ABSTRACT
Musculoskeletal ultrasound has emerged as a key tool for the diagnosis, prognosis, and management of patients with RA (rheumatoid arthritis) and other rheumatic diseases. The most important sonographic findings in RA include erosions, effusions, synovitis, and tenosynovitis. Investigators have suggested various "optimal" numbers of joints to scan in RA to assess disease activity, gauge treatment response, provide prognostic information, and guide management decisions. The complexity of pediatric sonoanatomy has delayed its validation in juvenile idiopathic arthritis, yet ultrasound reliably measures the extent of synovitis/tenosynovitis and guides precise injections.
Subject(s)
Arthritis, Juvenile/diagnostic imaging , Arthritis, Juvenile/therapy , Arthritis, Rheumatoid/diagnostic imaging , Arthritis, Rheumatoid/therapy , Ultrasonography/methods , Algorithms , HumansABSTRACT
OBJECTIVE: The aim of the study was to describe parents' experiences and the information used when making decisions about tumor necrosis factor-α inhibitor (TNFαi) treatment. METHODS: We interviewed parents of children with Crohn disease (CD) or juvenile idiopathic arthritis who had experience deciding about TNFαi treatment. Interview questions focused on information used to make decisions and factors that influenced decision making. We used thematic analysis for all coding and analysis. Coding structure was developed by a multidisciplinary team review of the initial interviews. Two coders then coded the remaining interviews, compared coding, and resolved disagreements through discussion. Data were analyzed by thematic grouping and then compared between diseases. RESULTS: We interviewed 35 parents. For nearly all parents the decision about TNFαi treatment was the most challenging medical decision they had made; however, parents of children with CD experienced more stress and anxiety than did other parents. Both groups of parents sought information from multiple sources including health care providers, the Internet, and social contacts. They looked for information related to treatment effectiveness, adverse effects, and other individuals' treatment experiences. In CD, information was used to help make the decision, whereas in juvenile idiopathic arthritis it was used to confirm the decision. CONCLUSIONS: The decision-making experience, and associated information seeking, leaves some parents with long-lasting concerns and worry about TNFαi treatment. Providing parents with structured decision-making support may lead to more effective and efficient decision making, decreased psychosocial distress, and, ultimately, improved outcomes for their children.
Subject(s)
Arthritis, Juvenile/drug therapy , Crohn Disease/drug therapy , Decision Making , Parents/education , Patient Education as Topic , Patient Participation , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adolescent , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antirheumatic Agents/adverse effects , Antirheumatic Agents/therapeutic use , Child , Child, Preschool , Female , Hospitals, Pediatric , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Information Seeking Behavior , Male , Needs Assessment , OhioABSTRACT
OBJECTIVES: To determine if the rise in platelet count after transfusion in neonates is associated with platelet yield of the pheresed platelet unit. STUDY DESIGN: Cohort study of infants in a level 3 Neonatal Intensive Care Unit that received single donor platelets (SDP). Platelet rise in infants were compared between 3 groups: underproduction, destruction, and idiopathic. The main outcome variable studied was the rise in platelet count posttransfusion. Statistical analysis included analysis of variance, Pearson correlation, and multivariate linear regression. RESULTS: The gestational age was 28+/-4.5 weeks. The platelet yield was 4.2+/-0.7 (x10(11)) and resultant platelet rise was 71+/-58.6x1000/mm3. Infants with platelet underproduction (n=30) had a greater rise compared with infants with platelet destruction (n=51) after transfusion (95.3+/-58 vs. 59.6+/-57.5x1000/mm3, P=0.01). After controlling for confounding variables, there was no correlation between the platelet yield and platelet rise, but the etiology of the thrombocytopenia remained associated with increased platelet rise. CONCLUSIONS: There was no association between platelet yield of SDP and platelet rise. Infants with thrombocytopenia related to platelet underproduction had a greater rise in platelets after transfusion compared with those with platelet destruction, independent of yield or volume of the SDP transfusion.
