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Stussman B, Calco B, Norato G, Gavin A, Chigurupati S, Nath A, Walitt B. Mixed methods system for the assessment of post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an exploratory study. BMJ Neurol Open 2024; 6:e000529. [PMID: 38352048 PMCID: PMC10862339 DOI: 10.1136/bmjno-2023-000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
Background A central feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is post-exertional malaise (PEM), which is an acute worsening of symptoms after a physical, emotional and/or mental exertion. Dynamic measures of PEM have historically included scaled questionnaires, which have not been validated in ME/CFS. To enhance our understanding of PEM and how best to measure it, we conducted semistructured qualitative interviews (QIs) at the same intervals as visual analogue scale (VAS) measures after a cardiopulmonary exercise test (CPET). Methods Ten ME/CFS and nine healthy volunteers participated in a CPET. For each volunteer, PEM symptom VAS (12 symptoms) and semistructured QIs were administered at six timepoints over 72 hours before and after a single CPET. QI data were used to plot the severity of PEM at each time point and identify the self-described most bothersome symptom for each ME/CFS volunteer. Performance of QI and VAS data was compared with each other using Spearman correlations. Results Each ME/CFS volunteer had a unique PEM experience, with differences noted in the onset, severity, trajectory over time and most bothersome symptom. No healthy volunteers experienced PEM. QI and VAS fatigue data corresponded well an hour prior to exercise (pre-CPET, r=0.7) but poorly at peak PEM (r=0.28) and with the change from pre-CPET to peak (r=0.20). When the most bothersome symptom identified from QIs was used, these correlations improved (r=0.0.77, 0.42. and 0.54, respectively) and reduced the observed VAS scale ceiling effects. Conclusion In this exploratory study, QIs were able to capture changes in PEM severity and symptom quality over time, even when VAS scales failed to do so. Measurement of PEM can be improved by using a quantitative-qualitative mixed model approach.
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Affiliation(s)
- Barbara Stussman
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Brice Calco
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Gina Norato
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Angelique Gavin
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Snigdha Chigurupati
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Brian Walitt
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
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Campbell JA, van der Mei I, Taylor BV, Palmer AJ, Henson GJ, Laslett LL, Simpson-Yap S, Claflin SB. Using qualitative free-text data to investigate the lived experience of the COVID-19 pandemic for a large cohort of Australians with different multiple sclerosis related disability levels. J Neurol Neurosurg Psychiatry 2023; 94:975-983. [PMID: 37884346 DOI: 10.1136/jnnp-2022-330755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/15/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND No large-scale qualitative studies have investigated the lived experience of people living with multiple sclerosis (PwMS) during the pandemic according to their disability level. We used qualitative research methods to investigate the lived experience of a large cohort of Australians living with differing multiple sclerosis (MS)-related disability levels during the COVID-19 pandemic. We also provided useful contextualisation to existing quantitative work. METHODS This was a retrospective survey-based mixed-methods cohort study. A quality-of-life study was conducted within the Australian MS Longitudinal Study during the pandemic. Disability severity was calculated using the Patient Determined Disease Steps. Qualitative free-text data regarding COVID-19 impacts was collected/analysed for word frequency and also thematically (inductively/deductively using sophisticated grounded theory) using NVivo software. We also triangulated word frequency with emerging themes. RESULTS N=509 PwMS participated providing n=22 530 words of COVID-19-specific data. Disability severity could be calculated for n=501 PwMS. The word 'working' was important for PwMS with no disability, and 'support' and 'isolation' for higher disability levels. For PwMS with milder disability, thematic analysis established that multitasking increased stress levels, particularly if working from home (WFH) and home-schooling children. If not multitasking, WFH was beneficial for managing fatigue. PwMS with severe disability raised increased social isolation as a concern including prepandemic isolation. CONCLUSIONS We found negative impacts of multitasking and social isolation for PwMS during the pandemic. WFH was identified as beneficial for some. We recommend targeted resourcing decisions for PwMS in future pandemics including child-care relief and interventions to reduce social isolation and suggest that these could be incorporated into some form of advanced care planning. As the nature of work changes postpandemic, we also recommend a detailed investigation of WFH for PwMS including providing tailored employment assistance.
