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Farmer N, Tuason R, Middleton KR, Ude A, Tataw-Ayuketah G, Flynn S, Kazmi N, Baginski A, Mitchell V, Powell-Wiley TM, Wallen GR. Assessing Acceptability: The Role of Understanding Participant, Neighborhood, and Community Contextual Factors in Designing a Community-Tailored Cooking Intervention. Nutrients 2024; 16:463. [PMID: 38337747 PMCID: PMC10857272 DOI: 10.3390/nu16030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Cooking is an identified dietary strategy that is positively associated with optimal diet quality. Prior to initiating cooking interventions, evaluating the prospective acceptability of the intervention among community members living within low food access areas and understanding geospatial food shopping locations may aid in designing community-tailored interventions. METHODS A sequential mixed methods study was conducted to determine the prospective acceptability of a planned community-located cooking intervention among African American adults living in a low food access area and with at least one cardiovascular disease risk factor. A semi-structured guide was used to conduct five virtual focus groups. Qualitative data were analyzed using thematic analysis and validated through participant check-in interviews. Survey responses were analyzed based on descriptive data. Geospatial analysis of participant locations that were reported for food shopping was conducted to show food environment utilization. RESULTS Focus groups with study participants (n = 20, all female, mean age 60.3, SD 9.3, mean cooking frequency per week 4.0, food insecure n = 7) were conducted between March and April, 2021. Thematic analysis of the focus group transcripts identified five main themes as follows: (A) Barriers to Cooking (family and caregiving, transportation, COVID-19 pandemic, time availability, household composition); (B) Motivators for Cooking (family, caregiving, health, enjoyment, COVID-19 pandemic); (C) Strategies (food shopping, social support, social media, meal planning); (D) Neighborhood (gentrification, perceived safety, stigmatization, disparities in grocery stores); (E) and Acceptability of the Intervention (reasons to participate, barriers, recruitment, intervention delivery). Participant validation interviews confirmed the themes and subthemes as well as the illustrative quotes. Geospatial analysis showed a majority of locations were outside of the participants' residential areas. CONCLUSIONS Prospective acceptability of a community-tailored cooking intervention found that the planned intervention could be modified to address individual level factors, such as caregiving and health, community contextual factors, such as perceived safety, and the general health needs of the community.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Ralph Tuason
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Kimberly R. Middleton
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Assumpta Ude
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Gladys Tataw-Ayuketah
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Sharon Flynn
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Alyssa Baginski
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
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An exploration into registered nurses' knowledge of adult fever in Scotland: A mixed method study. Nurse Educ Pract 2022; 63:103411. [PMID: 35868061 DOI: 10.1016/j.nepr.2022.103411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fever may be a result of many causes, infective or non-infective. Nurses' fever management can be affected by their knowledge and beliefs and also by patients' beliefs. Consequently, an understanding of fever is vital in the diagnosis, treatment and follow-up of various ailments and diseases. Greater knowledge of fever will guide more accurate assessments of the epidemiology of fever and its management. OBJECTIVES This study explored nurses' knowledge in the context of fever and identified factors that affected this knowledge acquisition. METHODS A mixed methods approach was used with a validated questionnaire designed to gather information about nurses' knowledge of fever. This was followed up by semi-structured interviews to explore factors associated with the acquisition of fever knowledge. The online survey was distributed to registered nurses in Scotland. RESULTS A total of 177 questionnaires were completed. The questionnaires were scored with a correct answer 1 point, while a wrong answer -1 point. The mean total score in the knowledge section was 0.47. Only 49.2 % of participants scored above 0. The stepwise linear regression demonstrated working experience in critical care unit, acute care unit and the role of nurse practitioner together could predict 10 % of the total knowledge score (P < 0.05). Through analysis of associations and qualitative data, it was found that many factors had contributed to the nurses' knowledge about fever, specifically educational content, individual confidence and the Sepsis Six bundle. CONCLUSIONS Considerable misconceptions were found to exist in the nurses' understanding of fever. Only a few factors were found to be associated with the total knowledge score. It was highlighted that the due to the strong influence of the Sepsis Six bundle, participants often assumed a direct causal connection between fever and infectious disease or sepsis. The study result indicated a concern in nurses' acquisition of fever knowledge. TWEETABLE ABSTRACT Misconceptions from foundational learning were found in nurses' understanding of fever. However, the Sepsis 6 was found to impact their current knowledge of fever.
