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Preußel K, Albrecht S, Offergeld R. Compliance of blood donors in Germany with non-sexual deferral criteria. Vox Sang 2024; 119:308-314. [PMID: 38226700 DOI: 10.1111/vox.13586] [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: 10/11/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND OBJECTIVES In addition to mandatory testing of blood donations, the deferral of donors in the case of various sexual and non-sexual risk exposures ensures the safety of blood products in Germany. The study aimed to quantify non-disclosure of non-sexual risk exposures, as no data are available so far. MATERIALS AND METHODS We conducted an anonymous online survey among whole-blood donors with successful donations between January and March 2020. Data on travel to countries with endemic malaria, recent mild or febrile infections, tattoos or piercings and drug use were collected. We analysed non-compliance in relation to donor demographics by multivariable analyses. RESULTS Altogether, 5.4% of the donors were non-compliant. Non-disclosure was highest for mild infection with 3.3% of donors, followed by febrile infections (1.4%), travel to malaria endemic countries (0.7%) and body modifications (0.5%). Intravenous drug use was negligible in our study population. Age was a predictor for all investigated risks, with higher prevalence in younger age groups. Prevalence ratios for non-disclosure of body modifications and mild infection were higher in females than males. Donation in blood establishments with mobile services was associated with higher non-disclosure of mild infections. CONCLUSION The considerable degree of non-compliance in some donor groups reflects the prevalence of risk factors in the underlying population (e.g., body modification) as well as probable tendency to socially desirable responding. Donor education should not focus exclusively on sexual risk behaviour, as undisclosed non-sexual exposures may bear risks for recipients and donors.
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Affiliation(s)
- Karina Preußel
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stefan Albrecht
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ruth Offergeld
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Hudgi A, Yan Y, Ayyala D, Rao SSC. Accuracy of patient-reported bowel symptoms for fecal incontinence: Historical recall versus prospective evaluation. Neurogastroenterol Motil 2024; 36:e14714. [PMID: 37994807 PMCID: PMC10842103 DOI: 10.1111/nmo.14714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Fecal incontinence (FI) is characterized by both irregular and unpredictable bowel symptoms. An accurate history of symptoms is important for diagnosis and guiding management. Whether a patient's history of bowel symptoms is reliable or if there is recall bias is unknown. AIM To evaluate the accuracy of FI symptoms based on patient's recall compared with a prospective stool diary. METHODS FI (Rome IV) patients completed a bowel questionnaire that included leakage episodes and stool consistency. Subsequently they completed a one-week FI stool diary. Agreement and correlation between historical recall and stool diary were compared. RESULTS One hundred patients participated. On average they reported 12 bowel movements (BMs) and five FI episodes per week. Fifty-two percent had completed under-graduation, 33% high school and 15% postgraduation. Using recall, 23% of patients accurately reported the number of FI episodes, whereas 41% underestimated and 36% overestimated its prevalence compared to the FI diary. Similarly, the concordance for the number of BMs was 30%, urgency was 54%, amount of stool leakage was 16%, and stool consistency was 12.5%. The concordance for nocturnal FI events, use of pads and lack of stool awareness were 63%, 75%, and 66.6% respectively. CONCLUSION There is poor concordance for key bowel symptoms including the number of FI episodes as reported by FI patients, suggesting significant recall bias. Thus, historical recall of chronic FI symptoms may be less accurate. A prospective stool diary could provide more accurate information for the evaluation of FI patients.