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Affiliation(s)
- Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Glen J Henson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Laura Louise Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Bedard NA, Katz JN, Losina E, Opare-Addo MB, Kopp PT. Administrative Data Use in National Registry Efforts: Blessing or Curse? J Bone Joint Surg Am 2022; 104:39-46. [PMID: 36260043 DOI: 10.2106/jbjs.22.00565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
"Big data" refers to a growing field of large database research. Administrative data, a subset of big data, includes information from insurance claims, electronic medical records, and registries that can be useful for investigating novel research questions. While its use provides salient advantages, potential researchers relying on big data would benefit from knowing about how these databases are coded, common errors they may encounter, and how to best use large data to address various research questions. In the first section of this paper, Dr. Nicholas A. Bedard addresses the four major pitfalls to avoid with diagnosis and procedure codes in administrative data. In the next section, Dr. Jeffrey N. Katz et al. focus on the strengths and limitations of administrative data, suggesting methods to mitigate these limitations. Lastly, Dr. Elena Losina et al. review the uses and misuses of large databases for cost-effectiveness research, detailing methods for careful economic evaluations.
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Affiliation(s)
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Maame B Opare-Addo
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul T Kopp
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Coast J, Bailey C, Canaway A, Kinghorn P. "It is not a scientific number it is just a feeling": Populating a multi-dimensional end-of-life decision framework using deliberative methods. HEALTH ECONOMICS 2021; 30:1033-1049. [PMID: 33647181 PMCID: PMC8129721 DOI: 10.1002/hec.4239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
The capability approach is potentially valuable for economic evaluation at the end of life because of its conceptualization of wellbeing as freedom and the potential for capturing outcomes for those at end of life and those close to persons at the end of life. For decision making, however, this information needs to be integrated into current evaluation paradigms. This research explored weights for an integrated economic evaluation framework using a deliberative approach. Twelve focus groups were held (38 members of the public, 29 "policy makers," seven hospice volunteers); budget pie tasks were completed to generate weights. Constant comparison was used to analyze qualitative data, exploring principles behind individuals' weightings. Average weights elicited from members of the general population and policy makers for the importance that should be given to close persons (vs. patients) were very similar, at around 30%. A "sliding scale" of weights between health gain and the capability for a good death resulted from the policy maker and volunteer groups, with increasing weight given to the capability for a good death as the trajectory got closer to death. These weights can be used in developing a more comprehensive framework for economic evaluation at end of life.
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Affiliation(s)
- Joanna Coast
- Health Economics BristolPopulation Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Cara Bailey
- School of NursingInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Alastair Canaway
- Warwick Clinical TrialsWarwick Medical SchoolUniversity of WarwickWarwickUK
| | - Philip Kinghorn
- Health Economics UnitInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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Xia Q, Campbell JA, Ahmad H, Si L, de Graaff B, Palmer AJ. Bariatric surgery is a cost-saving treatment for obesity-A comprehensive meta-analysis and updated systematic review of health economic evaluations of bariatric surgery. Obes Rev 2020; 21:e12932. [PMID: 31733033 DOI: 10.1111/obr.12932] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
Demand for bariatric surgery to treat severe and resistant obesity far outstrips supply. We aimed to comprehensively synthesise health economic evidence regarding bariatric surgery from 1995 to 2018 (PROSPERO registration number: CRD42018094189). Meta-analyses were conducted to calculate the annual cost changes "before" and "after" surgery, and cumulative cost differences between surgical and nonsurgical groups. An updated narrative review also summarized the full and partial health economic evaluations of surgery from September 2015. N = 101 studies were eligible for the qualitative analyses since 1995, with n = 24 studies after September 2015. Quality of reporting has increased, and the inclusion of complications/reoperations was predominantly contained in the full economic evaluations after September 2015. Technical improvements in surgery were also reflected across the studies. Sixty-one studies were eligible for the quantitative meta-analyses. Compared with no/conventional treatment, surgery was cost saving over a lifetime scenario. Additionally, consideration of indirect costs through sensitivity analyses increased cost savings. Medication cost savings were dominant in the before versus after meta-analysis. Overall, bariatric surgery is cost saving over the life course even without considering indirect costs. Health economists are hearing the call to present higher quality studies and include the costs of complications/reoperations; however, indirect costs and body contouring surgery are still not appropriately considered.
