prevalence of positional skull deformation increased dramatically. The management of positional deformity is controversial, and treatment recommendations and outcomes reporting are variable. The authors reviewed their institutional experience (2008–2014) with the treatment of positional plagiocephaly to explore factors associated with measured improvement. METHODS A retrospective chart review was conducted with risk factors and treatment for positional head shape deformity recorded. Univariate and multivariate analyses were used to assess the impact of these variables on the change in measured oblique diagonal difference (ODD) on head shape surface scanning pre- and posttreatment. RESULTS A total of 991 infants aged less than 1 year were evaluated for cranial positional deformity in a dedicated clinical program. The most common deformity was occipital plagiocephaly (69.5%), followed by occipital brachycephaly (18.4%) or a combination of both deformities (12.1%). Recommended treatment included repositioning (RP), physical therapy (PT) if indicated, or orthotic treatment with a customized cranial orthosis (CO) according to an age- and risk factor–dependent algorithm that the authors developed for this clinic. Of the 991 eligible patients, 884 returned for at least 1 follow-up appointment. A total of 552 patients were followed to completion of their treatment and had a full set of records for analysis: these patients had pre- and posttreatment 2D surface scanner evaluations. The average presenting age was 6.2 months (corrected for prematurity for treatment considerations). Of the 991 patients, 543 (54.8%) had RP or PT as first recommended treatment. Of these 543 patients, 137 (25.2%) transitioned to helmet therapy after the condition did not improve over 4–8 weeks. In the remaining cases, RP/PT had already failed before the patients were seen in this program, and the starting treatment recommendation was CO. At the end of treatment, the measured improvements in ODD were 36.7%, 33.5%, and 15.1% for patients receiving CO, RP/PT/CO, and RP/PT, respectively. Univariate analysis showed that sex, race, insurance, diagnosis, sleep position preference, torticollis history, and multiple gestation were not significantly associated with magnitude of ODD change during treatment. On multivariate analysis, corrected age at presentation and type of treatment received were significantly associated with magnitude of ODD change. Orthotic treatment corresponded with the largest ODD change, while the RP/PT group had the least change in ODD. Earlier age at presentation corresponded with larger ODD change. CONCLUSIONS Earlier age at presentation and type of treatment impact the degree of measured deformational head shape correction in positional plagiocephaly. This retrospective study suggests that treatment with a custom CO can result in more improvement in objective measurements of head shape.

scholarly journals The health belief model and factors associated with adherence to treatment recommendations for positional plagiocephaly

2017 ◽  
Vol 19 (3) ◽  
pp. 282-288 ◽  
Author(s):  
Sandi Lam ◽  
Thomas G. Luerssen ◽  
Caroline Hadley ◽  
Bradley Daniels ◽  
Ben A. Strickland ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Univariate Analysis ◽  
Treatment Recommendations ◽  
Head Shape ◽  
Positional Plagiocephaly ◽  
Commercial Insurance ◽  
Factors Associated ◽  
Recommended Treatment ◽  
Skull Deformity ◽  
The Impact

