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Sisler I, McClish DK, Villella A, Valrie C, Smith WR. Impact of community health workers on quality of life in adolescents and young adults with sickle cell disease: The SHIP-HU study. Br J Haematol 2024; 204:649-657. [PMID: 37779237 DOI: 10.1111/bjh.19113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
Health-related quality of life (HRQoL) is an important outcome for patients with sickle cell disease (SCD). It is often poor compared with other chronic medical conditions or measured as a multidomain disease-specific construct. We previously reported outcomes in the Start Healing in Patients with Hydroxyurea (SHIP-HU) randomized controlled trial in adolescents and adults with SCD at six clinical sites. Besides the primary outcomes, we also measured HRQoL as a secondary outcome. Patients in the intervention arm were each assigned community health workers (CHWs) who provided case management services. CHW services were independent of medical management, and medical managers were blinded to the study arm. Patients in the control arm received only standard of care. We hypothesized that having a CHW would improve HRQoL in patients enrolled in SHIP-HU. We did not find significant differences between domains of HRQoL in the two study arms. Possible explanations include selection bias of enrolled versus unenrolled patients, selection bias of sites, medical providers and medical management, enforced blinding, and a lack of cooperation between medical managers and CHWs. The importance of CHWs and HRQoL is nonetheless recognized based on the literature. Future interventions on HRQoL in SCD should consider alternative study designs and multimodal interventions.
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Affiliation(s)
- India Sisler
- Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, Virigina, USA
| | - Donna K McClish
- Health Care System, Virginia Commonwealth University Health System, Richmond, Virigina, USA
| | - Anthony Villella
- Department of Hematology and Oncology, Nationwide Children's Hospital Hematology Oncology & Blood and Marrow Transplant, Columbus, Ohio, USA
| | - Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, Virigina, USA
| | - Wally R Smith
- Health Care System, Virginia Commonwealth University Health System, Richmond, Virigina, USA
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Sisler I, McClish DK, Valrie C, Villella A, Smith WR. Satisfaction and access to care for adults and adolescents with sickle cell disease: ASCQ-Me quality of care and the SHIP-HU study. Pediatr Blood Cancer 2022; 69:e29948. [PMID: 36151945 DOI: 10.1002/pbc.29948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/20/2022] [Accepted: 08/06/2022] [Indexed: 11/09/2022]
Abstract
A lack of adult sickle cell providers has long been blamed for poor satisfaction and access to specialty care for adults with sickle cell disease (SCD). We were interested in comparing how adolescent and adult patients already in established SCD centers perceived access and quality of care. Hydroxyurea-eligible patients aged 15 years and older were enrolled in the Start Healing in Patients with Hydroxyurea trial, which required them to be affiliated with a SCD specialist. Patients were seen in one of three adult-oriented specialty clinic sites or one of three pediatric-oriented sites. At baseline, patients completed the Adult Sickle Cell Quality of Life Measurement Information System measure as part of a survey battery. Patients treated at adult clinic sites reported being less able to get timely ambulatory appointments (p = .004). They reported emergency department (ED) wait times of >1 h far more often (47.7 vs. 19.3%, p = .0048). They reported less overall satisfaction with care (7.47 vs. 8.77, p < .0001), and less satisfaction with care in the ED (2.88 vs. 3.4, p = .0068. Ambulatory satisfaction was no different between pediatric site versus adult site patients. Poorer systems of care appeared to underlie reported differences, rather than differences in biopsychosocial determinants. Even among specialty-care-affiliated SCD patients, those seen in adult clinics reported worse access to care and lower satisfaction with care than patients seen in pediatric clinics. In addition to increasing the number of adult SCD providers and better preparing pediatric SCD patients to transfer to adult programs, SCD clinical caregivers must also improve aspects of adult care quality to meet reasonable patient expectations of timeliness and interpersonal aspects of care quality.
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Affiliation(s)
- India Sisler
- Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Donna K McClish
- Department of Statistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anthony Villella
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Wally R Smith
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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He J, McClish DK, Sabo RT. Evaluating Misclassification Effects on Single Sequential Treatment in Sequential Multiple Assignment Randomized Trial (SMART) Designs. Stat Biopharm Res 2022. [DOI: 10.1080/19466315.2021.1883472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jun He
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Donna K. McClish
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Roy T. Sabo
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA
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Smith WR, McClish DK, Bovbjerg VE, Singh HK. Development and validation of the sickle cell stress scale-adult. Eur J Haematol Suppl 2022; 109:215-225. [PMID: 35585659 PMCID: PMC9531901 DOI: 10.1111/ejh.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Disease‐specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD‐specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3‐item Likert‐scale adapted from a previous disease stress measure and a 10‐item Likert‐scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health‐related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self‐defined vaso‐occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three‐item and 10‐item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6‐month stress for the 10‐item scale. Cronbach's alpha was high for both the 3‐item (0.73) and 10‐item (0.83) SCD stress scales, test–retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary‐measured healthcare utilization over 6 months. The correlations with the 3‐item scale were stronger, but only statistically significant for depression‐anxiety. The correlation between the two stress scales was 0.59. Both the 3‐item and the 10‐item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test–retest reliability. Further scale validation should determine population norms and response to interventions.
