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Cozart JS, Bruce AS, Befort C, Siengsukon C, Lynch SG, Punt S, Simon S, Shook RP, Huebner J, Bradish T, Robichaud J, Bruce JM. A pilot study evaluating the prefeasibility of a behavioral weight loss program in people with multiple sclerosis. Prev Med Rep 2023; 36:102437. [PMID: 37810265 PMCID: PMC10558767 DOI: 10.1016/j.pmedr.2023.102437] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Weight loss interventions seldom include individuals with neurologic disease. The aims of the present study were to: 1) develop and assess the prefeasibility of a 6-month telehealth behavioral weight loss program for people with multiple sclerosis (MS) and obesity and 2) examine changes in weight loss (primary outcome), physical activity, and fruit/vegetable consumption at follow-up. Participants with obesity and MS engaged in a 24-week weight loss program. Participants followed established diet, exercise, and self-monitoring guidelines and attended weekly online group meetings. Median percentage weight loss was 10.54 % (SD = 7.19). Participants who adhered more closely to the self-monitoring guidelines (r = 0.81, p =.02), and who averaged higher weekly active minutes (r = 0.91, p =.002) achieved greater percentage weight loss. Six of the eight pilot participants achieved clinically meaningful weight loss (>5%) after 6-months.
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Affiliation(s)
- Julia S. Cozart
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics, 2411 Holmes St., Kansas City, MO, USA
- University of Missouri-Kansas City, Department of Psychology, 5030 Cherry St., Kansas City, MO, USA
| | - Amanda S. Bruce
- Department of Pediatrics, University of Kansas Medical Center, 2801 Olathe Blvd., Kansas City, KS, USA
- Children’s Mercy Hospital, Center for Children’s Healthy Lifestyles and Nutrition, 610 E 22 St., Kansas City, MO, USA
| | - Christie Befort
- University of Kansas Medical Center, Department of Population Health, 2060 W 39 Ave., Kansas City, KS, USA
| | - Catherine Siengsukon
- University of Kansas Medical Center, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, 3901 Rainbow Blvd., Kansas City, KS, USA
| | - Sharon G. Lynch
- University of Kansas Medical Center, Department of Neurology, 3901 Rainbow Blvd., Kansas City, KS, USA
| | - Stephanie Punt
- University of Kansas, Department of Psychology, 1415 Jayhawk Blvd., Lawrence, KS, USA
- University of California, Los Angeles, Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Stephen Simon
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics, 2411 Holmes St., Kansas City, MO, USA
| | - Robin P. Shook
- Children’s Mercy Hospital, Center for Children’s Healthy Lifestyles and Nutrition, 610 E 22 St., Kansas City, MO, USA
- Department of Pediatrics, Children’s Mercy Hospital, 2401 Gillham Rd., Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St., Kansas City, MO USA
| | - Joanie Huebner
- University Health Lakewood Medical Center, UMKC Department of Community and Family Medicine, 7900 Lee’s Summit Rd., Kansas City, MO, USA
| | - Taylor Bradish
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics, 2411 Holmes St., Kansas City, MO, USA
| | - Jade Robichaud
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics, 2411 Holmes St., Kansas City, MO, USA
| | - Jared M. Bruce
- University of Missouri-Kansas City School of Medicine, Department of Biomedical and Health Informatics, 2411 Holmes St., Kansas City, MO, USA
- Department of Neurology, University Health, 2411 Holmes St., Kansas City, MO, USA
- Department of Psychiatry, University Health, 2411 Holmes St., Kansas City, MO, USA
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Punt S, Caicedo MR, Bessette K, Engel I, Giovanetti A, Izzo J, Stiles R, Gagnon K, Koob C, Loyd S, Zhang E, Maras M, Nelson EL. H - 15 Leveraging Community Health Care Workers in Rural Communities to Address Brain Health Equity. Arch Clin Neuropsychol 2023; 38:1496-1497. [PMID: 37807564 DOI: 10.1093/arclin/acad067.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE To address brain health in rural communities, Telehealth ROCKS developed a service delivery program with local partners. Community healthcare workers (CHWs) assess and provide students with referrals to address social determinants of health (SDoH) and mental health needs. DATA SELECTION Qualitative and quantitative data were collected. This program serves seven school districts and 6876 students in an area historically reliant on a mining/factory economies with high concerns for environmental exposures. Students were from diverse backgrounds with a range of neurological and neurodevelopmental conditions. To close SDOH gaps, CHWs utilized Community CareLink (CCL), an online platform tailored for rural communities that documents, tracks, and identifies SDOH gaps. DATA SYNTHESIS Since 2022, 85% of families elected to pursue CHW support. To date, 10 CHWs have worked directly with approximately 10% of the school population with 80% of encounters having an attendance component. Thematic analysis shows building trust has been an important encounter theme: "Building that trust within the families is so important. By being able to help them with housing, utility assistance or getting access to Medicaid can be a huge relief. . ." CONCLUSIONS The pandemic impacted SDOH domains, further exacerbating rural and other systemic disparities that will have long-lasting impact on brain health in rural communities. For neuropsychologists, adopting this program design may help to foster trusted relationships and community partnerships, improve culturally informed referrals, and provide scaffolding/coaching around referrals so that our expertise can aid patients and families where and when it is needed most.
