Combining a Being Imitated Strategy With IBT Improves Basic Joint Attention Behaviors in Young Children With ASD

In the present study, we examined how an initial being imitated (BIm) strategy affected the development of initiating joint attention (IJA) among a group of children newly diagnosed with autism spectrum disorder (ASD). One group received 3 months of BIm followed by 12 months of intensive behavior treatment (IBT) which equaled treatment as usual whereas a second group received IBT for the entire 15-month study period. We utilized two measures of IJA: an eye gaze and a gesture score (point and show). IJA did not change during the first 3 months of treatment, nor were any significant between-group differences noted. However, at the end of the 15-month-long intervention period, the BIm group used eye gaze significantly more often to initiate joint attention. No significant change was noted for the gesture score. These results suggest that an early implementation of a being imitated strategy might be useful as less resource intensive but beneficial “start-up” intervention when combined with IBT treatment as a follow-up.

Development of a risk-score for pericarditis recurrence in patients with a first episode of acute pericarditis

Background/Introduction Currently we remain uncertain about which patients are at increased risk for recurrent pericarditis. Purpose We developed a risk score for pericarditis recurrence in patients with acute pericarditis. Methods We prospectively recruited 262 patients with acute pericarditis. Patients' demographics, clinical, imaging and laboratory data at presentation, were collected. Patients were followed-up for a median of 51 months (interquartile range 21–71) for recurrence. Variables with <10% missingness were entered into multivariable logistic regression models with stepwise elimination to explore independent predictors of recurrence. The performance of the final model was assessed by the c-index and model's calibration and the optimism corrected c-index were evaluated after 10-fold cross-validation. Results We identified six independent predictors for pericarditis recurrence i.e., age, effusion size, platelet count (negative predictors) and reduced inferior vena cava collapse, in-hospital use of corticosteroids, and heart rate (positive predictors). The final model had good performance for recurrence, c-index 0.783 (95% CI 0.725–0.842), while the optimism corrected c-index after cross-validation was 0.752. Based on these variables we developed a risk score point system for recurrence (0–22 points) with equally good performance (c-index 0.740, 95% CI 0.677–0.803). Patients with a low score (0–7 points) had 21.3% risk for recurrence, while those with high score (≥12 points) had a 69.8% risk for recurrence (Figure 1). The score was predictive of recurrence among most patient subgroups. Conclusions A simple risk score point system based on 6 variables can be used to predict the individualized risk for pericarditis recurrence among patients with a first episode of acute pericarditis. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

I Can Grow as an In Utero if You Give Me Enough Nutrition: Premature ≤29 Weeks Gestation

Introduction: In general, everyone believe they should grow as “in utero” for the smallest premature babies but many thinks that it is not possible with today's nutrition “guidelines”. There is resistance to give enough nutrition for fear of "toxicity". We use volumes that some would consider high, although there are more and more groups that accept it. We chose the difference in Z-score between birth and a corrected discharge gestational age to assess postnatal growth in our unit.Material and methods: Between January 2018 and December 2020, we review all cases ≤ 29 weeks of GA at birth that survived to 36 weeks corrected gestational age, or that were discharged home if this occurred before. We had a protocol with extremely aggressive nutrition including parenteral as well as oral nutrition. We then separated the patients who had lost more than 1 Z-score point to see the weight trajectory plotted on the Fenton 2013 growth curve and to review the clinical characteristics of those patients. We also graphed the patients who had had a smaller Z-score difference to also see their trajectory in the Fenton curves. We calculate the number of cases, medians, and interquartile ranges for all groups.Results: We fount 32 cases. The median ± IQR (interquartile range) of change in Z-score between birth and discharge of the whole group was -0.52 ± 0.53; 6/32 (19%) had more than 1 point drop; all had severe diseases listed in Figure 1 with plotting all cases. The median decline in Z score ± IQR of this group with poor growth was 1.24 ± 0.22. The group of cases with a fall of <1 point of Z score were 26 (81%), the median ± IQR of fall of Z score was 0.39 ± 0.55 (see figure 2). All cases had the initial fall in weight the first 1-2 weeks. No important complications secondary to the ingested volumes or parenteral nutrition were reported. Conclusion: The group of cases with a fall of > 1 point of Z score had severe pathologies. The other cases had an adequate growth parallel to normal growth charts in some cases with some catch up.Discussion: With this work we try to show that in many premature babies it is possible to grow like in utero if they are given enough nutrition. Randomized studies are necessary to confirm our findings.

