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Connolly ME, Forman S, Sharkey CM, Merwin S, Darbari DS, Hardy SJ. Feasibility and preliminary efficacy of the Balance Program to reduce pain-related disability in pediatric sickle cell disease. Pediatr Blood Cancer 2023; 70:e30667. [PMID: 37726889 DOI: 10.1002/pbc.30667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) pain is associated with functional impairment, and treatment is often limited to pharmacological approaches with unwanted side effects. Although behavioral interventions exist for non-SCD pain populations, interventions designed to address pain-related impairment in SCD are lacking. METHODS Twenty youth (9-17 years) with SCD completed a four-week telemedicine pain intervention (NCT04388241). Participants and caregivers completed baseline and post-intervention PROMIS pain measures and the Treatment Evaluation Inventory-Short Form (TEI-SF). Descriptive analyses assessed feasibility and acceptability. Reliable Change Index analyses assessed for significant post-intervention changes in pain functioning. Paired t test analyses compared baseline and post-intervention opioid prescription fills. RESULTS All participants completed at least one treatment session. Eighteen (90%) youth completed all sessions. Youth (100%) and caregivers (94%) rated the intervention as moderately or highly acceptable on the TEI-SF. Forty-seven percent of caregivers and 44% of youth reported reliably significant improvements in pain interference after the intervention (median T-score differences: 24.8 and 23.5, respectively). Sixty-five percent of caregivers (T-score improvement difference: 19.3) and 31% of youth (T-score improvement difference: 32) reported improvements in pain behaviors. There was no significant difference in opioid prescription fills pre- and post-intervention (P > 0.05). CONCLUSIONS The Balance Program is feasible, highly acceptable, and can be delivered remotely to reduce barriers to care. Approximately half of youth and caregivers reported significant declines in pain interference following the intervention, with substantial improvements in functioning for treatment responders. Behavioral pain interventions are important adjunctive treatments to uniquely address functional impairment associated with acute and chronic pain in SCD.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sydney Forman
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Christina M Sharkey
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Stephanie Merwin
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Deepika S Darbari
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
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Sarlo GL, Haughton T, Rizakos E, Merwin S, Havens KA, Pasupuleti A, Gaillard WD, Berl MM. Comparison of psychosocial screeners in an epilepsy clinic. Epilepsy Behav 2023; 148:109452. [PMID: 37797485 PMCID: PMC10842982 DOI: 10.1016/j.yebeh.2023.109452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
Screenings are recommended for co-occurring conditions in pediatric epilepsy. However, there is limited research regarding which screener to implement in the clinic. This study aimed to compare different screening measures for attention-deficit/hyperactivity disorder (ADHD) and emotional concerns in a pediatric epilepsy population during a routine neurology clinic visit. Fifty (22%) of 226 contacted parents of children with epilepsy ages 5-17 years old agreed to participate. Screening measures included the Strengths and Difficulties Questionnaire (SDQ; Hyperactivity/Inattention (ADHD), Emotional Problems (E) subscales), the Pediatric Quality of Life Inventory Epilepsy Module (PedsQL-EM; Executive Functioning (EF), Mood/Behavior (M/B) subscales), and the ADHD Rating Scale (ADHD-RS). Analyses comparing measures included Chi Square, Pearson's correlation, and agreement statistics (Cohen's kappa, overall agreement). Consistent with prior literature, positive screening rates ranged from 40% to 72% for ADHD concerns and 38% to 46% for emotional concerns. Agreement between measures ranged from fair to substantial, with the highest agreement (85%; κ = 0.70) between the SDQ-E and PedsQL-EM-M/B. Although all measures rendered positive screens within expected rates, there are differences among the measures that inform screening measure selection.
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Affiliation(s)
- Gabrielle L Sarlo
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States
| | - Taylor Haughton
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Eleni Rizakos
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Stephanie Merwin
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Kathryn A Havens
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Archana Pasupuleti
- Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - William D Gaillard
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States
| | - Madison M Berl
- Center for Neuroscience, Children's National Research Institute, Washington, DC, United States; Center for Neuroscience and Behavioral Health CNH, George Washington University, Washington, DC, United States.
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Merwin S, Mackey E, Sule S. US NHANES Data 2013-2016: increased risk of severe obesity in individuals with history of juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:119. [PMID: 34380512 PMCID: PMC8359191 DOI: 10.1186/s12969-021-00621-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stephanie Merwin
- Division of Psychology and Behavioral Health, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Eleanor Mackey
- grid.239560.b0000 0004 0482 1586Division of Psychology and Behavioral Health, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Sangeeta Sule
- grid.239560.b0000 0004 0482 1586Division of Rheumatology, Children’s National Hospital, Washington, DC USA
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Record EJ, Bumbut A, Shih S, Merwin S, Kroner B, Gaillard WD. Risk factors, etiologies, and comorbidities in urban pediatric epilepsy. Epilepsy Behav 2021; 115:107716. [PMID: 33444988 DOI: 10.1016/j.yebeh.2020.107716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
The Seizures and Outcomes Study in Children (SOS-KIDS) identifies risk factors, etiologies, and comorbidities in a pediatric epilepsy population in a major city with diversity in socioeconomic levels. A thorough understanding of the range of issues impacting children with epilepsy is critical to establishing treatment that will produce better health outcomes. SOS-KIDS is a cross-sectional cohort study of pediatric epilepsy patients who live in Washington D.C. and are evaluated at Children's National Hospital. Families were recruited at the time of the child's routine clinic appointment or inpatient visit. Information was extracted from participants' electronic medical records (EMR) and parent reports; participants were screened for comorbidities using standardized screening measures. Data were collected from 289 participants (47% female, 53% male), and mean age was 7.9 years (2 months to 17 years). Twenty-nine percent of participants had primary generalized epilepsy, 63% focal epilepsy, 0.3% combined generalized and focal epilepsy, and 8% could not be distinguished. There were a variety of epilepsy risk factors including prematurity (10%), intraventricular hemorrhage (7%), neonatal seizures (8%), and febrile seizures (17%). The most common etiologies were cerebral malformations (13%) and genetic disorders (25%). Numerous participants had documented comorbidities including developmental delay (56%), intellectual disability (20%), headaches (16%), attention-deficit hyperactivity disorder (23%), and autism (7%). Of participants aged six years and older, depression, and anxiety were reported in 5% and 6% within the EMR, 14% and 19% in parent surveys, and 22% and 33% with standardized screening measures. We identified a wide variety of risk factors and etiologies among urban pediatric epilepsy patients, with genetic and structural being the most common. Neurologic and psychiatric comorbidities were common, but the prevalence of several psychiatric disorders reported within the EMR was substantially lower compared to that found when using parent surveys and standardized screening measures.
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Affiliation(s)
- E Justine Record
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA.
| | - Adrian Bumbut
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Sharon Shih
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Stephanie Merwin
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Barbara Kroner
- RTI International, 701 13th St NW #750, Washington, DC 20005, USA
| | - William D Gaillard
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
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