Predictors of a relapsing course in myelin oligodendrocyte glycoprotein antibody-associated disease.

BACKGROUND: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described demyelinating disorder, and children represent about 50% of all cases. Almost half of the patients experience relapses, but very few studies have evaluated predictors of relapse risk, challenging clinical management. The study aimed to identify predictors at MOGAD onset that are associated with a relapsing course. METHODS: Prospectively collected data from paediatric patients with MOGAD seen by the US Network of Paediatric MS Centres were leveraged. Univariable and adjusted multivariable models were used to predict recurrent disease. RESULTS: We identified 326 MOGAD cases (mean age at first event 8.9 years [SD 4.3], 57% female, 77% white and 74% non-Hispanic) and 46% relapsed during a mean follow-up of 3.9 years (SD 4.1). In the adjusted multivariable model, female sex (HR 1.66, 95% CI 1.17 to 2.36, p=0.004) and Hispanic/Latino ethnicity (HR 1.77, 95% CI 1.19 to 2.64, p=0.005) were associated with a higher risk of relapsing MOGAD. Maintenance treatment initiated before a second event with rituximab (HR 0.25, 95% CI 0.07 to 0.92, p=0.037) or intravenous immunoglobulin (IVIG) (HR 0.35, 95% CI 0.14 to 0.88, p=0.026) was associated with lower risk of a second event in multivariable analyses. Conversely, maintenance steroids were associated with a higher estimated relapse risk (HR 1.76, 95% CI 0.90 to 3.45, p=0.097). CONCLUSION: Sex and ethnicity are associated with relapsing MOGAD. Use of rituximab or IVIG therapy shortly after onset is associated with a lower risk of the second event. Preventive treatment after a first event could be considered for those with a higher relapse risk.

Patient and family views on research priorities and design of clinical trials and research studies in pediatric multiple sclerosis.

BACKGROUND AND OBJECTIVES: This survey study aimed to (1) identify patient/family research priorities in pediatric-onset multiple sclerosis (POMS), and (2) delineate optimized methods for research study/clinical trials design, engagement, and implementation. METHODS: Participants were as follows: (1) parents of a child (<18 years) with POMS enrolled in a national registry, (2) adolescents (13-17 years) with POMS in the registry, and (3) adults (18-40 years) with POMS receiving care at a registry affiliated clinic. Of 293 eligible participants, 192 completed surveys. RESULTS: Experiences with health care and medications were generally positive but there remain areas of priority improvement. Incentives to participate in clinical trials included medications previously tested and in pill form, bloodwork/study visits required ⩾ every 3 months, cognitive testing ⩽1 hour, compensation for travel and time, ability to continue current multiple sclerosis (MS) medication, option to take study medication if on placebo, and individualized study feedback. Priorities for clinical research were (1) psychosocial impact, (2) cognitive/academic impact, (3) environmental risk, and (4) nutrition. CONCLUSIONS: Results highlighted the importance of a holistic approach to study design and a focus on the impact of disease on daily life to best engage patients and families in POMS clinical trials and research.

Provider-to-provider telehealth for sepsis patients in a cohort of rural emergency departments.

BACKGROUND: Telehealth has been proposed as one strategy to improve the quality of time-sensitive sepsis care in rural emergency departments (EDs). The purpose of this study was to measure the association between telehealth-supplemented ED (tele-ED) care, health care costs, and clinical outcomes among patients with sepsis in rural EDs. METHODS: Cohort study using Medicare fee-for-service claims data for beneficiaries treated for sepsis in rural EDs between February 1, 2017, and September 30, 2019. Our primary hospital-level analysis used multivariable generalized estimating equations to measure the association between treatment in a tele-ED-capable hospital and 30-day total costs of care. In our supporting secondary analysis, we conducted a propensity-matched analysis of patients who used tele-ED with matched controls from non-tele-ED-capable hospitals. Our primary outcome was total health care payments among index hospitalized patients between the index ED visit and 30 days after hospital discharge, and our secondary outcomes included hospital mortality, hospital length of stay, 90-day mortality, 28-day hospital-free days, and 30-day inpatient readmissions. RESULTS: In our primary analysis, sepsis patients in tele-ED-capable hospitals had 6.7% higher (95% confidence interval [CI] 2.1%-11.5%) total health care costs compared to those in non-tele-ED-capable hospitals. In our propensity-matched patient-level analysis, total health care costs were 23% higher (95% CI 16.5%-30.4%) in tele-ED cases than matched non-tele-ED controls. Clinical outcomes were similar. CONCLUSIONS: Tele-ED capability in a mature rural tele-ED network was not associated with decreased health care costs or improved clinical outcomes. Future work is needed to reduce rural-urban sepsis care disparities and formalize systems of regionalized care.

