This document discusses home care in children and challenges families face administering medications at home. It provides examples of medication errors observed in home visits and identifies risk factors like increased number of medications and complex dosing schedules. The document recommends that doctors routinely ask families about their home medication administration process to identify difficulties and partner with families to develop support strategies and systems to prevent errors.
2016 modifiers of stress related to timing of diagnosis in parents of childre...gisa_legal
This study examined differences in parental stress levels between parents who received a prenatal versus postnatal diagnosis of complex congenital heart disease in their child that required surgery before newborn discharge. The study found that after adjusting for factors like disease severity, parents who received a prenatal diagnosis had lower levels of anxiety and global stress at the time of diagnosis and birth compared to parents receiving a postnatal diagnosis, though there was no difference at follow-up. The differences were primarily seen in fathers. For parents receiving a prenatal diagnosis, mothers had higher stress scores than fathers, and a later gestational age at diagnosis was linked to higher anxiety and stress.
The study assessed the reproductive education needs of infertile clients undergoing assisted reproduction treatment in Iran. A questionnaire was used to evaluate the knowledge and attitudes of 154 clients regarding fertility, infertility, and infertility treatment. Results showed the highest knowledge scores related to factors affecting pregnancy, while the lowest scores related to the natural reproductive cycle and genital anatomy. Males had higher knowledge than females for some topics. Education level also impacted knowledge, with those having less than a diploma scoring lower. Most clients believed education programs should address treatment types and procedures. The study concluded it is important to educate infertile clients on infertility causes and treatments to enable informed decision making.
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
MedicalResearch.com: Medical Research Interviews Month in ReviewMarie Benz MD FAAD
MedicalResearch.com powerpoint of exclusive interviews with medical researchers from NEJM, JAMA, BMJ, The Lancet and other major and specialty medical journals.
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
This document discusses home care in children and challenges families face administering medications at home. It provides examples of medication errors observed in home visits and identifies risk factors like increased number of medications and complex dosing schedules. The document recommends that doctors routinely ask families about their home medication administration process to identify difficulties and partner with families to develop support strategies and systems to prevent errors.
2016 modifiers of stress related to timing of diagnosis in parents of childre...gisa_legal
This study examined differences in parental stress levels between parents who received a prenatal versus postnatal diagnosis of complex congenital heart disease in their child that required surgery before newborn discharge. The study found that after adjusting for factors like disease severity, parents who received a prenatal diagnosis had lower levels of anxiety and global stress at the time of diagnosis and birth compared to parents receiving a postnatal diagnosis, though there was no difference at follow-up. The differences were primarily seen in fathers. For parents receiving a prenatal diagnosis, mothers had higher stress scores than fathers, and a later gestational age at diagnosis was linked to higher anxiety and stress.
The study assessed the reproductive education needs of infertile clients undergoing assisted reproduction treatment in Iran. A questionnaire was used to evaluate the knowledge and attitudes of 154 clients regarding fertility, infertility, and infertility treatment. Results showed the highest knowledge scores related to factors affecting pregnancy, while the lowest scores related to the natural reproductive cycle and genital anatomy. Males had higher knowledge than females for some topics. Education level also impacted knowledge, with those having less than a diploma scoring lower. Most clients believed education programs should address treatment types and procedures. The study concluded it is important to educate infertile clients on infertility causes and treatments to enable informed decision making.
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
MedicalResearch.com: Medical Research Interviews Month in ReviewMarie Benz MD FAAD
MedicalResearch.com powerpoint of exclusive interviews with medical researchers from NEJM, JAMA, BMJ, The Lancet and other major and specialty medical journals.
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This document provides information on chronic illness in adolescents including:
- Chronic illnesses are long-lasting health conditions that impact physical, mental, and social well-being. Examples include asthma, cancer, diabetes, and heart disease.
- Approximately 20-30% of adolescents in the US have a chronic illness, with 10-13% reporting substantial limitations. Depression and non-adherence to treatment plans are common issues.
- Several assessment tools are recommended to evaluate an adolescent's medical history, illness impact, depression, anxiety, quality of life, and treatment adherence.
- Suggested intervention strategies include cognitive behavioral therapy to challenge irrational thoughts and beliefs, develop coping skills, and improve treatment adherence.
Anxiety perceived by children during venipunctureIJARIIT
Introduction: When it comes to paediatric patients undergoing venipuncture, it should be every phlebotomist’s nurse’s top goal
to reduce a child’s fear, pain, and distress. Most children have some fear of needles. When a child’s level of distress in
anticipation of the venipuncture is on the rise, it can be a rather difficult task for the nurse and parent to make the blood
collection process go over smoothly!
Methods: This study was conducted using a descriptive correlational design among 181 children who met the inclusion criteria
using purposive sampling technique. Data collection was done using Demographic, Clinical Variables Proforma and Modified
Venham’s Anxiety Scale.
Results: The findings revealed that 42.5% of the children had moderate anxiety, 7.7% had worst anxiety and 1.10% had no
anxiety during venipuncture. The study findings revealed significant association between the anxiety and age of the child at the
level of (P < 0.05)
Research Presentation on the Influence of Irrational Health Beliefs on Dental...Munir Gomaa
This research is conducted by Munir Gomaa in his third and fourth years of dental school and is titled "Influence of Irrational Health Beliefs in Adults on Dental-Related Perceptions, Practices, and Diseases in Adult and Pediatric Patients." The research examines how, as an example, irrational fears related to going to a dentist might contribute to that patient's overall oral health.
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“STUDY ON THE IMPACT OF PRAKRITI IN CHILDREN WITH ACADEMIC STRESS AND EVALUAT...Dr-sumod Khedekar
“STUDY ON THE IMPACT OF PRAKRITI IN CHILDREN WITH ACADEMIC STRESS AND EVALUATION OF ANTISTRESS EFFECT OF SARASWAT CHURNA”
presented in Kochi International seminar.
This document provides an overview and update on autism spectrum disorder (ASD) research. It summarizes several studies on various topics:
- Genetic factors are strongly implicated in ASD risk, though hundreds of genes may be involved.
- Early intensive behavioral intervention shows benefits for social/communication skills but evidence is limited.
- Some treatments like risperidone and melatonin show benefits for specific symptoms but evidence is still limited overall.
- Joint attention interventions effectively improve joint attention skills in children with ASD.
- Ongoing research is exploring new drug treatments and personalized approaches.
1) The study examined the quality of life of 11 pediatric heart transplant recipients between ages 6-12 through qualitative interviews.
2) The children described their quality of life as "mostly good" but reported life was "easy and not easy."
3) Three key themes emerged that affected the children's quality of life: 1) Doing what kids do like activities and school, 2) Being with friends and family, and 3) Managing life as a heart transplant recipient with its medical responsibilities and challenges.