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Affiliation(s)
- Amit Hudgi
- Division of Neurogastroenterology/Motility, Augusta University, Augusta, Georgia, USA
| | - Yun Yan
- Division of Neurogastroenterology/Motility, Augusta University, Augusta, Georgia, USA
| | | | - Satish S C Rao
- Division of Neurogastroenterology/Motility, Augusta University, Augusta, Georgia, USA
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Chilver MR, Burns RA, Botha F, Butterworth P. Comparing estimates of psychological distress using 7-day and 30-day recall periods: Does it make a difference? PLoS One 2023; 18:e0295535. [PMID: 38064444 PMCID: PMC10707700 DOI: 10.1371/journal.pone.0295535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Self-report measures are widely used in mental health research and may use different recall periods depending on the purpose of the assessment. A range of studies aiming to monitor changes in mental health over the course of the COVID-19 pandemic opted to shorten recall periods to increase sensitivity to change over time compared to standard, longer recall periods. However, many of these studies lack pre-pandemic data using the same recall period and may rely on pre-existing data using standard recall periods as a reference point for assessing the impact of the pandemic on mental health. The aim of this study was to assess whether comparing scores on the same questionnaire with a different recall period is valid. A nationally representative sample of 327 participants in Australia completed a 7-day and 30-day version of the six-item Kessler Psychological Distress Scale (K6) and a single-item measure of psychological distress (TTPN item) developed for the Taking the Pulse of the Nation survey. Linear mixed models and mixed logistic regression models were used to assess whether altering the recall period systematically changed response patterns within subjects. No substantive recall period effects were found for the K6 or the TTPN, although there was a trend towards higher K6 scores when asked about the past 30 days compared to the past 7 days (b = 1.00, 95% CI: -0.18, 2.17). This may have been driven by the "feeling nervous" item which was rated higher using the 30-day compared to the 7-day recall period. Neither the K6 nor the TTPN item were significantly affected by the recall period when reduced to a binary variable of likely severe mental illness. The results indicate that altering the recall period of psychological distress measures does not substantively alter the score distribution in the general population of Australian adults.
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Affiliation(s)
- Miranda R. Chilver
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Richard A. Burns
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ferdi Botha
- Melbourne Institute: Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
- ARC Centre of Excellence for Children and Families Over the Life Course, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Butterworth
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- Melbourne Institute: Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
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Vickers AJ, Assel M, Hannon M, Desai P, Carlsson SV, McCready T, Cracchiolo J, Simon B. A comparison of brief versus explicit descriptors for verbal rating scales: interrupted time series design. Health Qual Life Outcomes 2023; 21:105. [PMID: 37705045 PMCID: PMC10498613 DOI: 10.1186/s12955-023-02184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Verbal rating scales (VRS) are widely used in patient-reported outcome (PRO) measures. At our institution, patients complete an online instrument using VRSs with a five-point brief response scale to assess symptoms as part of routine follow-up after ambulatory cancer surgery. We received feedback from patients that the brief VRS descriptors such as "mild" or "somewhat" were vague. We added explicit descriptors to our VRSs, for instance, "Mild: I can generally ignore my pain" for pain severity or "Somewhat: I can do some things okay, but most of my daily activities are harder because of fatigue" for fatigue interference. We then compared responses before and after this change was made. METHODS The symptoms investigated were pain, fatigue and nausea. Our hypothesis was that the explicit descriptors would reduce overall variance. We therefore compared the coefficient of variation of scores and tested the association between symptoms scores and known predictors thereof. We also compared time to completion between questionnaires with and without the additional descriptors. RESULTS A total of 17,500 patients undergoing 21,497 operations were assigned questionnaires in the period before the descriptors were added; allowing for a short transition period, 1,417 patients having 1436 operations were assigned questionnaires with the additional descriptors. Symptom scores were about 10% lower with the additional descriptors but the coefficient of variation was slightly higher. Moreover, the only statistically significant difference between groups for association with a known predictor favored the item without the additional language for nausea severity (p = 0.004). Total completion time was longer when the instrument included the additional descriptors, particularly the first and second time that the questionnaire was completed. CONCLUSIONS Adding descriptors to a VRS of post-operative symptoms did not improve scale properties in patients undergoing ambulatory cancer surgery. We have removed the additional descriptors from our tool. We recommend further comparative psychometric research using data from PROs collected as part of routine clinical care.
