Patient-Centered Insights on Treatment Decision Making and Living with Acute Myeloid Leukemia and Other Hematologic Cancers

Expectations relating to treatment and survival, and factors influencing treatment decisions are not well understood in adult patients with acute myeloid leukemia. This study analyzed combined findings from a targeted literature review with patient-reported information shared on YouTube to further understand patient perspectives in hematologic cancers and, in particular, acute myeloid leukemia. The targeted literature review included articles concerning patient (aged ≥ 18 years) experiences or perspectives in acute myeloid leukemia or other hematologic cancers. YouTube video selection criteria included patients (aged ≥ 60 years) with self-reported acute myeloid leukemia. In total, 26 articles (13 acute myeloid leukemia-specific and 14 other hematologic cancers, with one relevant to both populations) and 28 videos pertaining to ten unique patients/caregivers were identified. Key concepts reported by patients included the perceived value of survival for achieving personal and/or life milestones, the emotional/psychological distress of their diagnosis, and the uncertainties about life expectancy/prognosis. Effective therapies that could potentially delay progression and extend life were of great importance to patients; however, these were considered in terms of quality-of-life impact and disruption to daily life. Many patients expressed concerns regarding the lack of treatment options, the possibility of side effects, and how their diagnosis and treatment would affect relationships, daily lives, and ability to complete certain tasks. Both data sources yielded valuable and rich information on the patient experience and perceptions of hematologic cancers, in particular for acute myeloid leukemia, and its treatments. Further understanding of these insights could aid discussions between clinicians, patients, and their caregivers regarding treatment decisions, highlight outcomes of importance to patients in clinical studies, and ultimately, inform patient-focused drug development and evaluation.

Characterisation of ovine bone marrow-derived stromal cells (oBMSC) and evaluation of chondrogenically induced micro-pellets for cartilage tissue repair in vivo

Abstract

Bone marrow stromal cells (BMSC) show promise in cartilage repair, and sheep are the most common large animal pre-clinical model.

Objective

The objective of this study was to characterise ovine BMSC (oBMSC) in vitro, and to evaluate the capacity of chondrogenic micro-pellets manufactured from oBMSC or ovine articular chondrocytes (oACh) to repair osteochondral defects in sheep.

Design

oBMSC were characterised for surface marker expression using flow cytometry and evaluated for tri-lineage differentiation capacity. oBMSC micro-pellets were manufactured in a microwell platform, and chondrogenesis was compared at 2%, 5%, and 20% O₂. The capacity of cartilage micro-pellets manufactured from oBMSC or oACh to repair osteochondral defects in adult sheep was evaluated in an 8-week pilot study.

Results

Expanded oBMSC were positive for CD44 and CD146 and negative for CD45. The common adipogenic induction ingredient, 3-Isobutyl-1-methylxanthine (IBMX), was toxic to oBMSC, but adipogenesis could be restored by excluding IBMX from the medium. BMSC chondrogenesis was optimal in a 2% O₂ atmosphere. Micro-pellets formed from oBMSC or oACh appeared morphologically similar, but hypertrophic genes were elevated in oBMSC micro-pellets. While oACh micro-pellets formed cartilage-like repair tissue in sheep, oBMSC micro-pellets did not.

Conclusion

The sensitivity of oBMSC, compared to human BMSC, to IBMX in standard adipogenic assays highlights species-associated differences. Micro-pellets manufactured from oACh were more effective than micro-pellets manufactured from oBMSC in the repair of osteochondral defects in sheep. While oBMSC can be driven to form cartilage-like tissue in vitro, the effective use of these cells in cartilage repair will depend on the successful mitigation of hypertrophy and tissue integration.

Supplementary information

The online version contains supplementary material available at 10.1186/s13287-020-02045-3.

Development of the impact of weight on daily activities questionnaire: A patient-reported outcome measure

While patient-reported outcome measures are available to evaluate health-related quality of life and functioning in obesity, existing measures do not evaluate the impact of excess weight and weight loss on the ability to perform regularly occurring daily activities. Three iterative sets of qualitative interviews were conducted in two countries (United States, n = 23; United Kingdom, n = 23) with individuals with body mass index ≥30 kg/m² to inform development of the Impact of Weight on Daily Activities Questionnaire (IWDAQ) for use in clinical trials to evaluate daily activity limitations associated with excess weight. Candidate concepts were selected based on the literature, expert opinion, and previously conducted qualitative research, after which the draft IWDAQ was developed and tested. Interviews included a brief concept elicitation phase, followed by cognitive debriefing during which the IWDAQ was refined based upon participants' feedback. The IWDAQ uses a novel, adaptive questionnaire design, such that clinical trial participants choose the three IWDAQ activities they would most like to improve with weight loss and rate the degree of limitation in each of these activities at baseline. By allowing individuals participating in trials to identify and monitor changes in the activities they most want to see improve with weight loss, the 19-item IWDAQ has the potential to detect the benefits of weight-loss treatment that individuals with obesity value most.