1) The case study examines the design of a clinical trial for a malaria vaccine that aims to be scientifically valid and have a favorable risk-benefit ratio.
2) There are questions around the scientific validity of the study design, as it may not adequately demonstrate the efficacy of the vaccine and could put participants at risk.
3) Evaluating the risk-benefit ratio and ensuring the study has social or scientific value are important for ethical research. However, the case study raises issues regarding how risks to child participants are justified.
This document summarizes a case study about developing a vaccine for malaria. It discusses three key ethical requirements for clinical research: 1) social or scientific value, 2) scientific validity, and 3) favorable risk-benefit ratio. For each requirement, the document analyzes how the malaria vaccine study meets or fails to meet that standard. For example, it notes that the study design may not adequately demonstrate the vaccine's efficacy and could put participants at risk without providing therapeutic benefit.
Ethical and Legal Issues Related to Medical Genetics Rayhan Shahrear
Define ethics and bioethics.
State the major ethical issues related to medical genetics.
Outline the uniqueness of medical genetics.
Outline the relevant ethical principles in medicine.
Discuss some ethical dilemmas that arise in the genetic clinic.
Explain the ethical dilemmas and public interest.
Dr. Najnin Akhter
Phase-A, Year-2, Block-6
Guided by Prof. K M Shamim
1. The document outlines the evidence-based medicine (EBM) process which involves five stages: formulating a question, searching for evidence, appraising the evidence, applying to practice, and evaluating.
2. It provides examples of clinical questions and formulates them using the PICO framework.
3. It describes the different types of studies and levels of evidence to consider when evaluating different types of clinical questions related to therapy, diagnosis, etiology/harm, and prognosis.
4. Resources for both filtered and unfiltered information are presented to guide searching for evidence depending on the question type.
5. Criteria for app
The document provides a literature review and methodology for a study examining the non-medical information needs of parents with newly diagnosed sick children. The literature review identifies key challenges faced by parental caregivers like stress, informational barriers, and needs. A quantitative survey was conducted with parents in oncology and haematology units to understand their awareness and satisfaction with supportive information provided. The results found that length of care, timing of information, and availability of financial support information most impacted parental satisfaction.
This summary provides an overview of a thesis that examined the relationship between prenatal cocaine exposure, respiratory sinus arrhythmia, and behavioral outcomes in 153 children by second grade. The thesis reviewed literature showing that prenatal cocaine exposure is associated with behavioral dysregulation and problems. It hypothesized that prenatal cocaine exposure would be related to higher respiratory sinus arrhythmia in infancy/early childhood, which would in turn be linked to more behavior problems by second grade. Additionally, it proposed that this relationship could be moderated by factors like child gender, maternal negative affect, parenting behaviors, and exposure to violence. The thesis involved analyzing longitudinal data collected between 2001-2013 to test these hypotheses and explore potential pathways between prenatal drug exposure and later
Vilma Mejia has over 25 years of experience in clinical trials as a research professional. She has worked in roles such as clinical research coordinator, monitor, associate clinical trials manager, and project manager. She has managed multi-million dollar, global clinical trials in various therapeutic areas, including cardiology, neurology, and psychiatry. Currently, she is a Clinical Trials Manager at Mount Sinai Hospital, where she oversees regulatory documents, data collection, quality assurance, finances, and staff for cardiology research studies.
This document provides a summary of the education, experience, and areas of expertise of naturopathic doctor Todd Adam Born. It outlines his extensive training and experience in integrative medicine with a focus on chronic disease, gastrointestinal issues, neurological disorders, endocrinology, cardiovascular disease, autoimmune disease, behavioral issues, HIV/AIDS, and geriatrics. It also lists his professional activities including owning his own practice, editing newsletters, reviewing journals, and presenting on various health topics.
Childhood Obsessive Compulsive Disorder Ocdramkumar g s
1. Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs) like sertraline and fluoxetine are the first-line treatments for pediatric OCD.
2. CBT for OCD involves psychoeducation, developing a fear hierarchy, and using ERP to systematically expose patients to feared situations while preventing compulsive rituals.
3. SSRIs are generally effective and well-tolerated treatments for pediatric OCD, though combination CBT+medication may be superior to either alone for severe cases.
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
This document proposes a solution to increase medication adherence through a three-part system: an application, smart medication packaging, and a tracking dispenser. Non-adherence costs the healthcare system $300 billion annually and leads to 125,000 deaths. The proposed solution aims to benefit patients through education and reminders, doctors through adherence data, pharmacies through increased sales, and insurance companies through lower costs from reduced non-adherence. It outlines how each stakeholder would be positively impacted by connecting the various parts of a patient's care through a coordinated digital system.
Falls prevention and the role of the pharmacistRichard Harris
This document discusses the role of pharmacists in falls prevention. It notes that patients on four or more medications are at greater risk of falls. Pharmacist interventions like medication reviews and screenings can help identify risk factors and optimize treatment to reduce falls risk. A case study example is provided of a 74-year-old woman recently discharged after a fall to illustrate how a pharmacist might evaluate risk factors and make recommendations to improve medication safety and adherence.
Haberman Management Corp is a New York money management firm that has successfully managed small-cap funds for nearly two decades and now focuses on family funds. It supports charitable causes such as the Ovarian Cancer Research Fund, which provides grants to researchers studying ovarian cancer. A recent OCRF grant helped researchers at Case Western Reserve University identify a biomarker involved in tumor growth and treatment resistance that could allow doctors to better predict patients' responses to cancer therapies and improve treatment outcomes.
The document outlines a study that will expose lab rats to different anxiety tests over varying durations to determine the effects of prolonged anxiety exposure. Rats will be divided into experimental and control groups. The experimental groups will undergo tests like swimming in water or standing on a platform for increasing durations. This aims to induce anxiety and possibly depression over time. The study will measure symptoms in rats, compare effects of low vs high exposure, and test treatments like anxiety and depression medications to determine the best for alleviating induced disorders. The goal is to understand how prolonged anxiety impacts physical and mental health in rats.
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This document provides information on chronic illness in adolescents including:
- Chronic illnesses are long-lasting health conditions that impact physical, mental, and social well-being. Examples include asthma, cancer, diabetes, and heart disease.
- Approximately 20-30% of adolescents in the US have a chronic illness, with 10-13% reporting substantial limitations. Depression and non-adherence to treatment plans are common issues.
- Several assessment tools are recommended to evaluate an adolescent's medical history, illness impact, depression, anxiety, quality of life, and treatment adherence.
- Suggested intervention strategies include cognitive behavioral therapy to challenge irrational thoughts and beliefs, develop coping skills, and improve treatment adherence.
