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Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 100610
Author(s):  
Dana Drzayich Antol ◽  
Angela Hagan ◽  
Hannah Nguyen ◽  
Yong Li ◽  
Gilbert S. Haugh ◽  
...  

2022 ◽  
pp. 027112142110647
Author(s):  
Ann M. Mickelson ◽  
Rebecca Hoffman

A family-capacity building approach to coaching, where providers support caregivers to embed identified strategies into daily routines and activities, is commonly embraced in Part C Early Intervention (EI). EI providers use several coaching strategies within this approach, yet few studies have reported process features, and coaching strategies are not well defined in the literature. We partnered in this Participatory Action Research (PAR) with current EI providers engaged in a year-long self-study process to provide an empirical account of one coaching strategy, joint planning, and related documentation. Our results indicate both providers and caregivers view documentation of joint planning as beneficial, highlight supports and challenges, and suggest that joint planning documentation holds significant promise for improving practice, data-based decision making, and progress monitoring of child and family outcomes including changes in caregiver capacity.


2022 ◽  
pp. 1-2
Author(s):  
Markus Stücker

<b>Importance:</b> One-year outcomes from the Early Venous Reflux Ablation (EVRA) randomized trial showed accelerated venous leg ulcer healing and greater ulcer-free time for participants who are treated with early endovenous ablation of lower extremity superficial reflux. <b>Objective:</b> To evaluate the clinical and cost-effectiveness of early endovenous ablation of superficial venous reflux in patients with venous leg ulceration. <b>Design, Setting, and Participants:</b> Between October 24, 2013, and September 27, 2016, the EVRA randomized clinical trial enrolled 450 participants (450 legs) with venous leg ulceration of less than 6 months’ duration and superficial venous reflux. Initially, 6555 patients were assessed for eligibility, and 6105 were excluded for reasons including ulcer duration greater than 6 months, healed ulcer by the time of randomization, deep venous occlusive disease, and insufficient superficial venous reflux to warrant ablation therapy, among others. A total of 426 of 450 participants (94.7%) from the vascular surgery departments of 20 hospitals in the United Kingdom were included in the analysis for ulcer recurrence. Surgeons, participants, and follow-up assessors were not blinded to the treatment group. Data were analyzed from August 11 to November 4, 2019. <b>Interventions:</b> Patients were randomly assigned to receive compression therapy with early endovenous ablation within 2 weeks of randomization (early intervention, n  =  224) or compression with deferred endovenous treatment of superficial venous reflux (deferred intervention, n  =  226). Endovenous modality and strategy were left to the preference of the treating clinical team. <b>Main Outcomes and Measures:</b> The primary outcome for the extended phase was time to first ulcer recurrence. Secondary outcomes included ulcer recurrence rate and cost-effectiveness. <b>Results:</b> The early-intervention group consisted of 224 participants (mean [SD] age, 67.0 [15.5] years; 127 men [56.7%]; 206 White participants [92%]). The deferred-intervention group consisted of 226 participants (mean [SD] age, 68.9 [14.0] years; 120 men [53.1%]; 208 White participants [92%]). Of the 426 participants whose leg ulcer had healed, 121 (28.4%) experienced at least 1 recurrence during follow-up. There was no clear difference in time to first ulcer recurrence between the 2 groups (hazard ratio, 0.82; 95% CI, 0.57–1.17; P  =  .28). Ulcers recurred at a lower rate of 0.11 per person-year in the early-intervention group compared with 0.16 per person-year in the deferred-intervention group (incidence rate ratio, 0.658; 95% CI, 0.480–0.898; P  =  .003). Time to ulcer healing was shorter in the early-intervention group for primary ulcers (hazard ratio, 1.36; 95% CI, 1.12–1.64; P  =  .002). At 3 years, early intervention was 91.6% likely to be cost-effective at a willingness to pay of £20 000 ($26 283) per quality-adjusted life year and 90.8% likely at a threshold of £35 000 ($45 995) per quality-adjusted life year. <b>Conclusions and Relevance:</b> Early endovenous ablation of superficial venous reflux was highly likely to be cost-effective over a 3-year horizon compared with deferred intervention. Early intervention accelerated the healing of venous leg ulcers and reduced the overall incidence of ulcer recurrence. <b>Trial Registration:</b> ClinicalTrials.gov identifier: ISRCTN02335796.


