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Le Cunff AL, Glover C, Martis BL, Giampietro V, Dommett E. Methodological adjustments for experimental studies including neurodiverse participants: A checklist for before, during, and after laboratory visits. MethodsX 2024; 12:102658. [PMID: 38510933 PMCID: PMC10950872 DOI: 10.1016/j.mex.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
In this paper, we developed an experimental checklist for laboratory experiments including neurodiverse participants, particularly those with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and dyslexia. The checklist suggests additions to the basic requirements for ethical laboratory-based studies with human participants. The suggestions emphasize physical comfort, the agency of participants concerning environmental adjustments, clarity of communication, and a focus on participants' overall well-being. Those methodological guidelines aim to help researchers in facilitating inclusive and accessible laboratory environments for neurodiverse participants in order to: •Enhance research validity by minimizing the influence of factors that affect responses in neuroscience experiments.•Facilitate research recruitment by encouraging continued participation in future studies and increasing word-of-mouth.•Improve research dissemination by fostering a more positive perception of the research process amongst neurodiverse individuals and encouraging community involvement.
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Affiliation(s)
- Anne-Laure Le Cunff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
| | - Caitlin Glover
- School of Engineering and Informatics, University of Sussex, Brighton, BN1 9RH, United Kingdom
| | - Brandon-Lee Martis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
| | - Vincent Giampietro
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
| | - Eleanor Dommett
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
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Grant A, Turner S, Shaw SCK, Williams K, Morgan H, Ellis R, Brown A. "I am afraid of being treated badly if I show it": A cross-sectional study of healthcare accessibility and Autism Health Passports among UK Autistic adults. PLoS One 2024; 19:e0303873. [PMID: 38809913 PMCID: PMC11135756 DOI: 10.1371/journal.pone.0303873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/01/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Autistic people are more likely to experience stigma, communication barriers and anxiety during healthcare. Autism Health Passports (AHPs) are a communication tool that aim to provide information about healthcare needs in a standardised way. They are recommended in research and policy to improve healthcare quality. AIM To explore views and experiences of AHPs among Autistic people from the UK who have been pregnant. METHODS We developed an online survey using a combination of open and closed questions focused on healthcare impairments and views and experiences of AHPs. Data were anlaysed using descriptive statistics, Kruskal-Wallis tests, and content analysis. FINDINGS Of 193 Autistic respondents (54% diagnosed, 22% undergoing diagnosis and 24% self-identifying), over 80% reported anxiety and masking during healthcare always or most of the time. Some significant differences were identified in healthcare (in)accessibility by diagnostic status. Only 4% of participants knew a lot about AHPs, with 1.5% of participants using one at least half of the time. Almost three quarters of respondents had not previously seen an AHP. Open text responses indicated that the biggest barrier to using an AHP was a belief that health professionals would discriminate against Autistic patients. Additional barriers included staff lack of familiarity with AHPs and respondents expecting a negative response to producing an AHP. CONCLUSIONS Our findings suggest that AHPs are not reducing health inequalities for Autistic adults who have been pregnant. Alternative solutions are needed to reduce health inequalities for Autistic people.