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Curran D, Cabrera ES, Bracke B, Raymond K, Foster A, Umanzor C, Goulet P, Powers JH. Impact of respiratory syncytial virus disease on quality of life in adults aged ≥50 years: A qualitative patient experience cross-sectional study. Influenza Other Respir Viruses 2022; 16:462-473. [PMID: 34981637 PMCID: PMC8983922 DOI: 10.1111/irv.12929] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/27/2022] Open
Abstract
Background Information about the impact of respiratory syncytial virus (RSV) on quality of life in older adults is limited. This study characterized the patient experience of RSV illness in USA older adults and assessed the content validity of the InFLUenza Patient Reported Outcome (FLU‐PRO) in this population. Methods This qualitative, non‐interventional, cross‐sectional study included hybrid concept elicitation and cognitive debriefing interviews with 30 individuals (age ≥50 years) with polymerase chain reaction‐confirmed RSV diagnosed within 6 months of screening. Targeted literature review was first conducted to inform the development of interview materials. Webcam or telephone interviews were conducted by qualitative researchers using a semistructured interview guide. Interview transcripts were coded and analyzed using Excel and NVivo software. Results All participants reported impacts on daily activities, social activities, and relationships during RSV disease. Physical functioning was impaired in 25 (83%) participants, and 18 (60%) reported not engaging in leisure activities/hobbies. All nine participants who were working reported major impacts on work. Most (n = 28; 93%) described emotional impacts. A majority (n = 19; 63%) reported symptoms lasting beyond the acute disease stage from a week to >1 month. Symptom concepts reported generally matched FLU‐PRO items and domains. Cognitive debriefing indicated that FLU‐PRO was easy to understand and captured participants' experiences of RSV illness. Conclusions This study indicates that RSV disease in adults aged ≥50 years in the USA has substantial impacts on daily life and that the concepts included in FLU‐PRO are appropriate and fit for purpose as a measure of RSV symptoms in this population.
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Affiliation(s)
| | | | | | - Kimberly Raymond
- Scientific Consulting, QualityMetric, Johnston, Rhode Island, USA
| | - April Foster
- Scientific Consulting, QualityMetric, Johnston, Rhode Island, USA
| | - Cindy Umanzor
- Scientific Consulting, QualityMetric, Johnston, Rhode Island, USA
| | | | - John H Powers
- Department of Clinical Medicine, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
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Portsmouth S, Echols R, Toyoizumi K, Tillotson G, Nagata TD. Structured patient interview to assess clinical outcomes in complicated urinary tract infections in the APEKS-cUTI study: pilot investigation. Ther Adv Infect Dis 2021; 8:20499361211058257. [PMID: 34868583 PMCID: PMC8637798 DOI: 10.1177/20499361211058257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background The APEKS-cUTI study demonstrated the non-inferiority of cefiderocol to imipenem-cilastatin in the primary endpoint of the composite of clinical and microbiological outcome in patients with complicated urinary tract infections (cUTIs). We piloted a structured patient interview (SPI) to evaluate clinical outcomes based on patient-reported symptoms while conducting this pivotal randomized, double-blind, phase-2 study. The objectives were to assess the value of the SPI, using its performance relative to physician assessment, and also to strengthen the value of patient-reported measures in conducting clinical trials for cUTI treatment. Methods In addition to the protocol-defined clinical and microbiological outcomes, patients randomized in the APEKS-cUTI study were interviewed by the investigator or qualified study personnel at screening/baseline, early assessment (EA), end of treatment (EOT), test of cure (TOC), and follow-up (FUP). The 14-element questionnaire graded cUTI symptoms as absent or present, and if present, as mild, moderate, or severe. Changes in post-baseline symptoms based on patients' responses were rated by the interviewer. The overall clinical outcome was evaluated based on the responses provided by patients at each time point. Results Among the 371 patients in the modified intention-to-treat population, the rate of SPI completion in each treatment arm exceeded 90% at each time point. SPI-assessed clinical cure rates were 89.7% in the cefiderocol arm and 84.9% in the imipenem-cilastatin arm. There was substantial agreement between SPI evaluation and investigator global assessment of clinical outcome at TOC and FUP, with lower agreement at EA and EOT. Conclusion This analysis suggests that patient-reported symptoms can be effectively captured in hospitalized patients with cUTI in a clinical trial setting. Development of a validated patient-reported outcome for use in such a setting is warranted. Registration NCT02321800 (registered on 22 December 2014).