F1000Research ◽  
2022 ◽  
Vol 10 ◽  
pp. 571
Author(s):  
Siprianus Ugroseno Yudho Bintoro ◽  
Pradana Zaky Romadhon ◽  
Satriyo Dwi Suryantoro ◽  
Rusdi Zakki Aminy ◽  
Choirina Windradi ◽  
...  

Priapism in chronic myeloid leukemia (CML) appears to be an infrequent manifestation as well as a crucial emergency. Here, we report an 18-year-old male presenting with a persistent erection of the penis for 20 days. We evaluated and compared the reported cases within 20 years discussing the management of priapism in CML. Cytoreductive therapy followed by leukapheresis, the administration of tyrosine kinase inhibitor, and intra-cavernosal blood aspiration may resolve the symptoms of priapism. Early intervention for cytoreduction and aspiration are the pivotal keys to successfully impeding the complications.


2022 ◽  
pp. 070674372110657
Author(s):  
Bastian Bertulies-Esposito ◽  
Srividya Iyer ◽  
Amal Abdel-Baki

Introduction Early intervention services for psychosis (EIS) are associated with improved clinical and economic outcomes. In Quebec, clinicians led the development of EIS from the late 1980s until 2017 when the provincial government announced EIS-specific funding, implementation support and provincial standards. This provides an interesting context to understand the impacts of policy commitments on EIS. Our primary objective was to describe the implementation of EIS three years after this increased political involvement. Methods This cross-sectional descriptive study was conducted in 2020 through a 161-question online survey, modeled after our team's earlier surveys, on the following themes: program characteristics, accessibility, program operations, clinical services, training/supervision, and quality assurance. Descriptive statistics were performed. When relevant, we compared data on programs founded before and after 2017. Results Twenty-eight of 33 existing EIS completed the survey. Between 2016 and 2020, the proportion of Quebec's population having access to EIS rose from 46% to 88%; >1,300 yearly admissions were reported by surveyed EIS, surpassing governments’ epidemiological estimates. Most programs set accessibility targets; adopted inclusive intake criteria and an open referral policy; engaged in education of referral sources. A wide range of biopsychosocial interventions and assertive outreach were offered by interdisciplinary teams. Administrative/organisational components were less widely implemented, such as clinical/administrative data collection, respecting recommended patient-to-case manager ratios and quality assurance. Conclusion Increased governmental implementation support including dedicated funding led to widespread implementation of good-quality, accessible EIS. Though some differences were found between programs founded before and after 2017, there was no overall discernible impact of year of implementation. Persisting challenges to collecting data may impede monitoring, data-informed decision-making, and quality improvement. Maintaining fidelity and meeting provincial standards may prove challenging as programs mature and adapt to their catchment area's specificities and as caseloads increase. Governmental incidence estimates may need recalculation considering recent epidemiological data.


2022 ◽  
pp. 004005992110683
Author(s):  
Carrie A. Davenport ◽  
Joan Weir

Parents, teachers, and administrators report concerns and challenges related to the transition from early intervention (EI) to preschool for children who are deaf/hard-of-hearing. The goal of the current article is to assist teachers, administrators, and specialists involved in the transition of a young child who is deaf/hard-of-hearing from EI into preschool. The TEAM approach involves Transition planning, establishing an Educational team, determining and providing appropriate Accommodations, and Making connections for continued success. Although the TEAM approach may apply to all young children transitioning, the focus of this article is on addressing the unique needs of this particular population. Recommendations and resources are provided.


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