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Weerkamp PMM, Geuens S, Collin P, Goemans N, Vermeulen RJ, De Waele L, Hendriksen JGM, Klinkenberg S. Psychopharmaceutical treatment for neurobehavioral problems in Duchenne muscular dystrophy: a descriptive study using real-world data. Neuromuscul Disord 2023; 33:619-626. [PMID: 37453172 DOI: 10.1016/j.nmd.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
Patients with Duchenne muscular dystrophy (DMD) are at risk to develop neurobehavioral problems. Evidence on how to treat these difficulties is scarce. This descriptive study reports the clinical experience with psychopharmaceutical treatment in 52 patients with DMD. Electronic patient files were searched for patients with DMD that had been treated with psychopharmaceuticals between 2008 and 2022. Information about neurobehavioral symptoms, type of medication, side effects, and behavioral changes were collected. Two independent clinicians used the clinical global impression scale (CGI) to assess severity of the neurobehavioral problems before and the change in symptoms after treatment. Descriptive statistics were used. Our results include 52 males with DMD (mean age 11 years) treated with psychopharmaceuticals of which 55.8% had four or more comorbid neurobehavioral symptoms. The clinical condition was much improved on the GCI in 54.2% treated with methylphenidate, in 38.9% of the patients treated with fluoxetine, and in 22.2% treated with risperidone. Minimal effects and side effects were also reported. In conclusion, patients with DMD may experience severe neurobehavioral symptoms interfering with learning and/or development. Treatment with psychopharmaceuticals can improve these neurobehavioral symptoms, but further research is needed to gain better insights in psychopharmaceutical treatment in patients with DMD.
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Affiliation(s)
- Pien M M Weerkamp
- Kempenhaege, Centre for Neurological Learning Disabilities, Heeze, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Sam Geuens
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Philippe Collin
- Kempenhaege, Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Department of Child and Adolescent Psychiatry, Koraal, Sittard, the Netherlands
| | - Nathalie Goemans
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - R Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Liesbeth De Waele
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Jos G M Hendriksen
- Kempenhaege, Centre for Neurological Learning Disabilities, Heeze, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Kempenhaege, Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Orso M, Migliore A, Polistena B, Russo E, Gatto F, Monterubbianesi M, d'Angela D, Spandonaro F, Pane M. Duchenne muscular dystrophy in Italy: A systematic review of epidemiology, quality of life, treatment adherence, and economic impact. PLoS One 2023; 18:e0287774. [PMID: 37368924 DOI: 10.1371/journal.pone.0287774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE This systematic review aims to update the evidence on Duchenne muscular dystrophy (DMD) in Italy, describing the epidemiology, quality of life (QoL) of patients and caregivers, treatment adherence, and economic impact of DMD. METHODS Systematic searches were conducted in PubMed, Embase and Web of Science up to January 2023. Literature selection process, data extraction and quality assessment were performed by two independent reviewers. Study protocol was registered in PROSPERO (CRD42021245196). RESULTS Thirteen studies were included. The prevalence of DMD in the general population is 1.7-3.4 cases per 100,000, while the birth prevalence is 21.7-28.2 per 100,000 live male births. The QoL of DMD patients and caregivers is lower than that of healthy subjects, and the burden for caregivers of DMD children is higher than that of caregivers of children with other neuromuscular disorders. The compliance of real-world DMD care to clinical guidelines recommendations in Italy is lower than in other European countries. The annual cost of illness for DMD in Italy is € 35,000-46,000 per capita while, adding intangible costs, the total cost amounts to € 70,000. CONCLUSION Although it is a rare disease, DMD represents a significant burden in terms of quality of life of patients and their caregivers, and economic impact.
