[Evolution of the levels of the caregiver burden in bipolar patients' family members who participated in a psychoeducational workshop]. / Evolución de los niveles de sobrecarga del cuidador en familiares de pacientes bipolares que participaron de un taller de psicoeducación.

PURPOSE: Caregiver burden is a variable which measures the impact of a chronic disease on the people who are closer to the patient. Different investigations have shown that the burden suffered by family members of patients with bipolar disorder is similar to that suffered by the relatives of schizophrenic patients and superior to the excessive strain caused by chronic diseases, such as diabetes. Lowering burden levels has been proved to improve family members' welfare and also to reduce patients' relapse indexes. This research accounts for the diminution in the burden endured by family members who participated in a psychoeducational workshop which included an "expert patient" in the coordinators team. METHODS: Zarit scale for assessment of caregiver burden was used at three stages: at the beginning of the workshop (n=95), at the end of the workshop (n=64) and three months later by a follow-up (n=34). RESULTS: The percentage of participants with overburden was reduced from a 75 % in the first sample taken to a 63% in the last one with a significant fall in the intense burden. CONCLUSIONS: The study has succeeded in showing that there was a reduction in the burden. However, it could not prove whether the results came as a consequence of the intervention model or as the natural evolution of the burden over the course of time. We have been advancing in further investigations which will shed light on these variables.

The Role of Positron Emission Tomography/Computed Tomography in Management and Prediction of Survival in Pancreatic Cancer.

The role of positron emission tomography (PET) and PET/computed tomography (CT) in the management of pancreatic cancer patients has not been clearly established. Although value of PET/CT in the staging of pancreatic cancer is still being debated, several studies pointed to its superior role in determining therapy response, recurrence detection, and survival prediction in comparison to conventional imaging including contrast-enhanced CT. This article reviews the current literature on usefulness of PET/CT in the management of pancreatic cancer patients.

Examination of the effects of age, sex, and motor ability level on balance capabilities in children with cerebral palsy GMFCS levels I, II, III and typical development using the Pediatric Balance Scale.

PURPOSE: Explore effects of age, sex, and motor ability level on balance capabilities in preschoolers with and without Cerebral Palsy (CP). METHOD: PBS was administered to 477 children 24 through 59 months: 258 with typical development (TD) and 219 with CP GMFCS levels I, II and III. RESULTS: 3-way ANOVA indicated PBS scores were significantly affected by age (F4,437=26.95, p<0.0001, η2p=0.198), motor ability level (F3,437=482.15, p<0.0001, η2p=0.768) and sex (F1,437=4.64, p<0.03, η2p=0.01) with significant interaction between motor ability level and age (F 12,437=5.25, p<0.001, η2p=0.126). Children's performance on individual items was analyzed by age, sex and motor ability level. CONCLUSION: Children with TD outperformed children with CP GMFCS level I 36-59 months and children with CP GMFCS levels II and III 24-59 months. Expected performance values for children with TD and children with CP, ages 24-59 months, at GMFCS levels I, II and III are provided.

Using the tidal model of mental health recovery to plan primary health care for women in residential substance abuse recovery.

Women currently are 30% of the substance abuse recovery population in North America and have gender specific treatment needs as they enter the difficult work of recovery. Important among women's specific needs as they enter recovery is the need for a focus on primary health care. Few models designed to guide the provision of health care for this population are available in the literature. The Tidal Model of Mental Health Recovery and Reclamation is based on the concept of nursing as "caring with" persons in the experience of distress. Given the emphasis in this model on developing a partnership between caregiver and client, it is especially appropriate for women in recovery for substance abuse. The Tidal Model, integrated with the United States Substance Abuse and Mental Health Services' CSAT model for comprehensive alcohol and other drug (AOD) abuse treatment, is used to guide planning for delivery of primary health care in a residential women's substance abuse recovery center in the Midwest. This article describes the Tidal Model, and identifies how the model can improve the delivery of primary care to women in residential substance abuse treatment. Strategies for implementation of the model are proposed. Evaluation and outcome criteria are identified.

The performance of children developing typically on the pediatric balance scale.

PURPOSE: To investigate Pediatric Balance Scale (PBS) performance in children developing typically. METHODS: The PBS was administered to 643 children developing typically per parent report, aged 2 years 4 months to 13 years 7 months. RESULTS: A 2-way analysis of variance and post hoc analyses identified significant age and gender differences in PBS performance. The Spearman rank correlation analysis identified associations between PBS scores and age, height, weight, and body mass index. Data were analyzed using 95% confidence intervals of the means to identify PBS typical performance ranges for each age and gender group. The lower bound of the 95% confidence intervals was used to identify outliers and determine a "critical cut score" for each group. The numbers and percentages of children scoring above and below this critical cut score were calculated to further describe the sample. CONCLUSIONS: This study provides the clinician with guidelines for interpretation of PBS performance.