Patient and healthcare professional experiences of the Salford Lung Studies: qualitative insights for future effectiveness trials

Background

Randomized controlled trials (RCTs) conducted in the routine care setting provide the opportunity to better understand the effectiveness of new medicines but can present recruitment difficulties. An improved understanding of the challenges/opportunities for patient and healthcare professional (HCP) engagement in clinical research is needed to enhance participation and trial experience. In this study, we explored patient and HCP drivers for, and experiences of, participation in the Salford Lung Studies (SLS), and their views on future trial participation and the overall value of such trials.

Methods

This was a qualitative study set in Salford, UK, comprising patient telephone interviews (N = 10) and HCP advisory boards (one with general practitioners [GPs], one with practice managers [PMs]); all individuals had participated in the SLS. Semi-structured telephone interviews were recorded, transcribed and analysed thematically. Advisory board meetings were analysed based on transcriptions of audio recordings and field notes.

Results

For patients, key positive aspects of the SLS were the ease/convenience of study assessments and excellent relationships with study nurses. GPs and PMs considered the SLS to be well-organized and highlighted the value of research nurse support; they also described minor challenges relating to trial systems, initial financial strain on practices and staff turnover. All participants indicated that they were very likely to participate in future trials, citing a design closely aligned with routine care practice as essential. Several strategies to encourage trial participation were suggested, such as clearly communicating benefits to patients and ensuring flexible study assessments.

Conclusions

Patients and HCPs had positive experiences of the SLS. The study design, closely aligned with routine care, was considered important to their high likelihood of participating in future trials. The experiences of patients and HCPs in the SLS provide valuable insights that will help inform future best practice in the design and conduct of future real-world effectiveness RCTs in primary care. The detailed first-hand experiences of HCPs will be of significant value to others considering engaging in clinical research and participating in effectiveness RCTs.

Attitudes towards risk-reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study

OBJECTIVE

To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk.

DESIGN

Multicentre, cohort, questionnaire study (IRSCTN:12310993).

SETTING

United Kingdom (UK).

POPULATION

UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups.

METHODS

Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes.

MAIN OUTCOMES

RRESDO acceptability, menopausal sequelae, satisfaction/regret.

RESULTS

In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2-7.7, P = 0.025). Women experiencing sexual dysfunction after premenopausal RRSO were more likely to find RRESDO acceptable in retrospect (OR = 5.3, 95% CI 1.2-27.5, P < 0.031). In all, 88.8% (143/161) premenopausal and 95.2% (80/84) postmenopausal women who underwent RRSO, respectively, were satisfied with their decision, whereas 9.4% (15/160) premenopausal and 1.2% (1/81) postmenopausal women who underwent RRSO regretted their decision. HRT uptake in premenopausal individuals without breast cancer (BC) was 74.1% (80/108). HRT use did not significantly affect satisfaction/regret levels but did reduce symptoms of vaginal dryness (OR = 0.4, 95% CI 0.2-0.9, P = 0.025).

CONCLUSION

Data show high RRESDO acceptability, particularly in women concerned about sexual dysfunction. Although RRSO satisfaction remains high, regret rates are much higher for premenopausal women than for postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction but does reduce vaginal dryness.

TWEETABLE ABSTRACT

RRESDO has high acceptability among premenopausal women at increased ovarian cancer risk, particularly those concerned about sexual dysfunction.

Quinolone-induced Biceps Tendon Rupture

Presentation A 76-year-old man presented with acute left upper limb pain and subsequent large ecchymosis. Diagnosis An ultrasound study was performed which showed partial left biceps tendon rupture. Treatment He was managed conservatively with Orthopaedic input. The patient was given analgesia and reassured. Discussion Tendon rupture is an unusual but serious complication of quinolone exposure. This case highlights that this should be included in the differential for acute limb pain in patients who have been prescribed these drugs.