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Zhang E, Bellinger S, Swails L, Punt S, Tepper K, Nelson EL. Connecting Behavioral Health Specialists With Schools: Adapting a Telementoring Series During COVID-19. Rural Spec Educ Q 2023; 42:94-104. [PMID: 37265709 PMCID: PMC9908514 DOI: 10.1177/87568705231152619] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To address the daunting behavioral and mental health needs of Kansas' rural and underserved communities, Telehealth ROCKS (Rural Outreach for the Children of Kansas) Schools project partnered with school-based health centers, school districts, and special education cooperatives to provide a range of telebehavioral health intervention services and teletraining. This project used the Project Extension for Community Healthcare Outcomes (ECHO) telementoring framework to connect specialty providers with school/community providers for web-based continuing education and case consultation to support students with special education needs. Our team created the Function Friday for Better Behavior ECHO series to address challenging behaviors in schools, based on the concept of functional behavior assessment and function-based treatment. Part of the ECHO series came into being after the onset of the COVID-19 pandemic. This article describes how our ECHO series provided an effective mechanism for supporting school and community providers during the pandemic, and participating educators utilized skills as they transitioned from onsite education to the virtual learning environment with students.
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Affiliation(s)
- E Zhang
- University of Kansas Medical Center,
Kansas City, USA
| | | | - Leni Swails
- University of Kansas Medical Center,
Kansas City, USA
| | - Stephanie Punt
- University of Kansas Medical Center,
Kansas City, USA
- University of Kansas, Kansas City,
USA
| | - Katy Tepper
- University of Kansas Medical Center,
Kansas City, USA
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Ng VY, Louie P, Punt S, Conrad EU. Malignant Transformation of Synovial Chondromatosis: A Systematic Review. Open Orthop J 2017; 11:517-524. [PMID: 28694891 PMCID: PMC5481616 DOI: 10.2174/1874325001711010517] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 12/20/2022] Open
Abstract
Background: Synovial chondromatosis (SCh) can undergo malignant transformation. Pathologic diagnosis of secondary synovial chondrosarcoma (SChS) is challenging and misdiagnosis may result in over- or undertreatment. Method: A systematic review revealed 48 cases of SChS published in 27 reports since 1957. Data was collected to identify findings indicative of SChS and outcomes of treatment. Results: At median follow-up of 18 months, patients were reported as alive (10%), alive without disease (22%), alive with disease (15%), dead of disease (19%), dead of pulmonary embolism (4%), and unknown (29%). Initial diagnosis of SChS (grade: low/unknown 48%, intermediate/high 52%) was after biopsy in 58%, local resection in 29%, and amputation in 13%. Seventy-four percent of patients underwent 1.8 (mean) resections. Patients treated prior to 1992 were managed with amputation in 79% of cases compared to 48% after 1992. Symptoms were present for 72 mos prior to diagnosis of SChS. Synovial chondrosarcoma demonstrated symptom progression over several months (82%), rapid recurrence after complete resection (30%), and medullary canal invasion (43%). The SChS tumor dimensions were seldom quantified. Conclusion: Malignant degeneration of synovial chondromatosis is rare but can necessitate morbid surgery or result in death. Pathognomonic signs for SChS including intramedullary infiltration are present in the minority of cases. Progression of symptoms, quick local recurrence, and muscle infiltration are more suggestive of SChS. Periarticular cortical erosion, extra-capsular extension, and metaplastic chondroid features are non-specific. Although poorly documented for SChS, tumor size is a strong indicator of malignancy. Biopsy and partial resection are prone to diagnostic error. Surgical decisions are frequently based on size and clinical appearance and may be in conflict with pathologic diagnosis.