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Affiliation(s)
- Andrew J Vickers
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA.
| | - Melissa Assel
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Michael Hannon
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Priyanka Desai
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Sigrid V Carlsson
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
- Department of Urology, (SC) Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Taylor McCready
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Jennifer Cracchiolo
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
| | - Brett Simon
- Departments of Epidemiology and Biostatistics (AV, MA, SC), Anesthesiology (PD, TM, BS) and Surgery (MH, JC, SC), Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2Nd Floor, New York, NY, 10017, USA
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Anderson DJ, Aucoin A, Toups CR, Cormier D, McDonald M, Hasoon J, Viswanath O, Kaye AD, Urits I. Lower Urinary Tract Symptoms in Depression: A Review. Health Psychol Res 2023; 11:81040. [PMID: 37465591 PMCID: PMC10351871 DOI: 10.52965/001c.81040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Lower Urinary Tract Symptoms (LUTS) are frequently present in the general population as patients age with approximately a third of individuals experiencing LUTS during their lifetime. LUTS can be further defined as having any of the following symptoms: urinary hesitancy, straining, nocturia, increased urination frequency, and dysuria. LUTS has the potential for patients to contribute their symptoms to what can normally occur as we age. This can lead to a decrease in patients seeking care and could negatively impact patients' health-related quality of life (HRQL). In conjunction with LUTS, we obtained from our analysis that LUTS and depression are closely related and worsening depressive symptoms may increase the severity of LUTS. We also discerned three categories of factors that can yield major depression namely adversity, internalizing, and externalizing factors. Within these categories, trauma, social support, genetic factors, and minimal education appeared to increase the risk of depression in patients. With the recent increase in mental health awareness and more access to mental health care amid the COVID-19 Pandemic, further screening, and collaboration between providers to treat both urological and psychiatric symptoms could improve patient outcomes. It is important for providers to have an increased understanding of the mental and physical impact both LUTS and depression can have on patients' wellbeing. This has the potential to help patients be more open about their symptoms with the aim of better addressing LUTS and depression to positively impact their HRQL.
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Affiliation(s)
| | - Alise Aucoin
- Department of Anesthesiology Louisiana State University Health
| | - Colton R Toups
- Department of Anesthesiology Louisiana State University Health
| | - Devin Cormier
- Department of Anesthesiology Louisiana State University Health
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alan D Kaye
- Department of Anesthesiology Louisiana State University Health
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Glaser AP, Kristof TW, Judge C, Javitch G, Hirsch S, Talaty P, Helfand BT, Smith AR, Griffith JW. The 10-item LURN Symptom Index (LURN SI-10) Detects Additional Symptoms and Shows Convergent Validity With the IPSS in Men Presenting With Lower Urinary Tract Symptoms. Urology 2023; 171:184-189. [PMID: 36370771 DOI: 10.1016/j.urology.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine how the LURN-SI-10, a novel questionnaire developed by the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN), compares with the International Prostate Symptom Score (IPSS) in men with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). Specifically, to assess convergent validity and determine how frequently the LURN-SI-10 identifies symptoms not captured by the IPSS. MATERIALS AND METHODS Men presenting with BPH/LUTS were prospectively administered LURN-SI-10 and IPSS questionnaires. Urinary incontinence (UI) including post-void dribbling (PVD), urgency urinary incontinence (UUI), stress urinary incontinence (SUI), as well as bladder pain were considered present if the patient reported "about half the time or more" on LURN-SI-10. Correlations between LURN-SI-10 and IPSS were assessed as continuous and categorical variables. Multivariable linear regression analysis was performed to determine associations with symptom scores. RESULTS LURN-SI-10 and IPSS were highly correlated in men with BPH/LUTS (r = 0.82, n = 429), as were respective bother and quality of life scores (ρ = 0.74). The LURN-SI-10 identified additional symptoms including PVD (24%), UUI (13%), SUI (2%), and pain (8%). Men with any UUI, SUI, or PVD had on average a 7.6-point higher LURN-SI-10 score than those without UI (P<.001) and 8.0-point higher IPSS score than those without UI (P<.001). CONCLUSION The LURN-SI-10 correlates strongly with the IPSS, but the LURN-SI-10 identifies additional important symptomatology in men with LUTS. This additional information may improve the evaluation and treatment of men with BPH/LUTS. Further prospective studies of the LURN-SI-10 is warranted.