Object surveillance with radio-frequency atomic magnetometers

The capabilities of a radio-frequency atomic magnetometer for object detection based on magnetic induction tomography are explored. The determination of object orientation is demonstrated by utilizing the measurement geometry. The self-compensation configuration of the atomic magnetometer is implemented to address the issue of saturation of the sensor response by the radio-frequency primary field that generates the object signature. Three methods of "covert" detection are investigated as a testbed for exploring the functionalities of this sensor, where (1) the operational frequency of the sensor is continuously changed, (2) the primary field has non-monochromatic frequency distribution, and (3) the sensor operates in the so-called spin maser mode. The results of the measurements are also discussed in terms of possible magnetic field communication.

Abstract P1-15-05: Identifying educational needs and areas for improvement in the management of HR+, HER2- breast cancer using cyclin-dependent kinase 4/6 inhibitors

Background: Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) offer the potential to significantly improve outcomes for women with HR+, HER2- breast cancer. However, given the relative short time period of their availability, appropriate evidence-based uses of CDK4/6i therapies depend on effective education and implementation strategies. In the context of an accredited continuing medical education (CME) and quality improvement (QI) program, we conducted a survey study to identify educational needs and areas for improvement involving CDK4/6i decision-making and clinical management.

Methods: Baseline surveys were administered to medical oncologists and clinical staff in 2 large U.S. healthcare systems. The surveys included items for assessing participants’ challenges, barriers, and education/training needs in managing patients with HR+/HER2- breast cancer, specifically focusing on uses of CDK4/6i therapies. In addition to conducting the survey study, at baseline we audited 100 electronic medical records (EMRs) of women with HR+, HER2- breast cancer in each of the 2 systems. The oncology teams then participated in CME/QI activities in which national leaders in breast cancer research and education presented the baseline survey results and EMR-audit feedback, and guided participants in developing targeted action plans to overcome barriers and to close clinical gaps.

Results: Survey respondents were 15 medical oncologists, 3 nurses, and 2 QI personnel. Regarding their patients on CDK4/6i therapies, large percentages of the respondents indicated low levels of satisfaction with current CDK4/6i treatment algorithms (40%), scheduling of patient follow-up visits (35%), team-based coordination of care (15%), and protocols for supportive care (15%). The most commonly reported challenges and barriers in managing patients with HR+/HER2- breast cancer were identifying women who would benefit from CDK4/6i therapies (35%), monitoring patients for disease progression (25%), and receiving support from administrative leadership (15%). Regarding facilitators to reducing patient risks of discontinuing CDK4/6i due to toxicity, the most common responses were increasing interprofessional collaboration and care coordination (45%), and providing education about adverse events to patients and caregivers (20%) and to oncology clinical team members (15%). Participants in the CME/QI activities developed action plans that included establishing protocols and EMR tracking mechanisms for monitoring patients using CDK4/6i therapies, tracking pharmacy dispensing of CDK4/6i therapies, and documenting patient characteristics such as staging, menopausal status, and progression to guide individualized treatment decision-making.

Conclusions: Concerning the implementation of CDK4/6i therapies, this survey study addresses challenges and variable practices that have been recently reported in the literature. The findings reveal specific education and training needs, along with targeted strategies, that are essential for promoting evidence-based, appropriate decision-making and management processes involving these therapies for women with HR+, HER2- breast cancer.

Citation Format: Sara Tolaney, Joyce A. O'Shaughnessy, Rebecca Crawford, Tariqa Ackbarali, Laurence Greene, Jeffrey Carter, Tamar Sapir. Identifying educational needs and areas for improvement in the management of HR+, HER2- breast cancer using cyclin-dependent kinase 4/6 inhibitors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-15-05.

Deep Learning-Based Femoral Cartilage Automatic Segmentation in Ultrasound Imaging for Guidance in Robotic Knee Arthroscopy

Knee arthroscopy is a minimally invasive surgery used in the treatment of intra-articular knee pathology which may cause unintended damage to femoral cartilage. An ultrasound (US)-guided autonomous robotic platform for knee arthroscopy can be envisioned to minimise these risks and possibly to improve surgical outcomes. The first necessary tool for reliable guidance during robotic surgeries was an automatic segmentation algorithm to outline the regions at risk. In this work, we studied the feasibility of using a state-of-the-art deep neural network (UNet) to automatically segment femoral cartilage imaged with dynamic volumetric US (at the refresh rate of 1 Hz), under simulated surgical conditions. Six volunteers were scanned which resulted in the extraction of 18278 2-D US images from 35 dynamic 3-D US scans, and these were manually labelled. The UNet was evaluated using a five-fold cross-validation with an average of 15531 training and 3124 testing labelled images per fold. An intra-observer study was performed to assess intra-observer variability due to inherent US physical properties. To account for this variability, a novel metric concept named Dice coefficient with boundary uncertainty (DSC_UB) was proposed and used to test the algorithm. The algorithm performed comparably to an experienced orthopaedic surgeon, with DSC_UB of 0.87. The proposed UNet has the potential to localise femoral cartilage in robotic knee arthroscopy with clinical accuracy.