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Affiliation(s)
- Vincent Y Ng
- Department of Orthopaedics, Greenebaum Cancer Center, University of Maryland Medical Center, 110 S. Paca St., 6 Floor, Suite 300, Baltimore, MD 21201, USA
| | - Philip Louie
- Department of Orthopaedics, Rush University Medical Center, Chicago IL, USA
| | - Stephanie Punt
- Department of Orthopaedics, Rush University Medical Center, Chicago IL, USA
| | - Ernest U Conrad
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
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Abstract
Background: The most common modes of failure for megaprostheses are aseptic loosening followed by periprosthetic infection and stem fracture. Surgical technique for bone and implant exposure is controversial and may influence the success of revision and the need for additional future revisions. The purpose of this study was to evaluate the effectiveness of cortical fenestration for megaprosthesis revision, particularly for stem fracture. Methods: From 1985-2014, 196 adult and pediatric patients underwent limb salvage with a distal femoral or proximal tibial megaprosthesis (109 cemented, 87 pressfit). A retrospective chart review was performed to assess the rate of revision based on cemented or pressfit fixation and the use of a cortical window to extract the failed stem. Results: 27% (29 of 109) of cemented and 18% (16 of 87) of pressfit implants were revised for stem failure. The reasons for revision in the cemented group were loosening (62%), infection (24%), and stem fracture (13%). In the pressfit group, the reasons were loosening (43%), infection (31%), stem fracture (6%), limb-length discrepancy (6%), malrotation (6%), and local recurrence (6%). A cortical window was used in 10 of 45 initial revisions (7 cemented, 3 pressfit) including all of the stem fractures, and in 2 of 15 subsequent re-revisions. Conclusion: Cortical fenestration is an effective, bone-preserving method of implant extraction, particularly for broken or cemented stems. It is associated with low rates of loosening and no increase in periprosthetic fractures.
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Affiliation(s)
- Vincent Y Ng
- University of Maryland Medical Center, Department of Orthopedics, Baltimore MD, USA
| | | | - Stephanie Punt
- University of Washington Medical Center, Department of Orthopaedics and Seattle Children's Hospital, Seattle WA, USA
| | - Ernest U Conrad Iii
- University of Washington Medical Center, Department of Orthopaedics and Seattle Children's Hospital, Seattle WA, USA
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Abstract
Background: Allograft reconstruction of oncologic resections involving the tibia can have unpredictable results. Prior studies have reported a high rate of complications and a long recovery period involving prolonged bracing, repeated procedures and extended periods of antibiotics. Methods: The case details of 30 tibial allografts (12 adults, 18 children; 20 intercalary, 7 hemicortical, 3 other) were reviewed retrospectively. Based on factors including function, pain, healing and infection, clinical outcomes were stratified into three categories: excellent, moderate, and poor. Results: The overall survival rate of the allografts was 66% at a mean follow-up of 42 mos (adults) and 63 mos (children). Healing for metaphyseal junctions was successful in 73% at a mean of 44 weeks and for diaphyseal junctions, 64% at 41 weeks. Intercalary allografts in adults (4 of 20) all became infected and none had excellent results. All hemicortical allografts were performed in adults and 6 of 7 had excellent results. Distal intercalary allografts in children (6 of 20) had either excellent or moderate results with no infections, but had 3 nonunions and 2 fractures. Proximal intercalary allografts in children (8 of 20) had 2 excellent results, but had 6 infections requiring a cement spacer. Five of the six spacers were ultimately revised to another allograft or an arthroplasty. Conclusion: For tibial allograft reconstruction, surgeons and patients should prepare for a prolonged treatment course that may include multiple complications and surgeries. Excellent or moderate results can be achieved eventually in most, but amputation may be necessary in 15-20% of cases.