The Cost-Effectiveness of Three Prevention Strategies in Alzheimer's Disease: Results from the Multidomain Alzheimer Preventive Trial (MAPT)

BACKGROUND: To date, no curative treatment is available for Alzheimer’s disease (AD). Therefore, efforts should focus on prevention strategies to improve the efficiency of healthcare systems. Objective: Our aim was to assess the cost-effectiveness of three preventive strategies for AD compared to a placebo. Design: The Multidomain Alzheimer Preventive Trial (MAPT) study was a multicenter, randomized, placebo-controlled superiority trial with four parallel groups, including three intervention groups (one group with Multidomain Intervention (MI) plus a placebo, one group with Polyunsaturated Fatty Acids (PFA), one group with a combination of PFA and MI) and one placebo group. Setting: Participants were recruited and included in 13 memory centers in France and Monaco. Participants: Community-dwelling subject aged 70 years and older were followed during 3 years. Interventions: We used data from the MAPT study which aims to test the efficacy of a MI along PFA, the MI plus a placebo, PFA alone, or a placebo alone. Measurement: Direct medical and non-medical costs were calculated from a payer’s perspective during the 3 years of follow-up. The base case incremental Cost-Effectiveness Ratio (ICER) represents the cost per improved cognitive Z-score point. Sensitivity analyses were performed using different interpretation of the effectiveness criteria. Results: Analyses were conducted on 1,525 participants. The ICER at year 3 that compares the MI + PFA and the MI alone to the placebo amounted to €21,443 and €21,543 respectively, per improved Z score point. PFA alone amounted to €111,720 per improved Z score point. Conclusion: Our study shows that ICERS of PFA combined with MI and MI alone amounted to €21,443 and €21,543 respectively per improved Z score point compared to the placebo and are below the WTP of €50,000 while the ICER of PFA alone amounted to €111,720 per improved Z score point. This information may help decision makers and serve as a basis for the implementation of a lifetime decision analytic model.

Using an Office-Based, Dedicated Extremity MRI Scanner for Depicting Important Structures in Common Wrist Pathologies: A Pilot Comparison with a Conventional MRI Scanner

Background Compared with the conventional magnetic resonance imaging (MRI), dedicated MRI scanners are more accessible. Images of a dedicated 1.0-T MRI specifically developed for the hand and wrist were compared with images of a conventional 1.5-T MRI. Methods Paired images of the right wrist were randomized and separately graded by two experienced radiologists for the quality of anatomical details, including the triangular fibrocartilage complex, carpal ligaments, intercarpal cartilage, median and ulnar nerves, overall image quality, and artifacts. Interrater reliability was measured with the percentage of exact agreement and agreement within a range of ± 1 score point. Participant experience of undergoing the examination in both MRI scanners was evaluated using a questionnaire. Results The overall image quality of all sequences was considered to be moderate to high. In 25 of 38 paired images, no statistically significant difference was found between the MRI scanners. Ten scores were found to be in favor of the dedicated extremity MRI. Within a range of ± 1 score point, the extremity MRI and the conventional MRI demonstrated an interrater agreement of 67 to 100% and 70 to 100%, respectively. Among the respondents of the questionnaire, the extremity MRI scored better for participant satisfaction when compared with the conventional MRI. Conclusions In healthy volunteers, the dedicated extremity MRI generally is similar or superior to the conventional MRI in the depiction of anatomical structures of the wrists, image quality, and artifacts, and significantly scored better on participant satisfaction. Future clinical studies should focus on defining the diagnostic value of the extremity MRI in wrist pathologies.