Anxiety perceived by children during venipunctureIJARIIT
Introduction: When it comes to paediatric patients undergoing venipuncture, it should be every phlebotomist’s nurse’s top goal
to reduce a child’s fear, pain, and distress. Most children have some fear of needles. When a child’s level of distress in
anticipation of the venipuncture is on the rise, it can be a rather difficult task for the nurse and parent to make the blood
collection process go over smoothly!
Methods: This study was conducted using a descriptive correlational design among 181 children who met the inclusion criteria
using purposive sampling technique. Data collection was done using Demographic, Clinical Variables Proforma and Modified
Venham’s Anxiety Scale.
Results: The findings revealed that 42.5% of the children had moderate anxiety, 7.7% had worst anxiety and 1.10% had no
anxiety during venipuncture. The study findings revealed significant association between the anxiety and age of the child at the
level of (P < 0.05)
Research Presentation on the Influence of Irrational Health Beliefs on Dental...Munir Gomaa
This research is conducted by Munir Gomaa in his third and fourth years of dental school and is titled "Influence of Irrational Health Beliefs in Adults on Dental-Related Perceptions, Practices, and Diseases in Adult and Pediatric Patients." The research examines how, as an example, irrational fears related to going to a dentist might contribute to that patient's overall oral health.
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
“STUDY ON THE IMPACT OF PRAKRITI IN CHILDREN WITH ACADEMIC STRESS AND EVALUAT...Dr-sumod Khedekar
“STUDY ON THE IMPACT OF PRAKRITI IN CHILDREN WITH ACADEMIC STRESS AND EVALUATION OF ANTISTRESS EFFECT OF SARASWAT CHURNA”
presented in Kochi International seminar.
This document provides an overview and update on autism spectrum disorder (ASD) research. It summarizes several studies on various topics:
- Genetic factors are strongly implicated in ASD risk, though hundreds of genes may be involved.
- Early intensive behavioral intervention shows benefits for social/communication skills but evidence is limited.
- Some treatments like risperidone and melatonin show benefits for specific symptoms but evidence is still limited overall.
- Joint attention interventions effectively improve joint attention skills in children with ASD.
- Ongoing research is exploring new drug treatments and personalized approaches.
1) The study examined the quality of life of 11 pediatric heart transplant recipients between ages 6-12 through qualitative interviews.
2) The children described their quality of life as "mostly good" but reported life was "easy and not easy."
3) Three key themes emerged that affected the children's quality of life: 1) Doing what kids do like activities and school, 2) Being with friends and family, and 3) Managing life as a heart transplant recipient with its medical responsibilities and challenges.
1) The case study examines the design of a clinical trial for a malaria vaccine that aims to be scientifically valid and have a favorable risk-benefit ratio.
2) There are questions around the scientific validity of the study design, as it may not adequately demonstrate the efficacy of the vaccine and could put participants at risk.
3) Evaluating the risk-benefit ratio and ensuring the study has social or scientific value are important for ethical research. However, the case study raises issues regarding how risks to child participants are justified.
This document summarizes a case study about developing a vaccine for malaria. It discusses three key ethical requirements for clinical research: 1) social or scientific value, 2) scientific validity, and 3) favorable risk-benefit ratio. For each requirement, the document analyzes how the malaria vaccine study meets or fails to meet that standard. For example, it notes that the study design may not adequately demonstrate the vaccine's efficacy and could put participants at risk without providing therapeutic benefit.
Ethical and Legal Issues Related to Medical Genetics Rayhan Shahrear
Define ethics and bioethics.
State the major ethical issues related to medical genetics.
Outline the uniqueness of medical genetics.
Outline the relevant ethical principles in medicine.
Discuss some ethical dilemmas that arise in the genetic clinic.
Explain the ethical dilemmas and public interest.
Dr. Najnin Akhter
Phase-A, Year-2, Block-6
Guided by Prof. K M Shamim
1. The document outlines the evidence-based medicine (EBM) process which involves five stages: formulating a question, searching for evidence, appraising the evidence, applying to practice, and evaluating.
2. It provides examples of clinical questions and formulates them using the PICO framework.
3. It describes the different types of studies and levels of evidence to consider when evaluating different types of clinical questions related to therapy, diagnosis, etiology/harm, and prognosis.
4. Resources for both filtered and unfiltered information are presented to guide searching for evidence depending on the question type.
5. Criteria for app
The document provides a literature review and methodology for a study examining the non-medical information needs of parents with newly diagnosed sick children. The literature review identifies key challenges faced by parental caregivers like stress, informational barriers, and needs. A quantitative survey was conducted with parents in oncology and haematology units to understand their awareness and satisfaction with supportive information provided. The results found that length of care, timing of information, and availability of financial support information most impacted parental satisfaction.
This summary provides an overview of a thesis that examined the relationship between prenatal cocaine exposure, respiratory sinus arrhythmia, and behavioral outcomes in 153 children by second grade. The thesis reviewed literature showing that prenatal cocaine exposure is associated with behavioral dysregulation and problems. It hypothesized that prenatal cocaine exposure would be related to higher respiratory sinus arrhythmia in infancy/early childhood, which would in turn be linked to more behavior problems by second grade. Additionally, it proposed that this relationship could be moderated by factors like child gender, maternal negative affect, parenting behaviors, and exposure to violence. The thesis involved analyzing longitudinal data collected between 2001-2013 to test these hypotheses and explore potential pathways between prenatal drug exposure and later
Vilma Mejia has over 25 years of experience in clinical trials as a research professional. She has worked in roles such as clinical research coordinator, monitor, associate clinical trials manager, and project manager. She has managed multi-million dollar, global clinical trials in various therapeutic areas, including cardiology, neurology, and psychiatry. Currently, she is a Clinical Trials Manager at Mount Sinai Hospital, where she oversees regulatory documents, data collection, quality assurance, finances, and staff for cardiology research studies.
This document provides a summary of the education, experience, and areas of expertise of naturopathic doctor Todd Adam Born. It outlines his extensive training and experience in integrative medicine with a focus on chronic disease, gastrointestinal issues, neurological disorders, endocrinology, cardiovascular disease, autoimmune disease, behavioral issues, HIV/AIDS, and geriatrics. It also lists his professional activities including owning his own practice, editing newsletters, reviewing journals, and presenting on various health topics.
Childhood Obsessive Compulsive Disorder Ocdramkumar g s
1. Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs) like sertraline and fluoxetine are the first-line treatments for pediatric OCD.
2. CBT for OCD involves psychoeducation, developing a fear hierarchy, and using ERP to systematically expose patients to feared situations while preventing compulsive rituals.
3. SSRIs are generally effective and well-tolerated treatments for pediatric OCD, though combination CBT+medication may be superior to either alone for severe cases.