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Affiliation(s)
- Aimee Grant
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
| | - Sarah Turner
- Children’s Hospital Research Institute, University of Manitoba, Winnipeg City, Canada
| | - Sebastian C. K. Shaw
- Department of Medical Education, Brighton and Sussex Medical School, Brighton and Hove, United Kingdom
| | - Kathryn Williams
- Autistic UK CIC, Polegate, United Kingdom
- School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Hayley Morgan
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
| | - Rebecca Ellis
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
| | - Amy Brown
- School of Health and Social Care, Swansea University, Swansea, United Kingdom
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Antosh S, Drennan C, Stolfi A, Lawson R, Huntley E, McCullough-Roach R, Hill M, Adelekan T, Vachhrajani S. Use of an adaptive sensory environment in patients with autism spectrum disorder (ASD) in the perioperative environment: a parallel, randomized controlled trial. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100736. [PMID: 38645550 PMCID: PMC11031801 DOI: 10.1016/j.lana.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
Background Patients with autism spectrum disorders (ASD) experience higher rates of perioperative anxiety and are likely to receive premedication. Little is known about nonpharmaceutical interventions which may decrease anxiety. This study aims to evaluate the use of an adaptive sensory environment (ASE) to reduce ASD patient anxiety during the perioperative process. Methods Our feasibility study (ClinicalTrials.govNCT04994613) enrolled 60 patients in two parallel groups randomized to a control (no ASE) or intervention group (ASE). We included all surgical patients aged three to twelve years, with a formal diagnosis of ASD, Asperger's Syndrome, or pervasive developmental disorder not otherwise specified. Preoperative behaviors were recorded by an unblinded nurse utilizing the validated Modified Yale Preoperative Anxiety Scale (mYPAS). The difference in score on the mYPAS was the primary outcome, and an intention-to-treat analysis was employed. A generalized estimating equations model was used to compare mYPAS scores controlling for significant independent variables. Findings 58 patients were analyzed after 1:1 randomization of 30 patients to each group. Groups were balanced except the median number of intraoperative pain medications was significantly lower in the ASE group (1 vs. 3, p = 0.012). Mean (SD) age for all patients was 7.2 (2.9) years, range 2.6-12.7. 72.4% (42/58) were White and all were Non-Hispanic or Latino. 74% were Male (21/30 ASE and 22/28 Control) and 26% were Female (9/30 ASE and 6/28 Control). No differences were found in mYPAS scores between groups at three time periods (43.5 vs. 42, p = 0.88, 47.8 vs. 48.4, p = 0.76, and 36.4 vs. 43.8, p = 0.15, ASE vs. control group, respectively). The ASE group had a significant within-group decrease in mYPAS scores from nursing intake to transition (p = 0.030). Interpretation An ASE did not significantly reduce perioperative anxiety. However, the promising results deserve further investigation. Funding Dayton Children's Hospital Foundation Robert C. Cohn Memorial Research Grant.
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Affiliation(s)
- Sean Antosh
- Department of Anesthesia, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Chelsea Drennan
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Adrienne Stolfi
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Robin Lawson
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Elise Huntley
- Department of Child Life, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Reaundra McCullough-Roach
- Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Hwy., Dayton, OH, 45435, USA
| | - Madelyn Hill
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Tahira Adelekan
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Division of Developmental Pediatrics, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Shobhan Vachhrajani
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Department of Neurosurgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
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Le Cunff AL, Dommett E, Giampietro V. Neurophysiological measures and correlates of cognitive load in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia: A scoping review and research recommendations. Eur J Neurosci 2024; 59:256-282. [PMID: 38109476 DOI: 10.1111/ejn.16201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023]
Abstract
Working memory is integral to a range of critical cognitive functions such as reasoning and decision-making. Although alterations in working memory have been observed in neurodivergent populations, there has been no review mapping how cognitive load is measured in common neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia. This scoping review explores the neurophysiological measures used to study cognitive load in these specific populations. Our findings highlight that electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) are the most frequently used methods, with a limited number of studies employing functional near-infrared spectroscopy (fNIRs), magnetoencephalography (MEG) or eye-tracking. Notably, eye-related measures are less commonly used, despite their prominence in cognitive load research among neurotypical individuals. The review also highlights potential correlates of cognitive load, such as neural oscillations in the theta and alpha ranges for EEG studies, blood oxygenation level-dependent (BOLD) responses in lateral and medial frontal brain regions for fMRI and fNIRS studies and eye-related measures such as pupil dilation and blink rate. Finally, critical issues for future studies are discussed, including the technical challenges associated with multimodal approaches, the possible impact of atypical features on cognitive load measures and balancing data richness with participant well-being. These insights contribute to a more nuanced understanding of cognitive load measurement in neurodivergent populations and point to important methodological considerations for future neuroscientific research in this area.