OBJECTIVE This study aimed to examine factors associated with adherence to recommended treatment among pediatric patients with positional skull deformity by reviewing a single-institution experience (2007–2014) with the treatment of positional plagiocephaly. METHODS A retrospective chart review was conducted. Risk factors, treatment for positional head shape deformity, and parent-reported adherence were recorded. Univariate and multivariate analyses were used to assess the impact of patient clinical and demographic characteristics on adherence. RESULTS A total of 991 patients under age 12 months were evaluated for positional skull deformity at the Texas Children's Hospital Cranial Deformity Clinic between 2007 and 2014. According to an age- and risk factor–based treatment algorithm, patients were recommended for repositioning, physical therapy, or cranial orthosis therapy or crossover from repositioning/physical therapy into cranial orthosis therapy. The patients' average chronological age at presentation was 6.2 months; 69.3% were male. The majority were white (40.7%) or Hispanic (32.6%); 38.7% had commercial insurance and 37.9% had Medicaid. The most common initial recommended treatment was repositioning or physical therapy; 85.7% of patients were adherent to the initial recommended treatment. Univariate analysis showed differences in adherence rates among subgroups. Children's families with Medicaid were less likely to be adherent to treatment recommendations (adherence rate, 80.2%). Families with commercial insurance were more likely to be adherent to the recommended treatment (89.6%). Multivariate logistic regression confirmed that factors associated with parent-reported adherence to recommended treatment included primary insurance payer, diagnosis (plagiocephaly vs brachycephaly), and the nature of the recommended treatment. Families were less likely to be adherent if they had Medicaid, a child with a diagnosis of brachycephaly, or were initially recommended for cranial orthosis therapy than families with commercial insurance, a child with a diagnosis of plagiocephaly, or an initial recommendation for repositioning or physical therapy. Factors associated with treatment completion included corrected age, insurance, diagnosis, recommended treatment, and distance to provider from patient's residence. Patients with commercial insurance (OR 1.49, 95% CI 1.10–2.02, p = 0.009), those diagnosed with both brachycephaly and plagiocephaly (OR 2.26, 95% CI 1.31–3.90, p = 0.003), those recommended for treatment with cranial orthosis (OR 4.55, 95% CI = 3.24–6.38, p < 0.001), and those living in proximity to the provider (OR 1.40, 95% CI 1.00–1.96, p = 0.047) were more likely to complete treatment. CONCLUSIONS Insurance type, degree of head shape deformity, and types of recommended treatment appear to affect rates of adherence to recommended treatments for positional skull deformation.

scholarly journals 962. Linkage to Care Outcomes among Known HIV-Positive Patients at a High Prevalence Urban Hospital Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S511-S511
Author(s):  
Alexander W Sudyn ◽  
Jeffrey M Paer ◽  
Swetha Kodali ◽  
Samuel Maldonado ◽  
Amesika Nyaku ◽  
...  
Keyword(s):  
Hiv Risk ◽  
Hiv Transmission ◽  
Univariate Analysis ◽  
Linkage To Care ◽  
Retrospective Chart Review ◽  
Retention In Care ◽  
Patient Navigator ◽  
Urban Hospital ◽  
Opt Out ◽  
The Impact

Abstract Background Retention in care of persons with HIV (PWH) is essential for achieving viral suppression and decreasing community transmission. CDC estimates that the 23% of known PWH not retained in care account for 43% of all new transmissions. This study seeks to describe the impact of an opt-out ED screening with navigator-assisted linkage to care (LTC) protocol for out of care PWH. Methods An IRB-approved retrospective chart review was conducted among PWH (prior positive) inadvertently retested in the ED between 2015 and 2018. Univariate and multivariate logistic regression was used to identify factors associated with LTC with patient navigator (PN) support. Factors with p ≤ 0.1 were included in the multivariate analysis as were age and sex at birth. Patients who died were excluded from statistical analyses. Results Among 464 patients who tested positive, 338 (73%) were known positive with 120 (35%) of those out of care at the time of screening. Mean age for this group was 47 (SD 11.9); 57% male, 81% non-Hispanic black, 10% Hispanic, and 6% non-Hispanic white. Fifty-five (46%) patients were successfully LTC, 54 (45%) referred to the state for linkage, and 11 (9%) died. A total of 109 patients were included in the analysis. Univariate analysis was performed for age (F(1, 107) = 0.98, p = 0.324) and female sex at birth (OR = 1.42 [95% CI 0.66, 3.05], p = 0.373) as well as Hispanic race (OR = 3.33 [95% CI 0.84, 13.04], p = 0.085), heterosexual HIV risk (OR = 2.76 [95% CI 1.27, 5.99], p = 0.011), IDU (OR = 0.49 [95% CI 0.21, 1.11], p = 0.088), and other SUD (OR = 0.42 [95% CI 0.19, 0.94], p = 0.035). Only heterosexual HIV risk (OR = 3.01 [95% CI 1.23, 7.32], p = 0.015) maintained significance in the final multivariate model. Conclusion Opt-out ED screening revealed &gt;30% of known positive PWH were out of care at the time of testing; of whom nearly 50% were LTC with PN support. It is possible that persons reporting heterosexual HIV risk may feel less stigmatized and therefore are more likely to LTC. Similarly, the association with SUD, albeit non-significant, may reflect underrepresentation of individuals with SUD in remission among patient navigators. Future opt-out ED screening protocols should build upon diverse care teams to further engage patients with SUD and those at risk for non-heterosexual HIV transmission. Disclosures All Authors: No reported disclosures