Incorporating Pharmacist Interns Into a Study of Fall-Risks

INTRODUCTION: Inpatient falls continue to have detrimental effects on patient care and recovery. Because controllable and uncontrollable factors impact fall rates, predicting which patients are at the greatest risk can be challenging. One method includes the incorporation of student learners to help identify which patients are at the greatest risk for falls.<br/> OBJECTIVE: To generate a scoring metric and investigate its reliability for appropriately identifying geriatric and medical psychiatric patients at risk for falling while hospitalized.<br/> METHODS: In this single-center, quasi-experimental study, pharmacist-interns led a fall-prevention initiative at a community hospital within two behavioral health units.<br/> RESULTS: A total of 96 patients were analyzed over the study period, revealing no notable trends for either geriatric or medical psychiatric patients. There was no significant change in the odds of falling for each fall score point increase for either the geriatric-psychiatric unit (odds ratio [OR] = 0.95; 95% confidence interval [CI] 0.83-1.08) or the medical-psychiatric unit (OR = 1.11; 95% CI 0.91-1.36).<br/> CONCLUSION: This pharmacist-intern-led falls-prevention initiative did not provide a statistically significant reduction in falls. While the scoring metric was helpful in reviewing charts to make recommendations for interventions, the assigned score did not correlate as expected to incidents of falls.

Incorporating Pharmacist Interns Into a Study of Fall-Risks

INTRODUCTION: Inpatient falls continue to have detrimental effects on patient care and recovery. Because controllable and uncontrollable factors impact fall rates, predicting which patients are at the greatest risk can be challenging. One method includes the incorporation of student learners to help identify which patients are at the greatest risk for falls.<br/> OBJECTIVE: To generate a scoring metric and investigate its reliability for appropriately identifying geriatric and medical psychiatric patients at risk for falling while hospitalized.<br/> METHODS: In this single-center, quasi-experimental study, pharmacist-interns led a fall-prevention initiative at a community hospital within two behavioral health units.<br/> RESULTS: A total of 96 patients were analyzed over the study period, revealing no notable trends for either geriatric or medical psychiatric patients. There was no significant change in the odds of falling for each fall score point increase for either the geriatric-psychiatric unit (odds ratio [OR] = 0.95; 95% confidence interval [CI] 0.83-1.08) or the medical-psychiatric unit (OR = 1.11; 95% CI 0.91-1.36).<br/> CONCLUSION: This pharmacist-intern-led falls-prevention initiative did not provide a statistically significant reduction in falls. While the scoring metric was helpful in reviewing charts to make recommendations for interventions, the assigned score did not correlate as expected to incidents of falls.

Adherence to Pakistan dietary guidelines – Findings from major cities of Pakistan

BackgroundPakistan dietary guidelines for better nutrition were developed to cater the local need and prevent nutritional deficiency by providing information to public about healthy eating practices.AimsTo assess the level of adherence to Pakistan Dietary Guidelines for Better Nutrition (PDGN)MethodsIt was a community based study conducted in five cities with two stage stratified sampling approach. Total of 448 participants were interviewed using Food frequency questionnaire adapted to local context. Five food groups (proteins, cereals, dairy, vegetables and fruits) were taken as per country guidelines. A score point of 1 was given to each food group making a total of 5 scores. Data were analyzed using SPSS.ResultsOverall adherence to PDGN was poor as none of the participants had 05 score while only 1% achieved score 04. However, adherence was more in females (B = 0.45, 95%CI = 0.24; 0.66), graduates (B = 0.45, 95% CI = 0.25; 0.64), unmarried (B = 0.30, 95% CI = 0.18; 0.43), unemployed (B = 0.22, 95% CI = 0.01-0.43) and aged >50 years (B = 0.34, 95% CI = 0.08; 0.60) as compared to others. Among food groups, mean intake of cereals (carbohydrates) was high (3.38±1.39) followed by other items with fruits was least (0.76±0.91). Overall, at least one serving of discretionary food was taken by participants which was more female gender (p= 0.001), graduates (p= 0.003), high socio-economic group (p=0.001) and employed persons (p= 0.04).ConclusionThe adherence to PDGN was poor and there is a need to bring behavior change by information education and communication to the society.