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Affiliation(s)
- Anne-Laure Le Cunff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eleanor Dommett
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vincent Giampietro
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Iweka E, Holmes S. Addressing the communication needs of cancer patients for Magnetic Resonance Imaging (MRI) investigations-A phenomenological study on the experiences of MRI radiographers. Radiography (Lond) 2024; 30:6-12. [PMID: 37864988 DOI: 10.1016/j.radi.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION A higher demand in MRI services could increase the pressure on MRI departments to increase scanning efficiency. This presents the risk of downplaying person-centred care especially for cancer patients with increased communication needs that result from anxiety associated with the nature of their disease. This study explored the experiences of MRI radiographers in addressing the communication needs of cancer patients attending for MRI examinations. METHODS The study adopted a descriptive phenomenological methodology. Single contact interviews were conducted on eight MRI specialist radiographers, and these were recorded and transcribed using Microsoft Teams conferencing platform. Thematic analysis of the transcribed data was done through an inductive approach, breaking down the data into meaningful codes and thereafter, into themes and sub-themes. RESULTS Common themes generated from the interview data included: identified communication needs, approach to communication needs, support for radiographers and factors affecting communication. Experiences of MRI radiographers indicated increased communication needs in anxious cancer patients and approaches adopted in addressing these were mainly through listening and use of empathetic gestures. Some radiographers admitted to using "blocking" strategies to avoid being drawn into emotionally exhausting conversations. Both intrinsic factors such as radiographers' personality and experience; and extrinsic factors such as time constraints, demanding workload, inadequate staffing, and skill mix were noted to influenced MRI radiographers in addressing these communication needs. CONCLUSION Cancer patients can present with communication needs due to anxieties related to their disease. For the radiographer to deal with these needs, adequate support is needed, and necessary steps taken to address the identified influencing factors. IMPLICATIONS FOR PRACTICE MRI departments should encourage enabling environment and services that address communication needs of patients with cancer.
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Affiliation(s)
- E Iweka
- Research/Clinical Trials, Radiology, University Hospitals of Derby and Burton NHS Foundation Trust, UK.
| | - S Holmes
- Scottish Academy of Breast Imaging (SABI), Glasgow, UK.
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Stogiannos N, Pavlopoulou G, Papadopoulos C, Walsh G, Potts B, Moqbel S, Gkaravella A, McNulty J, Simcock C, Gaigg S, Bowler D, Marais K, Cleaver K, Lloyd JH, Dos Reis CS, Malamateniou C. Strategies to improve the magnetic resonance imaging experience for autistic individuals: a cross-sectional study exploring parents and carers' experiences. BMC Health Serv Res 2023; 23:1375. [PMID: 38062422 PMCID: PMC10704820 DOI: 10.1186/s12913-023-10333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Autistic individuals encounter numerous barriers in accessing healthcare, including communication difficulties, sensory sensitivities, and a lack of appropriate adjustments. These issues are particularly acute during MRI scans, which involve confined spaces, loud noises, and the necessity to remain still. There remains no unified approach to preparing autistic individuals for MRI procedures. METHODS A cross-sectional online survey was conducted with parents and carers of autistic individuals in the UK to explore their experiences, barriers, and recommendations concerning MRI scans. The survey collected demographic information and experiential accounts of previous MRI procedures. Quantitative data were analysed descriptively, while key themes were identified within the qualitative data through inductive thematic analysis. RESULTS Sixteen parents/carers participated. The majority reported difficulties with communication, inadequate pre-scan preparation, and insufficient adjustments during MRI scans for their autistic children. Key barriers included an overwhelming sensory environment, radiographers' limited understanding of autism, and anxiety stemming from uncertainties about the procedure. Recommended improvements encompassed accessible communication, pre-visit familiarisation, noise-reduction and sensory adaptations, staff training on autism, and greater flexibility to meet individual needs. CONCLUSIONS There is an urgent need to enhance MRI experiences for autistic individuals. This can be achieved through improved staff knowledge, effective communication strategies, thorough pre-scan preparation, and tailored reasonable adjustments. Co-producing clear MRI guidelines with the autism community could standardise sensitive practices. An individualised approach is crucial for reducing anxiety and facilitating participation. Empowering radiographers through autism-specific education and incorporating insights from autistic individuals and their families could transform MRI experiences and outcomes.
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Affiliation(s)
- Nikolaos Stogiannos
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
- Medical Imaging Department, Corfu General Hospital, Corfu, Greece
| | - Georgia Pavlopoulou
- Department of Psychology and Human Development, University College London, Institute of Education Group for Research in Relationships in NeuroDiversity-GRRAND, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Chris Papadopoulos
- Institute for Health Research, University of Bedfordshire, Putteridge Bury Campus, Luton, UK.
