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Your search keyword '"Jay J. Mehta"' showing total 2 results
Start Over Author "Jay J. Mehta" Publisher biomed central
2 results on '"Jay J. Mehta"'

1. Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice

Author

Susan Shenoi, Kristen Hayward, Elizabeth Kessler, Megan L. Curran, Jay J. Mehta, Helen E. Foster, and Meredith P. Riebschleger

Subjects
Telemedicine, lcsh:Diseases of the musculoskeletal system, Coronavirus disease 2019 (COVID-19), Models of care, Pneumonia, Viral, Physical examination, computer.software_genre, Pediatrics, V-pGALS, Betacoronavirus, Videoconferencing, Rheumatology, Multidisciplinary approach, medicine, Immunology and Allergy, Humans, Pediatric rheumatology, Pandemics, Physical Examination, medicine.diagnostic_test, business.industry, SARS-CoV-2, Patient Selection, lcsh:RJ1-570, COVID-19, lcsh:Pediatrics, medicine.disease, E-visits, United States, Clinical Practice, Europe, Paradigm shift, Pediatrics, Perinatology and Child Health, Commentary, Medical emergency, lcsh:RC925-935, business, Coronavirus Infections, computer, Delivery of Health Care
Abstract

Background The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. Body This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. Conclusion This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.

Published
2020

2. Pilot study comparing the childhood arthritis and rheumatology research alliance consensus treatment plans for induction therapy of juvenile proliferative lupus nephritis.

Author

Cooper JC, Rouster-Stevens K, Wright TB, Hsu JJ, Klein-Gitelman MS, Ardoin SP, Schanberg LE, Brunner HI, Eberhard BA, Wagner-Weiner L, Mehta J, Haines K, McCurdy DK, Phillips TA, Huang Z, and von Scheven E

Subjects
Adolescent, Child, Cohort Studies, Consensus, Cyclophosphamide adverse effects, Feasibility Studies, Female, Glucocorticoids adverse effects, Humans, Immunosuppressive Agents adverse effects, Kidney pathology, Male, Mycophenolic Acid adverse effects, Pilot Projects, Prospective Studies, Registries, Remission Induction, Rheumatology organization & administration, Treatment Outcome, Cyclophosphamide therapeutic use, Glucocorticoids therapeutic use, Guideline Adherence statistics & numerical data, Immunosuppressive Agents therapeutic use, Lupus Nephritis drug therapy, Mycophenolic Acid therapeutic use
Abstract

Background: To reduce treatment variability and facilitate comparative effectiveness studies, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) published consensus treatment plans (CTPs) including one for juvenile proliferative lupus nephritis (LN). Induction immunosuppression CTPs outline treatment with either monthly intravenous (IV) cyclophosphamide (CYC) or mycophenolate mofetil (MMF) in conjunction with one of three corticosteroid (steroid) CTPs: primarily oral, primarily IV or mixed oral/IV. The acceptability and in-practice use of these CTPs are unknown. Therefore, the primary aims of the pilot study were to demonstrate feasibility of adhering to the LN CTPs and delineate barriers to implementation in clinical care in the US. Further, we aimed to explore the safety and effectiveness of the treatments for induction therapy., Methods: Forty-one patients were enrolled from 10 CARRA sites. Patients had new-onset biopsy proven ISN/RPS class III or IV proliferative LN, were starting induction therapy with MMF or IV CYC and high-dose steroids and were followed for up to 24 months. Routine clinical data were collected at each visit. Provider reasons for CTP selection were assessed at baseline. Adherence to the CTPs was evaluated by provider survey and medication logs. Complete and partial renal responses were reported at 6 months., Results: The majority of patients were female (83%) with a mean age of 14.7 years, SD 2.8. CYC was used more commonly than MMF for patients with ISN/RPS class IV LN (vs. class III), those who had hematuria, and those with adherence concerns. Overall adherence to the immunosuppression induction CTPs was acceptable with a majority of patients receiving the target MMF (86%) or CYC (63%) dose. However, adherence to the steroid CTPs was poor (37%) with large variability in dosing. Renal response endpoints were exploratory and did not show a significant difference between CYC and MMF., Conclusions: Overall, the immunosuppression CTPs were followed as intended in the majority of patients however, adherence to the steroid CTPs was poor indicating revision is necessary. In addition, our pilot study revealed several sources of treatment selection bias that will need to be addressed in for future comparative effectiveness research.

Published
2018
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