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Affiliation(s)
- Alexander P Glaser
- Department of Surgery, Division of Urology, NorthShore University HealthSystem, Evanston, IL.
| | - Tanya W Kristof
- Department of Surgery, Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Clark Judge
- Department of Surgery, Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - George Javitch
- Department of Surgery, Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | - Shira Hirsch
- Department of Surgery, Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | - Pooja Talaty
- Department of Surgery, Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | - Brian T Helfand
- Department of Surgery, Division of Urology, NorthShore University HealthSystem, Evanston, IL
| | | | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Flynn KE, Wiseman JB, Helmuth ME, Smith AR, Bradley CS, Cameron AP, Lai HH, Kirkali Z, Kreder KJ, Geynisman-Tan J, Merion RM, Weinfurt KP. Comparing clinical bladder diaries and recalled patient reports for measuring lower urinary tract symptoms in the symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). Neurourol Urodyn 2022; 41:1711-1721. [PMID: 36066068 PMCID: PMC9633398 DOI: 10.1002/nau.25030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/06/2022] [Accepted: 08/05/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Bladder diaries are a key source of information about lower urinary tract symptoms (LUTS); however, many patients do not complete them as instructed. Questionnaire-based patient-reported outcome measures (PROMs) are another option for reporting LUTS but may have recall bias. We assessed the strength of the associations between PROMs and a 3-day bladder diary. MATERIALS AND METHODS Symptomatic adults from 6 tertiary care sites completed a 3-day paper bladder diary and 3-, 7-, and 30-day electronic PROMs. We assessed the linear associations between mapped pairs of diary variables and responses to PROM items using biserial and polyserial correlation coefficients with 95% confidence intervals. RESULTS Of 290 enrolled participants, 175 (60%) completed the bladder diary as instructed and at least one corresponding PROM. Linear associations were strongest between the diary and 3-day recall of daytime frequency (r = 0.75) and nighttime frequency (r = 0.69), followed by voids with urgency sensations (r = 0.62), and an item reporting any incontinence (r = 0.56). Linear associations between bladder diary and specific incontinence variables (e.g., stress, urgency) were low to negligible (ranging from r = 0.16-0.39). Linear associations were consistent across the 3-, 7-, and 30-day recall periods. CONCLUSIONS Missing and unusable bladder diary data were common, highlighting the patient burden associated with this method of data collection. A questionnaire-based PROM is a reasonable alternative to a diary for reporting voiding frequency and may offer an easier option for reporting some symptoms.
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Affiliation(s)
- Kathryn E. Flynn
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee WI
| | | | | | | | - Catherine S. Bradley
- Department of Obstetrics and Gynecology, University of Iowa, Carver College of Medicine, Iowa City IA
| | | | - H. Henry Lai
- Department of Surgery, Washington University in St Louis, St Louis MO
| | - Ziya Kirkali
- Division of Kidney, Urologic, and Hematologic Diseases; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD
| | - Karl J. Kreder
- Department of Obstetrics and Gynecology, University of Iowa, Carver College of Medicine, Iowa City IA
| | | | | | - Kevin P. Weinfurt
- Department of Population Health Sciences, Duke University Medical Center, Durham NC
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AUGS-PERFORM: A New Patient-Reported Outcome Measure to Assess Quality of Prolapse Care. Female Pelvic Med Reconstr Surg 2022; 28:468-478. [PMID: 35982987 PMCID: PMC9365262 DOI: 10.1097/spv.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patient-reported outcomes (PRO) are important for measuring quality of care, particularly for interventions aimed at improving symptom bother such as procedures for pelvic organ prolapse. We aimed to create a concise yet comprehensive PRO measurement tool to assess pelvic organ prolapse care in high-volume clinical environments. Methods The relevant concepts to measure prolapse treatment quality were first established through literature review, qualitative interviews, and a patient and provider-driven consensus-building process. Extant items mapping to these concepts, or domains, were identified from an existing pool of patient-reported symptoms and condition-specific and generic health-related quality of life measures. Item classification was performed to group items assessing similar concepts while eliminating items that were redundant, inconsistent with domains, or overly complex. A consensus meeting was held in March 2020 where patient and provider working groups ranked the remaining candidate items in order of relevance to measure prolapse treatment quality. After subsequent expert review, the revised candidate items underwent cognitive interview testing and were further refined. Results Fifteen relevant PRO instruments were initially identified, and 358 items were considered for inclusion. After 2 iterative consensus reviews and 4 rounds of cognitive interviewing with 19 patients, 11 final candidate items were identified. These items map 5 consensus-based domains that include awareness and bother from prolapse, physical function, physical discomfort during sexual activity, pain, and urinary/defecatory symptoms. Conclusions We present a concise set of candidate items that were developed using rigorous patient-centered methodology and a national consensus process, including urogynecologic patients and providers.