| | - Gemma Walsh
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Ben Potts
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
- Southampton General Hospital, University Hospitals Southampton Foundation Trust, Southampton, UK
| | - Sarah Moqbel
- Anna Freud National Centre for Children and Families, London, UK
| | | | - Jonathan McNulty
- School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Clare Simcock
- Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, London, UK
| | - Sebastian Gaigg
- Department of Psychology, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Dermot Bowler
- Department of Psychology, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Keith Marais
- Community Involvement, University of London, London, UK
| | - Karen Cleaver
- Faculty of Education, Health & Human Sciences, University of Greenwich, London, UK
| | - Jane Harvey Lloyd
- Department of Specialist Science Education, University of Leeds, Leeds, UK
| | - Cláudia Sá Dos Reis
- School of Health Sciences (HESAV), University of Applied Sciences Western Switzerland (HES- SO), Lausanne, CH, Switzerland
| | - Christina Malamateniou
- Department of Midwifery & Radiography, School of Health and Psychological Sciences, City, University of London, London, UK
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Moretti R, Meffe G, Annunziata S, Capotosti A. Innovations in imaging modalities: a comparative review of MRI, long-axial field-of-view PET, and full-ring CZT-SPECT in detecting bone metastases. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:259-270. [PMID: 37870526 DOI: 10.23736/s1824-4785.23.03537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
The accurate diagnosis of bone metastasis, a condition in which cancer cells have spread to the bone, is essential for optimal patient care and outcome. This review provides a detailed overview of the current medical imaging techniques used to detect and diagnose this critical condition focusing on three cardinal imaging modalities: positron emission tomography (PET), single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Each of these techniques has unique advantages: PET/CT combines functional imaging with anatomical imaging, allowing precise localization of metabolic abnormalities; the SPECT/CT offers a wider range of radiopharmaceuticals for visualizing specific receptors and metabolic pathways; MRI stands out for its unparalleled ability to produce high-resolution images of bone marrow structures. However, as this paper shows, each modality has its own limitations. The comprehensive analysis does not stop at the technical aspects, but ventures into the wider implications of these techniques in a clinical setting. By understanding the synergies and shortcomings of these modalities, healthcare professionals can make diagnostic and therapeutic decisions. Furthermore, at a time when medical technology is evolving at a breakneck pace, this review casts a speculative eye towards future advances in the field of bone metastasis imaging, bridging the current state with future possibilities. Such insights are essential for both clinicians and researchers navigating the complex landscape of bone metastasis diagnosis.
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Affiliation(s)
- Roberto Moretti
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guenda Meffe
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Salvatore Annunziata
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Amedeo Capotosti
- Department of Diagnostic Imaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy -
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Kaneko T, Nakamura T, Ryokawa A, Washizuka S, Kitoh Y, Fujinaga Y. Connective differences between patients with depression with and without ASD: A case-control study. PLoS One 2023; 18:e0289735. [PMID: 37582068 PMCID: PMC10427005 DOI: 10.1371/journal.pone.0289735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Researchers find it difficult to distinguish between depression with ASD (Depress-wASD) and without ASD (Depression) in adult patients. We aimed to clarify the differences in brain connectivity between patients with depression with ASD and without ASD. METHODS From April 2017 to February 2019, 22 patients with suspected depression were admitted to the hospital for diagnosis or follow-up and met the inclusion criteria. The diagnosis was determined according to the Diagnostic and Statistical Manual of Mental Disorders-5 by skilled psychiatrists. The Hamilton Depression Rating Scale (HAM-D), Young Mania Raging Scale (YMRS), Mini-International Neuropsychiatric Interview, Parent-interview ASD Rating Scale-Text Revision (PARS-TR), and Autism-Spectrum Quotient-Japanese version (AQ-J) were used to assess the patients' background and help with diagnosis. Resting-state functional magnetic resonance imaging (rs-fMRI) was performed using the 3-T-MRI system. rs-fMRI was processed using the CONN functional connectivity toolbox. Voxel-based morphometry was performed using structural images. RESULTS No significant difference was observed between the Depress-wASD and Depression groups using the HAM-D, YMRS, AQ-J, Intelligence Quotient (IQ), and verbal IQ results. rs-fMRI for the Depress-wASD group indicated a positive connection between the salience network (SN) and right supramarginal gyrus (SMG) and a negative connection between the SN and hippocampus and para-hippocampus than that for the Depression group. No significant structural differences were observed between the groups. CONCLUSIONS We identified differences in the SN involving the SMG and hippocampal regions between the Depress-wASD and Depression groups.