Evaluation of VIDAS® Salmonella (SLM) Immunoassay Method with Rappaport-Vassiliadis (RV) Medium for Detection of Salmonella in Foods: Collaborative Study

A collaborative study was conducted to compare the VIDAS Salmonella (SLM) with Rappaport-Vassiliadis (RV) method for detection of Salmonella in foods to the current standard method presented in the U.S. Food and Drug Administration's Bacteriological Analytical Manual (BAM) and the culture method presented in AOAC's Official Methods of Analysis. The VIDAS SLM with RV method uses tetrathionate broth in combination with RV medium in place of selenite cystine broth for selective enrichment, thereby eliminating the hazardous waste issue for laboratories. Twenty five laboratories participated in the evaluation, each testing one or more of 8 test products: nonfat dry milk, dried egg, soy flour, lactic casein, milk chocolate, raw ground pork, raw ground turkey, and raw peeled shrimp. Results of the study showed no significant differences in the numbers of confirmed positive samples with the VIDAS SLM with RV procedure and the BAM/AOAC culture procedure. The VIDAS SLM with RV method was effective for rapid detection of Salmonella in foods. It is recommended that AOAC INTERNATIONAL modify the VIDAS Salmonella SLM procedure to include the RV method.

Treatment patterns and barriers involving the use of CDK4/6 inhibitors for women with HR+, HER2- breast cancer

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Background: For women with HR+, HER2- breast cancer, cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) can significantly improve outcomes. However, the most effective uses of CDK4/6i may be limited by barriers including a lack of systems-based pathways and education to guide individualized treatment. In a quality improvement program in 2 healthcare systems, we assessed baseline treatment patterns and barriers involving CDK4/6i use. Methods: Participants were 34 oncologists and team members. At baseline, we administered surveys to assess barriers to prescribing CDK4/6i and audited the EMRs of 100 women with HR+, HER2- breast cancer in each system. EMRs were audited for demographics; disease characteristics; and treatment history, monitoring, and shared decision-making (SDM) involving CDK4/6i. The teams participated in an audit-feedback session and developed action plans for resolving gaps. Results: Overall, 31% of the 200 women received a CDK4/6i, and 13% received a CDK4/6i as second-line therapy. More than 30% of women treated with a CDK4/6i had documentation of only Stage I/II disease. EMR audits revealed low rates of recommended electrolyte monitoring and ECGs (0%), liver function tests (LFT; 44%), and SDM (Table). Surveys were completed by 20 participants. Whereas 80% indicated being likely to recommend a CDK4/6i, they reported barriers of identifying eligible patients (35%) and monitoring for disease progression (45%). A moderate proportion of oncologists reported considering menopausal status (60%) and patient preferences (50%) in CDK4/6i decision-making. Participants developed action plans for improving EMR documentation for disease stage and protocols for monitoring progression. Conclusions: These baseline findings reveal gaps that may inform QI initiatives for promoting the appropriate use of CDK4/6i for women with HR+, HER2- breast cancer. Findings from baseline EMR audits (n = 200).

[Table: see text]

A descriptive follow-up interview study assessing patient-centred outcomes: Salford Lung Study in Asthma (SLS Asthma)

The Salford Lung Study in Asthma (SLS Asthma) was a multicentre, randomised, controlled, open-label trial that assessed initiating once-daily, single-inhaler fluticasone furoate/vilanterol (FF/VI) 100 μg/25 μg or 200 μg/25 μg versus continuing usual care. A subgroup (n = 400) from SLS Asthma was enrolled in this exploratory, interview-based follow-up study. Quantitative and qualitative data were collected via questionnaires. The primary objective was to capture patient-centred outcomes (symptom experience, quality of life [QoL], disease management behaviours) and patient experience. Secondary objectives were to assess the correlation of patient-reported outcomes with pre-defined variables from SLS Asthma (Asthma Control Test [ACT] score). The follow-up sample was representative of the SLS Asthma population; half reported asthma improvement during the study. Breathlessness was the most likely symptom to improve (47.8% of patients reported improvement). Most patients reported ‘no change’ in overall QoL (57.5%) and daily life domains (functioning 66.3%, activities 68.3%, relationships 86.8%, psychological 68.5%). Functioning was reported as the most frequently improved domain (29.8% of patients). Perceived improvement in asthma control (42.5%) and confidence (37.3%) was frequent. ACT responders (defined as patients achieving an ACT score ≥20 and/or an increase of ≥3 in ACT score from baseline at Week 52) were more likely to report asthma improvement (88.7% of patients reporting ‘a lot’ of improvement) than non-responders. Patients’ asthma experiences generally improved during SLS Asthma. Clinical improvements were often associated with perceived improvement by patients, particularly among ACT responders.

