A case report of a chronic migraine patient treated with three different anti-CGRP monoclonal antibodies: which parameters better represent the efficacy?

Objective: To report the efficacy of different anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) on headache frequency, intensity, and duration. Background: Blockade of CGRP receptors or neuropeptide with anti-CGRP mAbs have been successfully used for several years for the prevention of chronic and episodic migraine. The response is usually assessed by improvement seen in the number of days with headache per month. However, clinical praxis indicates that sole reliance on the frequency of headaches might be insufficient to interpret the efficacy of these treatments. Methods: Retrospective review of a case with a meticulous headache diary who has tried three different anti-CGRP mAbs for chronic migraine prevention. Results: The patient has been diagnosed with chronic migraine and was first treated with erenumab, followed by fremanezumab and thereafter galcanezumab due to several reasons. In addition to significant improvement in all three parameters analyzed with anti-CGRP mAb treatment, the most important and valuable effect on the patient's quality of life was decreased duration and frequency of headaches. At present, the patient is receiving fremanezumab treatment with an excellent tolerability. Conclusion: There is a clear need for careful follow-up and detailed daily records of headaches showing the frequency, duration, and severity for the evaluation of anti-CGRP mAbs treatment. This study shows the importance of this information in order for medical professionals to make an informed decision regarding the best course of anti-CGRP mAbs treatment in cases of side effects or lack of efficacy.

Tremor evaluation using smartphone accelerometry in standardized settings.

Tremor can be highly incapacitating in everyday life and typically fluctuates depending on motor state, medication status as well as external factors. For tremor patients being treated with deep-brain stimulation (DBS), adapting the intensity and pattern of stimulation according the current needs therefore has the potential to generate better symptomatic relief. We here describe a procedure for how patients independently could perform self-tests in their home to generate sensor data for on-line adjustments of DBS parameters. Importantly, the inertia sensor technology needed exists in any standard smartphone, making the procedure widely accessible. Applying this procedure, we have characterized detailed features of tremor patterns displayed by both Parkinson's disease and essential tremor patients and directly compared measured data against both clinical ratings (Fahn-Tolosa-Marin) and finger-attached inertia sensors. Our results suggest that smartphone accelerometry, when used in a standardized testing procedure, can provide tremor descriptors that are sufficiently detailed and reliable to be used for closed-loop control of DBS.

An investigation of factors affecting compassion levels of midwives.

INTRODUCTION: The profession of midwifery is seen as a genuinely individual-centric catalyst transforming compassion to care. Due to this, compassionate care should be the basis of midwives' care, especially for those who care for women and children. This research investigated the compassion levels of midwives to determine the factors affecting them. METHODS: This descriptive research was conducted between 10 February and 29 May 2020, with 119 midwives working in a training and research hospital in Istanbul. The data were collected using the 'Compassion Scale' and analyzed using the Mann-Whitney U test, Kruskal-Wallis test and logistic regression model. RESULTS: The total mean score on the compassion scale of midwives participating in the study was found to be 71.46 ± 9.60. Sociodemographic data and vocational belongings of participants were compared with the mean scores of the compassion scale sub-dimensions. It was determined that as the age of the midwives increased, they showed more kindness and awareness of compassion (p<0.021, p<0.023, respectively). It has been determined that as the education level of midwives decreases, their compassion level also decreases and they become more insensitive (p<0.044). It was found that being married increased the kindness (p<0.023) and common humanity characteristics (p<0.032) that affect compassion. It was found that the levels of kindness (p<0.020) and awareness (p<0.048) increased for those who had children, and compassion was associated with having a child. In addition, a statistically significant relationship was found between the professional commitment and kindness of the midwives participating in the study (p<0.034). It was found that midwives' knowledge of rules related to professional ethics increased their compassion scale scores by 1.2. CONCLUSIONS: Midwifery is a profession with a high sense of spirituality. However, professional belonging, love of the profession and professional development positively affect midwives' levels of compassion. Improving midwives' feelings of belonging and their professional development will also contribute to the quality of maternal and infant health.