Telemedicine of family-based treatment for adolescent anorexia nervosa: A protocol of a treatment development study.

BackgroundFamily-based treatment is an efficacious treatment available for adolescents with anorexia nervosa. Yet the implementation of this treatment, at least in the United States, is challenging due to a limited number of trained family-based treatment therapists and the concentration of these therapists in a limited number of urban centers. The use of telemedicine in the delivery of family-based treatment can increase access to this therapy for this patient population.Methods/designThis two-year treatment development study (December 2013-November 2015) follows a two-wave iterative case series design. The study is ongoing and addresses the treatment needs of families in remote, rural, or underrepresented parts of the United States by delivering family-based treatment via telemedicine (video chat). The first six months of the study was dedicated to selecting a cloud-based secure telemedicine portal for use with participants. Recruitment for the first of two consecutive case series (N = 5) began during month seven. After these five patients completed treatment, a systematic review of treatment via feedback from participants and therapists related to the delivery of this model and use of technology was completed. A second wave of recruitment is underway (N = 5). At the end of both waves (N = 10), and after a second review of treatment, we should be able to establish the feasibility and acceptability of family-based treatment delivered via telemedicine for this patient population.DiscussionThis study is the first attempt to deliver family-based treatment for adolescents with anorexia nervosa via telemedicine. If delivering family-based treatment in this format is feasible, it will provide access to an evidence-based treatment for families heretofore unable to participate in specialist treatment for their child's eating disorder

The outcome at 12 months of very-Iow-birth-weight infants ventilated at Tygerberg Hospital

Objective. To determine the outcome at 1 year of age of a group of very-Iow-birth-weight (VLBW) infants, from urban and rural communities, ventilated at Tygerberg Hospital, W. Cape. Study design. Prospective descriptive study in which the prevalence of bronchopulmonary dysplasia (BPD), sensorineural deafness, intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and abnormal motor developmental outcomes were determined in 153 ventilated VLBW infants from rural and urban areas. Of these, 69% were from lower socio-economic backgrounds. Main outcome measures. Attrition rates for rural and urban babies, BPD, ROP, IVH and abnormal motor development. Study population and setting. All ventilated VLBW infants discharged from the neonatal intensive care unit at Tygerberg Hospital over a 1-year period were followed up at 3-monthly intervals for 12 months. Results. BPD was diagnosed in 19% of the babies, with significantly more babies with birth weights under 1 000 g and gestational ages under 28 weeks having BPD. Of the babies with BPD, 25% had abnormal motor development at 1 year of age. Seven per cent of the babies had grade 3 or 4 ROP and 2,6% had sensorineural hearing loss. One hundred and seventeen (79%) of the infants attended the follow-up clinic until 12 months of age (corrected for prematurity). There were no significant differences in the number of babies followed up from rural or urban areas. Fourteen (11,9%) of the babies had abnormal motor development. A disturbing finding was that so many babies had spastic qiJadriplegia (8; 57%) versus diplegia (6; 43%).S Afr Med J 1995; 8

Endovascular treatment of intractable epistaxis - results of a 4-year local audit

Objective. Transcatheter embolisation is an accepted and effective treatment for intractable epistaxis. We analysed our success and complication rates and compared these with results from other published series.Design. Retrospective review.Setting. Unitas Interventional Unit, Centurion.Methods. Case record review (57 procedures) and telephonic interviews (36 traceable respondents).Outcome measures. A numerical audit of the success and complication rates for embolisation procedures performed during the 4-year period between July 1999 and June 2003.Results. A total of 57 endovascular embolisation procedures were performed for intractable epistaxis in 51 patients during this period. Eight patients (15.7%) developed a re-bleed between 1 and 33 days after embolisation of whom 5 were re- embolised, giving a primary short-term success rate of 86.3% and secondary assisted success rate of 94.1%. Thirty-five of 36 respondents {97.2%) reported no further epistaxis during the long-term follow-up period of 1-47months. The mortality rate was 0%, the major morbidity rate was 2% (l stroke) and the minor morbidity rate was 25%.Conclusion. Our Success and complication rates are acceptable and compare favourably with those reported in other large series

Current approaches to management of bone sarcoma in adolescent and young adult patients

Bone tumors are a group of histologically diverse diseases that occur across all ages. Two of the commonest, osteosarcoma (OS) and Ewing sarcoma (ES), are regarded as characteristic adolescent and young adult (AYA) cancers with an incidence peak in AYAs. They are curable for some but associated with unacceptably high rates of treatment failure and morbidity. The introduction of effective new therapeutics for bone sarcomas is slow, and to date, complex biology has been insufficiently characterized to allow more rapid therapeutic exploitation. This review focuses on current standards of care, recent advances that have or may soon change that standard of care and challenges to the expert clinical research community that we suggest must be met

Exploring differences in the role of hospitalization on weight gain based on treatment type from randomized clinical trials for adolescent anorexia nervosa

Background: This study explores the impact of weight gain during medical stabilization hospitalization on weight outcomes between three outpatient treatments for adolescent anorexia nervosa (AN): Adolescent Focused Therapy (AFT), Systemic Family Therapy (SyFT), and Family Based Treatment (FBT). Methods: A secondary analysis of weight gain data (N = 215) of adolescents (12-18 years) meeting DSM-IV criteria for AN (exclusive of amenorrhea criteria) who participated in two randomized clinical trials (RCTs) was conducted. Main outcomes examined were changes in weight restoration (≥95% expected body weight or EBW) and differences in weight change attributable to hospital weight gain. Results: Weight gain resulting from hospitalizations did not substantially change weight recovery rates. Hospital weight gain contributed most to overall treatment weight gain in AFT compared to FBT and SyFT. Conclusion: Brief medical stabilization weight gain does not contribute substantially to weight recovery in adolescents with AN who participated in RCTs

Health-related quality of life among adolescents with eating disorders

Objective Health-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL. Methods Sixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms. Results Participants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL. Conclusion The current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL

Parent version of the Eating Disorder Examination: Reliability and validity in a treatment-seeking sample

Background: Assessment of eating disorders (ED) in youth relies heavily on self-report, yet persistent lack of recognition of the presence and/or seriousness of symptoms can be intrinsic to ED. This study examines the psychometric properties of a semi-structured interview, the parent version of the Eating Disorder Examination (PEDE), developed to systematically assess caregiver report of symptoms. Methods: A multi-site, clinical sample of youth (N = 522; age range: 12 to 18 years) seeking treatment for anorexia nervosa (AN) and subsyndromal AN were assessed using the Eating Disorder Examination (EDE) for youth and the PEDE for collateral caregiver report. Results: Internal consistencies of the four PEDE subscales were on par with established ranges for the EDE. Significant medium-sized correlations and poor to moderate levels of agreement were found between the corresponding subscales on each measure. For the PEDE, confirmatory factor analysis of the EDE four-factor model provided a poor fit; an exploratory factor analysis indicated that a 3-factor model better fits the PEDE. Conclusions: Findings suggest that the PEDE has psychometric properties on par with the original EDE. The addition of the caregiver perspective may provide incremental information that can aid in the assessment of AN in youth. Future research is warranted to establish psychometric properties of the PEDE in broader transdiagnostic ED samples.</p

Is childhood trauma associated with lifetime suicide attempts in women with bulimia nervosa?

The purpose of this study was to explore the association between specific forms of childhood abuse and neglect with lifetime suicide attempts in women with bulimia nervosa (BN)