Clinical Features and Outcomes of Pediatric Monophasic and Recurrent Idiopathic Optic Neuritis.

Limited data exist on isolated optic neuritis in children. We report the clinical features and treatment of pediatric subjects with monophasic and recurrent idiopathic optic neuritis. This retrospective cohort study of patients with isolated optic neuritis identified 10 monophasic and 7 recurrent optic neuritis cases. Monophasic optic neuritis patients were older (mean 13.3 ± 4.22) than those with recurrent idiopathic optic neuritis (9.86 ± 3.63). Females represented 50% of monophasic and 85.7% of recurrent idiopathic optic neuritis cases. Patients with monophasic optic neuritis were less likely to have a bilateral onset than recurrent idiopathic optic neuritis (40% vs 57.1%). Only 1 case had oligoclonal bands in the cerebrospinal fluid CSF. Most recurrent idiopathic optic neuritis cases had evidence of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies (5/7). Treatment of recurrent idiopathic optic neuritis cases included intravenous pulse glucocorticosteroids and immunotherapy. We observed differences between recurrent and monophasic idiopathic optic neuritis. Immunosuppression appeared to prevent further relapses in recurrent idiopathic optic neuritis patients. Weaning immunotherapies after several years of quiescence in recurrent idiopathic optic neuritis may be possible, but larger studies are needed.

Puberty onset and pediatric multiple sclerosis activity in boys.

OBJECTIVES: To determine the association of age of onset and puberty with relapse rate in boys with pediatric multiple sclerosis (MS). BACKGROUND: While sex steroid hormones have been shown to have immune effects, it is not known how age or puberty influence disease course in boys with MS. We have previously shown an association in girls with menarche and risk of relapse. METHODS: Patients from the UCSF Regional Pediatric MS Center were included in this retrospective study. Age of disease onset was used to stratify patients into three groups approximating pubertal stage: age less than 11 years, between 11-14 years, and greater than 14 years, corresponding to pre-, peri-, and post-puberty, respectively. Negative binomial regression was used to determine the association between pubertal status at disease onset with relapse rate. RESULTS: 58 male pediatric patients with onset of relapsing-remitting MS before 18 years of age participated to the analyses (<11 onset, n = 21; 11-14 onset, n =21; >14 onset, n = 16). 60% of patients identified as White, and 43% as Hispanic. Median follow-up was 3.17 years (IQR 1.42-5.35). Univariate negative binomial regression models demonstrated a 2.4 fold increased relapse rate for boys with disease onset in the peri-puberty age group compared to the post-puberty age group (IRR = 2.43, 95% CI 1.33-4.47, p = 0.004). Adjustments for race, ethnicity, and use of disease-modifying therapy did not change these results (IRR = 2.39, 95% CI 1.20-4.79, p = 0.014). No differences in relapse rate between the pre-pubertal onset group and post-pubertal onset group were found. CONCLUSIONS: Pubertal onset of MS may be associated with increased relapses in boys. Further investigation is indicated to understand the intersection of pubertal effects and MS pathophysiology.

Comparative effectiveness: 18F-FDG-PET/CT versus CT for post-treatment follow-up of patients with lung cancer.

PURPOSE: This study aimed to evaluate the comparative effectiveness of follow-up fluorine-18-fluorodeoxyglucose (F-FDG)-PET/CT and chest CT in the detection of local, regional, and distant metastatic diseases in lung cancer. PATIENTS AND METHODS: Follow-up F-FDG-PET/CT and chest-CT pairs of biopsy-proven lung cancer patients were reviewed retrospectively (May 2004-June 2013). Histopathological, clinical, or imaging follow-up data of at least 6 months was considered the reference standard. The κ statistics, the percentage agreement between the two techniques, and per-scan basis diagnostic performances were reported. RESULTS: A total of 270 patients with a total of 423 paired F-FDG-PET/CT and chest-CT scans were included (median time interval between two scans=2 days). The two imaging modalities showed concordance of 82.7% (κ=0.71) for local disease, 82% (κ=0.65) for regional disease, and 77.3% (κ=0.55) for distant metastasis. Overall, F-FDG-PET/CT identified more lesions compared with chest CT both in the regional lymph nodes (308 vs. 204 regional zone involvement) and in cases of distant metastasis (253 vs. 182 metastatic sites). In the evaluation of local disease, F-FDG-PET/CT appeared to have fairly similar sensitivity (96 vs. 95.4%) and specificity (82.1 vs. 83%) compared with chest CT. In the evaluation of regional lymph nodes and distant metastases, F-FDG-PET/CT showed higher sensitivity (regional nodes: 96 vs. 89.8%; distant metastases: 91.9 vs. 70.7%) and comparable specificity (regional nodes: 87.1 vs. 88.9%; distant metastases: 87.1 vs.88.1%). CONCLUSION: The sensitivity of F-FDG-PET/CT is superior to that of chest CT in the detection of regional and distant metastasis, while having comparable specificity.

