Building Collaborative Capacity in Early Intervention Preservice Providers Through Interprofessional Education.

PURPOSE: Interprofessional practice within early intervention is underscored by policy, research, and recommended practices. The purpose of this study was to explore the impact of a brief interprofessional training on preservice speech-language pathology, early intervention/early childhood special education, physical therapy, and occupational therapy students' knowledge, beliefs, and attitudes about teaming and collaboration. Students' satisfaction with and perspectives of the training were also examined. METHOD: A one-group, pretest-posttest design was used to examine differences in 36 students' knowledge, attitudes, and beliefs around interprofessional practice after the training. Descriptive approaches were used to analyze student satisfaction data and focus group data in order to evaluate student perceptions of the interprofessional training. RESULTS: A paired-samples t test showed preservice students demonstrated increased scores in self-perceived ability, value, and comfort in working with others after the training institute. Descriptive analyses illustrated students gained a richer knowledge and appreciation for other disciplines and perceived the practice of interprofessional collaboration as a valuable learning experience. CONCLUSION: The interprofessional training procedures, evaluation of impacts, and future directions are discussed.

Challenges in the Clinical Recognition of Acute Flaccid Myelitis and its Implications.

OBJECTIVES: To explore the challenges in diagnosing acute flaccid myelitis (AFM) and evaluate clinical features and treatment paradigms associated with under recognition. STUDY DESIGN: This was a retrospective multicenter study of pediatric patients (≤18 years) who were diagnosed with AFM from 2014 to 2018 using the Centers for Disease Control and Prevention's case definition. RESULTS: In 72% of the cases (126 of 175), AFM was not considered in the initial differential diagnosis (n = 108; 61.7%) and/or the patient was not referred for acute care (n = 90; 51.4%) at the initial clinical encounter, and this did not improve over time. Although many features of the presentation were similar in those initially diagnosed with AFM and those who were not; preceding illness, constipation, and reflexes differed significantly between the 2 groups. Patients with a non-AFM initial diagnosis more often required ventilatory support (26.2% vs 12.2%; OR, 0.4; 95% CI, 0.2-1.0; P = .05). These patients received immunomodulatory treatment later (3 days vs 2 days after neurologic symptom onset; 95% CI, -2 to 0; P = .05), particularly intravenous immunoglobulin (5 days vs 2 days; 95% CI, -4 to -2; P < .001). CONCLUSIONS: Delayed recognition of AFM is concerning because of the risk for respiratory decompensation and need for intensive care monitoring. A non-AFM initial diagnosis was associated with delayed treatment that could have a clinical impact, particularly as new treatment options emerge.

Inadequate Vaccine Responses in Children With Multiple Sclerosis.

Objective: Immunizations against Hepatitis B virus (HBV) and Varicella Zoster virus (VZV), are recommended for patients with pediatric onset multiple sclerosis (POMS) and may be required prior to initiation of some disease modifying therapies. However, the efficacy of routine vaccine administration in POMS has never been studied. We sought to assess the humoral mediated vaccine response to HBV and VZV in children with POMS. Methods: A multi-center retrospective chart-based review of 62 patients with POMS was performed. Clinical data and antibody titers against HBV and VZV were collected prior to initiation of disease modifying therapy or steroids and compared to institutional control data, using t-test and chi squared analysis. Results: There were low rates of immunity against both HBV and VZV (33 and 25% respectively) among individuals with POMS. Fifteen individuals (24%) were non-immune to both. Compared to institutional control data, individuals with POMS were significantly less likely to be immune to and HBV (p = 0.003, 95% CI: 0.22-0.75) and VZV (p < 0.001, 95% CI: 0.09-0.39). Interpretation: Individuals with POMS have low rates of antibody-mediated immunity against HBV and VZV, despite receiving the appropriate vaccinations. This suggests an association between POMS and systemic immune dysregulation although further study is needed.

Underutilization of Contraception in Young Females with Demyelinating Disorders.