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Affiliation(s)
- Vincent Y Ng
- Department of Orthopaedics, University of Maryland Medical Center, 110 S. Paca St, 6 Floor, Baltimore, Maryland 21201, United States
| | - Philip Louie
- Department of Orthopaedics, Rush University, Chicago, United States
| | - Stephanie Punt
- Department of Orthopedics and Sports Medicine, University of Washington, 1959 NE Pacific Street, Seattle, Washington 98195, United States
| | - Ernest U Conrad
- Department of Orthopedics and Sports Medicine, University of Washington, 1959 NE Pacific Street, Seattle, Washington 98195, United States
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Ng VY, Louie P, Punt S, Conrad EU. Surgical Release of Severe Flexion Contracture for Oncologic Knee Arthroplasty. Open Orthop J 2017; 11:45-50. [PMID: 28400872 PMCID: PMC5366395 DOI: 10.2174/1874325001711010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 11/22/2022] Open
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Ng VY, Jones R, Bompadre V, Louie P, Punt S, Conrad EU. The effect of surgery with radiation on pelvic Ewing sarcoma survival. J Surg Oncol 2015; 112:861-5. [PMID: 26525492 DOI: 10.1002/jso.24081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/17/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pelvic Ewing sarcoma (ES) has poorer outcomes than extremity-based lesions and the method of local control is controversial. METHODS A retrospective review was performed of 40 primary pelvic or sacral ES treated by a single surgeon. All received modern chemotherapy and those that received radiation were treated with modern dosages. RESULTS Fifty-five percent were disease-free at latest follow-up (median, 83.1 mos). Sixty-one percent had ≥ 99% necrosis, which was associated with 65% disease-free survival. Larger size (P = 0.016) and the absence of metastatic disease (P = 0.005) was predictive of survival. Eighty-three percent of relapsed patients were DOD. Half of patients who received surgery alone or RT alone have NED while 57% of those who received S/RT have NED. Complication rates were 69% (S/RT), 75% (surgery alone), 10% (RT alone). Functional outcomes were similar. CONCLUSION Primary pelvic ES is localized at presentation in 50% and the absence of metastases is the strongest predictor for survival. Chemotherapy is key, but excellent histologic response is neither a guarantee nor a necessity for survival. More than one-third die despite an excellent histologic response and at least one-third with lung metastases survive. With chemotherapy, radiation, and surgery, reasonable control of disease can be achieved. LEVEL OF EVIDENCE III Case-control or retrospective cohort study.
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Affiliation(s)
- Vincent Y Ng
- Department of Orthopaedics, University of Maryland, Baltimore, Maryland
| | - Robin Jones
- Sarcoma Unit Royal Marsden Hospital, London, United Kingdom
| | - Viviana Bompadre
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Philip Louie
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Stephanie Punt
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Ernest U Conrad
- Department of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington
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Abstract
BACKGROUND Previously, we have shown that low IL-12p40 mRNA expression by cervical cancer cells is associated with a poor survival of cervical cancer patients. As IL-12p40 is both a subcomponent of interleukin (IL)-12 and IL-23, the aim of this study was to elucidate the role of IL-12p40 in cervical cancer. METHODS We have measured the expression of IL-23p19 mRNA, IL-12p35 mRNA and IL-12p40 mRNA using mRNA in situ hybridisation. The IL-1 and IL-6 were measured by immunohistochemistry. RESULTS As IL-23 is a component of the IL-17/IL-23 pathway, a pathway induced by IL-1 and IL-6 in humans, we have studied IL-1 and IL-6 expression. Only a high number of stromal IL-6-positive cells was shown to associate with poor disease-specific survival. The worst disease-specific survival was associated with a subgroup of patients that displayed a high number of IL-6-positive cells and low IL-12p40 expression (P<0.001). Both a high number of IL-6-positive cells and a high number of IL-6-positive cells, plus low IL-12p40 expression were shown to be clinicopathological parameters independent of lymph node metastasis, parametrial involvement and Sedlis score (P=0.009 and P=0.007, respectively). CONCLUSION Our results with IL-6 and IL-12p40 are in accordance with the hypothesis that the IL-17/IL-23 pathway has a suppressive role in cervical cancer.
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Affiliation(s)
- H J M A A Zijlmans
- Department of Gynecology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
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