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
This document proposes a solution to increase medication adherence through a three-part system: an application, smart medication packaging, and a tracking dispenser. Non-adherence costs the healthcare system $300 billion annually and leads to 125,000 deaths. The proposed solution aims to benefit patients through education and reminders, doctors through adherence data, pharmacies through increased sales, and insurance companies through lower costs from reduced non-adherence. It outlines how each stakeholder would be positively impacted by connecting the various parts of a patient's care through a coordinated digital system.
Falls prevention and the role of the pharmacistRichard Harris
This document discusses the role of pharmacists in falls prevention. It notes that patients on four or more medications are at greater risk of falls. Pharmacist interventions like medication reviews and screenings can help identify risk factors and optimize treatment to reduce falls risk. A case study example is provided of a 74-year-old woman recently discharged after a fall to illustrate how a pharmacist might evaluate risk factors and make recommendations to improve medication safety and adherence.
Haberman Management Corp is a New York money management firm that has successfully managed small-cap funds for nearly two decades and now focuses on family funds. It supports charitable causes such as the Ovarian Cancer Research Fund, which provides grants to researchers studying ovarian cancer. A recent OCRF grant helped researchers at Case Western Reserve University identify a biomarker involved in tumor growth and treatment resistance that could allow doctors to better predict patients' responses to cancer therapies and improve treatment outcomes.
The document outlines a study that will expose lab rats to different anxiety tests over varying durations to determine the effects of prolonged anxiety exposure. Rats will be divided into experimental and control groups. The experimental groups will undergo tests like swimming in water or standing on a platform for increasing durations. This aims to induce anxiety and possibly depression over time. The study will measure symptoms in rats, compare effects of low vs high exposure, and test treatments like anxiety and depression medications to determine the best for alleviating induced disorders. The goal is to understand how prolonged anxiety impacts physical and mental health in rats.
This document discusses diseases caused by smoking. It begins by explaining how smoking damages DNA and increases the risks of cancer, heart disease, and strokes. It then lists several changes in the body caused by smoking, including effects on the lungs, respiratory system, brain, skin, and other organs. Examples of lung diseases from smoking include lung cancer and COPD. The document also provides preventative measures like avoiding secondhand smoke. It describes treatments to quit smoking like nicotine patches and gum. Statistics show that around 30 deaths per day are caused by secondhand smoke. The conclusion emphasizes stamping out smoking is important to reduce disease.
ANTHONY KEEL RESEARCH PROPOSAL 17 MAY 2013Anthony Keel
This document discusses high blood pressure and hypertension in the African American community. It notes that African Americans have a higher rate of hypertension than other races. Some of the key causes identified include diet, genetics, income levels, and attitudes towards healthcare. The consequences of untreated hypertension can be severe, including damage to arteries, heart attack, stroke, kidney failure, and even brain damage at a young age. Effectively addressing the causes of hypertension in the African American community could help reduce these health impacts.
This document discusses peptic ulcers, including their definition, causes, symptoms, diagnosis, and treatment. Peptic ulcers form in the stomach or duodenum when the protective mucus layer is damaged, allowing acid and pepsin to erode the lining. The primary cause is infection by H. pylori bacteria, though smoking, caffeine, alcohol, stress, and NSAIDs can also contribute. Common symptoms include belching, nausea, vomiting, and abdominal pain. Diagnosis involves endoscopy or blood tests. Treatment includes medications to reduce acid production, antibiotics to treat H. pylori, and sometimes surgery. Nursing care focuses on medication administration, diet, rest, monitoring for complications, education, and stress
2014 San Francisco Walk to End Alzheimer’sScott Robarge
The document discusses the 2014 San Francisco Walk to End Alzheimer's hosted by the Alzheimer's Association on September 20th. The walk aims to raise $980,000 to support the Alzheimer's Association's mission of finding a cure for Alzheimer's disease. The three mile walk begins at Mission Creek Park and does not require a participation fee, though walkers are encouraged to fundraise or donate. Those who raise $100 or more will receive a commemorative t-shirt.
This document discusses the pharmacotherapy of peptic ulcers. It begins by classifying the main drugs used: 1) those that inhibit gastric acid secretion like H2 blockers and proton pump inhibitors, 2) antacids that neutralize acid, 3) ulcer protectives like sucralfate, and 4) anti-H. pylori drugs for eradication. It then goes into detail about the mechanisms, uses, and side effects of the major drug classes. H2 blockers competitively block H2 receptors to suppress acid secretion. Proton pump inhibitors irreversibly inactivate the H+/K+ ATPase pump for prolonged acid inhibition. Antacids chemically neutralize acid. Sucralfate
Peptic ulcer disease involves breaks in the mucosal lining of the stomach or duodenum that penetrate through the muscular layer. The most common causes are infection with H. pylori bacteria and use of non-steroidal anti-inflammatory drugs (NSAIDs). Symptoms include abdominal pain, nausea, and weight loss. Diagnosis involves endoscopy to visualize the ulcers. Treatment involves antibiotics to eradicate H. pylori, proton pump inhibitors to reduce acid secretion, and avoidance of NSAIDs. Surgery is reserved for complications or treatment failure.
This document discusses peptic ulcers. It defines peptic ulcers as breaks in the gastrointestinal mucosa exposed to acid and pepsin. The pathophysiology involves an imbalance between defensive and aggressive factors on the gastroduodenal mucosa. Common causes of ulcers include Helicobacter pylori infection, NSAIDs, smoking, alcohol, and acid hypersecretion. Management involves lifestyle modifications, medications to reduce acid secretion, antibiotics to treat H. pylori, and surgery for complications or treatment failures.
This document outlines a research proposal that examines the effects of the 2009 economic downturn on Emirates Airlines as a high-cost carrier. The proposal includes objectives to identify impacts on high-cost airlines during the recession, compare customer numbers before and after, and provide recommendations. The methodology involves secondary research on aviation data and a questionnaire distributed to Emirates Aviation College students and staff. The analysis section presents survey results on travel habits, class of travel, and opinions on measures airlines could take in a recession. The conclusion finds prices dropped as fewer people traveled. Recommendations include calculating pre- and post-recession rate changes and precisely measuring industry impacts.
In the first study, researchers found that women who experienced early onset and frequent hot flashes had higher risks of cardiovascular disease. Specifically, these women showed poorer vascular health on certain indices compared to women with fewer or later hot flashes. A second study replicated these findings, further refining the understanding of how menopausal hot flashes may increase cardiovascular risks for some women. The studies suggest that experiencing hot flashes earlier and more frequently in midlife is linked to poorer vascular health and increased cardiovascular disease risk.
