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- Marmstål Hammar, Lena, 1979-, et al.
(författare)
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Caregiver Singing Intervention : Do Expressions of Emotion and Resistance Differ Between Persons with Vascular Dementia and Those with Alzheimer’s Disease? A Pilot Study
- 2022
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Ingår i: Music & Science. - : SAGE Publications. - 2059-2043. ; 5, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: The music intervention caregiver singing (CS) has been shown to be beneficial in facilitating care of persons with dementia in residential care, but no studies have focused on possible differences with respect to dementia diagnosis, which might be important due to possible different symptoms. Aim: To describe expressed emotions and resistiveness to care among persons with vascular dementia or Alzheimer’s disease during CS. Method: The study is a pilot intervention of CS which contains pre- and intervention measurements. Participants were persons with vascular dementia or Alzheimer’s disease. Measures were the Resistiveness to Care Scale and the Observed Emotion Rating Scale. Care situations without and with CS were compared of persons with vascular dementia and Alzheimer’s disease. The data are described with descriptive statistics. Results: During CS, positive emotion increased for persons with Alzheimer’s disease and vascular disease, with far longer intervals observed among persons with Alzheimer’s disease. Conclusion: CS may have positive influences regardless of diagnosis, but when targeting different emotional expressions, diagnosis may play an important role. However, larger studies need to be undertaken to confirm the results of this pilot study. © The Author(s) 2022.
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| 3. |
- Piehl, F., et al.
(författare)
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Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis The RINOMAX Randomized Clinical Trial
- 2022
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Ingår i: Jama Neurology. - : American Medical Association (AMA). - 2168-6149 .- 2168-6157.
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Rituximab is a third-line option for refractory generalized myasthenia gravis (MG) based on empirical evidence, but its effect in new-onset disease is unknown. OBJECTIVE To investigate the efficacy and safety of rituximab compared with placebo as an add-on to standard of care for MG. DESIGN, SETTING, AND PARTICIPANTS This randomized, double-blind, placebo-controlled study took place throughout 48 weeks at 7 regional clinics in Sweden. Key inclusion criteria were age older than 18 years, onset of generalized symptoms within 12 months or less, and a Quantitative Myasthenia Gravis (QMG) score of 6 or more. Patients were screened from October 20, 2016, to March 2, 2020. Key exclusion criteria included pure ocular MG, suspected thymoma, previous thymectomy, and prior noncorticosteroid immunosuppressants or high doses of corticosteroids. INTERVENTIONS Participants were randomized 1:1 without stratification to a single intravenous infusion of 500 mg of rituximab or matching placebo. MAIN OUTCOMES AND MEASURES Minimal disease manifestations at 16 weeks defined as a QMG score of 4 or less with prednisolone, 10 mg or less daily, and no rescue treatment. RESULTS Of 87 potentially eligible patients, 25 were randomized to rituximab (mean [SD] age, 67.4 [13.4] years; 7 [28%] female) and 22 to placebo (mean [SD] age, 58 [18.6] years; 7 [32%] female). Compared with placebo, a greater proportion with rituximab met the primary end point; 71% (17 of 24) in the rituximab group vs 29% (6 of 21) in the placebo group (Fisher exact test P = .007; probability ratio, 2.48 [95% CI, 1.20-5.11]). Secondary end points, comparing changes in Myasthenia Gravis Activities of Daily Living and Myasthenia Gravis Quality of Life at 16 weeks with QMG at 24 weeks did not differ between groups with censoring for rescue treatment (per-protocol analysis) but were in favor of active treatment when rescue treatment was taken into account by worst rank imputation (post hoc analysis). Rescue treatments were also more frequent in the placebo arm (rituximab: 1 [4%]; placebo, 8 [36%]). One patient in the placebo arm had a myocardial infarction with cardiac arrest and 1 patient in the active arm experienced a fatal cardiac event. CONCLUSIONS AND RELEVANCE A single dose of 500 mg of rituximab was associated with greater probability of minimal MG manifestations and reduced need of rescue medications compared with placebo. Further studies are needed to address long-term benefit-risk balance with this treatment.
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