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Affiliation(s)
- Massimiliano Orso
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
| | - Antonio Migliore
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
| | - Barbara Polistena
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | | | | | | | - Daniela d'Angela
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- University of Rome Tor Vergata, Rome, Italy
| | - Federico Spandonaro
- C.R.E.A. Sanità (Centre for Applied Economic Research in Healthcare), Rome, Italy
- San Raffaele University, Rome, Italy
| | - Marika Pane
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
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Zhang S, Wang S, Dong Y, Chen X, Hu M, Kou S, Zhang C, Wu S, Tian Y. Current care practices for patients with Duchenne muscular dystrophy in China. Brain Dev 2022; 44:623-629. [PMID: 35691779 PMCID: PMC9181563 DOI: 10.1016/j.braindev.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has presented challenges in the care of patients with chronic diseases. We identified the challenges faced by Chinese patients with Duchenne muscular dystrophy (DMD) during the pandemic. METHODS An online cross-sectional survey was conducted between March 27 and June 30, 2021. RESULTS Of the 2105 valid questionnaire responses, 2,056 patients were from non-lockdown areas. In these areas, 42.8% reduced outside daily activities, 49.4% reduced rehabilitation service use, 39.7% postponed regular follow-ups, and 40.8% reported accelerated motor function decline. These figures generally increased for patients from lockdown areas-67.3% reduced outside daily activities, 44.9% reduced rehabilitation service use, 79.6% postponed regular follow-ups, and 55.1% reported accelerated motor function decline. Ambulation loss was most commonly reported in September and March before 2020; however, this trend was absent in 2020. Regarding the informed prices of disease-modifying drugs in Europe and the United States, 86.7% could afford a maximum of one-twentieth of the prices, 8.0% could afford one-tenth of the prices, and only 0.6% of the patients could afford the full prices. CONCLUSIONS Implementation of standardized care for DMD in China is consistent with global practices, and the COVID-19 pandemic has affected the care of patients with chronic diseases worldwide, particularly in lockdown areas. Telemedicine is an effective model for providing healthcare to such patients. Healthcare workers should assist patients and establish more robust chronic disease management systems. Collaboration between governmental and non-governmental entities could address the cost of disease-modifying drugs in China and other developing countries.
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Affiliation(s)
- Shu Zhang
- Research Center for Birth Defects Prevention and Control Technology, Chinese PLA General Hospital, 28 Fu-Xing Road, Beijing 100853, China,Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Shaoxia Wang
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Yuru Dong
- Department of Radiology, Third Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xinyu Chen
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Miao Hu
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Sen Kou
- Department of Neurology, Third Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Chunyan Zhang
- Research Center for Birth Defects Prevention and Control Technology, Chinese PLA General Hospital, 28 Fu-Xing Road, Beijing 100853, China
| | - Shiwen Wu
- Department of Neurology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Yaping Tian
- Research Center for Birth Defects Prevention and Control Technology, Chinese PLA General Hospital, 28 Fu-Xing Road, Beijing 100853, China.
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Barnard AM, Lott DJ, Batra A, Triplett WT, Willcocks RJ, Forbes SC, Rooney WD, Daniels MJ, Smith BK, Vandenborne K, Walter GA. Characterizing Expiratory Respiratory Muscle Degeneration in Duchenne Muscular Dystrophy Using MRI. Chest 2022; 161:753-763. [PMID: 34536384 PMCID: PMC9160975 DOI: 10.1016/j.chest.2021.08.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Expiratory muscle weakness and impaired airway clearance are early signs of respiratory dysfunction in Duchenne muscular dystrophy (DMD), a degenerative muscle disorder in which muscle cells are damaged and replaced by fibrofatty tissue. Little is known about expiratory muscle pathology and its relationship to cough and airway clearance capacity; however, the level of muscle replacement by fat can be estimated using MRI and expressed as a fat fraction (FF). RESEARCH QUESTION How does abdominal expiratory muscle fatty infiltration change over time in DMD and relate to clinical expiratory function? STUDY DESIGN AND METHODS Individuals with DMD underwent longitudinal MRI of the abdomen to determine FF in the internal oblique, external oblique, and rectus abdominis expiratory muscles. FF data were used to estimate a model of expiratory muscle degeneration by using nonlinear mixed effects and a cumulative distribution function. FVC, maximal inspiratory and expiratory pressures, and peak cough flow were collected as clinical correlates to MRI. RESULTS Forty individuals with DMD (aged 6-18 years at baseline) participated in up to five visits over 36 months. Modeling estimated the internal oblique progresses most quickly and reached 50% replacement by fat at a mean patient age of 13.0 years (external oblique, 14.0 years; rectus abdominis, 16.2 years). Corticosteroid-untreated individuals (n = 4) reached 50% muscle replacement by fat 3 to 4 years prior to treated individuals. Individuals with mild clinical dystrophic phenotypes (n = 3) reached 50% muscle replacement by fat 4 to 5 years later than corticosteroid-treated individuals. Internal and external oblique FFs near 50% were associated with maximal expiratory pressures < 60 cm H2O and peak cough flows < 270 L/min. INTERPRETATION These data improve understanding of the early phase of respiratory compromise in DMD, which typically presents as airway clearance dysfunction prior to the onset of hypoventilation, and links expiratory muscle fatty infiltration to pulmonary function measures.
