Medication and its Effect on Safe & Sound Protocol Therapy Outcomes in a Pediatric Population

Victoria Cook; Doreen Hunt; Jacek Kolacz

doi:10.18060/25904

Medication and its Effect on Safe & Sound Protocol Therapy Outcomes in a Pediatric Population

Proceedings of IMPRS ◽

10.18060/25904 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Victoria Cook ◽

Doreen Hunt ◽

Jacek Kolacz

Keyword(s):

Treatment Response ◽

Emotional Reactivity ◽

Positive Impact ◽

Synergistic Effects ◽

Pediatric Population ◽

Medication Use ◽

State Regulation ◽

Clinical Practices ◽

Polyvagal Theory ◽

Medication Group

Background and Hypothesis: The current study evaluated the effect of different medications on a child’s response to the Safe & Sound Protocol (SSP) therapy. Informed by the Polyvagal Theory and the evidenced relationship between state regulation and autonomic imbalance, the therapy aims to improve state dysregulation which can manifest in children as emotional reactivity, sensory processing issues, and auditory sensitivities. Prior studies have shown a reduction in auditory hypersensitivities after the SSP therapy plus evidence shows SSRIs and stimulants have a positive impact on hearing in the presence of background noise. We hypothesized that a) the SSP could improve treatment response in those taking neurotransmitter-altering medication due to synergistic effects or b) it could show reduce treatment response due to sensitivities already being managed by medication. Project Methods: Children in the study underwent a month of the SSP therapy with auditory processing standardized parent reports (Brain Body Center Sensory Scale) taken prior to treatment then approximately 1 week and 4 weeks after treatment. The data was then separated into different medication groups: stimulants (n=4), non-stimulant neurotransmitter altering medications (n=4), and other non-neurotransmitter altering medications (n=9) such as albuterol. Non-medication and medication group outcomes were then compared to identify significant differences between the groups using independent and paired samples t-tests. Results: The results from this study found a significant reduced response to the SSP in children taking non-stimulant neurotransmitter altering medications, which included both sertraline, a selective serotonin reuptake inhibitor, and guanfacine, an a2A-adrenergic agonist. In addition, the non-neurotransmitter altering medication group was the only medication group that showed significant improvement in hypersensitivities while each non-medication group improved in hypersensitivity and hyposensitivity. Potential Impact: Commonly-used guidelines for SSP are to maintain typical medication use during the intervention. This study, the first to systematically assess treatment response to the SSP by medication use, could inform how clinicians implement both SSP and medication treatments concurrently. However, these results are based on very small medication groups, therefore follow-up studies with larger samples are necessary to inform current clinical practices.

Download Full-text

The investigation of the state of Ukraine furniture industry development under current economic conditions

Galic'kij ekonomičnij visnik ◽

10.33108/galicianvisnyk_tntu2021.01.174 ◽

2021 ◽

Vol 68 (1) ◽

pp. 174-184

Author(s):

N. Bondarenko ◽

D. Udalykh

Keyword(s):