Patterns of Care in Patients with Chemotherapy Receiving Erythropoiesis Stimulating Agents (ESAs).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 964-964 ◽  
Author(s):  
Arash Naeim ◽  
Lyssa Friedman ◽  
Eric Elkin ◽  
Sara Adams ◽  
Hema Viswanathan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Initiation ◽  
Retrospective Chart Review ◽  
Patterns Of Care ◽  
Chronic Obstructive ◽  
Policy Debate ◽  
National Guidelines ◽  
Obstructive Pulmonary Disease ◽  
Recommended Treatment ◽  
The Impact

Abstract Background: Hemoglobin (Hb) levels at ESA treatment initiation have undergone recent policy debate. This retrospective chart review used baseline data prior to an educational intervention on anemia guidelines in community-based oncology practices to understand ESA patterns of care among cancer patients receiving chemotherapy. National guidelines at the time of data collection recommended treatment when Hb was <11 g/dL or when Hb was 11–12 g/dL in the presence of anemia symptoms or risk factors for development of symptomatic anemia. The objectives of this analysis were to examine Hb levels and presence of symptoms or risk factors at ESA treatment initiation and proportion of patients receiving at least one transfusion after initial ESA treatment. Methods: Medical charts of patients ≥18 years receiving chemotherapy (June 2005 – August 2006) for lung, ovarian, multiple myeloma, Hodgkin’s and non-Hodgkin’s lymphoma, colorectal, breast, head and neck, bladder or testicular cancer from 47 sites were abstracted. Hb level at initial ESA administration was defined as the value recorded within 7 days prior to or on the day of treatment initiation. Anemia symptoms (chest pain, peripheral edema, sustained tachycardia, severe fatigue, dizziness) and risk factors for the development of symptomatic anemia (prior transfusion, radiation or chemotherapy; chronic obstructive pulmonary disease, cerebrovascular disease or cardiac disease; age ≥ 65 years) were identified using national guidelines. Results: Of 2844 patients on chemotherapy, mean age was 62 years; 66% were female; most common malignancies were breast (36%), non-small cell lung cancer (19%) and colorectal (18%). A total of 1268 patients (44%) received at least one administration of an ESA and of these 1165 (92%) had Hb levels recorded at treatment initiation. A total of 238 patients (20%) had Hb levels ≤10g/dL at ESA initiation, 419 (36%) had Hb levels from 10.1–11.0 g/dL, 358 (31%) had Hb levels from 11.1–12.0 g/dL and 150 (13%) had Hb levels >12g/dL at treatment initiation. Of the 1268 patients who received initial treatment with an ESA, 102 (8%) required at least one transfusion during chemotherapy. Anemia symptoms or risk factors were present in 206 patients (87%) with Hb ≤10g/dL, 335 (80%) with Hb 10.1–11.0 g/dL and 287 (80%) with Hb 11.1–12.0 g/dL at ESA treatment initiation. Of the 1616 patients (56%) who did not receive an ESA during chemotherapy, the majority had a lowest recorded Hb level >12g/dL (647 patients, 40%) and 68% of such patients had anemia symptoms or risk factors. In comparison, 83% of patients receiving an initial ESA administration at Hb >12 g/dL had anemia symptoms or risk factors. Conclusions: Initiation of ESAs occurred most commonly between Hb levels of 10.1–11.0 g/dL. A majority of patients had symptoms or risk factors at ESA treatment initiation across Hb levels. Evaluation of specific symptoms and the role of ESAs in symptom alleviation is needed. Future studies should investigate the impact of new polices for ESA use on utilization patterns. Hb Levels at ESA Treatment Initiation and Presence of Symptoms or Risk Factors (N=1165)* ESA Treatment Presence of Symptoms or Risk Factors Hb at ESA Treatment Initiation N % N % *n=102 with no Hb in week prior to initial ESA treatment ≤10 238 20.4 206 86.6 >10–11 419 36.0 335 80.0 >11–12 358 30.7 287 80.2 >12 150 12.9 125 83.3

