ABSTRACT:Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening condition. Caplacizumab substantially shortens the time to clinical response, yet delayed platelet count recovery is occasionally observed, raising concerns about iTTP refractoriness. This retrospective multicenter study analyzed 204 acute iTTP episodes reported to the German REACT (Retrospective Evaluation of Acquired Thrombotic Thrombocytopenic Purpura in Caplacizumab-Treated Patients) 2020 and ATMAR (Austrian Thrombotic Microangiopathy Registry) registries, all treated with caplacizumab. Refractoriness was assessed using the 2017 International Working Group criteria and the more stringent definition by the French Reference Center for Thrombotic Microangiopathies. We evaluated time to platelet recovery and presence of confounding clinical conditions, potentially accounting for persistent thrombocytopenia, in all episodes. By day 5 after caplacizumab initiation, 171 of 204 patients (83.8%) achieved a clinical response, and the remaining 33 of 204 (16.2%) showed at least a doubling of the platelet count. Only 3 patients (1.5%) met laboratory criteria for refractoriness. In all cases, plausible alternative causes were present (eg, missed doses, infection). No patient was refractory without a confounding factor. In 8 of 204 patients (3.9%) we observed a markedly prolonged thrombocytopenia (≥10 days) and identified confounding conditions in all cases. In the stratified Cox model, the presence of alternative causes of thrombocytopenia was the only independent determinant of delayed platelet count normalization (hazard ratio, 0.16; 95% confidence interval, 0.09-0.28; P< .001). In the context of caplacizumab-based therapy, true refractoriness is rare. Delayed platelet count recovery is predominantly attributable to concomitant clinical conditions. Careful clinical assessment and context-sensitive interpretation of treatment response before escalating iTTP-specific therapy may avoid unnecessary treatment intensification and associated risks.
Background: Structured formats for interprofessional communication and shared decision-making are fostering positive effects communication, collaboration, and patient-related outcomes in clinical practice. Previous studies show considerable heterogeneity in format, structure, and implementation with a lack of nurse-led case discussion models. A nurse-led interprofessional case discussion (InCaD) was developed and piloted on a nurse-led unit (NLU) in a German maximum-care hospital. This study describes the implementation process, explores participating professionals’ expectations before first their participation, and evaluates their experiences across repeated sessions. Methods: In an observational cross-sectional design, data were collected over seven months before and after six InCaD-sessions, using standardized questionnaires. Pre-session questionnaires assessed sociodemographic characteristics, prior experiences, and expectations. Post-session questionnaires assessed session characteristics and ratings of structure, usefulness, interprofessional exchange, and shared decision-making. Data were analyzed descriptively in Excel and R. Results: 14 pre-session and 28 post-session questionnaires were included. Participants were nurses (N = 17), physicians (N = 2), care and case management (N = 3), and others (N = 6). Mean age was 39.28 years, most participants were female and worked full-time, and mean professional experience was 13.62 years. Expectations before first participation were consistently positive. All respondents expected to express opinion, thoughts, and feelings freely, clarify relevant questions and concerns, improve interprofessional collaboration, and improve discharge planning (each 14/14; 100%). Expectations were lower for competence gain (9/14; 64.3%) and for others’ perspectives changing one’s own assessment (12/14; 85.7%). Post-participation evaluations were likewise predominantly positive. All respondents agreed that sufficient information had been provided, main problems had been identified, care goals had been defined, shared decisions had occurred, InCaD was helpful, and interprofessional exchange took place on equal footing (each 28/28; 100%). Lower agreement was reported for timely invitation (19/28; 67.9%), consideration of patients’ or relatives’ wishes and needs (24/28; 85.7%), and planning security for relatives or caregivers (21/28; 75.0%). Conclusion: InCaD demonstrated feasibility, contextual appropriateness, and high acceptance. The findings suggest to support structured coordination, shared decision-making, and care planning in complex care situations and provide an empirical basis for further refinement, sustained implementation, and theory-informed evaluation of InCaD as a nurse-led intervention in hospital care.
ZusammenfassungZu den Hypnotika aus der Substanzklasse der Non-Benzodiazepine zählen das Zyklopyrrolon Zopiclon, das Imidazopyridin Zolpidem sowie das Pyrazolopyrimidin Zaleplon. Die Non-Benzodiazepin-Hypnotika können zur kurzzeitigen Behandlung von Insomnie eingesetzt werden, wenn die kognitive Verhaltenstherapie für Insomnien nicht hinreichend effektiv war oder nicht durchführbar ist.