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Schaffer EM, Basch EM, Schwab GM, Bennett AV. Comparison of weekly and daily recall of pain as an endpoint in a randomized phase 3 trial of cabozantinib for metastatic castration-resistant prostate cancer. Clin Trials 2021; 18:408-416. [PMID: 33884929 PMCID: PMC8290982 DOI: 10.1177/17407745211009547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Scant evidence reveals whether the use of weekly versus daily pain ratings leads to meaningful differences when measuring pain as a clinical trial outcome. We compared the ability of weekly ratings and descriptors of daily ratings to evaluate pain as an endpoint in a randomized phase 3 drug trial. Methods Participants (n = 119) with metastatic castration-resistant prostate cancer were randomized to treatment arms and rated their pain on the average and at its worst during a baseline week and at weeks 3, 6, and 12 of study treatment. For each reporting period, participants rated their pain daily for 7 days. On day 7, participants rated their pain over the prior 7 days. We estimated mean differences and intraclass correlation coefficients of the weekly ratings and the mean and the maximum daily ratings. We compared the ability of the weekly ratings and the daily rating descriptors to detect change in pain and evaluated the agreement of the weekly rating and the mean daily rating of pain at its worst to detect treatment response. Results For both pain constructs, the weekly rating was consistently higher than the mean daily rating and lower than the maximum daily rating yet was moderately to highly correlated with both daily rating descriptors (intraclass correlation coefficient range = 0.55–0.94). The weekly rating and the daily rating descriptors consistently detected change in pain for the study sample and participant subgroups. Substantial agreement existed between the weekly rating and the mean daily rating of pain at its worst when used with trial protocol opioid criteria to detect treatment response (Cohen’s κ = 0.71). Conclusion Use of daily over weekly ratings delivered no added benefit in evaluating pain in this clinical trial. This study is the first to compare weekly and daily recall to measure pain as an endpoint in a randomized phase 3 drug trial, and the pattern of differences in ratings that we observed is consistent with other recent evaluations of weekly and daily symptom reporting.
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Affiliation(s)
| | - Ethan M Basch
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Antonia V Bennett
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
- Antonia V Bennett, Department of Health Policy and Management, University of North Carolina, Campus Box #7411, Chapel Hill, NC 27516-7411, USA.
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10
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Analyzing and Characterizing Why Men Seek Care for Lower Urinary Tract Symptoms. Curr Urol Rep 2020; 21:58. [DOI: 10.1007/s11934-020-01006-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
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Hong N, Yu W, Xia J, Shen Y, Yap M, Han W. Evaluation of ocular symptoms and tropism of SARS-CoV-2 in patients confirmed with COVID-19. Acta Ophthalmol 2020; 98:e649-e655. [PMID: 32336042 PMCID: PMC7267628 DOI: 10.1111/aos.14445] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE The SARS-CoV-2 RNA has been detected in tears and conjunctival samples from infected individuals. Conjunctivitis is also reported in a small number of cases. We evaluated ocular symptoms and ocular tropism of SARS-CoV-2 in a group of patients with COVID-19. METHOD Fifty-six patients infected with SARS-CoV-2 were recruited as subjects. Relevant medical histories were obtained from the electronic medical record system. Ocular history and ocular symptoms data were obtained by communicating directly with the subjects. The Ocular Surface Disease Index (OSDI) and Salisbury Eye Evaluation Questionnaire (SEEQ) were used to assess the anterior ocular surface condition before and after the onset of disease. RESULTS Patients classified as severe COVID-19 cases were more likely to have hypertension compared to mild cases (p = 0.035). Of the 56 subjects, thirteen patients (23%) were infected in Wuhan, 32 patients (57%) were community-infected, 10 patients (18%) were unknown origin, 1 (2%) was a physician likely infected by a confirmed patient. Three patients wore face mask with precaution when contacting the confirmed patients. Fifteen (27%) had aggravated ocular symptoms, of which 6 (11%) had prodromal ocular symptoms before disease onset. The differences in mean scores of OSDI questionnaire and SEEQ between before and after onset of COVID-19 were all significant (p < 0.05 for both). CONCLUSIONS Ocular symptoms are relatively common in COVID-19 disease and may appear just before the onset of respiratory symptoms. Our data provided the anecdotal evidences of transmission of SARS-CoV-2 via ocular surface.