Patient characteristics associated with dose-limiting sunitinib adverse events

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16110-e16110
Author(s):  
B. Atkinson ◽  
J. Hart ◽  
E. Lin ◽  
N. Tannir ◽  
E. Jonasch
Keyword(s):  
Adverse Events ◽  
Tyrosine Kinases ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Retrospective Chart Review ◽  
Continuation Methods ◽  
Eligibility Criteria ◽  
The Impact

e16110 Background: Sunitinib, an inhibitor of multiple tyrosine kinases, is FDA approved for metastatic renal cell cancer (mRCC). Though better tolerated than historical therapies, sunitinib is associated with adverse events (AEs) that may require dose modifications (DM). We sought to identify 1) baseline patient (pt) characteristics that predispose for DM, 2) the most common AEs requiring DM in a non-protocol setting, and 3) the impact of dose limiting AEs on treatment continuation. Methods: Single-center, retrospective chart review. Pts ≥ 18 years of age with mRCC of clear-cell histology on sunitinib therapy with active follow-up at MDACC were eligible. Univariate and multivariate logistic regression analysis of 66 pt variables (demographics, laboratory analysis, past medical and treatment history, etc) and dose-limiting AEs was completed, with a 6 month endpoint of sunitinib continuation, alternative therapy, or death. Results: From January 1, 2006 through September 30, 2007, 146 pts were identified meeting eligibility criteria. By univariate analysis, increased age (p=0.04; OR 1.04, 1.002–1.081 CI) and elevated BUN (p=0.03; OR 1.06, 1.006 –1.108 CI) were directly associated with increased incidence of dose-limiting AEs. ECOG PS of 2 (p=0.04; OR 0.3, 0.114–0.951 CI) was associated with a decreased incidence of dose limiting AEs. In a multivariate analysis, only BUN remained significant. 57% of patients (n= 83) had dose-limiting AEs. DM were often attributed to multiple AEs (55%), with fatigue, mucositis, hand-foot syndrome and nausea being the most common. At 6 months follow-up, 63% of pts with dose-limiting AEs remained on sunitinib vs. 37% (p=0.18). There was no difference in death rate at 6 months between the two groups. Conclusions: Elevated baseline BUN is associated with an increased rate of DM in patients with RCC receiving sunitinib. Despite the high-incidence of AEs, pts can be maintained on sunitinib with DM and without an adverse impact on outcome. Whether specific AEs are biologic indicators of activity should be evaluated in a larger clinical trial. [Table: see text]

scholarly journals 1741. Invasive Fungal Infections in Patients with Multiple Myeloma in the Era of Novel Therapies

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S637-S638
Author(s):  
Emily Baneman ◽  
Ajai Chari ◽  
Meenakshi Rana ◽  
Dallas Dunn ◽  
Timothy Sullivan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Progressive Disease ◽  
Fungal Infections ◽  
Checkpoint Inhibitors ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Disease Status ◽  
Antifungal Prophylaxis ◽  
Cell Transplant ◽  
The Impact