Introduction to pediatric nursing nurs 3340 fall 2017Shepard Joy
This document provides an introduction to pediatric nursing. It discusses key differences between caring for children versus adults, including differences in physical assessment techniques according to age and development. The roles of nurses in caring for children are to provide direct care, patient education, advocacy, and case management. The primary goals of pediatric care are health promotion and health maintenance for children and their families.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Tucson Medical Center - Guidelines for teaching EBM in your practiceTucsonMedicalCenter
Ryan is a first-year resident who presents clinical cases to his attending physician, Dr. Waters, without thoroughly researching the medical literature. When asked about his research process, Ryan replies that he primarily uses UpToDate, which Dr. Waters feels lacks depth. To encourage Ryan to become a more self-directed learner, Dr. Waters could have Ryan identify his own learning needs, develop a plan to address them, and review the outcomes, following the self-directed learning process. Dr. Waters could also role model searching medical literature and emphasize evidence-based medicine principles to help Ryan frame answerable clinical questions and critically appraise the evidence.
Tucson Medical Center Faculty Edu PPT #7 - Guidelines for teaching EBM in you...TucsonMedicalCenter
Ryan is a first-year resident who presents clinical cases to his attending physician, Dr. Waters, without thoroughly researching the medical literature. When asked about his research process, Ryan replies that he primarily uses UpToDate, which Dr. Waters feels lacks depth. To encourage Ryan to become a more self-directed learner, Dr. Waters could have Ryan identify his own learning needs, develop a research plan, and review outcomes - the key steps of self-directed learning. Dr. Waters could also emphasize incorporating principles of evidence-based medicine to critically evaluate sources and frame answerable clinical questions.
1) There are two basic types of experimental research designs: randomized controlled trials and quasi-experimental designs. Randomized controlled trials are considered the gold standard as randomization makes treatment groups comparable.
2) There are four main types of observational studies: cohort studies, case-control studies, cross-sectional surveys, and case reports. Cohort studies follow groups over time from exposure to outcome while case-control studies work backwards from an outcome to exposures.
3) Experimental and observational studies both have strengths and weaknesses for evaluating causes and effects in health research. The strongest evidence comes from systematic reviews and meta-analyses of multiple studies.
Obesity is quickly becoming one of the most common chronic.docxhopeaustin33688
Obesity is quickly becoming one of the most common chronic diseases among children. These rates have increased at an alarming rate and is a major public health problem because of related physical and psychological comorbidities, including type II diabetes, insulin resistance, metabolic syndrome, cardiovascular disease and mental health disorders. Dramatic increase in the number of overweight and obese children in recent years.
Studies indicate that children's lives may be shortened as a result of this alarming health problem. Estimates state that for any degree of overweight/obesity, younger adults (20-30 years of age) may have greater years of life lost due to obesity than older adults. Childhood obesity has been determined to be an independent risk factor for adult overweight/obesity.
To combat childhood obesity, there is a great need for public health interventions as well as education parents regarding childhood obesity and its consequences. Parents differ on causation of obesity, and differ in focus on nutrition and physical exercise. Many parents in the research do not see obesity as a barrier to physical activity. The parents need to recognize their child as overweight. Prevention is the most effective method for dealing with this growing health concern. The evidence reviewed, confirmed that family-centered interventions were associated with short-term reduction in obesity and improved medical parameters. The goal should be to involve community resources and provider referrals. Nurse Practitioners have a unique role in being the best facilitators to deliver health messages and are able to educate parents and increase awareness about the causes and consequences of childhood obesity.
Parents of young children need to interact with their child's primary healthcare provider for health advice and preventive health information during regularly scheduled physical examinations. It is up to the parents of these young children to combat intervention strategies such as:
a combination of nutritional and activity information, a cognitive-behavioral aspect to the intervention parent-directed activities
limiting sedentary child behaviors, provide positive approaches with children by parents and practitioners (e.g., emphasize positive rewards for healthy behaviors, encourage self-efficacy)
Future research is required to identify moderators and mediators to produce enduring changes in weight status of children.
The Objective was to determine in children who are at risk for becoming overweight or obese, does education with parental involvement on exercise and nutrition compared to individual education with the child alone decrease the risk of developing obesity and the health problems associated with obesity?
(P) In overweight, obese, or at risk young children (2-18years of age) Is family centered education/treatment interventions
(C) versus control or comparison interventions
(O) more effective in decreasing childhood obesity and compli.
Neurodevelopmental Treatment and Cerebral Palsy- Researchda5884
An alternative description of my Critically Appraised Topic on Neurodevelopmental treatment when used on children with cerebral palsy. This presentation focuses more on the process of the research.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It describes how IMPACT began with a few clinicians in 2005 and has expanded to include various complementary and alternative medicine services. IMPACT assesses patients' physical, psychosocial and spiritual needs. It also provides education to medical staff and students on palliative care and integrative medicine. IMPACT is researching the effectiveness of interventions like aromatherapy, yoga and alternative diets.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It discusses how IMPACT evolved from an initial focus on palliative care to offering additional complementary and alternative medicine services. IMPACT now includes practitioners of herbal medicine, yoga, massage, acupuncture, nutrition counseling, and other therapies. It also provides education to medical students and conducts research on topics like the effectiveness of different diets for pediatric oncology patients.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It discusses how IMPACT evolved from an initial focus on palliative care to incorporate complementary and alternative medicine (CAM) approaches. IMPACT now provides a range of CAM services like yoga, massage, acupuncture, and herbal medicine to improve patients' quality of life. It also conducts education and research on palliative care and CAM for pediatric cancer patients.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It describes how IMPACT evolved from initial assessments of patient needs to a multidisciplinary team providing services like herbal medicine, yoga, massage, and spiritual support. It also discusses IMPACT's education initiatives and current research studies exploring topics like the effectiveness of different diets for cancer patients and the impact of therapies like aromatherapy and yoga on symptoms.
This literature review examines previous studies on children undergoing treatment for chronic or life-threatening diseases. The studies found that these children often have lower health-related quality of life than their healthy peers. They also found that current quality of life tests may be too brief or generalized to fully assess these children's experiences. The review suggests that an intervention center could help children through difficult medical treatments by utilizing general quality of life tests along with more customized evaluations. This would help the center better understand children's specific needs and improve their health outcomes and social development.
Systemic juvenile idiopathic arthritis (JIA) is a form of juvenile arthritis characterized by fever and systemic symptoms. The presentation, diagnostic criteria, epidemiology, clinical features, and treatment options for systemic JIA were discussed in detail. Treatment involves NSAIDs, methotrexate, corticosteroids, biologic medications that target cytokines like TNF, IL-1, and IL-6 which are implicated in the pathogenesis of systemic inflammation and joint damage in JIA.