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Affiliation(s)
- Alison M Barnard
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Donovan J Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Abhinandan Batra
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | | | | | - Sean C Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | | | - Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | | | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL.
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Conway KM, Grosse SD, Ouyang L, Street N, Romitti PA. Direct costs of adhering to selected Duchenne muscular dystrophy care considerations: estimates from a Midwestern state. Muscle Nerve 2022; 65:574-580. [PMID: 35064961 PMCID: PMC9109677 DOI: 10.1002/mus.27505] [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: 11/26/2020] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION/AIMS The multidisciplinary Duchenne muscular dystrophy (DMD) Care Considerations were developed to standardize care and improve outcomes. We provide cumulative cost estimates for selected key preventive (i.e., excluding new molecular therapies and acute care) elements of the care considerations in eight domains (neuromuscular, rehabilitation, respiratory, cardiac, orthopedic, gastrointestinal, endocrine, psychosocial management) independent of completeness of uptake or provision of non-preventive care. METHODS We used de-identified insurance claims data from a large Midwestern commercial health insurer during 2018. We used Current Procedural Terminology and National Drug codes to extract unit costs for clinical encounters representing key preventive elements of the DMD Care Considerations. We projected per-patient cumulative costs from ages 5 to 25 years for these elements by multiplying a schedule of recommended frequencies of preventive services by unit costs in 2018 US dollars. RESULTS Assuming a diagnosis at age 5 years, independent ambulation until age 11, and survival until age 25, we estimated 670 billable clinical events. The 20-year per-patient cumulative cost was $174,701 with prednisone ($2.3 million with deflazacort) and an expected total of $12,643 ($29,194) for out-of-pocket expenses associated with those events and medications. DISCUSSION Standardized monitoring of disease progression and treatments may reduce overall costs of illness. Costs associated with these services would be needed to quantify potential savings. Our approach demonstrates a method to estimate costs associated with implementation of preventive care schedules.
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Affiliation(s)
- Kristin M Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lijing Ouyang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natalie Street
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
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Heutinck L, Houwen-van Opstal SL, Krom YD, Niks EH, Verschuuren JJ, Jansen M, de Groot IJ. Compliance to DMD Care Considerations in the Netherlands. J Neuromuscul Dis 2021; 8:927-938. [PMID: 34120911 PMCID: PMC8673507 DOI: 10.3233/jnd-210670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE To optimize care for patients with DMD, it is essential to know to what extent current care complies with the recommended monitoring frequencies suggested by the DMD care considerations. The objective of this study was to investigate the current care for patients with DMD in the Netherlands and to what extent the care complies with the international care considerations. METHODS A cross-sectional questionnaire was carried out among the Dutch DMD patients and caregivers about the patients' functional and health status, visits to healthcare professionals, clinical tests and assessments, therapy, medication use and access to medical aids and devices. Compliance to guidelines was defined by comparing the frequency of visits to health care providers and clinical tests with the recommended frequencies derived from the care considerations of 2010. RESULTS Eighty-four participants completed the questionnaire. The majority of participants met the recommended visit frequencies to a neuromuscular specialist and cardiologist. Compliance was suboptimal for respiratory assessments in the non-ambulatory phase, monitoring of side effects of corticosteroid use and neuromuscular assessments. Disease specific information supply was perceived as sufficient and participants were satisfied with the received care. CONCLUSIONS This study identifies areas in which compliance is lacking. Countries, such as the Netherlands, working according to a shared care system require easy and low-threshold communication between health care centers and a clear division of roles and responsibilities to reach optimal compliance. In the Netherlands the Duchenne Center Netherlands has the coordinating role.