Abstract Background Rapid advances in multiple myeloma (MM) therapy have led to improved survival, yet the impact of novel agents on the risk of invasive fungal infection (IFI) is largely unknown. We aim to describe the epidemiology of IFIs in MM patients in the current era of chemotherapy. Methods We performed a retrospective chart review of MM patients at Mount Sinai Hospital in New York, NY who entered care between December 2009 and October 2016 and had proven or probable IFI between January 2011 and October 2017. Probable and proven IFIs were defined by revised EORTC/MSG criteria. Descriptive statistics are reported as median (range). We evaluated factors associated with mortality by univariate analysis using Fisher’s exact and Mann–Whitney U tests. Results 2,960 MM patients entered care during the study period. We identified 30 episodes of IFI among 29 patients. Median age was 59 (42–80) years and 21 (70%) were men. IFI occurred at a median of 3.7 (0.3–18) years from MM diagnosis. At the time of IFI diagnosis, patients had received a median of 4 (1–12) lines of chemotherapy, 18 (60%) had undergone autologous stem cell transplant (ASCT), and 21 (70%) had progressive disease status. Agents received immediately prior to IFI were immunomodulators (n = 14), proteasome inhibitors (n = 14), conventional chemotherapy (n = 11), monoclonal antibodies (n = 6), checkpoint inhibitors (n = 3) and other (n = 3). Twenty-two (73%) patients received corticosteroids in the prior 30 days. Neutropenia and lymphopenia were present in 12 (40%) and 13 (43%) patients, respectively. There were 9 proven and 21 probable IFIs: invasive aspergillosis (n = 19), candidemia (n = 5), cryptococcosis (n = 3), talaromycosis (n = 1), mucormycosis (n = 1) and other (n = 2). Bacterial and viral respiratory co-infections occurred in 7 and 4 patients, respectively. Eight (27%) patients required ICU admission and 9 (30%) died within 30 days of IFI diagnosis. In univariate analysis, number of lines of chemotherapy (P = 0.05), progressive disease status (P = 0.03), and prior ASCT (P = 0.004) were associated with 30-day mortality. Conclusion IFIs are uncommon in MM patients receiving newer agents but are associated with significant morbidity and mortality. Further study is needed to identify high-risk subgroups that may benefit from antifungal prophylaxis or increased surveillance. Disclosures All authors: No reported disclosures.

Predictors for Postoperative Chyle Leak Following Neck Dissection, a Technique-Based Comparison

2021 ◽  
pp. 019459982199381
Author(s):  
Quinn Dunlap ◽  
Matthew Bridges ◽  
Kurt Nelson ◽  
Deanne King ◽  
Brendan C. Stack ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Care Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Severe Malnutrition ◽  
Chyle Leak ◽  
Significant Difference ◽  
Monopolar Electrocautery ◽  
The Impact

Objective Assess the impact of surgical technique used to address level IV on the rate of postoperative chyle leak. Study Design Retrospective chart review. Setting Academic tertiary care center. Methods An analysis of 436 consecutive neck dissections (NDs) in 368 patients was performed by 3 head and neck surgeons between 2014 and 2017. Variation in technique reflects individual approaches to the management of level IV and included suture ligation (SL), monopolar electrocautery (MC), and harmonic scalpel transection (HS). Data points included patient demographics, surgical technique, intraoperative findings, postoperative chyle leaks, and leak management. Correlation between variables was analyzed through χ2 test and Student t test with statistical α set at .05. Results Overall, 12 patients (3.2%) developed chyle leaks postoperatively. Nine of 12 and 3 of 12 presented with left- and right-sided leaks, respectively. Five of 12 leaks occurred following bilateral ND, 5 of 12 following left ND, and 2 of 12 following right ND. Univariate analysis showed a statistically significant difference ( P = .001) favoring SL (1.0%) and MC (1.2%) techniques over the HS technique (8.6%). A statistically significant increase existed in the rate of leak with endocrine vs nonendocrine pathology ( P = .003). Average duration of leak was 13.3 ± 13.5 days. Management included diet modification (n = 11, 91.6%), pressure-dressing placement (n = 7, 58.3%), and octreotide (n = 5, 41.7%). No cases required reoperation, and no mortality or severe malnutrition was observed in this series. Conclusions SL and MC techniques demonstrated superiority over the HS technique in preventative management of chyle leak in level IV, with a significantly higher rate of chyle leak observed in endocrine-related pathology.