This document summarizes a presentation about managing pain from juvenile arthritis (JA) beyond just pills and procedures. It discusses that while medications and surgeries can provide relief, they do not always eliminate pain and have limitations. Alternative strategies discussed include physical activity, nutrition, distraction techniques, relaxation methods, massage, and combining approaches. It also stresses the importance of regular school attendance and addressing any mood or anxiety issues. Finally, it discusses the role of parents in modeling flexible coping and supporting their child's development beyond just their medical condition.
Juvenile Spondyloarthritis and Fever Syndromes by Reema Syed,MD, Assistant Professor of Internal Medicine and Pediatrics, Division of Adult and Pediatric Rheumatology, Saint Louis University
This document provides information and guidance for parents of children with chronic illnesses on managing stress and mental health. It discusses the high rates of pediatric chronic illnesses and common parental responses like guilt, anger, and grief. Parents of children with conditions like Juvenile Idiopathic Arthritis are at heightened risk for depression and anxiety. The document recommends stress reduction strategies for parents like relaxation techniques, social support, and self-care. It provides guidance on identifying signs of poor mental health and obtaining help through counseling, support groups or self-help books.
This document provides information to help patients and families navigate care for juvenile arthritis (JA). It discusses the healthcare team, facilities, equipment, and navigation of insurance. The team includes doctors, nurses, social workers and other specialists. It emphasizes the roles of the primary care doctor, physical/occupational therapists, pharmacists, labs, and ophthalmologists. It also reviews insurance plans like HMO, PPO, Medicaid and explains resources like social workers and state programs for children with special needs.
More from Arthritis Foundation 2012 JA Conference (7)
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
1. RESEARCH UPDATE
2012 JUVENILE ARTHRITIS CONFERENCE, ST LOUIS, MO
Mara L Becker, MD MSCE
Associate Professor of Pediatrics, UMKC
Children’s Mercy Hospitals and Clinics, Kansas City, MO
3. Break Down
Why do we need to be even talking about research
in children?
What makes kids different?
How can research benefit my child?
Research Basics
Research vs. clinical care, risks vs. benefits, safety
Types of research
Examples of new clinical trials currently or soon to be
enrolling
Other ways of contributing/getting involved
4. Sir William Osler, 1903
―the most influential physician in history‖
―Who can tell of the uncertainties of medicine as an art? The
science on which it is based is accurate and definite enough…
but no two individuals react alike and behave alike under the
abnormal conditions which we know as disease‖
―The good physician treats the disease; the great physician
treats the patient who has the disease‖
His description of the inadequacy of treatment methods for
most disorders was a major factor leading to the creation of
the Rockefeller Institute for Medical Research in New York
5. Startling facts…
• By age 5 yrs, 95% of children have been prescribed a
medication, with an average of 8.5 prescriptions and 5.5
different medications
• Medicines, devices and treatments are often NOT tested in
children
– In fact, 70% of medicines prescribed to children have been tested
ONLY IN ADULTS
• ―Off-Label‖ use of drugs in children is commonplace
– 79% of hospitalized children received at least 1 off label drug
– Utilize a weight based dose adjustment for children
– Necessary… but NOT ENOUGH!!
Loebstein R et al, Pediatr Rev, 1998 (19)12:423-428, Shah S et al, Arch Pediatr Adolesc Med, 2007 (3) 161: 282-90
6. Children are not little adults!
Lucas at The Magic House– St Louis, MO
7. Stages of growth: Makes pediatric
patients unique at every stage
• Differences in digestion and
enzyme function
• Differences in muscle mass and
organ size
• Differences in the effect of
therapies upon a growing body
– Are there long term
consequences?
• Differences in how the disease
acts in kids compared to adults
http://www.nhlbi.nih.gov/childrenandclinicalstudies/whyclinical.php
9. Why should children be included in
research?
If we don’t include children in research, we leave
them vulnerable to:
Incorrect drug dosing
Sideeffects
Doesn’t work
Not being prioritized for:
research targeted at disease CURE
genetic risk studies and counseling for future risk
Understanding the role of disease prevention
Understanding how complementary approaches may affect
disease
Identification of biomarkers to guide disease activity or
inactivity
10. Examples of HOW research can help
my child?
• Find the best doses of medicines to prevent harmful effects or under
treatment
• Making safe and easily administered medicines for kids (chewables,
liquids, yummy tasting!)
• Finding treatments to conditions that are expressed differently in kids
compared to adults (Juvenile arthritis)
• Finding treatments for new or existing diseases to improve health in
the future (vaccines)
• Understand how medicines affect growing children and their
development
11. Research vs. Clinical Care
• Research is done to help find out if a treatment or
procedure is good for a large group of people with a
certain disease or condition. Research helps to answer
questions for the future health of those populations.
Standard medical care, however, focuses on individual
needs in the present
• Similarities:
– Researcher and your healthcare provider can be the SAME
person
– Setting may be in your regular clinic
– The treatments may seem the same
12. Research vs. Clinical Care: questions to
ask
• How is this different from standard care?
– Will I see different doctors and nurses for the study?
– Will I go to a different hospital or clinic for the study?
– Will the doctors and nurses ask me a lot more questions
about my child's condition?
– Will there be more paperwork or additional tests when
we are in the study?
– Will there be more rules and deadlines in the study?
13. Will my child benefit?
Research is done to gain information about a
disease, condition, drug or treatment that will
benefit children in the future– different than regular
medical treatment that is given to help a specific
child
However- there are potential benefits:
Helping future generations
Having access to new drugs or treatments, doctors or
other families with same condition
Getting closer monitoring or additional testing
14. How will my child be protected?
http://www.nhlbi.nih.gov/childrenandclinicalstudies
/safety.php
15. How will my child be protected?
Research team
Investigator, doctors, nurses, statistical experts, pharmacists
Determine the right study, performed in the right number of
patients, done in the right way, with the right participants
Institutional Review Board
an independent committee that reviews research plans and
consent forms to make sure that people in a study are
informed and protected. They review studies both before
they start and throughout the study.
16. Protection of study participants, cont.
Informed consent/Patient assent
Parent is given details about a study so that you can
decide if your child should join a study. You are
"informed" so that you can give your "consent" or okay.
Nothing can happen until you consent to it.
Most children from age 7 can understand basic
information if it is given at their level. So, in most studies,
children are now asked if they agree (assent) to be in a
study and are asked to sign an assent form.
Data and safety monitoring board/medical monitor
impartial Board/person that oversees studies and says
if a study should be changed or closed at any time for
safety issues.
