Research ArticleOriginal Article
Open Access

Effect of new modalities of treatment on physicians’ management plan for patients with spinal muscular atrophy

Fahad A. Bashiri, Hiyam A. Idris, Fahad M. Al-Sohime, Mohamad H. Temsah and Khalid A. Alhasan
Neurosciences Journal January 2019, 24 (1) 16-21; DOI: https://doi.org/10.17712/nsj.2019.1.20180321

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Tables

  • Table 1

    Physician demographic and professional characteristics (N=169).

    Characteristicsn (%)
    Gender
     Female82 (48.5)
     Male87 (51.5)
    Median years of experience (Q1, Q3), range6 (3.11)
    Specialty
     Pediatric neurology88 (52.1)
     Adult neurology17 (10.1)
     Pediatric intensivist30 (17.8)
     General pediatrician22 (13)
     Other specialties: (Geneticist, Pediatric pulmonologist, Adult intensivist)12 (7.1)
    Current Position
     Consultant89 (52.7)
     Fellow16 (9.5)
     Specialist28 (16.6)
     Resident36 (21.3)
    Facility Level
     Tertiary Hospital132 (78.1)
     Secondary Hospital35 (20.7)
     Primary Health care2 (1.2)
    Hospital Sector Type
     Public/governmental158 (93.5)
     Private11 (6.5)

    • Q 1 - Quartile 1, Q 3 - Quartile 3

  • Table 2

    Physician demographics and bivariate analysis of the associations between professional and working conditions with awareness regarding SMA consensus care protocol.

    CharacteristicsAwareness of the consensus SMA standard of careTest statistics
    No=85Yes=83
    *Sex
     Female36 (42.4)45 (54.2)χ2(1)=2.37
     Male49 (57.6)38 (45.8)
    †Years of experience, mean±SD8.3±7.27.8±5.7t (166)=0.497
    ‡Specialty
     Pediatric neurology31 (36.5)56 (67.5)χ2(4)=18.9
     Adult neurology9 (10.5)8 (9.6)
     Pediatric intensivist21 (24.7)9 (10.8)
     General pediatrics17 (20)5 (6)
     Other specialists: pediatric pulmonologist & geneticist7 (8.2)5 (6)
    §Current position
     Consultant48 (56.5)41 (49.4)χ2(1)=3.34
     Fellow10 (11.8)6 (7.2)
     Specialist13 (15.3)14 (16.9)
    Agreement level to the SMA standard of care (mean Likert scale)6.6 (2.64)
    Compliance level to the SMA standard of care (mean Likert scale)6.11 (2.7)

    • SMA - spinal muscular atrophy.

    • ↵* p-value=0.124,

    • ↵† p-value=0.620,

    • ↵‡ p-value= 0.001,

    • ↵§ p-value= 0.342

  • Table 3

    Multivariate logistic regression analysis of the combined and individual associations between physician demographic and professional characteristics with their awareness of the consensus of the standard of SMA patients care (N=168).

    CharacteristicsBSEOR95% CIP-value
    LowerUpper
    Gender (male)-.532.352.588.2951.1720.131
    Physicians’ experience in years.268.1851.308.9101.8800.147
    Hospital sector (private hospital)1.155.7633.174.71114.1630.130
    Physicians’ field of expertise-.493.123.611.480.776<0.001
    Physicians’ current position.264.1581.303.9561.7760.094
    Presence of a clear DNR policy at work (yes)-.516.550.597.2031.7550.348
    Presence of mechanically ventilated SMA patients (yes)0.164
    Presence of mechanically ventilated SMA patients (no)-.502.381.605.2871.2760.187
    Presence of mechanically ventilated SMA patients (unsure)-.943.527.390.1391.0940.073
    Constant-.1081.075.8980.920

    • SMA - spinal muscular atrophy, DNR - do-not-resuscitate, B - coefficient of regression parameters, SE - standard error, OR - odds ratio, CI - confidence interval.

  • Table 4

    Physicians’ reported aspects and practices of SMA patients care (N=169).

    Aspects and practicesn (%)
    Awareness of consensus statement for standard SMA care
     Yes84 (49.7)
     No85 (50.3)
    Awareness of the new treatment (Nusinersen)
     Not sure/undecided88 (52.1)
     No23 (13.6)
     Yes58 (34.3)
    Will (Nusinersen) improve the SMA outcomes?
     Unsure/undecided90 (53.3)
     No25 (14.8)
     Yes54 (32)
    Would you reverse code status of an end stage DNR SMA subject given the new potential medication?
     No42 (24.9)
     Unsure/undecided/hesitate88 (52.1)
     Yes39 (23.1)

    • SMA - spinal muscular atrophy, DNR - do-not-resuscitate

  • Table 5

    Multivariate logistic regression analysis of the combined and individual associations between physician demographic and professional characteristics with their odds to reverse the code status of SMA patients in light of impending compromise (N=168).

    CharacteristicsBSEOR95% CIP-value
    LowerUpper
    Gender (male)-.191.414.826.3671.8620.646
    Physicians’ experience in years.023.0371.023.9521.0990.536
    Physicians current position.526.1871.6921.1742.4390.005
    Hospital Sector (private).893.7082.444.6119.7800.207
    Hospital type (secondary).908.4792.480.9696.3480.058
    Physicians field of speciality-.371.178.690.487.9790.038
    Constant-3.5631.186.0280.003

    • SMA - spinal muscular atrophy, B - coefficient of regression parameters, SE - standard error, OR - odds ratio, CI - confidence interval.

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