Cognitive prognosis is poor for a subset of patients characterized by chronicity of epilepsy, older age, lower intellectual ability, and more baseline abnormalities in quantitative magnetic resonance volumetrics.

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BackgroundAsthma is the most common pediatric illness in the United States, burdening low-income and minority families disproportionately and contributing to high health care costs. Clinic-based asthma education and telephone case management have had mixed results on asthma control, as have eHealth programs and online games.ObjectivesTo test the effects of (1) CHESS+CM, a system for parents and children ages 4–12 years with poorly controlled asthma, on asthma control and medication adherence, and (2) competence, self-efficacy, and social support as mediators. CHESS+CM included a fully automated eHealth component (Comprehensive Health Enhancement Support System [CHESS]) plus monthly nurse case management (CM) via phone. CHESS, based on self-determination theory, was designed to improve competence, social support, and intrinsic motivation of parents and children.MethodsWe identified eligible parent–child dyads from files of managed care organizations in Madison and Milwaukee, Wisconsin, USA, sent them recruitment letters, and randomly assigned them (unblinded) to a control group of treatment as usual plus asthma information or to CHESS+CM. Asthma control was measured by the Asthma Control Questionnaire (ACQ) and self-reported symptom-free days. Medication adherence was a composite of pharmacy refill data and medication taking. Social support, information competence, and self-efficacy were self-assessed in questionnaires. All data were collected at 0, 3, 6, 9, and 12 months. Asthma diaries kept during a 3-week run-in period before randomization provided baseline data.ResultsOf 305 parent–child dyads enrolled, 301 were randomly assigned, 153 to the control group and 148 to CHESS+CM. Most parents were female (283/301, 94%), African American (150/301, 49.8%), and had a low income as indicated by child’s Medicaid status (154/301, 51.2%); 146 (48.5%) were single and 96 of 301 (31.9%) had a high school education or less. Completion rates were 127 of 153 control group dyads (83.0%) and 132 of 148 CHESS+CM group dyads (89.2%). CHESS+CM group children had significantly better asthma control on the ACQ (d = –0.31, 95% confidence limits [CL] –0.56, –0.06, P = .011), but not as measured by symptom-free days (d = 0.18, 95% CL –0.88, 1.60, P = 1.00). The composite adherence scores did not differ significantly between groups (d = 1.48%, 95% CL –8.15, 11.11, P = .76). Social support was a significant mediator for CHESS+CM’s effect on asthma control (alpha = .200, P = .01; beta = .210, P = .03). Self-efficacy was not significant (alpha = .080, P = .14; beta = .476, P = .01); neither was information competence (alpha = .079, P = .09; beta = .063, P = .64).ConclusionsIntegrating telephone case management with eHealth benefited pediatric asthma control, though not medication adherence. Improved methods of measuring medication adherence are needed. Social support appears to be more effective than information in improving pediatric asthma control.Trial RegistrationClinicaltrials.gov NCT00214383; http://clinicaltrials.gov/ct2/show/NCT0021...

Background This study examined the effectiveness of an online support system (CHESS) versus the Internet in relieving physical symptom distress in patients with nonsmall cell lung cancer (NSCLC). Methods 285 informal caregiver-patient dyads were randomly assigned to standard care plus the Internet or CHESS for up to 25 months. Caregivers agreed to use CHESS or the Internet and complete bimonthly surveys; for patients, these tasks were optional. The primary endpoint, patient symptom distress, was measured by caregiver reports using a modified Edmonton Symptom Assessment Scale (ESAS). Results Caregivers in the CHESS arm consistently reported lower patient physical symptom distress than caregivers in the Internet arm, with significant differences at 4 months (P = .031, Cohen’s d = .42) and 6 months (P = .004, d = .61). Similar but marginally significant effects were observed at 2 months (P = .051, d = .39) and 8 months (P = .061, d = .43). Exploratory analyses showed that survival curves did not differ significantly between the arms (log rank, P = .172), although a survival difference in an exploratory subgroup analysis suggests an avenue for further study. Conclusions An online support system may reduce patient symptom distress. The effect on survival bears further investigation.

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