BACKGROUND: Demyelinating disorders in young females are frequently treated with immunomodulatory therapy which often have unknown risks to fetuses during pregnancy. In spite of this, there is no literature in this population about the use of contraception. Our objective was to determine the rate of use of contraception used in a real-world cohort of pediatric patients on immunotherapy for demyelinating diseases. METHODS: A retrospective, multi-center, chart-based review was performed. Inclusion criteria was female gender, use of immunotherapy for a demyelinating disorder, and age >11 years. RESULTS: Fifty-six female patients were identified with an average age of 15.4 years. The most common demyelinating disorders was multiple sclerosis (n = 33, 59%). The most common treatments were rituximab (n = 18, 32%), dimethyl fumarate (n = 13, 23%), IVIg (n = 11, 20%), and fingolimod (n = 11, 20%). Overall, only 16% (n = 9) of patients used contraception at any point during their immunotherapy regimen. Hispanic patients accounted for 41% of the cohort but were uniformly not on contraceptives (p = 0. 02). Contraceptive use did not impact ARR in any disease (p = 0.45). CONCLUSIONS: Contraceptive use in young females with demyelinating disorders is less than 1/3rd of the general population with particular discrepancies in persons of Hispanic/Latino descent.

Immunotherapy responsive SARS-CoV-2 infection exacerbating opsoclonus myoclonus syndrome.

The global pandemic of SARS-CoV-2 has been known to have diverse neurologic complications among adult patients. The neurologic effects of SARS-CoV-2 in the pediatric population is poorly described, especially in those with rare underlying neurologic conditions. We describe the first known case of SARS-CoV-2 in a pediatric patient with refractory opsoclonus-myoclonus syndrome. A 25-month-old female with progressive opsoclonus-myoclonus syndrome secondary to metastatic neuroblastoma status-post resection and chemotherapy presented with worsening opsoclonus, tremor, and breakthrough seizures. She had no fever or respiratory symptoms at presentation. Urine catecholamines were unchanged, with low suspicion for tumor recurrence. She was found to have SARS-CoV-2 via nasopharnygeal PCR assay. She received intravenous immunoglobulin and dexamethasone therapy with improvement in opsoclonus-myoclonus syndrome symptoms and was discharged home at her neurologic baseline. Patients with opsoclonus-myoclonus syndrome may present with exacerbation of symptoms in the context of SARS-CoV-2. This case describes a sentinel report of a child with opsoclonus-myoclonus syndrome presenting with worsening symptoms with concomitant SARS-CoV-2. Improvement in symptoms was achieved with standard of care therapies.

Brief Report: Autism Knowledge and Stigma in University and Community Samples.

Increased public understanding of autism may lead to better access to services and participation in the community for individuals with autism. The goal of this study was to explore autism understanding and stigma among university students, and general community members recruited at a state fair. Participants between 18 and 79 years of age (n = 478) completed the Autism Stigma and Knowledge Questionnaire (ASK-Q; Harrison et al., Journal of Autism and Developmental Disorders 47(10):3281-3295, 2017). All ASK-Q means fell within the adequate knowledge range, indicating relatively high levels of autism knowledge and low levels of stigma. ASK-Q scores were correlated with gender, education, and self-ratings of understanding but not age. The results of this study suggest the need for continued inquiry into metrics that indicate autism understanding and stigma.

Osteopathic manipulative treatment for self-reported fatigue, stress, and depression in first-year osteopathic medical students.

CONTEXT: During medical education, many students experience psychological distress, including symptoms such as fatigue, stress, and depression. OBJECTIVE: To evaluate the effect of osteopathic manipulative treatment (OMT) on self-perceived fatigue, stress, and depression in first-year osteopathic medical students. METHODS: This randomized controlled pilot study with repeated measures was conducted at the Lake Erie College of Osteopathic Medicine-Bradenton in Florida during the fall 2012 semester. First-year osteopathic medical students voluntarily enrolled in the study and were randomly assigned to directed OMT (D-OMT), nondirected OMT (ND-OMT), or control groups. The D-OMT and ND-OMT groups received treatment by osteopathic physicians weekly for 4 weeks. The control group received no treatment. All groups completed the Epworth Sleepiness Scale (ESS), the Self-Perceived Stress Scale (SPSS), and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire 9 (PHQ-9) depression scale before treatment (pretest), after 2 treatments (midtest), and after 4 treatments (posttest). RESULTS: All participants self-reported as white and single, with both sexes equally represented, and had an mean age of 24 years. Analysis of ESS scores revealed a statistically significant decrease in the D-OMT group from pretest and posttest scores and a statistically significant increase in the ND-OMT group from pretest to midtest but not from pretest to posttest scores. No statistically significant differences were noted in the control group scores on this measure. No statistically significant differences were seen in the SPSS or PHQ-9 scores from pretest to midtest or pretest to posttest in any of the 3 groups. CONCLUSION: The D-OMT regimen used in the current study produced a statistically significant decrease in self-perceived fatigue in first-year osteopathic medical students. Osteopathic manipulative treatment represents a potential modality to reduce self-perceived distress in medical students. Further research is warranted.