Factors associated with self-perceived burden to the primary caregiver in older patients with hematologic malignancies: an exploratory study

Objective: Although cancer patients frequently experience self-perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of selfperceived burden to the primary caregiver (SPB-PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. Methods: In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients’ SPB-PC was assessed using a 100-mm visual analogue scale (VAS). Characteristics potentially associated with SPB-PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT-Cog) Scale), and patients’/primary caregivers’ personal relationship characteristics (family tie, support), were assessed. Results: Thirty-five percent of patients reported moderate to severe SPB-PC (VAS ≥ 50 mm). Patients’ SPB-PC was associated with lower Karnofsky performance (β = 0.135, p = 0.058) and ADL (β = 0.148, p = 0.037) scores, and higher HADS (β = 0.283, p<0.001) and FACT-Cog perceived cognitive impairments subscale (β = 0.211, p = 0.004) scores. The proportion of explained variance was 23.5%. Conclusions: Health care professionals should be aware that about one third of older cancer patients experience moderate to severe SPB-PC at the time of chemotherapy initiation. They should adapt their support of patients who report such a feeling

Natalizumab treatment shows low cumulative probabilities of confirmed disability worsening to EDSS milestones in the long-term setting.

Abstract Background Though the Expanded Disability Status Scale (EDSS) is commonly used to assess disability level in relapsing-remitting multiple sclerosis (RRMS), the criteria defining disability progression are used for patients with a wide range of baseline levels of disability in relatively short-term trials. As a result, not all EDSS changes carry the same weight in terms of future disability, and treatment benefits such as decreased risk of reaching particular disability milestones may not be reliably captured. The objectives of this analysis are to assess the probability of confirmed disability worsening to specific EDSS milestones (i.e., EDSS scores ≥3.0, ≥4.0, or ≥6.0) at 288 weeks in the Tysabri Observational Program (TOP) and to examine the impact of relapses occurring during natalizumab therapy in TOP patients who had received natalizumab for ≥24 months. Methods TOP is an ongoing, open-label, observational, prospective study of patients with RRMS in clinical practice. Enrolled patients were naive to natalizumab at treatment initiation or had received ≤3 doses at the time of enrollment. Intravenous natalizumab (300 mg) infusions were given every 4 weeks, and the EDSS was assessed at baseline and every 24 weeks during treatment. Results Of the 4161 patients enrolled in TOP with follow-up of at least 24 months, 3253 patients with available baseline EDSS scores had continued natalizumab treatment and 908 had discontinued (5.4% due to a reported lack of efficacy and 16.4% for other reasons) at the 24-month time point. Those who discontinued due to lack of efficacy had higher baseline EDSS scores (median 4.5 vs. 3.5), higher on-treatment relapse rates (0.82 vs. 0.23), and higher cumulative probabilities of EDSS worsening (16% vs. 9%) at 24 months than those completing therapy. Among 24-month completers, after approximately 5.5 years of natalizumab treatment, the cumulative probabilities of confirmed EDSS worsening by 1.0 and 2.0 points were 18.5% and 7.9%, respectively (24-week confirmation), and 13.5% and 5.3%, respectively (48-week confirmation). The risks of 24- and 48-week confirmed EDSS worsening were significantly higher in patients with on-treatment relapses than in those without relapses. An analysis of time to specific EDSS milestones showed that the probabilities of 48-week confirmed transition from EDSS scores of 0.0–2.0 to ≥3.0, 2.0–3.0 to ≥4.0, and 4.0–5.0 to ≥6.0 at week 288 in TOP were 11.1%, 11.8%, and 9.5%, respectively, with lower probabilities observed among patients without on-treatment relapses (8.1%, 8.4%, and 5.7%, respectively). Conclusions In TOP patients with a median (range) baseline EDSS score of 3.5 (0.0–9.5) who completed 24 months of natalizumab treatment, the rate of 48-week confirmed disability worsening events was below 15%; after approximately 5.5 years of natalizumab treatment, 86.5% and 94.7% of patients did not have EDSS score increases of ≥1.0 or ≥2.0 points, respectively. The presence of relapses was associated with higher rates of overall disability worsening. These results were confirmed by assessing transition to EDSS milestones. Lower rates of overall 48-week confirmed EDSS worsening and of transitioning from EDSS score 4.0–5.0 to ≥6.0 in the absence of relapses suggest that relapses remain a significant driver of disability worsening and that on-treatment relapses in natalizumab-treated patients are of prognostic importance

“Milieu didactique” et “régulations” comme outils d’analyse de l’activité du professeur en éducation physique

From a comparative didactics point of view, this contribution is to investigate the "didactical techniques" used by physical education teachers. A certain kind of genericity of these didactical techniques is postulated. The paper tries to highlight this through the concepts of "didactical environment" and "regulations" which are pertinent tools used to analyse different didactical episodes in three teaching-learning contexts : primary school, middle school and high-schoolCette contribution se propose d’examiner, selon le point de vue de la didactique comparée, quelques "techniques didactiques" utilisées par les professeurs d’éducation physique. Il est postulé une certaine généricité de ces techniques. L’article tente de la mettre en évidence en mobilisant les concepts de "milieu didactique" et de "régulations" comme outils d’analyse d’épisodes didactiques observés dans trois contextes d’enseignement/ apprentissage : l’école primaire, le collège, le lycée.Amade-Escot Chantal, Verscheure Ingrid, Devos Odile. “Milieu didactique” et “régulations” comme outils d’analyse de l’activité du professeur en éducation physique. In: Les dossiers des sciences de l'éducation, N°8, 2002. Didactique des disciplines scientifiques et technologiques : concepts et méthodes. pp. 87-97

Remédiation (rehabilitation) de la neuropathie auditive/Désynchronisation auditive: Expérience d’un centre de réadaptation

Despite the availability of published recommendations for the management of Auditory Neuropathy/Auditory Dyssynchrony, numerous questions remain unanswered and different opinions can still be found on the subject Moreover, the entity is characterized by an important inter- and even intra- individual variability. This makes prognosis particularly difficult The experience accumulated in our rehabilitation center comes from eleven children diagnosed at an early, pre-lingual stage and having auditory deficits ranging from moderate-severe to profound hearing loss. They have been followed-up for at least six years. The results indicate that a major determinant of the level of language development is the presence or absence of associated handicap(s), particulany neurological deficits, but also psycho-social problems and simultaneous exposure to two or more languages. Only four out of the eleven children reached a level of language development appropriate for their ages (Linguistic Quotient around 100%). None of them had an associated handicap whereas the seven others, each of them being afflicted with at least one additional handicap, achieved Linguistic Quotient values between 36 and 67 %. No correlation between the results and the level of auditory deficit or the type of prosthetic aid (amplification or cochlear implantation) was found. We still have a lot to learn about the numerous factors affecting the linguistic development of children affected with Auditory Neuropathy/Auditory Dyssynchrony. A comprehensive, international data bank as projected in chapter XVII should be of a great help in this regard.info:eu-repo/semantics/publishe

“Sense of being a burden to the primary caregiver“ in elderly patients with hematologic malignancies at the start of a chemotherapy treatment

info:eu-repo/semantics/publishe