17. And remember your rights…
Ask as many questions as you’d like
You can say NO at any time, for any reason
www.rfried.info
18. Research Organizations Specific to
Pediatric Rheumatology
CARRA: Childhood Arthritis and Rheumatology
Research Alliance
Typically manages investigator-initiated studies
PRCSG: The Pediatric Rheumatology Collaborative
Study Group
Handles drug industry-initiated research
19. Types of Research
Observational Studies
Translational Studies
Clinical Trials
Comparative Effectiveness Research (CER)
20. Observational studies
Retrospective
In the past
Likely no consent will be obtained
Combine clinical data (without identifiers) to look for
associations
This is a big part of the research we have to go on from the
past
Ex:
Arthritis Rheum. 1977 Mar;20(2 Suppl):327-31.
Drs. Sullivan, Cassidy and Petty evaluated the charts of 33 patients
with JDM treated with steroids, and found that the outcomes of
these children were infinitely better than children NOT treated with
steroids
21. Observational Studies
Prospective:
Current/future
Collect specific information on patients, often over time
Registry
Ex.
CARRAnet registry (CARRA= Childhood Arthritis &
Rheumatology Research Alliance)
observational retrospective and prospective study that enrolls children
and adolescents with major rheumatic diseases followed at
participating study sites. All patients with defined rheumatic diseases
who are 21 years of age or younger and who are seen/followed at a
CARRA site for medical care will be approached for participation in
the registry.
22. Translational Studies
Used as a bridge linking bench/basic scientific research
with the patient
Multiple disciplines often involved
Goal for faster application of knowledge to patient
Usually a combined collection of clinical information
and biologic sample(s) (blood, urine, tissue, hair, etc)
Ex.
Arthritis Rheum.2010 Jun;62(6):1803-12.
My work is in measuring methotrexate metabolites in
cells to determine if different patterns or genetic
associations are predictive of better or worse response to
the medicine
23. Clinical Trials
Compares 1 or more treatments
Often randomized
Means your child may NOT get active drug/therapy
Treatment follows very exact guidelines
protocol
Not all patients will qualify
Inclusion and exclusion criteria
Most scientifically rigorous and most expensive
24. Clinical Trials
Phase 1
Safety doses
Phase 2
Efficacy doses
Phase 3
Compare drug to placebo, or current
treatment- does it work? Is it safe?
Phase 3 OLE
Open label extension gathers
additional safety data and longer
term info about treatment effects
Phase 4
Large observational registries to Basic Science/bench experiments
explore medication safety once drug
approved by FDA
25. What do we have going on in clinical
trials in the US?
26. TRial of Early Aggressive Therapy in
Polyarticular Juvenile Idiopathic Arthritis
2 arms
Methotrexate subcutaneously OR
Methotrexate subcutaneous, enbrel, steroids
Both arms had patients who achieved clinically
inactive disease at 6 months
Methotrexate only: 23%
Triples (M+E+S): 40%
Both arms (although fewer) had patients who
reached clinical remission on medication
Methotrexate only: 7%
Triples (M+E+S): 21%
27. RAPPORT: IL-1 TRAP in systemic JIA
Closed to enrollment
Last patient will finish in December 2012
3 translational studies are attached to this trial
Analysis will begin in January 2013
28. Biologics: CIMZIA
ClinicalTrials.gov Identifier: NCT01550003
Pediatric Arthritis Study of Certolizumab Pegol (PASCAL):
Phase 3 with OLE- all patients receive drug
Anti-TNF-α monoclonal antibody—fragmented
Given subcutaneously every 2 weeks
Inclusion Criteria:
Diagnosis of Polyarticular-course Juvenile Idiopathic Arthritis (JIA) for at least
6 months prior to Baseline
Children and adolescents, aged 2 to 17 years (inclusive); weight ≥ 10 kg
Inadequate response or intolerance to at least 1 Disease-Modifying
Antirheumatic Drug (DMARD) (previous exposure to a maximum of 2 biologic
agents will be allowed)
Methotrexate (MTX) and oral Corticosteroids will be allowed at stable doses
prior to Screening
Inadequate response or intolerance to Methotrexate (MTX)
29. Biologics: SIMPONI
ClinicalTrials.gov Identifier: NCT01230827
Safety and Efficacy of Golimumab in Children With JIA and
Multiple Joint Involvement Who Have Poor Response to
Methotrexate (GO KIDS)
Phase 3 (randomized placebo arm after 16 weeks on therapy through
48 weeks)
Anti-TNF-α monoclonal antibody--Given once a month injection
Inclusion Criteria:
Diagnosis must have been before the patient's 16th birthday
Disease duration of at least 6 months before study entry
Must have >=5 joints with active arthritis
Must be taking a stable dose of methotrexate
May take a stable dose of prednisone less than 10 mg/day 4 weeks
prior to entry or may take a stable dose of NSAIDS (non-steroidal anti-
inflammatory drugs) 2 weeks prior to entry
Must have qualifying laboratory values at the first visit.
30. Biologics: Actemra
Clinical Trials.gov Identifier NCT01603355
Tocilizumab (anti IL-6 receptor antagonist) in the Management
of Juvenile Idiopathic Arthritis Associated Uveitis
Phase 1 and Phase 2, pharmacokinetics study (will measure blood
levels of Tocilizumab, and assess safety )
Tocilizumab given IV every 4 weeks (dose depending on weight)
JIA- associated Uveitis (ages 2-17 yrs)
Oregon Health and Science University (not yet recruiting)
Inclusion Criteria:
Subjects with Juvenile Idiopathic Arthritis
Subjects with vision-threatening autoimmune uveitis.
Failure to respond to methotrexate or at least one other systemic
immunosuppressive or intolerance to such medications due to side effects.
bilateral eye disease.
If subjects are on oral corticosteroids, the dosage must be stable for 2 weeks
prior to baseline and not exceed 10 mg per day or 2mg/kg/day (whichever is
less) of prednisone
Must have a chest radiograph within 3 months prior to enrollment
31. Biologics: Actemra
Clinical Trials.gov Identifier NCT01455701
A Study of Tocilizumab in Patients Less Than 2 Years Old With
Active Systemic Juvenile Idiopathic Arthritis
Phase 1 and Phase 2, pharmacokinetics study (will measure blood
levels of Tocilizumab, and assess safety in this age group)
Tocilizumab (Anti IL-6 Rab, IV every 2 weeks x 12 weeks)
Inclusion Criteria:
Patients, less than 24 months old at baseline
Diagnosis of systemic juvenile idiopathic arthritis (sJIA)
Duration of systemic juvenile idiopathic arthritis (sJIA) lasting at least 3
months since the onset of sJIA symptoms
Presence of active disease
Uncontrolled disease despite treatment with non-steroidal anti-
inflammatory drugs and corticosteroids
32. Vaccine safety in JIA: Gardasil
Clinical Trials.gov Identifier NCT00573651
Safety and Efficacy of Gardasil in Females With Juvenile
Idiopathic Arthritis (JIA)/Seronegative Arthritis (CHASE)
Phase 4 safety observational study after vaccine administered at 0, 2
and 6 months
Inclusion Criteria:
Female patients, age 9-26 years, with polyarticular JIA, pauciarticular
JIA, and sero-negative arthritis.