GAMBARAN PENGETAHUAN SISWA TENTANG PERILAKU SEKS BEBAS DI SMA/SMK KOTA LUBUKLINGGAU TAHUN 2016

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Rini Mayasari Rini Mayasari
Keyword(s):  
High School ◽  
Univariate Analysis ◽  
Good Knowledge ◽  
Sex Behavior ◽  
School Class ◽  
Sufficient Knowledge ◽  
High School Class ◽  
Study Population ◽  
The Impact ◽  
Disease Free

ABSTRACT   Free sex is a relationship that is done by men and women without matrimony. Various forms of sexual behavior, such as intimate dating, courtship, to have sexual contact. Factors associated with sex behavior among others, is the lack of knowledge about free sex, free sex impact, forms of promiscuity, perversion LGBT, and disease-free sex. This study design is the technique of sampling using quantitative indirectly using a questionnaire tools shaped questionnaires. Be knew overview of students' knowledge about sex in high school / vocational Lubuk Linggau Year 2016. The study population was high school class XII students in schools in the city Lubuklingga 2016. The sample in this study is the high school class XII students in 9 schools there in Lubuklinggau of 167 people. Results of univariate analysis showed respondent knowledge about free sex amounted to 48 people (28,74%), students with sufficient knowledge of 54 people (32,33%), and students with less knowledge of 65 people (38, 93%). Students with a good knowledge about the impact of free sex amounted to 57 (34,13%), students with sufficient knowledge of 69 people (41,31%), and students with less knowledge 41 (24,56%). Students with a good knowledge about the form of free sex amounted to 58 students (34,73%), students with sufficient knowledge totaled 49 peoples (29,34%), and students with less knowledge of 60 people (35,93%). Students with a good knowledge about LGBT amounted to 54 (32,34%), students with sufficient knowledge amounted to 68 peoples (40.71%), and students with less knowledge amounted 45 peoples (26,95%). Students with a good knowledge about the disease free sex amounted to 22 peoples (13,17%), students with sufficient knowledge of 39 peoples (23,35%), and students with less knowledge amounted to 106 peoples (63,48%).     ABSTRAK   Seks bebas merupakan hubungan yang dilakukan oleh laki-laki dan perempuan tanpa adanya ikatan perkawinan. Berbagai bentuk tingkah laku seksual, seperti berkencan intim, bercumbu, sampai melakukan kontak seksual. Faktor-faktor yang berhubungan dengan perilaku seks bebas antara lain adalah kurangnya pengetahuan tentang seks bebas, dampak seks bebas, bentuk-bentuk seks bebas, penyimpangan LGBT, dan penyakit seks bebas. Desain penelitian ini adalah teknik pengambilan sampel menggunakan teknik kuantitatif yaitu secara tidak langsung menggunakan alat bantu angket berbentuk kuisener. Di ketahuinya gambaran pengetahuan siswa tentang seks bebas di SMA/SMK Kota Lubuk Linggau Tahun 2016. Populasi penelitian ini adalah siswa kelas XII SMA di sekolah yang ada di Kota Lubuklingga tahun 2016. Sampel pada penelitian ini adalah siswa kelas XII SMA di 9 sekolah yang ada di Kota Lubuklinggau yang berjumlah 167 orang. Hasil analisis univariat menunjukan respondent pengetahuan tentang seks bebas berjumlah 48 orang (28,74%), siswa dengan pengetahuan cukup 54 orang (32,33%), dan siswa dengan pengetahuan kurang 65 orang (38,93%). Siswa dengan pengetahuan baik tentang dampak perilaku seks bebas berjumlah 57 orang (34,13%), siswa dengan pengetahuan cukup 69 orang (41,31%), dan siswa dengan pengetahuan kurang 41 orang (24, 56%). Siswa dengan pengetahuan baik tentang bentuk perilaku seks bebas  berjumlah 58 siswa (34,73%), siswa dengan pengetahuan cukup  berjumlah 49orang (29,34%), dan siswa dengan pengetahuan kurang berjumlah 60 orang  (35,93%). Siswa dengan  pengetahuan baik tentang LGBT berjumlah 54 orang (32,34%), siswa dengan pengetahuan cukup berjumlah 68 orang (40,71%), dan siswa dengan  pengetahuan kurang berjumlah 45orang (26,95%). Siswa dengan pengetahuan baik tentang penyakit seks bebas berjumlah 22 orang (13,17%), siswa dengan pengetahuan cukup 39 orang (23,35%), dan siswa dengan pengetahuan kurang berjumlah 106 orang (63,48%).  