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Affiliation(s)
| | - Roger Echols
- Infectious Disease Drug Development Consulting, LLC, Easton, CT, USA
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Hallucinations: diagnosis, neurobiology and clinical management. Int Clin Psychopharmacol 2020; 35:293-299. [PMID: 32324611 DOI: 10.1097/yic.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hallucinations are important diagnostic symptoms in schizophrenia, but also occur in other medical and neuropsychiatric conditions. Not all patients with hallucinations are psychotic. There has been a surge of interest in the topic of hallucinations, as new research data have begun to reveal their neurobiology. Hallucinogenic molecules may also serve as new scaffolds for the development of new psychotropic drugs. We searched and reviewed recent literature, focusing on the refinement of clinical management, which was inspired by new data regarding the neurobiology of hallucination subtypes. We concluded that the successful management of hallucinations depends on accurate differential diagnosis to identify subtypes, which would then determine the most appropriate treatment.
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Farmer N, Powell-Wiley TM, Middleton KR, Roberson B, Flynn S, Brooks AT, Kazmi N, Mitchell V, Collins B, Hingst R, Swan L, Yang S, Kakar S, Harlan T, Wallen GR. A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart. Pilot Feasibility Stud 2020; 6:158. [PMID: 33088581 PMCID: PMC7574184 DOI: 10.1186/s40814-020-00697-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cooking interventions have increased in popularity in recent years. Evaluation by meta-analyses and systematic reviews show consistent changes in dietary quality reports and cooking confidence, but not of cardiovascular (CVD) biomarkers. Interventions evaluating or reporting behavioral mechanisms as an explanatory factor for these outcomes has been sparse. Moreover, evaluations of cooking interventions among communities with health disparities or food access limitations have received little attention in the literature. Methods This study will occur over two phases. Phase 1 will assess acceptability among the target population of African-American adults living within an urban food desert. Phase 2 will consist of a 6-week cooking intervention delivered at a community kitchen setting. Pre and post intervention visits for clinical examinations and biomarker collection will be conducted, as well as dietary and cooking skill assessments. Primary outcomes include cooking behavior and feasibility measures. Secondary outcomes are related to dietary quality, psychosocial factors, CVD biomarkers, and food environment measures. Discussion This study seeks to demonstrate feasibility of a community-based cooking intervention and to provide necessary information to plan future interventions that identify cooking behavior as an outcome of participation in cooking interventions among African-American adults, especially in relation to dietary and biomarker outcomes. Trial registration This study was registered at ClinicalTrials.gov (NCT04305431) on March 12, 2020.
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Affiliation(s)
- Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA.,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD USA
| | | | - Brenda Roberson
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Sharon Flynn
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Alyssa T Brooks
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Narjis Kazmi
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Billy Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Rachel Hingst
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Lucy Swan
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Shanna Yang
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Seema Kakar
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Timothy Harlan
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Bethesda, MD USA
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Abstract
In addition to a large variety of somatic symptoms, fever also affects cognition, sleep, and mood. In an online survey with 164 participants, 100 fever dream reports were submitted. Fever dreams were more bizarre and more negatively toned and included more references to health and temperature perception compared to "normal" most recent dreams - findings that are in line with the continuity hypothesis of dreaming. Future studies should follow up this line of research by conducting diary studies during naturally occurring febrile illnesses and sleep laboratory studies with experimentally induced fever. It would also be very interesting to study the effect of thermal stimulation applied during sleep on dream content. This research helps to understand subjective experiences while sleeping in an extreme condition (elevated body temperature).