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Affiliation(s)
- Lotte Heutinck
- Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.,Duchenne Center Netherlands; Leiden University Medical Center Leiden, Leiden; Kempenhaeghe, Center for Neurological Learning Disabilities, Heeze; Radboudumc University Nijmegen Medical Center, Nijmegen; European Reference Network center, The Netherlands
| | - Saskia Ls Houwen-van Opstal
- Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.,Duchenne Center Netherlands; Leiden University Medical Center Leiden, Leiden; Kempenhaeghe, Center for Neurological Learning Disabilities, Heeze; Radboudumc University Nijmegen Medical Center, Nijmegen; European Reference Network center, The Netherlands
| | - Yvonne D Krom
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Duchenne Center Netherlands; Leiden University Medical Center Leiden, Leiden; Kempenhaeghe, Center for Neurological Learning Disabilities, Heeze; Radboudumc University Nijmegen Medical Center, Nijmegen; European Reference Network center, The Netherlands
| | - Erik H Niks
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Duchenne Center Netherlands; Leiden University Medical Center Leiden, Leiden; Kempenhaeghe, Center for Neurological Learning Disabilities, Heeze; Radboudumc University Nijmegen Medical Center, Nijmegen; European Reference Network center, The Netherlands
| | - Jan Jgm Verschuuren
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Duchenne Center Netherlands; Leiden University Medical Center Leiden, Leiden; Kempenhaeghe, Center for Neurological Learning Disabilities, Heeze; Radboudumc University Nijmegen Medical Center, Nijmegen; European Reference Network center, The Netherlands
| | - Merel Jansen
- Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.,Duchenne Center Netherlands; Leiden University Medical Center Leiden, Leiden; Kempenhaeghe, Center for Neurological Learning Disabilities, Heeze; Radboudumc University Nijmegen Medical Center, Nijmegen; European Reference Network center, The Netherlands
| | - Imelda Jm de Groot
- Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.,Duchenne Center Netherlands; Leiden University Medical Center Leiden, Leiden; Kempenhaeghe, Center for Neurological Learning Disabilities, Heeze; Radboudumc University Nijmegen Medical Center, Nijmegen; European Reference Network center, The Netherlands
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Hurvitz MS, Bhattacharjee R, Lesser DJ, Skalsky AJ, Orr JE. Determinants of usage and non-adherence to noninvasive ventilation in children and adults with Duchenne muscular dystrophy. J Clin Sleep Med 2021; 17:1973-1980. [PMID: 33949945 DOI: 10.5664/jcsm.9400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Duchenne muscular dystrophy (DMD) is a neuromuscular disorder that leads to chronic respiratory insufficiency and failure. Use of home noninvasive ventilation (NIV) has been linked to improved outcomes including reduced mortality. Despite the importance of NIV, factors promoting optimal NIV usage and determinants of non-adherence have not been rigorously examined. Moreover, given that respiratory issues in DMD span between childhood and adulthood, examination across a broad age group is needed. The objectives of this study were to (1) evaluate NIV usage across a broad spectrum of DMD patients including both children and adults; and (2) identify biological and socioeconomic determinants of NIV usage and NIV non-adherence. METHODS We performed a retrospective review of all DMD patients from Feb 2016 to Feb 2020 who underwent evaluation at associated pediatric and adult neuromuscular disease clinics. NIV use was determined objectively from device downloads. A priori, we defined non-adherence as <4 hours use per night, quantified as the percentage of nights below this threshold across a 30-day period within 6 months of a clinic visit. We also assessed the average hours of NIV usage over this time period. Predictors examined included demographics, social determinants, and pulmonary function. RESULTS 33 patients with DMD were identified, 29 (87%) of whom were using NIV (13 age < 21 years). Mean age was 22.9±6.6 years (range 13-39 years), BMI was 23.4±10.4 kg/m², and seated forced vital capacity (FVC) was 23%±18% predicted. Mean nightly NIV usage was 7.4±3.8 hours and mean percentage of non-adherent nights was 13%±30%. In univariable analysis, age did not predict use. Those with lower FVC had higher NIV usage hours (p=0.01) and a trend toward less non-adherence (p=0.06). Higher estimated household income demonstrated a trend towards increased usage hours and less non-adherence (both p=0.08). Multivariable analysis found increased usage hours were predicted best by higher income, higher IPAP, and higher bicarbonate. Non-adherence was higher in those with lower income or higher FVC. CONCLUSIONS In this cohort of adult and pediatric DMD patients, most individuals were using NIV. While usage hours were higher with lower lung function, substantial variability remains unexplained by examined factors. Non-adherence was observed in some individuals, including those with advanced disease. Further investigations should focus on evaluating patient-oriented outcomes in order to define optimal NIV usage across the spectrum of disease, and determine strategies to counteract issues with non-adherence.