Positive Impact ◽

State Regulation ◽

Economic Conditions ◽

Foreign Direct Investments ◽

Furniture Industry ◽

Number Increase ◽

Long Time ◽

Business Entities ◽

Design Diversity

Furniture for a long time has been an integral component of human activity, recreation and everyday life. Its design, diversity and versatility along with the development of human civilization is increasingly becoming the object of further improvement. At present furniture production in Ukraine is the developing industry, gradually entering the European market in terms of quality and design. European furniture market is extremely attractive to operators and, therefore, has dynamics towards the competitor number increase. One of the factors of increasing the industry attractiveness is the support of amendments to the Law of Ukraine «On peculiarities of state regulation of business entities related to the sale and export of timber» by the Verkhovna Rada of Ukraine in April 2015, which imposed temporary, gradual prohibition on the export of raw timber (forest logs) for 10 years. The corresponding partial prohibition entered into force on 11.01.2015, and complete prohibition (including pine wood) - from January 1, 2017. The consequences of this moratorium during the first five years of its operation, which is important in the context of politicization of this problem are analyzed in this paper. The dynamics and structure of the amount of enterprises in industry and the number of employees employed in them are investigated. The volume of furniture industry sales in general and the areas of their implementation (internal or external markets) are analyzed. The next stage is the analysis of the dynamics of the ratio of furniture products exports and imports in Ukraine and determination of the major exporters of such products. The final stage is the investigation of the dynamics of foreign direct investments in the enterprises capital share in this industry in order to identify its investment attractiveness. As a result, it is determined that the introduced moratorium has partial positive impact on the development of furniture industry in Ukraine. However, at present, the furniture industry is not attractive enough for new foreign investment. This is the consequence of significant amount of «shadow» production, which in its turn destabilizes the situation in the furniture market. Ukrainian manufacturers will be able to strengthen their position in domestic market and even abroad, if they solve the main problems in furniture production and eliminate all disincentives.

Download Full-text

Positive Impact of Technician-Driven MTM Program on Performance Measures

Journal of Pharmacy Practice ◽

10.1177/0897190018801107 ◽

2018 ◽

Vol 33 (3) ◽

pp. 283-286

Author(s):

Leslie D. Moore ◽

Megan G. Smith

Keyword(s):

High Risk ◽

Performance Measures ◽

Positive Impact ◽

Medication Use ◽

Renin Angiotensin System ◽

Quality Performance ◽

Part D ◽

Medication Therapy ◽

Pharmacy Quality ◽

Pharmacy Chain

Objective: To determine the effect of using a technician-driven medication therapy management (MTM) program on quality performance measures for a community pharmacy chain. Methods: A technician-driven MTM program was incorporated in 35 stores of a regional supermarket pharmacy chain. The overall chain percentage score for the 4 quality measures used in Medicare Part D Star Ratings—proportion of days covered (PDC) for cholesterol, diabetes, renin–angiotensin system antagonists (RASA), and high-risk medication use—was compared pre- and postimplementation of the technician-driven MTM program. Data were collected from Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) platform and t tests were used to analyze 1 year pre- and postimplementation. Results: The PDC for RASA, high cholesterol medications, and diabetes medications significantly increased pre- to postimplementation for each drug class ( P < .001, P = .011, P = .001, respectively). The combined overall mean PDC score for RASA, cholesterol medications, and diabetes medication classes significantly increased by 5.6% from 2015 to 2016 (74.2% vs 79.8%, P < .001); there was also a nonsignificant decrease in high-risk medication use for the entire chain. Conclusions This technician-driven MTM program can positively affect pharmacy quality performance and potentially improve patient outcomes.

Download Full-text

Synergistic Effects of FGF-18 and TGF-β3 on the Chondrogenesis of Human Adipose-Derived Mesenchymal Stem Cells in the Pellet Culture

Stem Cells International ◽

10.1155/2018/7139485 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Liangjie Huang ◽

Lingxian Yi ◽

Chunli Zhang ◽

Ying He ◽

Liangliang Zhou ◽

...

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Chondrogenic Differentiation ◽