scholarly journals POS1234 IMPACT OF THE CHANGE IN ADMINISTRATION ROUTE OF TOCILIZUMAB AND ABATACEPT, DUE TO THE COVID-19 LOCKDOWN ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 900.1-900
Author(s):  
L. Diebold ◽  
T. Wirth ◽  
V. Pradel ◽  
N. Balandraud ◽  
E. Fockens ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Disease Activity ◽  
Univariate Analysis ◽  
Route Of Administration ◽  
Anxiety And Depression ◽  
Administration Route ◽  
Factors Associated ◽  
The Impact

Background:Among therapeutics used to treat rheumatoid arthritis (RA), Tocilizumab (TCZ) and Abatacept (ABA) are both biologic agents that can be delivered subcutaneously (SC) or intravenously (IV). During the first COVID-19 lockdown in France, all patients treated with IV TCZ or IV ABA were offered the option to switch to SC administration.Objectives:The primary aim was to assess the impact of changing the route of administration on the disease activity. The second aim was to assess whether the return to IV route at the patient’s request was associated with disease activity variation, flares, anxiety, depression and low physical activity during the lockdown.Methods:We conducted a prospective monocentric observational study. Eligibility criteria: Adult ≥ 18 years old, RA treated with IV TCZ or IV ABA with a stable dose ≥3 months, change in administration route (from IV to SC) between March 16, 2020, and April 17, 2020. The following data were collected at baseline and 6 months later (M6): demographics, RA characteristics, treatment, history of previous SC treatment, disease activity (DAS28), self-administered questionnaires on flares, RA life repercussions, physical activity, anxiety and depression (FLARE, RAID, Ricci &Gagnon, HAD).The primary outcome was the proportion of patients with a DAS28 variation>1.2 at M6. Analyses: Chi2-test for quantitative variables and Mann-Whitney test for qualitative variables. Factors associated with return to IV route identification was performed with univariate and multivariate analysis.Results:Among the 84 patients who were offered to switch their treatment route of administration, 13 refused to change their treatment. Among the 71 who switched (48 TCZ, 23 ABA), 58 had a M6 follow-up visit (13 lost of follow-up) and DAS28 was available for 49 patients at M6. Main baseline characteristics: female 81%, mean age 62.7, mean disease duration: 16.0, ACPA positive: 72.4%, mean DAS28: 2.01, previously treated with SC TCZ or ABA: 17%.At M6, the mean DAS28 variation was 0.18 ± 0.15. Ten (12.2%) patients had a DAS28 worsening>1.2 (ABA: 5/17 [29.4%] and TCZ: 5/32 [15.6%], p= 0.152) and 19 patients (32.8%) had a DAS28 worsening>0.6 (ABA: 11/17 [64.7%] and TCZ: 8/32 [25.0%], p= 0.007).At M6, 41 patients (77.4%) were back to IV route (26 TCZ, 15 ABA) at their request. The proportion of patients with a DAS28 worsening>1.2 and>0.6 in the groups return to IV versus SC maintenance were 22.5%, 42.5% versus 11.1% and 22.2% (p=0.4), respectively. The univariate analysis identified the following factors associated with the return to IV route: HAD depression score (12 vs 41, p=0.009), HAS anxiety score (12 vs 41, p=0.047) and corticosteroid use (70% vs 100%, p=0.021), in the SC maintenance vs return to IV, respectively.Conclusion:The change of administration route of TCZ and ABA during the first COVID-19 lockdown was infrequently associated with a worsening of RA disease. However, the great majority of the patients (77.4%) request to return to IV route, even without disease activity worsening. This nocebo effect was associated with higher anxiety and depression scores.Disclosure of Interests:None declared

