The ability of the general movements assessment to predict fine motor and visuomotor outcomes in six-year old children born preterm

Survival rates of infants born preterm have increased, resulting in a shift in interest from mortality to morbidity. Importantly, there is a need to identify children who will benefit from early rehabilitation services so as to maximize later developmental and functional outcomes. Prechtl's General Movements Assessment is a purely observational infant evaluation suggested to have greater specificity than other infant exams.The primary objective of this master's thesis was to describe the extent to which the classification on the General Movements Assessment at 12 weeks adjusted age predicts fine motor and visuomotor impairment in 6-year-old children born very preterm and very low or extremely low birthweight. A high prevalence of visuomotor and fine motor disability was found at school age. However, no significant association was found between the results of the General Movements Assessment and the outcomes under study. Nonetheless, it was shown that the General Movements Assessment did have high specificity (although low sensitivity) values. Multiple perinatal markers (i.e. birthweight, gestational age, perinatal brain injury and gender) were found to be associated to later visuomotor and fine motor dysfunction. The results of this study suggest that children born premature reperesent a high-risk population for fine motor and visuomotor dysfunction at school age. While the General Movements Assessment did not prove to be indicative of fine motor or visuomotor difficulties, the results of this study suggest that the predictive abilities of this particular assessment may be more attuned to spinal cord generated skills.De récents progrès ont résulté en une amélioration du taux de survie d'enfants nés prématurés et de petit poids. Par conséquent, l'emphase est maintenant placée sur la morbidité et non la mortalité. Il est donc important d'identifier correctement les enfants à risque de problèmes de développement afin que leurs capacités futures soient maximisées. Le General Movements Assessment de Prechtl est une évaluation néonatale qui est uniquement constituée d'observation. De plus, des études suggèrent que sa spécificité surpasse celle d'autres examens néonatals.L'objectif général de cette thèse était de décrire l'association entre la classification du General Movements Assessment à 12 semaines d'âge ajusté et la présence de troubles de la motricité fine et du développement visuel-moteur à l'âge de six ans auprès des enfants nés très prématurés et de très petit poids. Les résultats indiquent une prévalence élevée de problèmes de motricité fine et du contrôle visuel-moteur. Aucune association n'a était détectée entre les résultats du General Movements Assessment et les résultats à 6 ans. Cependant, la spécificité était élevée. Des indicateurs périnataux (poids, âge de gestion, insultes cérébrales, et sexe) étaient associés aux difficultés de contrôle visuel-moteur et de motricité fine. Ces résultats indiquent que cette population est à risque de développer des difficultés au niveau de la motricité fine et du contrôle visuel-moteur à l'âge de six ans. Bien que le General Movements Assessment n'as pas prédit ces incapacités, il est possible que la capacité prédictive de cette évaluation soit plutôt liée aux habiletés générées par la colonne vertébrale

Association Between Time‐in‐Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant

© 2019 Pharmacotherapy Publications, Inc. Background: Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT. Methods: This is a single-center retrospective cohort study of consecutive adult HT patients receiving immunosuppression. Goal trough tacrolimus levels were 10–15 ng/ml. Surveillance endomyocardial biopsies were performed weekly for 4 weeks. Outcomes included the effect of time to and time-in-therapeutic tacrolimus range (Rosendaal method) on 30-day clinical rejection, 1R/1B, and 2R or higher histologic occurrences. Results: We reviewed 67 HT patients (median age 58.8 yrs). For clinical rejection versus no-rejection groups, the median (25th, 75th percentile) time to therapeutic tacrolimus levels was 9.5 (8, 12.3) days versus 9.0 (7, 13) days (p=0.623). The median time-in-therapeutic tacrolimus range was 34.1% (23.2, 42.2) versus 36.2% (19.9, 51.2), respectively (p=0.512). Similarly, we observed no significant differences in time to and time-in-therapeutic tacrolimus range in patients who developed grade 1R/1B (p=0.650 and p=0.725) or grade 2R or higher histology (p=0.632 and p=0.933). Conclusions: Our small single-center analysis suggests that neither time to nor time in therapeutic tacrolimus range predicted acute rejection within 30 days of HT

Association Between Time-in-Therapeutic Tacrolimus Range and Early Rejection After Heart Transplant

© 2019 Pharmacotherapy Publications, Inc. Background: Historically, there is perceived pressure to achieve therapeutic levels of tacrolimus quickly after heart transplant (HT). We evaluated the association between time within therapeutic tacrolimus range and time to therapeutic trough and rejection in the 30 days following HT. Methods: This is a single-center retrospective cohort study of consecutive adult HT patients receiving immunosuppression. Goal trough tacrolimus levels were 10–15 ng/ml. Surveillance endomyocardial biopsies were performed weekly for 4 weeks. Outcomes included the effect of time to and time-in-therapeutic tacrolimus range (Rosendaal method) on 30-day clinical rejection, 1R/1B, and 2R or higher histologic occurrences. Results: We reviewed 67 HT patients (median age 58.8 yrs). For clinical rejection versus no-rejection groups, the median (25th, 75th percentile) time to therapeutic tacrolimus levels was 9.5 (8, 12.3) days versus 9.0 (7, 13) days (p=0.623). The median time-in-therapeutic tacrolimus range was 34.1% (23.2, 42.2) versus 36.2% (19.9, 51.2), respectively (p=0.512). Similarly, we observed no significant differences in time to and time-in-therapeutic tacrolimus range in patients who developed grade 1R/1B (p=0.650 and p=0.725) or grade 2R or higher histology (p=0.632 and p=0.933). Conclusions: Our small single-center analysis suggests that neither time to nor time in therapeutic tacrolimus range predicted acute rejection within 30 days of HT