Positive Impact ◽

Synergistic Effects ◽

Cartilage Regeneration ◽

Matrix Deposition ◽

Cell Based Therapy ◽

Chondrogenic Potential

Cell-based therapy serves as an effective way for cartilage repair. Compared with a limited source of autologous chondrocytes, adipose-derived stem cells (ADSCs) are proposed as an attractive cell source for cartilage regeneration. How to drive chondrogenic differentiation of ADSCs efficiently remains to be further investigated. TGF-β3 has shown a strong chondrogenic action on ADSCs. Recently, fibroblast growth factor 18 (FGF-18) has gained marked attention due to its anabolic effects on cartilage metabolism, but existing data regarding the role of FGF-18 on the chondrogenic potential of mesenchymal stem cells (MSCs) are conflicting. In addition, whether the combined application of FGF-18 and TGF-β3 would improve the efficiency of the chondrogenic potential of ADSCs has not been thoroughly studied. In the current study, we isolated human ADSCs and characterized the expression of their surface antigens. Also, we evaluated the chondrogenic potential of FGF-18 on ADSCs using an in vitro pellet model by measuring glycosaminoglycan (GAG) content, collagen level, histologic appearance, and expression of cartilage-related genes. We found that FGF-18, similarly to TGF-β3, had a positive impact on chondrogenic differentiation and matrix deposition when presented throughout the culture period. More importantly, we observed synergistic effects of FGF-18 and TGF-β3 on the chondrogenic differentiation of ADSCs in the in vitro pellet model. Our results provide critical information on the therapeutic use of ADSCs with the help of FGF-18 and TGF-β3 for cartilage regeneration.

Download Full-text

PRIORITY DIRECTIONS OF REALIZATION OF THE INSTRUMENTS FOR FINANCING SMALL AND MEDIUM ENTERPRISES IN MODERN CONDITIONS: REGIONAL COMPARISON

Scientific bulletin of the Southern Institute of Management ◽

10.31775/2305-3100-2017-2-82-87 ◽

2017 ◽

pp. 82-87

Author(s):

I. P. Vishnyakov

Keyword(s):

Financial Services ◽

Small Businesses ◽

Positive Impact ◽

Small And Medium Enterprises ◽

Banking System ◽

Special Kind ◽

Developed Countries ◽

State Regulation ◽

Special Role ◽

Medium Enterprises

The article considers the problem of supporting small and medium businesses in the southern Federal district and Rostov region. The topic is relevant, because on small and medium enterprises hold the economy of the developed countries. The development of the microcredit sector in Russia and market development of financial services requires the theoretical study and practical resolution of issues that are associated with the organization levers of the financial interaction between the public and private sectors of the economy, the development of the legal base and state regulation. Special attention is paid to the problem of microcrediting of small businesses, with a description of regional programs of support and analysis specific amounts of subsidies and microcredit, the conditions of issuance, etc.. The specifics of microfinance organizations and credit organizations of a special kind, their special role and positive impact on the economic processes in Russia, which is reflected in the demand for loans to enterprises medium and small businesses and strengthening the flow of capital through the provision of loans to enterprises of the real sector of the economy, and participation in the transformation of the banking system, to ensure the flexibility of the financial system and the functioning of the differentiated structure of the banking organizations in Russia.

Download Full-text

Status Epilepticus Mortality Risk Factors and a Correlation Survey with the Newly Modified STESS

Healthcare ◽

10.3390/healthcare9111570 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1570

Author(s):

Tzu-Hsin Huang ◽

Ming-Chi Lai ◽

Yu-Shiue Chen ◽

Chin-Wei Huang

Keyword(s):

Status Epilepticus ◽

Predictive Accuracy ◽

Positive Impact ◽

Mortality Rates ◽

Underlying Disease ◽

Clinical Practices ◽

Predictive Capacity ◽

Prediction Of Mortality ◽

The Status ◽

Prediction Of Prognosis

Background: Status epilepticus (SE) is a neurological emergency and is usually associated with significant morbidity and mortality rates. Several clinical scales have been proposed to predict the clinical outcome of such incidents, including the Status Epilepticus Severity Score (STESS), the modified STESS (mSTESS), and the Encephalitis-Nonconvulsive Status Epilepticus-Diazepam Resistance-Image Abnormalities-Tracheal intubation (END-IT). Nevertheless, there is still a need for a more practical and precise predictive scale. Methods: This is a retrospective cohort study which examines data from patients with SE in our Department of Neurology between 2009 and 2020. Based on the outcome of each case, the patients were divided into survivor and non-survivor groups. We analyzed the independent factors and adjusted the STESS to achieve a better prediction of prognosis. The predictive accuracy of our new STESS scale was then compared with that of the mSTESS and the END-IT. Results: Data on a total of 59 patients were collected, with 6 of them classified as non-survivors. The effects of the variables of age, sex, underlying disease(s), and type(s) of antiepileptic drug (AED) use showed no significant differences between the survivor and non-survivor groups. Importantly, the number of AEDs used in the first week and the use of thiobarbiturates predicted non-survival. We adjusted the STESS to create the newly modified STESS (nSTESS), which showed a better predictive capacity than the STESS, the mSTESS, and the END-IT. Conclusions: Our adjustment of the STESS with the addition of the factors “number of AEDs within the first week” and “use of thiobarbiturates”, could have a positive impact on the prediction of mortality rates compared with currently used scales. This nSTESS could potentially be useful in clinical practices, for the early prediction of outcomes for patients with SE.