scholarly journals Correlation between fundus autofluorescence and visual function in patients with cone-rod dystrophy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Satoru Kanda ◽  
Takumi Hara ◽  
Ryosuke Fujino ◽  
Keiko Azuma ◽  
Hirotsugu Soga ◽  
...  
Keyword(s):  
Visual Field ◽  
Significant Relationship ◽  
Fundus Autofluorescence ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Mean Deviation ◽  
Wide Field ◽  
The Mean ◽  
The Relationship ◽  
Field Imaging

AbstractThis study aimed to investigate the relationship between autofluorescence (AF) signal measured with ultra-wide field imaging and visual functions in patients with cone-rod dystrophy (CORD). A retrospective chart review was performed for CORD patients. We performed the visual field test and fundus autofluorescence (FAF) measurement and visualized retinal structures with optical coherence tomography (OCT) on the same day. Using binarised FAF images, we identified a low FAF area ratio (LFAR: low FAF/30°). Relationships between age and logMAR visual acuity (VA), central retinal thickness (CRT), central choroidal thickness (CCT), mean deviation (MD) value, and LFAR were investigated. Thirty-seven eyes of 21 CORD patients (8 men and 13 women) were enrolled. The mean patient age was 49.8 years. LogMAR VA and MD were 0.52 ± 0.47 and − 17.91 ± 10.59 dB, respectively. There was a significant relationship between logMAR VA and MD (p = 0.001). LogMAR VA significantly correlated with CRT (p = 0.006) but not with other parameters. Conversely, univariate analysis suggested a significant relationship between MD and LFAR (p = 0.001). In the multivariate analysis, LFAR was significantly associated with MD (p = 0.002). In conclusion, it is useful to measure the low FAF area in patients with CORD. The AF measurement reflects the visual field deterioration but not VA in CORD.

scholarly journals Infant Safe Sleep Promotion: Increasing Capacity of Child Protective Services Employees

2021 ◽  
Vol 18 (8) ◽  
pp. 4227
Author(s):  
Carolyn R. Ahlers-Schmidt ◽  
Christy Schunn ◽  
Ashley M. Hervey ◽  
Maria Torres ◽  
Cherie Sage ◽  
...  
Keyword(s):  
Infant Death ◽  
Child Protective Services ◽  
Sudden Infant Death ◽  
Sudden Infant ◽  
Protective Services ◽  
Safe Sleep ◽  
Train The Trainer ◽  
Baseline Knowledge ◽  
One Year ◽  
The Impact

Sleep-related infant deaths, including Sudden Infant Death Syndrome (SIDS), are the number one cause of death in infants between 28 days and one year of life. Nearly half of families experiencing a sleep-related infant death in Kansas were involved with the Department of Children and Families Child Protective Services (CPS), making CPS staff a priority for safe sleep training. This study assessed the impact of the two-day Kansas Infant Death and SIDS (KIDS) Network Safe Sleep Instructor (SSI) train-the-trainer program on CPS staffs’ knowledge of the American Academy of Pediatrics safe sleep recommendations. Training was attended by 43 participants, 27 (63%) of whom were employed by CPS. CPS staff had significantly lower baseline knowledge on the 10-item pretest (t = 3.33, p = 0.002), but both CPS and other attendees showed significant improvement by posttest (t = 8.53, p < 0.001 and t = 4.44, p < 0.001, respectively). Following SSI certification, CPS SSIs provided more safe sleep training to professionals than other SSIs (1051 vs. 165, respectively), and both groups of SSIs were able to significantly increase the knowledge of their trainees. Overall, the KIDS Network SSI training was successful. The innovative partnership with CPS allowed for provision of training to a group not historically targeted for safe sleep education.

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