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Affiliation(s)
- Nan Hong
- The Department of OphthalmologyFirst Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Wangshu Yu
- The Department of OphthalmologyFirst Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Jianhua Xia
- The Department of OphthalmologyFirst Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Ye Shen
- The Department of OphthalmologyFirst Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Maurice Yap
- School of OptometryThe Hong Kong Polytechnic UniversityHong KongChina
| | - Wei Han
- The Department of OphthalmologyFirst Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
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Flynn KE, Mansfield SA, Smith AR, Gillespie BW, Bradley CS, Cella D, Helmuth ME, Lai HH, Kirkali Z, Talaty P, Griffith JW, Weinfurt KP. Patient demographic and psychosocial characteristics associated with 30-day recall of self-reported lower urinary tract symptoms. Neurourol Urodyn 2020; 39:1939-1948. [PMID: 32856723 DOI: 10.1002/nau.24461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 11/09/2022]
Abstract
AIMS Measurement of self-reported lower urinary tract symptoms (LUTS) typically uses a recall period, for example, "In the past 30 days…." Compared to averaged daily reports, 30-day recall is generally unbiased, but recall bias varies by item. We examined the associations between personal characteristics (eg, age, symptom bother) and 30-day recall of LUTS using items from the Symptoms of Lower Urinary Tract Dysfunction Research Network Comprehensive Assessment of Self-reported Urinary Symptoms questionnaire. METHODS Participants (127 women and 127 men) were recruited from 6 US tertiary care sites. They completed daily assessments for 30 days and a 30-day recall assessment at the end of the study month. For each of the 18 tested items, representing 10 LUTS, the average of the participant's daily responses was modeled as a function of their 30-day recall, the personal characteristic, and the interaction between the 30-day recall and the characteristic in separate general linear regression models, adjusted for sex. RESULTS Nine items representing 7 LUTS exhibited under- or overreporting (recall bias) for at least 25% of participants. Bias was associated with personal characteristics for six LUTS. Underreporting of incontinence was associated with older age, lower anxiety, and negative affect; overreporting of other LUTS was associated with, symptom bother, symptom variability, anxiety, and depression. CONCLUSIONS We identified under- or overreporting that was associated with personal characteristics for six common LUTS. Some cues (eg, less bother and lower anxiety) were related to recall bias in an unexpected direction. Thus, providers should exercise caution when making judgments about the accuracy of a patient's symptom recall based on patient demographic and psychosocial characteristics.