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Affiliation(s)
- Michael Schredl
- Sleep Laboratory, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Erlacher
- Institute of Sport Science, University of Bern, Bern, Switzerland
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Ludwig J, McWhinnie H. Antipyretic drugs in patients with fever and infection: literature review. ACTA ACUST UNITED AC 2019; 28:610-618. [PMID: 31116598 DOI: 10.12968/bjon.2019.28.10.610] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND antipyretic drugs are routinely administered to febrile patients with infection in secondary care. However, the use of antipyretics to suppress fever during infection remains a controversial topic within the literature. It is argued that fever suppression may interfere with the body's natural defence mechanisms, and may worsen patient outcomes. METHOD a literature review was undertaken to determine whether the administration of antipyretic drugs to adult patients with infection and fever, in secondary care, improves or worsens patient outcomes. RESULTS contrasting results were reported; two studies demonstrated improved patient outcomes following antipyretic administration, while several studies demonstrated increased mortality risk associated with antipyretics and/or demonstrated fever's benefits during infection. Results also demonstrated that health professionals continue to view fever as deleterious. CONCLUSION the evidence does not currently support routine antipyretic administration. Considering patients' comorbidities and symptoms of their underlying illness will promote safe, evidence-based and appropriate administration of antipyretics.
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Affiliation(s)
| | - Hazel McWhinnie
- Senior Lecturer, Health and Community Services, Education Department, Government of Jersey
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Abstract
The thermoregulatory functions may vary with age. Thermosensitivity is active in neonates and children; both heat production and heat loss effector mechanisms are functional but easily exhaustable. Proportional and lasting defense against thermal challenges is difficult, and both hypothermia and hyperthermia may easily develop. Febrile or hypothermic responses to infections or endotoxin can also develop, together with confusion. In small children febrile convulsions may be dangerous. In old age the resting body temperature may be lower than in young adults. Further, thermosensitivity decreases, the thresholds for activating skin vasomotor and evaporative responses or metabolism are shifted, and responses to thermal challenges are delayed or insufficient: both hypothermia and hyperthermia may develop easily. Infection-induced fevers are often limited or absent, or replaced by hypothermia. Various types of brain damage may induce special forms of hypothermia, hyperthermia, or severe fever. Impaired mental state often accompanies hypothermia and hyperthermia, and may occasionally be a dominant feature of infection (instead of the most commonly observed fever). Aging brings about a turning point in women's life: the menopause. The well-known influence of regular hormonal cycles on the thermoregulation of a woman of fertile age gives way to menopausal hot flushes caused by estrogen withdrawal. Not all details of this thermoregulatory anomaly are fully understood yet.
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Ames NJ, Powers JH, Ranucci A, Gartrell K, Yang L, VanRaden M, Leidy NK, Wallen GR. A systematic approach for studying the signs and symptoms of fever in adult patients: the fever assessment tool (FAST). Health Qual Life Outcomes 2017; 15:84. [PMID: 28449675 PMCID: PMC5408372 DOI: 10.1186/s12955-017-0644-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/29/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although body temperature is one of four key vital signs routinely monitored and treated in clinical practice, relatively little is known about the symptoms associated with febrile states. The purpose of this study was to assess the validity, reliability and feasibility of the Fever Assessment Tool (FAST) in an acute care research setting. METHODS Qualitative: To assess content validity and finalize the FAST instrument, 12 adults from an inpatient medical-surgical unit at the National Institutes of Health (NIH) Clinical Center participated in cognitive interviews within approximately 12 h of a febrile state (tympanic temperature ≥ 38° Celsius). Quantitative: To test reliability, validity and feasibility, 56 new adult inpatients completed the 21-item FAST. RESULTS The cognitive interviews clarified and validated the content of the final 21-item FAST. Fifty-six patients completed the FAST from two to 133 times during routine vital sign assessment, yielding 1,699 temperature time points. Thirty-four percent of the patients (N = 19) experienced fever at one or more time points, with a total of 125 febrile time points. Kuder-Richardson 20 (KR-20) reliability of the FAST was 0.70. Four nonspecific symptom categories, Tired or Run-Down (12), Sleepy (13), Weak or Lacking Energy (11), and Thirsty (9) were among the most frequently reported symptoms in all participants. Using Generalized Estimating Equations (GEE), the odds of reporting eight symptoms, Warm (4), Sweating (5), Thirsty (9), General Body Aches (10), Weak or Lacking Energy (11), Tired or Run Down (12) and Difficulty Breathing (17), were increased when patients had a fever (Fever Now), compared to the two other subgroups-patients who had a fever, but not at that particular time point, (Fever Not Now) and patients who never had a fever (Fever Never). Many, but not all, of the comparisons were significant in both groups. CONCLUSION Results suggest the FAST is reliable, valid and easy to administer. In addition to symptoms usually associated with fever (e.g. feeling warm), symptoms such as Difficulty Breathing (17) were identified with fever. Further study in a larger, more diverse patient population is warranted. TRIAL REGISTRATION Clinical Trials Number: NCT01287143 (January 2011).