18F-FDG-PET/CT therapy assessment of locally advanced pancreatic adenocarcinoma: impact on management and utilization of quantitative parameters for patient survival prediction.

OBJECTIVES: This study aims to evaluate the impact of therapy assessment PET/computed tomography (CT) scan on the management of locally advanced pancreatic adenocarcinoma (LAPC), and the value of qualitative versus quantitative PET/CT interpretation for patient outcome prediction. MATERIALS AND METHODS: Forty-two LAPC patients were retrospectively included. PET/CT was performed at a median of 4.6 weeks after completion of chemo ± radiotherapy to assess the primary treatment response. PET was interpreted visually using a qualitative five-point scale (Hopkins criteria for therapy assessment). Quantitative PET parameters including maximum and peak standardized uptake value (SUV max and SUV peak), total lesion glycolysis, and metabolic tumor volume (MTV) were also measured using the gradient segmentation method. Kaplan-Meier and Cox regression analyses were performed. RESULTS: Thirty-five patients were followed up until death. Therapy assessment PET/CT led to a change in the overall management of 22 (52.4%) patients, prompting surgical resection (eight patients), adding radiation therapy (eight patients), or starting palliative chemotherapy (six patients). The median survival in patients with a negative or a positive PET scan, according to the Hopkins criteria, was 14.6 and 8.7 months, respectively (P=0.06). The median quantitative thresholds of SUV peak 2.64 [hazard ratio (HR)=2.67, P=0.03], total lesion glycolysis 44.0 g (HR=2.64, P=0.005), and MTV 24.7 ml (HR=2.57, P=0.008) were significant predictors of overall survival. Using combined quantitative scoring, patients with high SUV peak and high MTV (>median cut point) had a 5.45-fold (95% confidence interval: 1.76-16.87) increased risk for death compared with those with both low SUV peak and MTV (the reference group). CONCLUSION: PET-based volumetric parameters can predict survival outcomes of patients with LAPC. A combined quantitative PET/CT scoring system provides significantly improved prognostication.

Parent perspectives from a neonatal intensive care unit: a missing piece of the culturally congruent care puzzle.

The majority of existing theoretical models and tools of culturally competent and congruent care have been developed from the health care provider perspective. Recently, the Culturally Congruent Care Puzzle proposed a model in the form of a three-dimensional puzzle with a provider level and a client level that interact to create the outcome level, which is culturally congruent care. However, the constructs that comprise the client, or patient, level, have not yet been clearly articulated. This study explored parent (client/patient) perceptions of culturally congruent care within a tertiary neonatal intensive care unit based on interviews with culturally diverse families with hospitalized infants (n = 21). The findings identified four primary constructs in the client/patient level: (a) a provider-client relationship of caring and trust, (b) respectful and appropriate communication, (c) culturally responsive and accessible social and spiritual supports, and (d) a welcoming and flexible organizational environment. These four interconnecting pieces are infused with the sociopolitical history and dynamics of culture, ethnicity, immigration, and colonization that clients/patients bring to their experience of health and health care. These elements of the client/patient level also interact with the provider level in various ways.

Standardized Walking Obstacle Course (SWOC): reliability and validity of a new functional measurement tool for children.

PURPOSE: This study reports reliability of the Standardized Walking Obstacle Course (SWOC) and concurrent validity with the Timed Up and Go (TUG) for use in children with and without developmental disabilities. METHODS: Seventy-three children completed the SWOC and TUG during each of two sessions scheduled one week apart. Two raters took measures of time and number of steps on the SWOC to correlate with the same measures on the TUG. RESULTS: Very high interrater reliabilities for time (intercorrelation coefficient [ICC] 0.99) and number of steps (ICC 0.94-0.99) noted. High intrarater reliabilities recorded for time (ICC 0.83-0.97) and number of steps (ICC 0.84-0.96). Significant correlations (p < 0.05) between the TUG and SWOC were moderate to very high for time (r = 0.72-0.90) and number of steps (r = 0.63-0.92). CONCLUSION: The SWOC demonstrates good reliability within and between raters and concurrent validity with the TUG for use with children to establish their functional ambulation capability. The SWOC could easily be used in any setting for any child who can follow the directions and walk without an assistive device. Further testing is needed of the use of the SWOC to detect change and measure the extent of the environment's influence on activity and participation for different populations of children.