The experience of weight loss and its associated burden in patients with non-small cell lung cancer: results of an online survey

Background: The main objectives of this study were to characterize and compare the burden of non-small cell lung cancer (NSCLC) patients reporting considerable unintentional weight loss (≥ 5% in the past 6 months or ≥ 2% for a BMI < 20 kg/m2) to those who did not.Methods: Ninety-five advanced NSCLC patients were surveyed from the online patient-powered community PatientsLikeMe, which included health-related quality of life (QLQ-C15-PAL), anorexia-cachexia symptoms/concerns (FAACT A/CS domain), distress levels, clinical/demographic characteristics, and impact of weight loss (open-ended questions).Results: Thirty-five patients (37%) had considerable weight loss at the time of the survey and 60 (63%) did not. Mean age was 59 years, and most were female (81%) and American (81%). Patients with weight loss reported significantly (p < 0.05) lower overall quality of life (55.2 vs. 66.9), worsened anorexia-cachexia symptoms/concerns (30.7 vs. 36.0), and higher symptomology, specifically fatigue (64.8 vs. 49.1), nausea (19.5 vs. 9.2), and appetite loss (41.0 vs. 23.9) – than patients without weight loss. In addition, significantly more patients who lost weight reported moderate/high distress levels than patients who did not (71% vs. 38%). For patients with weight loss, changes in food taste, fatigue, and decrease in appetite were the most frequently reported symptoms with the greatest impact on their lives, and main worries included loss of energy and disease progression.Conclusions: Weight loss represents a substantial problem for NSCLC patients and symptoms associated with weight loss significantly impact patient lives. Interventions targeted at maintaining/increasing body weight may help to alleviate these findings.

Patients' motivations and interest in research: characteristics of volunteers for patient-led projects on PatientsLikeMe

PLAIN ENGLISH SUMMARY

PLM is an online platform that provides tools for individuals to track their health and connect with other patients and while PLM has invited patients to participate in various research projects throughout the years, an examination into what motivates patients to want to get involved in clinical research has not been done. During our analysis of applications submitted by members of the PLM community, we looked for reasons patients want to participate in research and their overall beliefs about clinical research, in general. In addition, we analyzed obstacles and barriers toward patients' research participation. We observed the following:Patients are typically motivated by their individual needs and are most interested in research specific to their own condition.To get the most from patients' involvement and to enhance patients' contribution towards research goals, researchers should explain the research goal and requirements of each goal in clear and transparent terms, making it easy for patients to understand, thus avoiding any potential miscommunication.Future studies are needed to determine the best methods for involving patients in clinical research.

BACKGROUND

Historically, throughout the clinical and medical research arenas, patients have been perceived as passive "subjects" rather than as individuals who may have thoughts regarding research development, research plans, implementation of research studies, and data analysis. However, it is becoming more clear that patients increasingly want to have a more active role in clinical research studies and in the management of their own medical conditions as evidenced by a "no decision about us without us" stance, meaning patients want to make informed decisions about their health while working alongside their healthcare professionals. The central aim of this research study was to determine patients' motivations for being involved in research design and understand their perceptions of current research practices.

METHODS

Two independent qualitative studies were conducted. In Study 1, we analyzed applications submitted by self-identified patients from within the PatientsLikeMe (PLM) community, for acceptance onto our advisory panel. The advisory panel was tasked with developing a best practice guide for how to involve patients in research. During the qualitative analysis, we identified major reasons for and topics of interest associated with PLM members' motivation to apply to the advisory panel. In Study 2, we analyzed applications from PLM community members and from patients outside the PLM community for a patient-led patient-reported-outcome (PRO) development project. Similar to Study 1, we identified themes associated with patients' motivations to participate in developing a new PRO.

RESULTS

PLM members are interested in being involved in medical research for various reasons, including facilitating provider-patient communication, improving comprehension of medical information, understanding their disease, and bringing a more individualized approach to health care in general.

CONCLUSION

Challenges in the process of appropriate involvement of patients in research are discussed. In both studies, the applicants shared their interests in being involved in research. However, in Study 2, many of the patients shared ideas that were not appropriate for the development of a PRO, which indicated limitations in how the invitation and application explained the project to patients. Future studies should contribute to determining the most appropriate method for involving patients in various settings.

Communicating laboratory test results for rheumatoid factor: what do patients and physicians want?

OBJECTIVE

This study aimed to explore patient and physician perspectives on current laboratory test reporting practices and to elicit ideas for improvement.

METHODS

Two independent studies were conducted. The first solicited members of an online physician community for opinions on current laboratory test reporting practices and possible improvements. The second addressed the same topic, but solicited patient feedback, and included an evaluation of a mock laboratory test report for the rheumatoid factor blood test.

RESULTS

Both physicians and patients expressed a desire for patient-friendly information on laboratory reports. Physicians expressed a need for education for patients around false-positive and false-negative results within laboratory reports, while patients sought context around the meaning of results, relevance to other tests, and follow-up steps.

