Decreasing physical and verbal aggression in a brain injured nursing home resident

Following a traumatic brain injury, patients often suffer a series of psychological and psychiatric sequalae. This study presents the case of Mr. K, a 52-year-old brain-injured nursing home resident who exhibited problematic physical aggression and verbal abuse toward staff and residents. His problem behaviors were intertwined with an ethical issue involving a heterosexual relationship with another resident who also was brain injured. Following a functional assessment of antecedents and consequences, a differential reinforcement of other behavior (DRO) schedule was implemented. Specifically, the resident was rewarded with short-term and long-term reinforcers following periods of time during which behaviors other than the target behavior were emitted. Although the behavior plan was successful, it resulted in a more noticeable decrease in physically aggressive behaviors than verbally abusive behaviors. Implications include increasing awareness of use of behavior plans in nursing homes and of ethical and behavioral issues associated with sexuality among nursing home residents

Quality-of-life analysis of pembrolizumab vs brentuximab vedotin for relapsed/refractory classical Hodgkin lymphoma

KEYNOTE-204 (NCT02684292) demonstrated a progression-free survival advantage for pembrolizumab over brentuximab vedotin (BV) in patients who had relapsed or refractory classical Hodgkin lymphoma (R/R cHL) following, or who were ineligible for, autologous stem cell transplantation (ASCT). Health-related quality of life (HRQoL), measured by patient-reported outcomes (PROs) from KEYNOTE-204, are reported from patients who received ≥1 dose of study treatment and completed ≥1 PRO assessment. The EORTC QoL Questionnaire Core 30 (QLQ-C30) and EuroQoL EQ-5D were administered at baseline, every 6 weeks until week 24, and every 12 weeks thereafter. Prespecified end points included least squares mean (LSM) changes from baseline to week 24 and time to true deterioration (TTD; ≥10-point decline from baseline). Comparisons were evaluated using 2-sided P values uncontrolled for multiplicity. High compliance at baseline (.90%) and through week 24 (.80%) was demonstrated across treatment groups (PRO analysis set: Pembrolizumab, n = 146; BV, n = 150). The EORTC QLQ-C30 global health status (GHS)/ quality of life (QoL) score improved from baseline to week 24 on pembrolizumab and worsened on BV and demonstrated significant LSM differences at 24 weeks (GHS/QoL: 8.60 [95% confidence interval, 3.89-13.31]; P = .0004). Significant improvements were observed in each QLQ-C30 domain except emotional and cognitive functioning. Compared with BV, pembrolizumab prolonged TTD for GHS/QoL (hazard ratio, 0.40 [95% CI, 0.22-0.74]; P = .003) and each QLQ-C30 domain except cognitive functioning. In conclusion, pembrolizumab demonstrated overall improvements in PROs of HRQoL measures over BV in the KEYNOTE-204 study. These data and previously reported efficacy results support pembrolizumab as the preferred treatment option for patients with R/R cHL who are ineligible for or experience relapse after ASCT

Translation into modern standard Arabic, cross-cultural adaptation and psychometric properties' evaluation of the Lower Extremity Functional Scale (LEFS) in Arabic-speaking athletes with Anterior Cruciate Ligament (ACL) injury

Background The Lower Extremity Functional Scale evaluates the functional status of patients that have lower extremity conditions of musculoskeletal origin. Regional Arabic dialects often create barriers to clear communication and comparative research. We aimed to cross-culturally adapt the Lower Extremity Functional Scale in modern standard Arabic that is widely used and understood in the Middle East and North Africa region, and assess its psychometric properties. Methods Cross-cultural adaptation followed a combination of recommended guidelines. For psychometric evaluation 150 patients with anterior cruciate ligament injury and 65 asymptomatic individuals were recruited. All measurement properties as indicated by the Consensusbased Standards for the selection of health status Measurement Instruments recommendations were evaluated, including content-relevance analysis, structural validity, longitudinal reproducibility, anchor- and distribution-based methods of responsiveness, as well as the longitudinal pattern of change of Lower Extremity Functional Scale in anterior cruciate ligament injured patients' functional status. Results The questionnaire presented excellent internal consistency (α = 0.96), reliability (0.80- 0.98), and good convergent validity (p = 0.85). For reproducibility testing: minimal detectable change was 9.26 points; for responsiveness assessment: minimal clinically important difference was 9 points and presented moderate effect sizes (Glass'δ = 0.71, Cohen's d = 0.81). Its unidimensionality was not confirmed and an exploratory factor analysis indicated a 2-factor solution explaining 78.1% of the variance. Conclusion The Arabic Lower Extremity Functional Scale presented acceptable psychometric properties comparable to the original version. The Arabic version of Lower Extremity Functional Scale can be used in research and clinical practice to assess the functional status of Arabicpatients suffering an anterior cruciate ligament injury. © 2019 Korakakis et al