Download Full-text

Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620944781 ◽

2020 ◽

Vol 57 (10) ◽

pp. 1238-1246 ◽

Cited By ~ 1

Author(s):

Rami S. Kantar ◽

Corstiaan C. Breugem ◽

Kristen Keith ◽

Serena Kassam ◽

Charanya Vijayakumar ◽

...

Keyword(s):

Clinical Practice ◽

Cleft Lip ◽

Positive Impact ◽

Clinical Practices ◽

Medium Term ◽

Short Term ◽

Cross Sectional Survey ◽

Educational Tools ◽

Simulation Based ◽

Cleft Surgery

Objective: Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. Design: Cross-sectional survey-based evaluation. Setting: Simulation-based comprehensive cleft care workshop. Participants: Total of 180 participants. Interventions: Three-day simulation-based comprehensive cleft care workshop. Main Outcome Measures: Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. Results: The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. Conclusion: Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants’ clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.

Download Full-text

Role of endoscopic ultrasound in pediatric gastrointestinal diseases

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.193738 ◽

2016 ◽

Vol 07 (03) ◽

pp. 104-109

Author(s):

Rajiv Ranjan Singh ◽

Narendra Singh Choudhary ◽

Rajesh Puri

Keyword(s):

Endoscopic Ultrasound ◽

Positive Impact ◽

Pediatric Population ◽

Fluid Collection ◽

Gastrointestinal Diseases ◽

Therapeutic Modality ◽

Celiac Plexus Block ◽

Pancreatic Fluid Collection ◽

Recurrent Acute Pancreatitis ◽

Submucosal Lesions

AbstractEndoscopic ultrasound (EUS) is a well-established diagnostic and therapeutic modality for adults. It is extremely helpful for a broad range of diagnostic indications including upper gastrointestinal (GI) malignancies, submucosal lesions, pancreatic lesions (masses, cystic lesions), chronic pancreatitis, etiological workup of recurrent acute pancreatitis, common bile duct evaluation (calculi versus tumor), gallbladder lesions/microliths, and rectal malignancy; well-established therapeutic roles include fine-needle aspiration of lesions/lymph nodes, pancreatic fluid collection drainage, pancreatic duct drainage, biliary drainage, gallbladder drainage, pelvic abscess drainage, celiac plexus block, or neurolysis. Some recent studies have reported the use of EUS in the pediatric population. EUS is safe and easy to perform in the pediatric population also. However, there is paucity of data on use of EUS in pediatric population. In contrast with its regular therapeutic use in adults, EUS is not commonly performed in children for therapeutic reasons and most of the data are available on diagnostic use only. All of studies have shown that EUS is safe and a useful modality with a positive impact on management in majority of study population. EUS is very useful in pediatric population for the evaluation of upper GI tract submucosal lesions or rectal masses, pancreaticobiliary disorders, characterization of esophageal strictures, and for evaluation of enteric duplication cysts. The advent of miniprobe that can be passed through conventional endoscopes has increased the applicability of EUS in infants and children. Although there are limited data regarding use of EUS in pediatric population, it appears to be a very promising diagnostic and therapeutic tool.