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Affiliation(s)
- Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Brenda W Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | | | - H Henry Lai
- Division of Urologic Surgery, Washington University in St Louis, St Louis, Missouri
| | - Ziya Kirkali
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Pooja Talaty
- NorthShore University Health System, Glenview, Illinois
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Kevin P Weinfurt
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina
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Bauer SR, Breyer BN, Oni-Orisan A, Steinman MA, Sim I, McCulloch CE, Kenfield SA. PERSONAL: Feasibility Study Protocol for Placebo-Controlled, Randomized n-of-1 Trials of Tamsulosin for Lower Urinary Tract Symptoms. Front Digit Health 2020; 2:7. [PMID: 34713020 PMCID: PMC8521798 DOI: 10.3389/fdgth.2020.00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Lower urinary tract symptoms (LUTS) affect more than half of men over age 70 and contribute to both poor health-related quality of life and polypharmacy. Tamsulosin hydrochloride, a selective α1-blocker, is the most common medication used to treat LUTS due to presumed benign prostatic hyperplasia and is often prescribed indefinitely, although not all men benefit from long-term therapy. N-of-1 trials allow for individualized estimates of benefit and harm and could facilitate decisions regarding chronic tamsulosin therapy for LUTS, particularly among older men. Our team developed the PERSONAL (PlacEbo-controlled, Randomized, patient-Selected Outcomes, N-of-1 triALs) app to track daily urinary symptoms and medication side effects for n-of-1 trials among older men with LUTS. Materials and Methods: We will conduct a feasibility study of 20 individual randomized n-of-1 trials using the PERSONAL app to compare tamsulosin (0.4 or 0.8 mg) vs. placebo among older men taking tamsulosin for LUTS. We will include men over age 65 with a smartphone for whom temporary discontinuation of tamsulosin is safe, (e.g., no history of acute retention). Participants will work with research staff to prospectively identify the most important urinary symptoms and medication side effects that they would like to digitally track. Men will then be randomized to 2-week treatment periods of tamsulosin or placebo followed by a 1-week wash-out with placebo, for 4 distinct treatment periods and 3 wash-out periods, totaling 11 weeks. Study medications will be blinded using over-encapsulation of tamsulosin pills and matching placebo. Our primary outcomes for this study will be recruitment and retention of eligible men, completion rates of n-of-1 trials and daily questionnaires using the PERSONAL app, and participants' perceived usefulness of their n-of-1 trial for determining whether tamsulosin is effective for them. Linear mixed effects models with individual-specific intercepts and intervention effects will also be used to estimate within-individual effects of tamsulosin. Discussion: The goal of this innovative study is to establish feasibility and acceptability of using a mobile health app and n-of-1 trials to provide older men with individualized estimates of benefits and harms of chronic tamsulosin therapy for LUTS.
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Affiliation(s)
- Scott R Bauer
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Veterans Affairs Medical Center, San Francisco, San Francisco, CA, United States
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Akinyemi Oni-Orisan
- Department of Clinical Pharmacy and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, United States
| | - Michael A Steinman
- Veterans Affairs Medical Center, San Francisco, San Francisco, CA, United States.,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ida Sim
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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14
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Knudsen MM, Balasubramaniam K, Haastrup PF, Jarbøl DE, Rasmussen S. Involvement of personal and professional relations among men bothered by lower urinary tract symptoms: a population-based cross-sectional study. BMC Public Health 2020; 20:868. [PMID: 32503507 PMCID: PMC7275308 DOI: 10.1186/s12889-020-08992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background Lower urinary tract symptoms (LUTS) are common among men worldwide and despite frequently of benign origin, the symptoms often influence quality of life. Most men experiencing LUTS manage their symptoms in private settings without consulting their general practitioner (GP). Therefore, the purpose of this study was to identify who in the personal and professional relations Danish men discussed their bothersome LUTS with, to analyse factors associated with discussing LUTS with personal and professional relations, and to analyse how having a social network influenced healthcare seeking. Methods A nationwide population-based, cross-sectional survey representative of the Danish population. A total of 46,647 randomly selected men aged 20+ were invited to participate. Data were collected in 2012. The main outcome measures were odds ratios between involvement of personal and professional relations, GP contact and different characteristics (age, number of symptoms, available social network, and involvement of personal relations) among men experiencing bothersome LUTS. We used multivariate logistic regression models. Results Overall, 22,297 men completed the questionnaire. Of those, 4885 (21.9%) had experienced at least one LUTS, 23.5% had not discussed their symptoms with either personal nor professional relations and 59.1% had not discussed their LUTS with any professional relation. The symptoms were most often discussed with personal relations, primarily the spouse/partner who was involved in more than half of the cases. Odds of consulting the GP, another doctor and other healthcare professionals were two to four-fold higher when the symptoms were discussed with a personal relation. Having an available social network was significantly associated with lower odds of consulting the GP regarding frequent urination. Conclusions Despite the high prevalence of bothersome LUTS more than one-fifth of men did not discuss their symptoms with either personal nor professional relations, and more than half did not discuss the symptoms with any professional relations. Discussing the symptoms with personal relations was generally associated with higher odds of seeking professional help, and for frequent urination, having an available social network was associated with lower odds of consulting the GP. The results may be useful for detecting and treating men bothered by LUTS.
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Affiliation(s)
| | - Kirubakaran Balasubramaniam
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark.
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