J Biomed Res. 2020 Nov 9;1-20. doi: 10.7555/ JBR.34.20200096.
Keywords: CRISPR; fetal hemoglobin; gene editing; genome engineering; hemoglobinopathy; sickle cell anemia; sickle cell disease.
Contemp Clin Trials. 2020 Dec 18;106252. doi: 10.1016/ j.cct.2020.106252.
Methods: We report the rationale and design of a multi-site, phase III, single-blinded, RCT to be conducted in six EDs in the United States. Eligible participants will be randomized after providing consent, anticipating 50% of those randomized would have an ED visit during the enrollment period. A total of 230 participants with one VOE ED visit provides sufficient power to detect a clinically significant difference in pain score reductions of 14 between groups with 0.05 type I error. Uniquely, this trial randomizes participants in a larger population than the study population, given the impossibility of consenting and randomizing participants during emergencies. The primary endpoint is the change in pain scores in the ED from time of placement in treatment area to time of disposition (hospitalization, discharged home, or assigned to observation status) or a maximum treatment duration of 6 h. Additional outcomes include hospitalizations and ED visits seven days post-enrollment, side effects, and safety assessments.
Conclusions: The COMPARE-VOE study design will provide high-level evidence to support the NHLBI VOE treatment guidelines.
Keywords: Clinical trial; Emergency department; Pain management protocol; Sickle cell disease; Vaso-occlusive crisis; Vaso-occlusive episode.
Nurse Educ Today. 2020 Dec 9;97:104700. doi: 10.1016/ j.nedt.2020.104700.
Objectives: To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses.
Design: A scoping review of published and unpublished research from 2009 to 2019.
Data sources: Nine electronic databases and hand-searching of reference lists.
Review methods: Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis.
Results: The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement.
Conclusion: Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.
Keywords: Artificial intelligence; Assessment; Education; Management; Nursing; Pain; Simulation.
Drugs Today (Barc). 2020 Nov;56(11):705-714. doi: 10.1358/ dot.2020.56.11.3178111.
Sickle cell disease (SCD) is a genetic disorder characterized by a single gene mutation leading to polymerization of erythrocytes, with subsequent assumption of a “sickle” shape. However, polymerization is just one aspect of the disorder’s pathology. It is also characterized by abnormalities in nitric oxide utilization and vasculopathy; generation of reactive oxygen species; hemolysis; hypercoagulability; and altered rheology including abnormal leukocyte rolling along endothelium, and sickle cell-endothelial and cell-cell adhesion. The latter phenomenon is associated with increased P- and E-selectin expression and creation of a proadhesive endothelial environment. The anti-P-selectin humanized monoclonal antibody crizanlizumab functions through selective inhibition of P-selectin. At a dose of 5 mg/kg in a clinical trial, it led to a 45.3% decline in the median annual crisis rate in individuals with SCD. Tolerability was good and the adverse event profile was acceptable. In this review, results of the clinical trials involving this drug and specific side effects are outlined. Analysis of cost efficacy is touched on, with an examination of the economic and social burden of SCD.
Keywords: Anemia; Blood disorders; Crizanlizumab; Monoclonal antibodies; P-selectin inhibitors; Sickle cell disease; Vaso-occlusive crisis.
Hemoglobin. 2020 Dec 17;1-12. doi: 10.1080/ 03630269.2020.1859383. Online ahead of print.
Keywords: Patient education; medical education; sickle cell disease.
Brain Sci. 2020 Dec 14;10(12):981. doi: 10.3390/ brainsci10120981.
Methods: Data on sleep habits and behavior were taken on the same day as an in-hospital polysomnography. This study assesses the developmental sleep profiles of children and young adults aged 4-23 years old with SCA. We examined retrospective polysomnography (PSG) and questionnaire data.
Conclusion: Sleep serves an important role for daytime functioning in SCA; hence, quantitative (i.e., PSG for clinical symptoms, e.g., sleep-disordered breathing, nocturnal limb movement) and qualitative (i.e., questionnaires for habitual sleep behavior) assessments of sleep should be mutually considered to guide interventions.
Keywords: blood disorders; developmental trajectory; obstructive sleep apnea; polysomnography; sickle cell anaemia; sleep characteristics.
Keywords: ASCAT conference; Anaemia; Blood transfusion; Bone marrow transplantation; Sickle cell disease; Thalassemia.