33. Biologics: General- when to stop?
Clinical Trials.gov Identifier NCT00792233
Determining Predictors of Safe Discontinuation of Anti-TNF
Treatment in JIA
Ages 4-20 years
Phase 4 study (but also a translational component)
Looking for predictors of safe discontinuation of anti-TNF therapy
Inclusion Criteria:
Diagnosis of polyarticular JIA or extended oligo JIA
Receiving therapy with one of the currently available anti-TNF biologic
Receiving slit lamp exams performed at regular intervals
Absence active arthritis/active disease (several criteria included)
Exclusion Criteria:
Diagnosis of a type of JIA other than polyarticular JIA
Diagnosis of another inflammatory disease that may affect laboratory results or
ability to discontinue anti-TNF biologic therapy
previous treatment with rituximab
concurrent treatment for JIA with corticosteroids >0.2 mg/kg/day OR >10 mg/day
34. Behavioral: Jointstrong
Clinical Trials.gov Identifier NCT01166750
Jointstrong Intervention for Juvenile Arthritis
Computer based intervention for 8 weeks
CD-ROM intervention (randomized) for behavioral modification
techniques for controlling symptoms of arthritis. Weekly modules with
―homework‖, daily questionnaire for patient for 2 week time period
University of Kansas Medical Center
Inclusion Criteria
8-12 years of age
diagnosis of JA by a pediatric rheumatologist using established criteria
have JA-related (joint) pain occurring on an average of at least once per
week
35. Behavioral: WebSmart
Clinical Trials.gov Identifier NCT01541917
Efficacy of Web-based Pain Self-management for Adolescents
With Juvenile Idiopathic Arthritis (WebSMART)
test of online coping skills training program for English- and Spanish-speaking
adolescents with JIA
experimental group :12-week interactive online multi-component treatment
protocol including targeted disease education, training in empirically supported
cognitive-behavioral coping skills, and social support augmented by monthly
telephone contact with a nurse
control group:12 weeks of guided access to extant online resources for disease
education and additional attention to own best efforts at managing JIA via
monthly telephone contact with a nurse.
Inclusion Criteria:
12-18 years of age (inclusive)
diagnosed with JIA by a pediatric rheumatologist
able to speak and read English and/or Spanish
able to complete online measures
reporting pain in at least one joint over the past 6 months
36. For those interested in the newest drug
targets…
Photograph: Ruth Orkin/Hulton Archive/Getty Images
37. Kinase Inhibitors: Block cytokine effects
Jak 3(CP-690,550; Tofacitinib)
Pharmacokinetics Of CP-690,550 In Pediatric
Patients With Juvenile Idiopathic Arthritis (JIA)
ClinicalTrials.gov Identifier: NCT01513902
Long-Term Safety Study Of CP-690,550 In Patients
With Juvenile Idiopathic Arthritis
ClinicalTrials.gov Identifier: NCT01500551
Pfizer: Czech Republic
38. Kinase Inhibitors: Block cytokine effects
Syk Kinase Inhibition (R935788)
Nothing I could find in JIA
Three completed Phase 2 studies in RA
ClinicalTrials.gov Identifier: NCT00326339
ClinicalTrials.gov Identifier: NCT00665925
ClinicalTrials.gov Identifier: NCT00326339
39. New Cytokine Targets
Anti IL-17: monoclonal antibody
Phase 2: Psoriasis, Crohn’s disease, RA
Anti IL-12/IL-23: monoclonal antibody: Ustekinumab
Phase 2: Psoriatic arthritis
Phase 3: Psoriatic arthritis (ongoing in adults)
40. Comparative Effectiveness Research
Agency for Healthcare Research and Quality definition
“A type of health care research that compares the
results of one approach for managing a disease to the
results of other approaches. Comparative effectiveness
usually compares two or more types of treatment, such
as different drugs, for the same disease. Comparative
effectiveness also can compare types of surgery or
other kinds of medical procedures and tests. The results
often are summarized in a systematic review.”
What does this actually mean??
41. Comparative Effectiveness Research
Wikipedia
Comparative effectiveness research (CER) is the direct
comparison of existing health care interventions to
determine which work best for which patients and which
pose the greatest benefits and harms. The core question
of comparative effectiveness research is which treatment
works best, for whom, and under what circumstances
These clinical research trials measure effectiveness—the
benefit the treatment produces in routine clinical
practice.
This is different than many regular clinical trials, which
measure efficacy--whether the treatment works or not in a
controlled environment such as a clinical trial
42. Comparative Effectiveness Research
why useful for JA?
Randomized Clinical Trials: CER:
Expensive and time More generalizable: ―real
consuming world‖
YEARS to complete and Easier recruitment (less
millions of dollars inclusion/exclusion
Complex (inclusion/exclusion restrictions)
criteria) ―head to head‖ comparisons
Hard to recruit, especially in Can assess patient-relevant
rare conditions outcomes, and clinically
meaningful outcomes
Can be less expensive
Potential to compare
treatments at an individual
and population level
43. CER in Juvenile Arthritis: the time is
NOW… or soon!
CARRA Consensus Treatment Plans (CTPs)
Observational CER within the CARRA registry
Formulated for several pediatric rheumatic diseases
CTPs developed over the past 1-2 years by polling the
CARRA community of pediatric rheumatologists and reaching
consensus about the most prevalent/agreed upon treatment
plans for specific diseases
Now, ready to implement and study what plans are best!
Using the CARRAnet registry as the vehicle to collect clinical
information on response/improvement, safety, patient quality
of life, etc.
44. Role of the Arthritis Foundation
Direct research grants AF support for CARRA
through the foundation to and CARRA sponsored
support research that: research
biomarkers that predict http://www.arthritis.org/
disease outcome, measure carra.php
response to treatment in http://www.arthritis.org/
JA. ja-research.php
Develops and/or assesses
new drugs and non-
pharmacologic methods to
improve JA.
Assesses comparative
effectiveness of different
interventions for JA using
the CARRA network.
45. Fundraising
AF- sponsored events Friends of CARRA
Jingle bell run/walk raises money through
Arthritis walk private donations, grants
and various fundraisers
put on by parents and
Locally sponsored friends across the country
fundraisers All of money raised goes
Can be designated to be directly to CARRA to
used in childhood fund research to find the
arthritis research only cause and cure for
rheumatic diseases in
children.
46. Children in Clinical Studies:
No More Hand Me Downs!
YouTube video for Families