Download Full-text

Assessment and Management of Delirium in the Pediatric Intensive Care Unit: A Review

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1730918 ◽

2021 ◽

Author(s):

Caren Liviskie ◽

Christopher McPherson ◽

Caitlyn Luecke

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Adverse Effects ◽

Pediatric Intensive Care Unit ◽

Positive Impact ◽

Pediatric Population ◽

Pediatric Intensive Care ◽

Signs And Symptoms ◽

Screening Tools ◽

Oral Medications

AbstractMany critically ill patients suffer from delirium which is associated with significant morbidity and mortality. There is a paucity of data about the incidence, symptoms, or treatment of delirium in the pediatric intensive care unit (PICU). Risk factors for delirium are common in the PICU including central nervous system immaturity, developmental delay, mechanical ventilation, and use of anticholinergic agents, corticosteroids, vasopressors, opioids, or benzodiazepines. Hypoactive delirium is the most common subtype in pediatric patients; however, hyperactive delirium has also been reported. Various screening tools are validated in the pediatric population, with the Cornell Assessment of Pediatric Delirium (CAPD) applicable to the largest age range and able to detect signs and symptoms consistent with both hypo- and hyperactive delirium. Treatment of delirium should always include identification and reversal of the underlying etiology, reserving pharmacologic management for those patients without symptom resolution, or with significant impact to medical care. Atypical antipsychotics (olanzapine, quetiapine, and risperidone) should be used first-line in patients requiring pharmacologic treatment owing to their apparent efficacy and low incidence of reported adverse effects. The choice of atypical antipsychotic should be based on adverse effect profile, available dosage forms, and consideration of medication interactions. Intravenous haloperidol may be a potential treatment option in patients unable to tolerate oral medications and with significant symptoms. However, given the high incidence of serious adverse effects with intravenous haloperidol, routine use should be avoided. Dexmedetomidine should be used when sedation is needed and when clinically appropriate, given the positive impact on delirium. Additional well-designed trials assessing screening and treatment of PICU delirium are needed.

Download Full-text

Defining the Path Forward for Biomarkers to Address Unmet Needs in Inflammatory Bowel Diseases

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa210 ◽

2020 ◽

Vol 26 (10) ◽

pp. 1451-1462

Author(s):

Gerard Honig ◽

Caren Heller ◽

Andrés Hurtado-Lorenzo

Keyword(s):

Disease Activity ◽

Disease Progression ◽

Treatment Response ◽

Inflammatory Bowel Diseases ◽

Unmet Needs ◽

Positive Impact ◽

Response Monitoring ◽

Disease Course ◽

Bowel Diseases ◽

Inflammatory Bowel

Abstract Despite major advances in the inflammatory bowel diseases field, biomarkers to enable personalized and effective management are inadequate. Disease course and treatment response are highly variable, with some patients experiencing mild disease progression, whereas other patients experience severe or complicated disease. Periodic endoscopy is performed to assess disease activity; as a result, it takes months to ascertain whether a treatment is having a positive impact on disease progression. Minimally invasive biomarkers for prognosis of disease course, prediction of treatment response, monitoring of disease activity, and accurate diagnosis based on improved disease phenotyping and classification could improve outcomes and accelerate the development of novel therapeutics. Rapidly developing technologies have great potential in this regard; however, the discovery, validation, and qualification of biomarkers will require partnerships including academia, industry, funders, and regulators. The Crohn’s & Colitis Foundation launched the IBD Biomarker Summit to bring together key stakeholders to identify and prioritize critical unmet needs; prioritize promising technologies and consortium approaches to address these needs; and propose harmonization approaches to improve comparability of data across studies. Here, we summarize the outcomes of the 2018 and 2019 meetings, including consensus-based unmet needs in the clinical and drug development context. We highlight ongoing consortium efforts and promising technologies with the potential to address these needs in the near term. Finally, we summarize actionable recommendations for harmonization, including data collection tools for improved consistency in disease phenotyping; standardization of informed consenting; and development of guidelines for sample management and assay validation. Taken together, these outcomes demonstrate that there is an exceptional alignment of priorities across stakeholders for a coordinated effort to address unmet needs of patients with inflammatory bowel diseases through biomarker science.

Download Full-text