Traditional knowledge-based lifestyle interventions in the prevention of obesity and type 2 diabetes in Indigenous children in Canada: a systematic review protocol

BACKGROUND

Approximately 50% of all youth-onset type 2 diabetes mellitus (T2DM) in Canada occurs in Indigenous children. In adults, cardiovascular disease is one of the leading causes of mortality in First Nations communities, and diabetes is a significant contributor to the risk of developing this disorder. The early onset of diabetes may predispose these children to premature cardiovascular disease and influence their longevity and quality of life. As a result, the implementation of culturally tailored obesity and T2DM primary prevention programs is vital. This systematic review aims to assess the effectiveness of existing traditional knowledge-based lifestyle intervention programs on preventing obesity and T2DM in Indigenous children in Canada.

METHODS

We will conduct database searches in MEDLINE, Embase, PsycINFO, SPORTDiscus, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, and the Cochrane Controlled Register of Trials. We will also conduct grey literature searches of central repository of trials ( ClinicalTrials.gov ), ProQuest Dissertations, Theses A&I, and Indigenous studies portal research tools. Reviewers will independently review titles, abstracts, and full-text articles retrieved from databases to assess potentially eligible studies, and relevant articles will be assessed for risk of bias and quality. The primary outcomes include the change in body mass index z-scores or a diagnosis of diabetes. The secondary outcomes include the change in measures of adiposity as well as lifestyle and metabolic profiles. A meta-analysis will be performed if two or more studies have used similar study designs, comparable intervention techniques , similar populations and measured similar outcomes.

DISCUSSION

This review will provide a summary of current interventions to prevent obesity and T2DM in Indigenous children in Canada and help determine the gaps in the literature so that interventions can be developed to control the surge in pediatric T2DM in Indigenous communities.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017072781.

Treatment Efficacy, Clinical Utility, and Cost-Effectiveness of Multidisciplinary Biopsychosocial Rehabilitation Treatments for Persistent Low Back Pain: A Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVES

To review the current literature on the treatment efficacy, clinical utility, and cost-effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) for patients suffering from persistent (nonspecific) lower back pain (LBP) in relation to pain intensity, disability, health-related quality of life, and work ability/sick leave.

METHODS

We carried out a systematic search of Web of Science, Cochrane Library, PubMed Central, EMBASE, and PsycINFO for English- and German-language literature published between January 2010 and July 2017. Study selection consisted of exclusion and inclusion phases. After screening for duplication, studies were excluded on the basis of criteria covering study design, number of participants, language of publication, and provision of information about the intervention. All the remaining articles dealing with the efficacy, utility, or cost-effectiveness of intensive (more than 25 hours per week) MBR encompassing at least 3 health domains and cognitive behavioral therapy-based psychological education were included.

RESULTS

The search retrieved 1199 publications of which 1116 were duplicates or met the exclusion criteria. Seventy of the remaining 83 articles did not meet the inclusion criteria; thus 13 studies were reviewed. All studies reporting changes in pain intensity or disability over 12 months after MBR reported moderate effect sizes and/or p-values for both outcomes. The effects on health-related quality of life were mixed, but MBR substantially reduced costs. Overall MBR produced an enduring improvement in work ability despite controversy and variable results.

CONCLUSIONS

MBR is an effective treatment for nonspecific LBP, but there is room for improvement in cost-effectiveness and impact on sick leave, where the evidence was less compelling.

