Dodoo, Christopher A

Objectives To comprehensively review the available literature on prehabilitation and rehabilitation exercise, nutrition, and psychological support interventions for patients with kidney cancer (KC), to summarise the clinically relevant efficacy and cost‐effectiveness of interventions, to expose key knowledge gaps, and to inform future investigations and initiatives. Methods This review was performed according to the per Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Extension for Scoping Reviews Guidelines. We included randomised controlled trials (RCTs) assessing programmes of prehabilitation or rehabilitation, exercise, psychological support, or nutrition components in patients with KC or KC caregivers from January 2004 to March 2022. Statistically significant positive (SS+) and negative (SS−) results were summarised. Results The systematic search yielded 10 968 records including 18 RCTs, involving 2774 unique subjects, 706 of whom were KC patients/survivors. None included caregivers or assessed cost‐effectiveness. Two interventions were implemented before surgery, one was implemented prior to initiation of systemic therapy, eight were implemented during systemic or radiation therapy, three were implemented after treatment, while implementation time was not specified for four interventions. Conclusion Most (14/18) RCTs involving exercise, nutrition, psychological support, or prehabilitative or rehabilitative programmes for KC performed to date demonstrated SS+ results. The evidence was most robust regarding previously evaluated psychological support, especially mindfulness‐based interventions (9/10 studies demonstrating SS+ improvement in primary outcomes), followed by therapeutically valid exercise with/without psychological support (5/8 RCTs demonstrated efficacy), then nutrition or pharmacological interventions (2/5 demonstrated efficacy). Level 1 evidence supports counselling patients and referral to mindfulness‐based psychological therapy along with physical therapy or physical medicine and rehabilitation, as well as consideration of preoperative carbohydrate drinks. No studies have examined impact on caregivers, or cost‐effectiveness, which are both critical areas for future study.

AbstractBackgroundPrevious publications have described the presence and severity of insomnia amongst those with persistent post‐traumatic headache (PPTH), but there has been a paucity of studies investigating insomnia during the acute phase of post‐traumatic headache (APTH). The primary study objective was to investigate insomnia symptoms and their severity in individuals with APTH due to mild traumatic brain injury (mTBI), and the secondary objective was to assess how psychological factors, sensory hypersensitivities, headache burden, and cognitive performance might associate with insomnia.MethodsIn this clinic‐based, cross‐sectional study, 82 individuals with APTH due to mTBI and 82 healthy controls (HC) were included. Participants completed the Insomnia Severity Index (ISI), Trail Making Test (TMT A and B), 12‐item Allodynia Symptom Checklist (ASC‐12), State–Trait Anxiety Inventory, Photosensitivity Assessment Questionnaire (PAQ), Beck Depression Inventory (BDI), Hyperacusis Questionnaire (HQ), Rey Auditory Verbal Learning Test (RAVLT), and a detailed headache characteristics questionnaire within 59 days of their mTBI to assess insomnia severity, psychological features, sensory hypersensitivities, headache symptoms, and cognitive performance. The questionnaire and test results were compared between APTH and HC groups. Within the APTH group, ISI scores were correlated with the other assessments to determine underlying clinical relationships.ResultsParticipants with APTH, evaluated an average of 27.2 days after their mTBI, had significantly higher ISI scores (median [interquartile range, IQR] score 12 [6–17]) compared to HC (0 [1.3–6], p < 0.001). Twenty‐four (29%) individuals with APTH had ISI scores categorized as moderate clinical insomnia compared to two (2%) in the HC group. Additionally, seven (9%) in the APTH group and none of the HC had ISI scores indicative of severe clinical insomnia. Those with APTH significantly differed from the HC on the BDI (median [IQR] score APTH: 9 [5–16.8] vs. HC: 2 [0–4]; p < 0.001), state anxiety (median [IQR] score APTH: 36.5 [26–45] vs. HC: 23 [20–27.5]; p < 0.001), trait anxiety (median [IQR] score APTH: 38 [27.3–46.8] vs. HC: 26 [23–30]; p < 0.001), photosensitivity (median [IQR] PAQ score APTH: 2 [1–4] vs. HC: 0 [0–1]; p < 0.001), allodynia (median [IQR] ASC‐12 score APTH: 2 [0–5.8] vs. HC: 0 [0–0], p < 0.001), hyperacusis (median [IQR] HQ score APTH: 15.5 [7–23] vs. HC: 4 [2.3–7], p < 0.001), and RAVLT‐delayed recall (median [IQR] score APTH: −0.8 [−1.5 to 0] vs. HC: −0.1 [−0.9 to 0.7], p = 0.019). For participants with APTH, the ISI was most significantly associated with the BDI (standardized regression coefficient (RC) [95% confidence interval, CI] 0.68 [0.52–0.84], p < 0.001), followed by state anxiety (RC [95% CI] 0.60 [0.42–0.78], p < 0.001), trait anxiety (RC [95% CI] 0.56 [0.37–0.74], p < 0.001), headache severity (RC [95% CI] 0.40 [0.19–0.60], p < 0.001), HQ (RC [95% CI] 0.36 [0.16–0.57], p = 0.001), and PAQ (RC [95% CI] 0.35 [0.15–0.56], p = 0.001).ConclusionsIndividuals with APTH have more symptoms of insomnia compared to HC with 38% of individuals with APTH experiencing moderate or severe insomnia symptoms. Insomnia symptoms may be associated with more severe depression, anxiety, photophobia, hyperacusis, headache severity, and cognitive impairment. To address the overall well‐being of patients with APTH, clinicians should screen for and appropriately manage insomnia along with other symptoms following mTBI.