CONCLUSION

Physicians and patients see value in enhancing laboratory test reports to improve communication. While reports should include the context that patients value, they should also contain cautionary interpretation emphasized by physicians. Patient consultation on improving laboratory reports may help improve such patient-focused communication and promote greater patient understanding of health information, thereby increasing patient participation in their own health care and improving outcomes.

PRACTICE IMPLICATIONS

Laboratory reports are typically designed by experts. Including patients in laboratory report design may facilitate communication and improve outcomes through better patient engagement.

Tilting at windmills: a comment on Auer and Griffiths

In their review of Internet gambling studies, Auer and Griffiths (Soc Sci Comput Rev 20(3):312-320, 2013) question the validity of using bet size as an indicator of gambling intensity. Instead, Auer and Griffiths suggest using "theoretical loss" as a preferable measure of gambling intensity. This comment identifies problems with their argument and suggests a convergent rather than an exclusionary approach to Internet gambling measures and analysis.

Using cross-game behavioral markers for early identification of high-risk internet gamblers

Using actual gambling behavior provides the opportunity to develop behavioral markers that operators can use to predict the development of gambling-related problems among their subscribers. Participants were 4,056 Internet gamblers who subscribed to the Internet betting service provider bwin.party. Half of this sample included multiple platform gamblers who were identified by bwin.party's Responsible Gambling (RG) program; the other half were controls randomly selected from those who had the same first deposit date. Using the daily aggregated Internet betting transactions for gamblers' first 31 calendar days of online betting activities at bwin.party, we employed a 2-step analytic strategy: (a) applying an exploratory chi-squared automatic interaction detection (CHAID) decision tree method to identify characteristics that distinguished a subgroup of high-risk Internet gamblers from the rest of the sample, and (b) conducting a confirmatory analysis of those characteristics among an independent validation sample. This analysis identified two high-risk groups (i.e., groups in which 90% of the members were identified by bwin.party's RG program): Group 1 engaged in three or more gambling activities and evidenced high wager variability on casino-type games; Group 2 engaged in two different gambling activities and evidenced high variability for live action wagers. This analysis advances an ongoing research program to identify potentially problematic Internet gamblers during the earliest stages of their Internet gambling. Gambling providers and public policymakers can use these results to inform early intervention programs that target high-risk Internet gamblers.

Accuracy of self-reported versus actual online gambling wins and losses

This study is the first to compare the accuracy of self-reported with actual monetary outcomes of online fixed odds sports betting, live action sports betting, and online casino gambling at the individual level of analysis. Subscribers to bwin.party digital entertainment's online gambling service volunteered to respond to the Brief Bio-Social Gambling Screen and questions about their estimated gambling results on specific games for the last 3 or 12 months. We compared the estimated results of each subscriber with his or her actual betting results data. On average, between 34% and 40% of the participants expressed a favorable distortion of their gambling outcomes (i.e., they underestimated losses or overestimated gains) depending on the time period and game. The size of the discrepancy between actual and self-reported results was consistently associated with the self-reported presence of gambling-related problems. However, the specific direction of the reported discrepancy (i.e., favorable vs. unfavorable bias) was not associated with gambling-related problems.

A study of online consultations for paediatric renal patients in Russia

We developed an educational website for parents of paediatric patients with kidney diseases in Russia. Parents could ask questions regarding their child's illness and submit information, including medical summaries and scanned or electronic images. A US-trained specialist in paediatric nephrology reviewed the information provided and advised about further evaluation or referral, as well as discussing possible treatment plans. In the first nine months, 141 distinct users communicated through the website. Fifty-eight percent of patients were female. An analysis of 70 cases suggested that in 45% there had been overdiagnosis of common paediatric problems, such as urinary tract infection and pyelonephritis. Users completed an anonymous satisfaction survey. The response rate was 84% (n = 59/70). The majority of respondents found the consultation useful (mean = 4.6 on a 5-point scale). The online consultation answered the questions of most respondents, provided useful information and relieved uncertainty regarding a follow-up. The majority of the respondents (>90%) confirmed that they trusted the online consultation and would recommend the technique to other parents. Online consultation for parents can provide reliable information that results in improved parental satisfaction and education. This approach may be useful in improving care and providing patient education in underserved areas in the USA and elsewhere.

How do gamblers start gambling: identifying behavioural markers for high-risk internet gambling

BACKGROUND

The goal of this study is to identify betting patterns displayed during the first month of actual Internet gambling on a betting site that can serve as behavioural markers to predict the development of gambling-related problems.

METHODS

Using longitudinal data, k-means clustering analysis identified a small subgroup of high-risk gamblers.

RESULTS

Seventy-three percent of the members of this subgroup eventually closed their account due to gambling-related problems. The characteristics of this high-risk subgroup were as follows: (i) frequent and (ii) intensive betting combined with (iii) high variability across wager amount and (iv) an increasing wager size during the first month of betting.

CONCLUSION

This analysis provides important information that can help to identify potentially problematic gamblers during the early stages of gambling-related problems. Public health workers can use these results to develop early interventions that target high-risk Internet gamblers for prevention efforts. However, one study limitation is that the results distinguish only a small proportion of the total sample; therefore, additional research will be necessary to identify markers that can classify larger segments of high-risk gamblers.