Age-related changes in trunk muscle activity and spinal and lower limb kinematics during gait

The influence of age on spinal muscle activation patterns and its relation to kinematics is poorly understood. We aimed at understanding age-related changes to spine and trunk muscle activity in addition to spinal and lower limb kinematics during treadmill walking under various conditions. An observational study was conducted evaluating asymptomatic young (n = 10; 3F, 7M; 26.3±2.5yrs) and older (n = 9; 3F, 6M; 67.1±4.2yrs) adults’ treadmill walking at 2km/h and 4km/h, each at 0, 1, 5, and 10% inclination. Unilateral (right side) electromyography (EMG) was recorded from deep and superficial multifidus (intramuscular) and erector spinae and abdominal obliques (surface); trunk and leg kinematics were also measured. Muscle activity was characterised by peak amplitude and duration of activity, and the time-point of peak amplitude in the gait cycle (0–100%). Peak activation in older adults was lower for the superficial multifidus (p<0.0001) and higher for the thoracolumbar (p<0.001) and lumbar erector spinae (p<0.01). The duration of activation was longer in older adults for all muscles (p<0.05) except the superficial multifidus, and longer during faster walking for all participants. The time-point of peak amplitude in the gait cycle was earlier in older participants for the external obliques (p<0.05). Walking speed appeared to influence muscle activity more than inclination. Older adults used less spine, trunk and lower limb motion, except at the ankle. Age-related differences within multifidus and between paravertebral and trunk muscles were inconsistent. Walking at 4km/h at 5–10% inclination may specifically target the lumbar paravertebral muscles.

Is the EQ-5D fit for purpose in asthma? Acceptability and content validity from the patient perspective

Background

The increasing emphasis on patient-reported outcomes in health care decision making has prompted greater rigor in the evidence to support the instruments used. Acceptability and content validity are important properties of any measure to ensure it assesses the relevant aspects of the target concept. The purpose of this study was to evaluate the acceptability and content validity of the EQ-5D 5-Level (EQ-5D-5L) to assess the impact of asthma on patients’ lives.

Methods

Qualitative interviews were conducted with 40 adults with asthma in the United Kingdom. The first 25 interviews used cognitive-debriefing methods to assess the relevance and acceptability of the EQ-5D-5L and two asthma-specific measures for comparison: an asthma-specific, preference-based measure (the Asthma Quality of Life Utility Index–5 Dimensions) and an Asthma Symptom Diary. The final 15 interviews combined concept elicitation to identify patient-perceived asthma impact, and cognitive debriefing to assess relevance and acceptability of the EQ-5D-5L and the Asthma Symptom Diary. Cognitive-debriefing feedback on the content of the measures was collated and summarized descriptively. The concept-elicitation data were analyzed thematically.

Results

Participants were aged 20 to 57 years and 62.5% were female. Although some participants expressed positive opinions on aspects of the EQ-5D-5L, only the usual activities dimension was consistently considered relevant to participants’ asthma experiences. The mobility and self-care dimensions prompted strong negative reactions from some participants. Variations in interpretation of the mobility dimension and difficulties with multiple concepts in the pain/discomfort and anxiety/depression dimensions also were noted. Concepts reported by participants as missing included environmental triggers, asthma symptoms, emotions, and sleep. The EQ-5D-5L was the least preferred measure to describe the impact of asthma on participants’ lives. Participants reported shortness of breath and impact on activities as especially salient issues.

Conclusions

The content of the EQ-5D-5L was poorly aligned with the patient-perceived impact of asthma, and the measure failed to meet basic standards for acceptability and content validity as a measure to assess the impact of asthma from the patient perspective. The shortcomings identified raise concerns regarding the appropriateness of the EQ-5D in asthma and further evaluation is warranted.

Preparing and sharing food: a quantitative analysis of a primary school-based food intervention

Background

Primary schools are increasingly used as arenas for public health initiatives. The aim of this study was to assess a primary school-based food intervention.

Methods

The intervention comprised timetabled kitchen classroom sessions (90 min, fortnightly). Pupils prepared and cooked food, which they then ate together. Children's relationship with food, including food enjoyment, experience and food neophobia, were addressed at the intervention school (baseline n = 154; follow-up n = 164) and at a matched control school (baseline n = 171; follow-up n = 174).

Results

Pupils at the intervention school scored significantly higher (M = 3.90, SD = 1.81) for scores on Kitchen Equipment, compared to the control school (M = 3.06, SD = 2.12); and again scored significantly higher (M = 9.34, SD = 3.79) for the overall Cooking Experience Score compared to the control school (M = 7.98, SD = 4.57). Shifts accompanying the intervention in three outcome measures for pupils (taste description, liking for cooking and helping with cooking at home) were also revealed. No main intervention effect for food neophobia and fussiness was found; a close to significant time by intervention interaction (P = 0.053) was evident.

Conclusions

The study indicates limited but encouraging changes, and contributes to the growing literature regarding school-based food initiatives.