An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.

Aim: Sepsis is a top contributor to in-hospital mortality and, healthcare expenditures and telehealth have been shown to improve short-term sepsis care in rural hospitals. This study will evaluate the effect of provider-to-provider video telehealth in rural emergency departments (EDs) on healthcare costs and long-term outcomes for sepsis patients. Materials & methods: We will use Medicare administrative claims to compare total healthcare expenditures, mortality, length-of-stay, readmissions, and category-specific costs between telehealth-subscribing and control hospitals. Results: The results of this work will demonstrate the extent to which telehealth use is associated with total healthcare expenditures for sepsis care. Conclusion: These findings will be important to inform future policy initiatives to improve sepsis care in rural EDs. Clinical Trial Registration: NCT05072145 (ClinicalTrials.gov).

Sepsis is a severe condition that results from infection. In addition to costly care, sepsis is a leading cause of death and disability. When comparing outcomes, those treated for sepsis in lower volume emergency departments fare worse and rural emergency departments often have lower patient volumes. While telehealth has been shown to improve sepsis care, the effect of telehealth on costs and long-term outcomes for patients is unclear. This study will use Medicare claims data to compare outcomes for people with sepsis in rural emergency departments who had video telehealth used with those who did not have video telehealth used, with the goal of measuring how telehealth affects healthcare costs, hospital readmissions and deaths after hospital discharge.

Effects of caffeine on vocal acoustic and aerodynamic measures of adult females.

PURPOSE: To explore the effect of caffeine on voice, as evidenced by acoustic and aerodynamic measures, based on the fact that caffeine is considered to be a systemic dehydrating agent. METHODS: The participants in this investigation were 58 females ranging in age from 18 to 35 years, who self-reported normal vocal production. The participants abstained from caffeine ingestion for 24 hours and from ingesting foods and liquids for 12 hours prior to the test. They were randomly assigned to one of two groups, control and experimental, and were individually tested. After the preliminary phase, participants in the experimental group ingested a 100 mg caffeine tablet; participants in the control group ingested placebo, and followed the same protocol as the experimental group. All participants were retested 30 minutes after ingesting caffeine or placebo. RESULTS: Differences were not identified in any of the acoustic or aerodynamic measures across both groups. CONCLUSION: These results suggest that a conservative (100 mg) dosage of caffeine may not have an impact on vocal acoustics and aerodynamics.

Effects of caffeine on vocal acoustic and aerodynamic measures of adult females / Efeitos da cafeína na voz avaliados por medidas acústicas e aerodinâmicas em mulheres adultas

PURPOSE: To explore the effect of caffeine on voice, as evidenced by acoustic and aerodynamic measures, based on the fact that caffeine is considered to be a systemic dehydrating agent. METHODS: The participants in this investigation were 58 females ranging in age from 18 to 35 years, who self-reported normal vocal production. The participants abstained from caffeine ingestion for 24 hours and from ingesting foods and liquids for 12 hours prior to the test. They were randomly assigned to one of two groups, control and experimental, and were individually tested. After the preliminary phase, participants in the experimental group ingested a 100 mg caffeine tablet; participants in the control group ingested placebo, and followed the same protocol as the experimental group. All participants were retested 30 minutes after ingesting caffeine or placebo. RESULTS: Differences were not identified in any of the acoustic or aerodynamic measures across both groups. CONCLUSION: These results suggest that a conservative (100 mg) dosage of caffeine may not have an impact on vocal acoustics and aerodynamics.

OBJETIVO: Explorar o efeito da cafeína na voz, evidenciado por medidas acústicas e aerodinâmicas, visto que a cafeína é considerada um agente desidratador. MÉTODOS: As participantes desta investigação foram 58 mulheres entre 18 e 35 anos de idade, que reportaram produção de voz normal. As participantes se abstiveram da ingestão de cafeína por 24 horas e de alimentos sólidos e líquidos por 12 horas antes do teste. Elas foram incluídas aleatoriamente em grupos controle e experimental e individualmente testadas. Após a fase preliminar, as integrantes do grupo experimental ingeriram um tablete de 100 mg de cafeína; o grupo controle ingeriu placebo e seguiu protocolo idêntico ao do grupo experimental. Todas as participantes foram retestadas 30 minutos após a administração de cafeína ou placebo. RESULTADOS: Não houve identificação de diferenças nas medidas em questão. CONCLUSÃO: Esses resultados sugerem que uma dose moderada (100 mg) de cafeína pode não ter impacto na acústica e aerodinâmica vocais.