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Affiliation(s)
- Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Campbell JA, Hensher M, Davies D, Green M, Hagan B, Jordan I, Venn A, Kuzminov A, Neil A, Wilkinson S, Palmer AJ. Long-Term Inpatient Hospital Utilisation and Costs (2007-2008 to 2015-2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia's Activity-Based Funding Model. PHARMACOECONOMICS - OPEN 2019; 3:599-618. [PMID: 31190236 PMCID: PMC6861543 DOI: 10.1007/s41669-019-0140-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Within the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia's Independent Hospital Pricing Authority's activity-based funding (ABF) model. OBJECTIVE We aimed to provide our Tasmanian state government partner with information regarding key evidence gaps about the resource use and costs of bariatric surgery (including pre- and postoperatively, types of surgery and comorbidities), the costs of surgical sequelae and policy direction regarding the types of bariatric surgery offered within the Tasmanian public hospital system. METHODS Hospital inpatient length of stay (days), episodes of care (number) and aggregated cost data were extracted for people who were waiting for and subsequently received bariatric surgery (for the fiscal years 2007-2008 to 2015-2016) from administrative sources routinely collected, clinically coded/costed according to ABF. Aggregated ABF costs were expressed in 2016-2017 Australian dollars ($A). Sensitivity (cost outliers) and subgroup analyses were conducted. RESULTS A total of 105 patients entered the study. Total costs (pre/postoperative over 8 years) for all inpatient episodes of care (n = 779 episodes of care) were $A6,018,349. When the ten cost outliers were omitted from the total cost, this cost reduced to $A4,749,265. Mean costs for primary laparoscopic adjustable gastric band (LAGB) and sleeve gastrectomy (SG) bariatric surgery were $A14,622 and $A15,014, respectively. The average cost/episode of care for people with diabetes decreased in the first year postoperatively, from $A7258 to $A5830/episode of care. In total, 27 LAGB patients (30%) required surgery due to surgical sequelae (including revisional/secondary surgery; n = 58 episodes of care) and 56% of these episodes of care were secondary LAGB device related (mostly port/reservoir related), with a mean cost of $A6267. CONCLUSIONS Taking into account our small SG sample size and the short time horizon for investigating surgical sequalae for SG, costs may be mitigated in the Tasmanian public hospital system by substituting LAGB with SG when clinically appropriate due to costs associated with the LAGB device for some patients. At 3 years postoperatively versus preoperatively, episodes of care and costs reduced substantially, particularly for people with diabetes/cardiovascular disease. We recommend that a larger confirmatory study of bariatric surgery including LAGB and SG be undertaken of disaggregated ABF costs in the Tasmanian public hospital system.
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Affiliation(s)
- Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences, 2 Building, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Martin Hensher
- Department of Health (DoH), Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Daniel Davies
- Department of Health (DoH), Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Matthew Green
- Department of Health (DoH), Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Barry Hagan
- Department of Health (DoH), Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Ian Jordan
- Department of Health (DoH), Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences, 2 Building, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Alexandr Kuzminov
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences, 2 Building, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences, 2 Building, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Stephen Wilkinson
- Department of Surgery, Royal Hobart Hospital, 48 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Sciences, 2 Building, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Melbourne, VIC, 3053, Australia.
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