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Affiliation(s)
- Tomoki Kaneko
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Toshinori Nakamura
- Department of Psychology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akiko Ryokawa
- Department of Psychology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shinsuke Washizuka
- Department of Psychology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yoshihiro Kitoh
- Department of Radiology, Shinshu University Hospital, Matsumoto, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Molloy CJ, Cooke J, Gatford NJF, Rivera-Olvera A, Avazzadeh S, Homberg JR, Grandjean J, Fernandes C, Shen S, Loth E, Srivastava DP, Gallagher L. Bridging the translational gap: what can synaptopathies tell us about autism? Front Mol Neurosci 2023; 16:1191323. [PMID: 37441676 PMCID: PMC10333541 DOI: 10.3389/fnmol.2023.1191323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/24/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple molecular pathways and cellular processes have been implicated in the neurobiology of autism and other neurodevelopmental conditions. There is a current focus on synaptic gene conditions, or synaptopathies, which refer to clinical conditions associated with rare genetic variants disrupting genes involved in synaptic biology. Synaptopathies are commonly associated with autism and developmental delay and may be associated with a range of other neuropsychiatric outcomes. Altered synaptic biology is suggested by both preclinical and clinical studies in autism based on evidence of differences in early brain structural development and altered glutamatergic and GABAergic neurotransmission potentially perturbing excitatory and inhibitory balance. This review focusses on the NRXN-NLGN-SHANK pathway, which is implicated in the synaptic assembly, trans-synaptic signalling, and synaptic functioning. We provide an overview of the insights from preclinical molecular studies of the pathway. Concentrating on NRXN1 deletion and SHANK3 mutations, we discuss emerging understanding of cellular processes and electrophysiology from induced pluripotent stem cells (iPSC) models derived from individuals with synaptopathies, neuroimaging and behavioural findings in animal models of Nrxn1 and Shank3 synaptic gene conditions, and key findings regarding autism features, brain and behavioural phenotypes from human clinical studies of synaptopathies. The identification of molecular-based biomarkers from preclinical models aims to advance the development of targeted therapeutic treatments. However, it remains challenging to translate preclinical animal models and iPSC studies to interpret human brain development and autism features. We discuss the existing challenges in preclinical and clinical synaptopathy research, and potential solutions to align methodologies across preclinical and clinical research. Bridging the translational gap between preclinical and clinical studies will be necessary to understand biological mechanisms, to identify targeted therapies, and ultimately to progress towards personalised approaches for complex neurodevelopmental conditions such as autism.
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Affiliation(s)
- Ciara J. Molloy
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jennifer Cooke
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nicholas J. F. Gatford
- Kavli Institute for Nanoscience Discovery, Nuffield Department of Clinical Neurosciences, University of Oxford, Medical Sciences Division, Oxford, United Kingdom
| | - Alejandro Rivera-Olvera
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sahar Avazzadeh
- Physiology and Cellular Physiology Research Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, University of Galway, Galway, Ireland
| | - Judith R. Homberg
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Joanes Grandjean
- Physiology and Cellular Physiology Research Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, University of Galway, Galway, Ireland
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Cathy Fernandes
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sanbing Shen
- Regenerative Medicine Institute, School of Medicine, University of Galway, Galway, Ireland
- FutureNeuro, The SFI Research Centre for Chronic and Rare Neurological Diseases, Royal College of Surgeons, Dublin, Ireland
| | - Eva Loth
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Deepak P. Srivastava
- MRC Centre for Neurodevelopmental Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
- The Hospital for SickKids, Toronto, ON, Canada
- The Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Toronto, ON, Canada
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Marterosyan J, Gooch J. Neurodivergence and radiology: How medical professionals can optimise the standard of care provided to autistic paediatric patients. Radiography (Lond) 2023; 29:680-683. [PMID: 37187064 DOI: 10.1016/j.radi.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Several studies have been published regarding patients with various neurodevelopmental diagnoses attending hospital appointments, however, few focus on autism and the radiology department. This paper aims to identify how implementing patient-centred strategies and protocols for autistic paediatric patients will benefit the patient pathway and provide a more comfortable experience for those undergoing different scans and procedures within the radiology department. METHODS Using several electronic databases, articles were collected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and analysed with the Critical Appraisals Skills Programme (CASP). DISCUSSION A total of 8 articles are discussed and analysed in this review, focussing specifically on patient-centred procedures and practice, costs of healthcare services and how multidisciplinary teamwork compares to applied behavioural analysis. RESULTS The articles concluded that the current practice of multidisciplinary working is the most beneficial for patients. Furthermore, implementing autism awareness programmes and patient-specific protocols will help reduce anxiety surrounding scans within the radiology department. CONCLUSION AND IMPLICATIONS FOR PRACTICE Implementing mandatory autism awareness programmes and continuing with the multidisciplinary approach for autistic paediatric patients would provide the best possible patient-centred care.