Predictors of medication adherence for African American patients diagnosed with hypertension

BACKGROUND

The prevalence, morbidity and mortality of hypertension are strikingly higher for African Americans than for Whites. Poor adherence to the antihypertensive medication regimen is a major cause of inadequate blood pressure control. In this study, we assess the relationship of antihypertensive medication adherence to sociodemographic, clinical and cognitive characteristics of urban African American adults.

METHOD

Data were drawn from a larger randomized controlled trial assessing the effect of a behavioral intervention to improve medication adherence and blood pressure control among hypertensive African American patients followed in an urban primary care network. Medication adherence was assessed at baseline using the Medication Event Monitoring System (MEMS)--a method regarded as the gold standard for assessing medication adherence in clinical research. Information on potential correlates of medication adherence (sociodemographic, clinical and cognitive) was obtained at baseline by computer-assisted interview. We assessed the cross sectional association of these factors to medication adherence in baseline data.

RESULTS

Medication adherence was significantly associated with systolic blood pressure (r=.253, P<.04) and self-reported medication adherence (r=.285, P<.03). The relationship of education to medication adherence varied significantly by sex (P<.05 for interaction). Specifically, lower educational attainment was related to higher adherence among men, but lower adherence among women.

CONCLUSION

Identifying correlates of low antihypertensive medication adherence and their interactions, as in this study, will help health providers to better recognize patients at higher risk for worse hypertension-related outcomes. This knowledge can also inform interventions which target a higher-risk subset of hypertensive patients.

The effect of mood on detection of covariation

The purpose of this research is to explore the effect of mood on the detection of covariation. Predictions were based on an assumption that sad moods facilitate a data-driven information elaboration style and careful data scrutinizing, whereas happy moods predispose individuals toward top-down information processing and decrease the attention given to cognitive tasks. The primary dependent variable involved is the detection of covariation between facial features and personal information and the use of this information for evaluating new target faces. The findings support the view that sad mood facilitates both conscious and unconscious detection of covariation because it increases motivation to engage in the task. Limiting available cognitive resources does not eliminate the effect of mood on the detecting of covariation.

Discrete emotions and persuasion: the role of emotion-induced expectancies

The authors argue that specific emotions can alter the persuasive impact of messages as a function of the emotional framing of persuasive appeals. Because specific emotions inflate expectancies for events possessing matching emotional overtones (D. DeSteno, R. E. Petty, D. T. Wegener, & D. D. Rucker, 2000), the authors predicted that attempts at persuasion would be more successful when messages were framed with emotional overtones matching the emotional state of the receiver and that these changes would be mediated by emotion-induced biases involving expectancies attached to arguments contained in the messages. Two studies manipulating discrete negative emotional states and message frames (i.e., sadness and anger) confirmed these predictions. The functioning of this emotion-matching bias in parallel with emotion-induced processing differences and the limitations of a valence-based approach to the study of attitude change are also considered.

Sex differences in jealousy: evolutionary mechanism or artifact of measurement?

Two studies are presented that challenge the evidentiary basis for the existence of evolved sex differences in jealousy. In opposition to the evolutionary view, Study I demonstrated that a sex difference in jealousy resulting from sexual versus emotional infidelity is observed only when judgments are recorded using a forced-choice response format. On all other measures, no sex differences were found; both men and women reported greater jealousy in response to sexual infidelity. A second study revealed that the sex difference on the forced-choice measure disappeared under conditions of cognitive constraint. These findings suggest that the sex difference used to support the evolutionary view of jealousy (e.g., D. M. Buss, R. Larsen, D. Westen, & J. Semmelroth, 1992; D. M. Buss et al., 1999) likely represents a measurement artifact resulting from a format-induced effortful decision strategy and not an automatic, sex-specific response shaped by evolution.

Spontaneous clostridia gas gangrene of uterus associated with endometrial malignancy

Only four patients with clostridia sepsis in association with gynecologic malignancy have been reported, all of whom had prior diagnostic or therapeutic intervention. Our patient is the first documented case of such clostridium sepsis that occurred spontaneously, i.e., without previous trauma, instrumentation, radiation or chemotherapy. The value of aggressive management is reviewed.

Screening for the patient at risk for postpartum depression

A simple, accurate, and practical device was designed for detecting the woman at risk for postpartum emotional disorder (PED). Women attending the Sainte-Justine prenatal clinic were requested to complete a 19-item "yes/no" type of questionnaire. Each patient was classified for presence or absence of PED according to preestablished criteria. The responses of the patients classified as having emotional disorders were compared to the "normal" group. Thirteen percent developed PED. Six items showed predictive value: 1) admission of often feeling unloved by husband; 2) admission of feeling that pregnancy is undesired; 3) past history of postpartum depression; 4) being single or separated; 5) admission of marital problems; 6) admission that pregnancy was unplanned. The presentation of these items as part of a routine patient prenatal history questionnaire would constitute a means of identifying the woman at risk to develop PED and preventive measures could be taken.