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Affiliation(s)
- Nancy J. Ames
- Clinical Center, National Institutes of Health, Bldg 10 Rm 2B-10, 10 Center Drive, Bethesda, MD 20892 USA
| | - John H. Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, Maryland 21702 USA
| | - Alexandra Ranucci
- Clinical Center, National Institutes of Health, Bldg 10 Rm 2B-10, 10 Center Drive, Bethesda, MD 20892 USA
| | - Kyungsook Gartrell
- National Library of Medicine/Lister Hill National Center for Biomedical Communications, and National Institutes of Health/Clinical Center Nursing Department, North Bethesda, Maryland USA
| | - Li Yang
- Clinical Center, National Institutes of Health, Bldg 10 Rm 2B-10, 10 Center Drive, Bethesda, MD 20892 USA
| | - Mark VanRaden
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland USA
| | | | - Gwenyth R. Wallen
- Clinical Center, National Institutes of Health, Bldg 10 Rm 2B-10, 10 Center Drive, Bethesda, MD 20892 USA
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Powers JH, Guerrero ML, Leidy NK, Fairchok MP, Rosenberg A, Hernández A, Stringer S, Schofield C, Rodríguez-Zulueta P, Kim K, Danaher PJ, Ortega-Gallegos H, Bacci ED, Stepp N, Galindo-Fraga A, St Clair K, Rajnik M, McDonough EA, Ridoré M, Arnold JC, Millar EV, Ruiz-Palacios GM. Development of the Flu-PRO: a patient-reported outcome (PRO) instrument to evaluate symptoms of influenza. BMC Infect Dis 2016; 16:1. [PMID: 26729246 PMCID: PMC4700740 DOI: 10.1186/s12879-015-1330-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To develop content validity of a comprehensive patient-reported outcome (PRO) measure following current best scientific methodology to standardize assessment of influenza (flu) symptoms in clinical research. METHODS Stage I (Concept Elicitation): 1:1 telephone interviews with influenza-positive adults (≥18 years) in the US and Mexico within 7 days of diagnosis. Participants described symptom type, character, severity, and duration. Content analysis identified themes and developed the draft Flu-PRO instrument. Stage II (Cognitive Interviewing): The Flu-PRO was administered to a unique set of influenza-positive adults within 14 days of diagnosis; telephone interviews addressed completeness, respondent interpretation of items and ease of use. RESULTS Samples: Stage I: N = 46 adults (16 US, 30 Mexico); mean (SD) age: 38 (19), 39 (14) years; % female: 56%, 73%; race: 69% White, 97% Mestizo. Stage II: N = 34 adults (12 US, 22 Mexico); age: 37 (14), 39 (11) years; % female: 50%, 50%; race: 58% White, 100% Mestizo. SYMPTOMS Symptoms identified by >50%: coughing, weak or tired, throat symptoms, congestion, headache, weakness, sweating, chills, general discomfort, runny nose, chest (trouble breathing), difficulty sleeping, and body aches or pains. No new content was uncovered during Stage II; participants easily understood the instrument. CONCLUSIONS Results show the 37-item Flu-PRO is a content valid measure of influenza symptoms in adults with a confirmed diagnosis of influenza. Research is underway to evaluate the suitability of the instrument for children and adolescents. This work can form the basis for future quantitative tests of reliability, validity, and responsiveness to evaluate the measurement properties of Flu-PRO for use in clinical trials and epidemiology studies.
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Affiliation(s)
- John H Powers
- Clinical Monitoring and Research Program, Clinical Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702 in support of the Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
- , 5601 Fishers Lane, Room 4D50, Rockville, MD, 20852, USA.
| | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Mary P Fairchok
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
- Madigan Army Medical Center, Tacoma, WA, USA.
| | - Alice Rosenberg
- Clinical Monitoring and Research Program, Clinical Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702 in support of the Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
| | - Andrés Hernández
- Instituto Nacional de Enfermedades Infecciosas, Mexico City, Mexico.
| | | | | | | | | | | | - Hilda Ortega-Gallegos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | | | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Michael Rajnik
- Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | | | - Michelande Ridoré
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | | | - Eugene V Millar
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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