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Affiliation(s)
- J Marterosyan
- Northampton General Hospital, Cliftonville, Northampton, NN1 5BD, UK.
| | - J Gooch
- Kedleston Rd, Derby, DE22 1GB, UK.
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Wang X, Liu X, Mi J. Perioperative management and drug selection for sedated/anesthetized patients undergoing MRI examination: A review. Medicine (Baltimore) 2023; 102:e33592. [PMID: 37083779 PMCID: PMC10118336 DOI: 10.1097/md.0000000000033592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
In recent years, magnetic resonance imaging (MRI) technology has become an indispensable imaging tool owing to significant improvements in MRI that have opened up new diagnostic perspectives. Due to the closed environment, long imaging time, and need to remain still during the examination process, the examiner may cannot cooperate with the completion of the examination of the procedure, which increases the need for deep sedation or anesthesia. Achieving this can sometimes be challenging, especially in the special nontraditional environment of MRI equipment (unfamiliar and narrow spaces, away from patients, strong magnetic fields) and in special populations requiring sedation/anesthesia during examinations, which pose certain challenges for the perioperative anesthesia management of MRI. A simple "checklist" is necessary because it allows the anesthesiologist to become familiar with the particular environment and human and material resources as quickly as possible. For the choice of sedative/anesthetic, the traditional drugs, such as midazolam and ketamine, are still used due to the ease of administration despite their low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, propofol, with high effectiveness and rapid recovery, and sevoflurane, which is mild and nonirritating, are preferred for sedation/anesthesia in children and adults undergoing MRI. Therefore, familiarity with the perioperative management of patient sedation and general anesthesia and drug selection in the MRI environment is critical for successful surgical completion and for the safe and rapid discharge of MRI patients receiving sedation/anesthesia.
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Affiliation(s)
- Xiaoyu Wang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - XueQuan Liu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Junqiao Mi
- Julius-Maximilians-Universität of Würzburg, Würzburg, Germany
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Pediatric Outpatient Noncontrast Brain MRI: A Time-Driven Activity-Based Costing Analysis at Three U.S. Hospitals. AJR Am J Roentgenol 2023; 220:747-756. [PMID: 36541593 DOI: 10.2214/ajr.22.28490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND. MRI utilization and the use of sedation or anesthesia for MRI have increased in children. Emerging alternative payment models (APMs) require a detailed understanding of the health system costs of performing these examinations. OBJECTIVE. The purpose of this study was to use time-driven activity-based costing (TDABC) to assess health system costs for outpatient noncontrast brain MRI examinations across three children's hospitals. METHODS. Direct costs for outpatient noncontrast brain MRI examinations at three academic free-standing pediatric hospitals were calculated using TDABC. Examinations were categorized as sedated MRI (i.e., sedation or anesthesia), nonsedated MRI, or limited MRI. Process maps were created to describe patient workflows based on input from key personnel and direct observation. Time durations for each process activity were determined; time stamps from retrospective EMR review were used when possible. Capacity cost rates were calculated for resource types within three cost categories (labor, equipment, and space); cost was calculated in a fourth category (supplies). Resources were allocated to each activity, and the cost of each process step was determined by multiplying step-specific capacity costs by the time required for each step. The costs of all steps were summed to yield a base-case total examination cost. Sensitivity analysis for sedated MRI was performed using minimum and maximum time duration inputs for each activity to yield minimum and maximum costs by hospital. RESULTS. The mean base-case cost for a sedated brain MRI examination was $842 (range, $775-924 across hospitals), for a nonsedated brain MRI examination was $262 (range, $240-285), and for a limited brain MRI examination was $135 (range, $127-141). For all examination types, the largest cost category as well as the largest source of difference in cost between hospitals was labor. Sensitivity analysis found that the greatest influence on overall cost at each hospital was the duration of the MRI acquisition. CONCLUSION. The health system cost of performing a sedated MRI examination was substantially greater than that of performing a nonsedated MRI examination. However, the cost of each individual examination type did not vary substantially among hospitals. CLINICAL IMPACT. Health systems operating within APMs can use this comparative cost information for purposes of cost reduction efforts and establishment of bundled prices.
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The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review. J Clin Med 2023; 12:jcm12030843. [PMID: 36769490 PMCID: PMC9917582 DOI: 10.3390/jcm12030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.
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