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Affiliation(s)
- Wally R Smith
- Section of Research, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Viktor E Bovbjerg
- College of Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Harjot K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
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Smith WR, McClish DK, Lottenberg R, Sisler IY, Sop D, Johnson S, Villella A, Liles D, Yang E, Chen I. A randomised controlled provider-blinded trial of community health workers in sickle cell anaemia: effects on haematologic variables and hydroxyurea adherence. Br J Haematol 2021; 196:193-203. [PMID: 34786695 DOI: 10.1111/bjh.17952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022]
Abstract
Hydroxyurea (hydroxycarbamide) (HU) for sickle cell anaemia (SCA) is underutilised. Case management is an evidence-based health management strategy and in this regard patient navigators (PNs) may provide case management for SCA. We hypothesised that HU-eligible patients exposed to PNs would have improved indicators of starting HU and HU adherence. We randomised 224 HU-eligible SCA adults into the Start Healing in Patients with Hydroxyurea (SHIP-HU) Trial. All patients received care from trained physicians using standardised HU prescribing protocols. Patients in the Experimental arm received case management and education from PNs through multiple contacts. All other patients were regarded as the Control arm and received specialty care alone. Study physicians were blinded to the study arms and did not interact with PNs. At baseline, 6 and 12 months we assessed and compared laboratory parameters and HU adherence indicators. Experimental patients had higher 6-month mean fetal haemoglobin (HbF) levels than controls. But at 12 months, mean HbF was similar, as were white blood cell count, absolute neutrophil count, total haemoglobin, platelet count and mean corpuscular volume. At 12 months there were fewer experimental patients missing HU doses than controls (mean 1·8 vs. 4·5, P = 0·0098), and more recent HU prescriptions filled than for controls (mean 53·8 vs. 92 days, median 27·5 vs. 62 days, P = 0·0082). Mean HU doses were largely similar. We detected behavioural improvements in HU adherence but no haematological improvements by adding PNs to specialty care.
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Affiliation(s)
- Wally R Smith
- Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard Lottenberg
- Division of Haematology/Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - India Y Sisler
- Department of Pediatrics, Division of Pediatric Haematology and Oncology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Daniel Sop
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Shirley Johnson
- Adult Sickle Cell Program, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Anthony Villella
- Department of Pediatrics, Haematology & Oncology, Columbus, OH, USA
| | - Darla Liles
- Department of Internal Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Elizabeth Yang
- Pediatric Specialists of Virginia, 6565 Arlington Boulevard, Falls Church, VA, USA
| | - Ian Chen
- Eastern Virginia Medical School, Medical Service, Hampton VA Medical Center, Hampton, VA, USA
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Smith WR, McClish DK, Roberts JD, Kandalaft O, Dahman B, Knisely J, Levenson J, Roseff S, Aisiku IP. Prescription Opioid Misuse Index in sickle cell patients: A brief questionnaire to assess at-risk for opioid abuse. J Opioid Manag 2019; 15:323-331. [PMID: 31637684 DOI: 10.5055/jom.2019.0517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To develop a survey instrument to identify adult sickle cell disease (SCD) patients on chronic opioid therapy who are at-risk for opioid abuse. DESIGN Prospective survey and interview. SETTING Adult SCD clinic in a large urban teaching facility. PATIENTS/PARTICIPANTS Convenience sampling of adult patients presenting to the sickle cell clinic. INTERVENTIONS None. MAIN OUTCOME Primary outcome was "at-risk for opioid misuse," defined as at least 3/8 "yes" answers (a positive composite score) on the Prescription Opioid Misuse Index (POMI) questionnaire. Secondary outcome was DSM-IV criteria for substance abuse using the DSM IV Diagnostic Interview Schedule. RESULTS Of the 99 patients who completed the POMI, the mean age was 36 years; 58.6 percent were female, 48 percent were hemoglobin SS (47/99), and 26 percent were SC (26/99). Twenty-four percent (24/99) were identified as at-risk for opioid misuse using the POMI. There were no differences in demographic, SCD genotype, or socioeconomic variables for at-risk versus not-at-risk patients. CONCLUSION Twenty-four percent of unselected adult SCD patients on opioids were identified as at-risk for opioid misuse using a quick survey. This may represent as much as 2.5-7 times the national misuse rate. This group of patients may benefit from additional diagnostic and therapeutic interventions to help understand and manage their opioid usage.
