User-perceived impact of long-term mechanical assisted cough in paediatric neurodisability.

AIM: To (1) compare the perceived benefit of long-term mechanical insufflation-exsufflation (MI-E) of children with neuromuscular disorders (NMDs) and central nervous system (CNS) disorders, including health care needs and treatment routines and (2) describe the children's health-related quality of life (HRQoL). METHOD: This cross-sectional study used a questionnaire and memory card data to assess the perceived benefit of MI-E via the Visual Analogue Scale (VAS; 10 maximum), willingness to pause treatment, level of health care needs before and after MI-E initiation, and the children's treatment routines. A DISABKIDS questionnaire assessed HRQoL (100 maximum). RESULTS: Seventy-three children using MI-E participated (42 males, median [interquartile range {IQR}] age 10 years 2 months [6 years 3 months-14 years 1 month]), 47 with NMDs (such as spinal muscular atrophy and Duchenne muscular dystrophy) and 26 with CNS disorders (such as cerebral palsy, encephalitis, neurometabolic and other diseases). The median (IQR) VAS score for the perceived benefit of MI-E therapy at stable state and respiratory tract infection were 9 (6-10) and 10 (8.5-10) respectively. Sixty-two per cent were reluctant or unwilling to pause MI-E therapy, with no NMD versus CNS disorder group difference. After MI-E initiation, fewer physician consultations and hospitalizations were reported by the group with NMDs. The MI-E routine was similar in both groups. The mean (SD) HRQoL score for 26 of 51 eligible children was 71 (16.7). INTERPRETATION: MI-E treatment was generally perceived as beneficial and performed equally in both diagnostic groups. HRQoL was in line with children with a moderate-to-severe chronic condition. WHAT THIS PAPER ADDS: Mechanical insufflation-exsufflation (MI-E) was generally perceived as beneficial by the children and parents. The reported benefit of MI-E was higher among daily than sporadic MI-E users. The MI-E treatment routine did not differ between diagnostic groups. The health-related quality of life in this neuropaediatric population was in line with that of children with other moderate-to-severe chronic conditions.

Ventilation of patients with amyotrophic lateral sclerosis. / Respiratorbehandling ved amyotrofisk lateral sklerose.

Just under 10 % of patients with amyotrophic lateral sclerosis receive life-prolonging ventilation via a tracheostomy. There is no international consensus on the planning of life-prolonging invasive ventilation for patients with this disease.

Prevalence of long-term mechanical insufflation-exsufflation in children with neurological conditions: a population-based study.

AIM: To determine the prevalence of long-term mechanical insufflation-exsufflation (MI-E) and concomitant mechanical ventilation in children with neurological conditions, with reported reasons behind the initiation of treatment. METHOD: This was a population-based, cross-sectional study using Norwegian national registries and a questionnaire. RESULTS: In total, 114 of 19 264 children with a neurological condition had an MI-E device. Seventy-three of 103 eligible children (31 females, 42 males), median (min-max) age of 10 years 1 month (1y 5mo-17y 10mo), reported their MI-E treatment initiation. Overall, 76% reported airway clearance as the main reason to start long-term MI-E. A prophylactic use was mainly reported by children with neuromuscular disorders (NMDs). Prevalence and age at initiation differed by diagnosis. In spinal muscular atrophy and muscular dystrophies, MI-E use was reported in 34% and 7% of children, of whom 83% and 57% respectively received ventilator support. One-third of the MI-E users were children with central nervous system (CNS) conditions, such as cerebral palsy and degenerative disorders, and ventilator support was provided in 31%. The overall use of concomitant ventilatory support among the long-term MI-E users was 56%. INTERPRETATION: The prevalence of MI-E in a neuropaediatric population was 6 per 1000, with two-thirds having NMDs and one-third having conditions of the CNS. The decision to initiate MI-E in children with neurological conditions relies on clinical judgment. WHAT THIS PAPER ADDS: The prevalence and age at initiation of mechanical insufflation/exsufflation (MI-E) differed between diagnoses. MI-E was most commonly used in spinal muscular atrophy, where it generally coincided with ventilatory support. One-third of MI-E devices were given to children with central nervous system conditions, and one-third also received ventilatory support.

Home electrical stimulation for urinary incontinence: a study of the diffusion ofa new technology.

The objective of this study was to investigate the extent to which physicians requested home electrical stimulation (ES) treatment for patients with urinary incontinence (UI). Home ES was requested by 429 general practitioners (GPs) and 147 gynecologists within 2 years (1992 to 1994) after the Norwegian National Insurance Service offered reimbursement for the procedure. For first-time requesters, cumulative plots of time to request were compared for GPs versus gynecologists. Characteristics of requesting GPs were compared with those of a randomly selected control sample of nonrequesting GPs, collected by postal questionnaire. A greater proportion of gynecologists than GPs prescribed home ES during the 2-year study period (42% vs 14%, P <0.001). Median time to request for ES was 5.8 months for gynecologists versus 8.6 months for GPs (P <0.01). A greater proportion of female GPs than male GPs requested the treatment (17% vs 13%, P <0.01). Sufficient information about and/or knowledge of treatment indications were claimed by 71% of requesting GPs versus 21% of controls (P <0.001). Altogether, 91% of requesters versus 62% of controls judged that home ES was effective or a good treatment alternative (P <0.001). Requesters (versus controls) prescribed more bladder training and estrogen for urge UI, more pelvic floor exercises and estrogen to treat stress UI, and more ES to treat both types of UI (all P <0.05). Gynecologists prescribed ES more often and earlier than GPs. Prescribers of ES were more proactive in treating UI in their practices than those who were not prescribers.

Side effects, feasibility, and adherence to treatment during home-managed electrical stimulation for urinary incontinence: a Norwegian national cohort of 3,198 women.

AIM: To analyze side effects, feasibility, and adherence to treatment during home-managed electrical stimulation for urinary incontinence in women. METHODS: This was a prospective study of 3,198 Norwegian women treated with home-managed electrical stimulation from 1992 to 1994. Data were collected from both patients and physicians by questionnaires before and after treatment. RESULTS: Eighty-nine percent of the patients found the stimulator easy or acceptable to use. Fifty percent had no or little discomfort from stimulator use. Nine percent found the stimulator very unpleasant, difficult, or impossible to use. Fifty-one percent had one or more side effects related to the treatment, most of them mild. A wide range of side effects was reported; the majority of which related to local discomfort. Three hundred and six patients (12%) discontinued treatment. A total of 79% of the patients recommended the treatment to other women with similar problems. CONCLUSIONS: Home-managed electrical stimulation was practicable and well accepted. Half of the patients reported various degrees of side effects with treatment, but no serious events were reported.