The Choice Between Advanced Therapies for Parkinson's Disease Patients: Why, What, and When?

When oral dopaminergic medication falls short in the treatment of Parkinson's disease, patients are left with motor response fluctuations and dyskinesias that may have a large impact on functioning in daily life. They may benefit from one of the currently available advanced treatments, namely deep brain stimulation, continuous levodopa-carbidopa intestinal gel, and continuous subcutaneous apomorphine infusion. The indication, choice between the separate advanced treatments and the timing can be challenging and will be discussed against the background of the progressive nature of the disease, the heterogeneity of disease manifestation and variable patient characteristics.

Using the MEDiPORT humanoid robot to reduce procedural pain and distress in children with cancer: A pilot randomized controlled trial.

BACKGROUND: Subcutaneous port needle insertions are painful and distressing for children with cancer. The interactive MEDiPORT robot has been programmed to implement psychological strategies to decrease pain and distress during this procedure. This study assessed the feasibility of a future MEDiPORT trial. The secondary aim was to determine the preliminary effectiveness of MEDiPORT in reducing child pain and distress during subcutaneous port accesses. METHODS: This 5-month pilot randomized controlled trial used a web-based service to randomize 4- to 9-year-olds with cancer to the MEDiPORT cognitive-behavioral arm (robot using evidence-based cognitive-behavioral interventions) or active distraction arm (robot dancing and singing) while a nurse conducted a needle insertion. We assessed accrual and retention; technical difficulties; outcome measure completion by children, parents, and nurses; time taken to complete the study and clinical procedure; and child-, parent-, and nurse-rated acceptability. Descriptive analyses, with exploratory inferential testing of child pain and distress data, were used to address study aims. RESULTS: Forty children were randomized across study arms. Most (85%) eligible children participated and no children withdrew. Technical difficulties were more common in the cognitive-behavioral arm. Completion times for the study and needle insertion were acceptable and >96% of outcome measure items were completed. Overall, MEDiPORT and the study were acceptable to participants. There was no difference in pain between arms, but distress during the procedure was less pronounced in the active distraction arm. CONCLUSION: The MEDiPORT study appears feasible to implement as an adequately-powered effectiveness-assessing trial following modifications to the intervention and study protocol. ClinicalTrials.gov NCT02611739.

Use of continuous insulin infusion pumps in young children with type 1 diabetes: a systematic review.

INTRODUCTION: Although insulin pump therapy has been successful in adults and adolescents, its use has been limited in young children because of perceived risk of severe or frequent hypoglycemia. The purpose of this review is to evaluate the safety and efficacy of continuous subcutaneous insulin infusion (CSII) in young children with type 1 diabetes. METHODS: We searched Medline, PubMed, and CINAHL for clinical trials comparing multiple-dose injection therapy to CSII therapy in children 6 years of age or younger who were diagnosed with type 1 diabetes at least 6 months prior to study. Primary outcome measures were glycosylated hemoglobin (HbA1c) and hypoglycemic episodes. Other outcomes of interest were quality of life and parental satisfaction. RESULTS: Most studies showed significant improvements in HbA1c and trends of decreased hypoglycemia. Quality of life improved in most CSII groups. Parental satisfaction with therapy was evidenced by continuation of CSII after study completion. DISCUSSION: Current evidence indicates CSII is a safe and effective method of insulin delivery in young children. When parents are highly motivated, CSII should be offered as a mode of insulin delivery for this age group.

Psychological aspects in continuous subcutaneous insulin infusion: a retrospective study.

The authors aimed to analyze the relation of psychological predictors with medical and psychological therapy success indicators in continuous subcutaneous insulin infusion (CSII). Besides blood glucose control as a medical indicator of therapy success (by means of HbA(1c) levels), the authors assessed treatment satisfaction, depressive symptoms, and quality of life among 51 adult patients on CSII. The authors examined the following psychological factors that were assumed to be associated with outcome variables: coping style, locus of control, and self-efficacy. Self-efficacy correlated positively with all psychological outcome variables. A high external locus of control was related to negative glycaemic outcome and more depressive symptoms. Multiple linear regression analyses revealed that when considering all psychological factors simultaneously, locus of control was the strongest predictor of HbA(1c). For the psychological outcomes, self-efficacy was the most powerful predictor. The authors demonstrated that medical and psychological diabetes-related outcomes were strongly related to psychological factors in adult CSII patients. Patients who felt responsible for the process of CSII therapy showed more positive outcomes; therefore, psychological care can be seen as an important part of diabetes education in CSII therapy.