Abstract The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.g., exercise, nutrition, or psychological support). Outcomes were characterized according to eight prespecified, clinically relevant categories. The search retrieved 10,968 records, 27 of which met the inclusion criteria, and 24 described unique RCTs with 2471 enrolled participants. Of 24 interventions, 17 (71%) yielded statistically significant results for the outcome of interest. Only one RCT included a cost‐effectiveness analysis, and only two characterized the efficacy of interventions for caregivers. Of 11 RCTs involving psychological support, eight yielded statistically significant results, as did nine of 11 RCTs with physical exercise interventions, three of four RCTs with educational interventions, three of four RCTs with nutritional support interventions, one of two RCTs with pharmacologic medications, and zero of one RCT with physical therapy. The most promising interventions for inclusion in multimodal, personalized (p)rehabilitation programs included exercise, stress management training, cognitive training, smoking and alcohol cessation counseling, immunonutrition, stoma education, and penile rehabilitation. Further studies of the cost effectiveness and efficacy for caregivers of such interventions are needed. Plain Language Summary In a scoping review of all randomized clinical trials involving prehabilitative or rehabilitative diet, exercise, and psychological support interventions for patients with bladder cancer, survivors, and their caregivers, 17 of 24 (71%) interventions yielded statistically significant improvements in the outcome of interest. Clinicians should consider implementing such interventions for those affected by bladder cancer.

Abstract Background Erenumab is a monoclonal antibody that targets the calcitonin gene‐related peptide (CGRP) receptor and is approved for the preventative treatment of migraine in adults. CGRP is involved in the regulation of vasomotor tone under physiologic and pathologic conditions, including hypertension. While there has not been evidence of hypertension in preclinical models or clinical trials, post‐marketing data suggest erenumab may be associated with hypertension. This led to a warning in the United States Food and Drug Administration prescribing information for erenumab. Objective To determine the frequency of worsening blood pressure (BP) after initiation of erenumab in patients with migraine and how this is associated with hypertension. Methods This is an observational retrospective cohort study evaluating patients at a tertiary headache or neurology department. Systolic and diastolic BPs were compared between the initial visit prior to initiation of erenumab, and follow‐up visit while on erenumab. Worsening BP was defined as moving from a lower stage to a higher stage of BP, as defined by the American Heart Association. Serious adverse vascular events were also recorded. Results A total of 335 patients were included in the final analysis (mean [SD] age of 45.7 [14.40] years, 83.9% [281/335] female). At baseline, 20.9% (70/335) of patients had a prior diagnosis of hypertension. The median (interquartile range) time to follow‐up appointment from initial appointment was 20.5 (13.3–35.3) weeks. The mean (SD) BP at baseline was systolic 124.7 (15) mmHg and diastolic 77 (11) mmHg, and at follow‐up was systolic 124.0 (15) mmHg and diastolic 77.8 (9) mmHg. Overall, 23.3% (78/335) of all patients had worsening BP, whereas 13/225 (3.9%) patients had improvement in their BP. Patients with atrial fibrillation were more likely to develop worsening BP (odds ratio, 4.9, 95% confidence interval 1.12–21.4; p = 0.035). There was no association between worsening BP and pre‐existing hypertension, sex, body mass index, or age. One patient had non‐ST elevation myocardial infarction attributed to a hypertensive emergency while on erenumab. Conclusion We found that 23.3% of patients initiated on erenumab may have developed worsening BP, suggesting the need for BP monitoring in patients initiated on erenumab.