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Affiliation(s)
- Manju S Hurvitz
- Department of Pediatrics, Division of Respiratory Medicine, Rady Children's Hospital San Diego University of California San Diego, San Diego, CA
| | - Rakesh Bhattacharjee
- Department of Pediatrics, Division of Respiratory Medicine, Rady Children's Hospital San Diego University of California San Diego, San Diego, CA
| | - Daniel J Lesser
- Department of Pediatrics, Division of Respiratory Medicine, Rady Children's Hospital San Diego University of California San Diego, San Diego, CA
| | - Andrew J Skalsky
- Department of Orthopedics, Division of Rehabilitation Medicine, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | - Jeremy E Orr
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA
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8
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Heutinck L, van Gameren M, Verschuuren JJ, Geurts AC, Jansen M, de Groot IJ. Clinical Management of Duchenne Muscular Dystrophy in the Netherlands: Barriers to and Proposals for the Implementation of the International Clinical Practice Guidelines. J Neuromuscul Dis 2021; 8:503-512. [PMID: 33814457 PMCID: PMC8461703 DOI: 10.3233/jnd-200586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In order to successfully implement the international clinical care guidelines for Duchenne muscular dystrophy (DMD) in the Netherlands, it is essential to know what barriers are experienced by healthcare practitioners regarding guideline adherence and organization of care. In the Netherlands, academic medical centers provide follow up visits and work together with peripheral hospitals, rehabilitation centers, centers for home ventilation and primary care centers for treatment. OBJECTIVE To investigate perceived barriers to international clinical DMD guideline adherence and identify potential areas of improvement for implementation in the Dutch 'shared care' organization. METHODS Semi-structured in-depth interviews with healthcare practitioners of academic medical hospitals and questionnaires for healthcare practitioners of rehabilitation centers, based on the framework of Cabana. RESULTS The analyses identified 4 barriers for non-adherence to the DMD guideline: (i) lack of familiarity/awareness, (ii) lack of agreement with specific guideline, (iii) lack of outcome expectancy, (iv) external barriers. CONCLUSIONS A heterogeneous set of barriers is present. Therefore, a multifaceted intervention strategy is proposed to overcome these barriers, including a clear division of roles, allowing for local (Dutch) adaptations per specialism by local consensus groups, and the facilitation of easy communication with experts/opinion leaders as well as between care professionals.
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Affiliation(s)
- Lotte Heutinck
- Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Maaike van Gameren
- Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jan J.G.M. Verschuuren
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Duchenne Center Netherlands, The Netherlands
| | - Alexander C.H. Geurts
- Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Imelda J.M. de Groot
- Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
- Duchenne Center Netherlands, The Netherlands
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Solé G, Salort-Campana E, Pereon Y, Stojkovic T, Wahbi K, Cintas P, Adams D, Laforet P, Tiffreau V, Desguerre I, Pisella LI, Molon A, Attarian S. Guidance for the care of neuromuscular patients during the COVID-19 pandemic outbreak from the French Rare Health Care for Neuromuscular Diseases Network. Rev Neurol (Paris) 2020; 176:507-515. [PMID: 32354651 PMCID: PMC7167585 DOI: 10.1016/j.neurol.2020.04.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/16/2020] [Indexed: 12/12/2022]
Abstract
In France, the epidemic phase of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in February 2020 and resulted in the implementation of emergency measures and a degradation in the organization of neuromuscular reference centers. In this special context, the French Rare Health Care for Neuromuscular Diseases Network (FILNEMUS) has established guidance in an attempt to homogenize the management of neuromuscular (NM) patients within the French territory. Hospitalization should be reserved for emergencies, the conduct of treatments that cannot be postponed, check-ups for which the diagnostic delay may result in a loss of survival chance, and cardiorespiratory assessments for which the delay could be detrimental to the patient. A national strategy was adopted during a period of 1 to 2 months concerning treatments usually administered in hospitalization. NM patients treated with steroid/immunosuppressants for a dysimmune pathology should continue all of their treatments in the absence of any manifestations suggestive of COVID-19. A frequently asked questions (FAQ) sheet has been compiled and updated on the FILNEMUS website. Various support systems for self-rehabilitation and guided exercises have been also provided on the website. In the context of NM diseases, particular attention must be paid to two experimental COVID-19 treatments, hydroxycholoroquine and azithromycin: risk of exacerbation of myasthenia gravis and QT prolongation in patients with pre-existing cardiac involvement. The unfavorable emergency context related to COVID-19 may specially affect the potential for intensive care admission (ICU) for people with NMD. In order to preserve the fairest medical decision, a multidisciplinary working group has listed the neuromuscular diseases with a good prognosis, usually eligible for resuscitation admission in ICU and, for other NM conditions, the positive criteria suggesting a good prognosis. Adaptation of the use of noninvasive ventilation (NIV) make it possible to limit nebulization and continue using NIV in ventilator-dependent patients.