Oral hygiene status of depressed patients

Introduction: Oral hygiene is one of the most critical factor in maintaining oral health. Depression symptoms may affect an individual’s oral health due to poor health behaviour, making depressed individuals prone to oral diseases such as caries and periodontal diseases. This study was aimed to obtain the oral hygiene status overview of depressed patients in West Java Psychiatric Hospital. Methods: This study was an observational descriptive with a cross-sectional approach to depressed patients (F.32 ICD Code). The measuring instrument used was Oral Hygiene Index-Simplified (OHI-S). Based on OHI-S, oral hygiene can be assessed into poor within 3.0 – 6.0 score point, fair within 1.3-3.0 score point, or good within 0.0 – 1.2 score point. Results: There were 30 respondents recruited using a purposive sampling method. Based on the plaque index, 1 respondent (3%) fell into good category, 23 respondents (77%) fell into the fair category, and 6 respondents (20%) fell into poor category. Based on the calculus index, 7 respondents (23%) fell into good category, 10 respondents (60%) fell into the fair category, and 5 respondents (17%) fell into poor category. Based on OHI-S, 2 respondents (7%) fell into the good category, 18 respondents (60%) fell into the fair category, and 10 respondents (33%) fell into poor category. Conclusion: Oral hygiene in-dex of depressed patients was categorised as fair.

Cerebral Perfusion and the Burden of Small Vessel Disease in Patients Referred to a Memory Clinic

<b><i>Background:</i></b> Cerebral small vessel disease (SVD) lesions on MRI are common in patients with cognitive impairment. It has been suggested that cerebral hypoperfusion is involved in the etiology of these lesions. <b><i>Objective:</i></b> The aim of the study was to determine the relationship between cerebral blood flow (CBF) and SVD burden in patients referred to a memory clinic with SVD on MRI. <b><i>Method:</i></b> We included 132 memory clinic patients (mean age 73 ± 10, 56% male) with SVD on MRI. We excluded patients with large non-lacunar cortical infarcts. Global CBF (mL/min per 100 mL of brain tissue) was derived from 2-dimensional phase-contrast MRI focused on the internal carotid arteries and the basilar artery. SVD burden was defined as the sum of (each 1 point): white matter hyperintensities (WMHs) Fazekas 1 or more, lacunes, microbleeds (MBs), or enlarged perivascular spaces (PVS) presence, and each SVD feature separately. Linear regression analyses were performed to study the association between CBF and SVD burden, age- and sex-adjusted. <b><i>Results:</i></b> Median SVD burden score was 2, 36.4% of patients had MBs, 35.6% lacunar infarcts, 48.4% intermediate to severe enlarged PVS, and 57.6% a WMH Fazekas score 2 or more. Median WMH volume was 21.4 mL (25% quartile: 9.6 mL, 75% quartile: 32.5 mL). Mean CBF ± SD was 44.0 ± 11.9 mL/min per 100 mL brain. There was no relation between CBF and overall SVD burden (CBF difference per burden score point [95% CI]: −0.5 [−2.4; 1.4] mL/min/100 mL brain, <i>p</i> = 0.9). CBF did also not differ according to presence or absence or an high burden of any of the individual SVD features. Moreover, there was no significant relation between WMH volume and CBF (CBF difference per ml increase in WMH [95% CI] −0.6 [−1.5; 0.3] mL/min/100 mL brain <i>p</i> = 0.2). <b><i>Conclusion:</i></b> Global CBF was not related to overall SVD burden or with individual SVD features in this memory clinic cohort, indicating that in this setting these lesions were not primarily due to cerebral hypoperfusion.