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Affiliation(s)
- G Solé
- Reference Center for Neuromuscular Disorders AOC, Department of Neurology, Nerve-Muscle Unit, CHU Bordeaux (Pellegrin University Hospital), place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - E Salort-Campana
- Reference Center of Neuromuscular disorders and ALS, Timone University Hospital, AP-HM, 13385 Marseille, France; Medical Genetics, Aix-Marseille Université, Inserm UMR_1251, 13005 Marseille, France
| | - Y Pereon
- CHU Nantes, Reference Center for Neuromuscular Disorders AOC, Hôtel-Dieu, Nantes, France
| | - T Stojkovic
- Reference Center of Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Inserm UMR_S 974, Paris, France
| | - K Wahbi
- AP-HP, Cochin Hospital, Cardiology Department, FILNEMUS, Centre de Référence de Pathologie Neuromusculaire Nord/Est/Île-de-France, Paris-Descartes, Sorbonne Paris Cité University, 75006 Paris, France; INSERM Unit 970, Paris Cardiovascular Research Centre (PARCC), Paris, France
| | - P Cintas
- Reference Center of Neuromuscular Disorders AOC, Toulouse, University Hospitals, 31000 Toulouse, France
| | - D Adams
- Department of Neurology, CHU Bicetre, Hôpitaux Universitaires Paris Sud, Paris, France
| | - P Laforet
- Nord/Est/Île-de-France Neuromuscular Reference Center, Neurology Department, Raymond-Poincaré Teaching Hospital, AP-HP, Garches, France; INSERM U1179, END-ICAP, Versailles-Saint-Quentin-en-Yvelines University, Université Paris Saclay, Montigny-le-Bretonneux, France
| | - V Tiffreau
- Reference Center of Neuromuscular Disorders Nord/Est/Île-de-France, Hôpital Pierre-Swynghedauw, CHU de Lille, EA 7369 URePSSS, 59000 Lille, France
| | - I Desguerre
- Reference Center of Neuromuscular Disorders Nord/Est/Île-de-France, Pediatric Neurology Department, Necker-Enfants-Malades Hospital, AP-HP, Paris, France
| | | | - A Molon
- Filnemus, AP-HM, Marseille, France
| | - S Attarian
- Reference Center of Neuromuscular disorders and ALS, Timone University Hospital, AP-HM, 13385 Marseille, France; Medical Genetics, Aix-Marseille Université, Inserm UMR_1251, 13005 Marseille, France.
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Ong KS, Kinnett K, Soelaeman R, Webb L, Bain JS, Martin AS, Westfield C, Bolen J, Street N. Evaluating Implementation of the Updated Care Considerations for Duchenne Muscular Dystrophy. Pediatrics 2018; 142:S118-S128. [PMID: 30275256 PMCID: PMC6298736 DOI: 10.1542/peds.2018-0333n] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 12/25/2022] Open
Abstract
Care Considerations for Duchenne Muscular Dystrophy were published in 2010. However, little is known about the extent to which these considerations were implemented after publication. With this article, we provide direction on evaluating the uptake of the 2018 Duchenne Muscular Dystrophy Care Considerations. We identify key elements of care and present suggestions for their use in evaluation and research.
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Affiliation(s)
- Katherine S Ong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
- Carter Consulting, Inc, Atlanta, Georgia
| | | | - Rieza Soelaeman
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Webb
- Muscular Dystrophy Association, Chicago, Illinois
| | - Jennifer S Bain
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
- McKing Consulting Corporation, Atlanta, Georgia; and
| | - Ann S Martin
- Parent Project Muscular Dystrophy, Middletown, Ohio
| | | | - Julie Bolen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natalie Street
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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