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Affiliation(s)
- Wally R Smith
- Professor, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Donna K McClish
- Professor, Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - John D Roberts
- Professor, Department of Medicine, Yale University, New Haven, Connecticut
| | - Osama Kandalaft
- Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Bassam Dahman
- Assistant Professor, Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia
| | - Janet Knisely
- Associate Professor, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - James Levenson
- Professor, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Susan Roseff
- Professor, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Imo P Aisiku
- Assistant Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Galadima HI, McClish DK. Controlling for confounding via propensity score methods can result in biased estimation of the conditional AUC: A simulation study. Pharm Stat 2019; 18:568-582. [PMID: 31111682 DOI: 10.1002/pst.1948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/10/2022]
Abstract
In the medical literature, there has been an increased interest in evaluating association between exposure and outcomes using nonrandomized observational studies. However, because assignments to exposure are not random in observational studies, comparisons of outcomes between exposed and nonexposed subjects must account for the effect of confounders. Propensity score methods have been widely used to control for confounding, when estimating exposure effect. Previous studies have shown that conditioning on the propensity score results in biased estimation of conditional odds ratio and hazard ratio. However, research is lacking on the performance of propensity score methods for covariate adjustment when estimating the area under the ROC curve (AUC). In this paper, AUC is proposed as measure of effect when outcomes are continuous. The AUC is interpreted as the probability that a randomly selected nonexposed subject has a better response than a randomly selected exposed subject. A series of simulations has been conducted to examine the performance of propensity score methods when association between exposure and outcomes is quantified by AUC; this includes determining the optimal choice of variables for the propensity score models. Additionally, the propensity score approach is compared with that of the conventional regression approach to adjust for covariates with the AUC. The choice of the best estimator depends on bias, relative bias, and root mean squared error. Finally, an example looking at the relationship of depression/anxiety and pain intensity in people with sickle cell disease is used to illustrate the estimation of the adjusted AUC using the proposed approaches.
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Affiliation(s)
- Hadiza I Galadima
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, Virginia
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
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McClish DK, Wilk AR, Schubert CM. Choosing between the BP and BN sequential strategies. Pharm Stat 2019; 18:533-545. [PMID: 31069929 DOI: 10.1002/pst.1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/16/2019] [Accepted: 03/05/2019] [Indexed: 11/06/2022]
Abstract
Cost and burden of diagnostic testing may be reduced if fewer tests can be applied. Sequential testing involves selecting a sequence of tests, but only administering subsequent tests dependent on results of previous tests. This research provides guidance to choosing between single tests or the believe the positive (BP) and believe the negative (BN) sequential testing strategies, using accuracy (as measured by the Youden Index) as the primary determinant. Approximately 75% of the parameter combinations examined resulted in either BP or BN being recommended based on a higher accuracy at the optimal point. In about half of the scenarios BP was preferred, and the other half, BN, with the choice often a function of the value of the ratio of standard deviations of those without and with disease (b). Large values of b for the first test of the sequence tended to be associated with preference for BN as opposed to BP, while small values of b appear to favor BP. When there was no preference between sequences and/or single tests based on the Youden Index, cost of the sequence was considered. In this case, disease prevalence plays a large role in the selection of strategies, with lower values favoring BN and sometimes higher values favoring BP. The cost threshold for the sequential strategy to be preferred over a single, more accurate test, was often quite high. It appears that while sequential strategies most often increase diagnostic accuracy over a single test, sequential strategies are not always preferred.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Amber R Wilk
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia.,United Network for Organ Sharing, Richmond, Virginia
| | - Christine M Schubert
- Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Ohio
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Ahmed AE, McClish DK, Alghamdi T, Alshehri A, Aljahdali Y, Aburayah K, Almaymoni A, Albaijan M, Al-Jahdali H, Jazieh AR. Modeling risk assessment for breast cancer in symptomatic women: a Saudi Arabian study. Cancer Manag Res 2019; 11:1125-1132. [PMID: 30787637 PMCID: PMC6366356 DOI: 10.2147/cmar.s189883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite the continuing increase in the breast cancer incidence rate among Saudi Arabian women, no breast cancer risk-prediction model is available in this population. The aim of this research was to develop a risk-assessment tool to distinguish between high risk and low risk of breast cancer in a sample of Saudi women who were screened for breast cancer. Methods A retrospective chart review was conducted on symptomatic women who underwent breast mass biopsies between September 8, 2015 and November 8, 2017 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results A total of 404 (63.8%) malignant breast biopsies and 229 (36.2%) benign breast biopsies were analyzed. Women ≥40 years old (aOR: 6.202, CI 3.497–11.001, P=0.001), hormone-replacement therapy (aOR 24.365, 95% CI 8.606–68.987, P=0.001), postmenopausal (aOR 3.058, 95% CI 1.861–5.024, P=0.001), and with a family history of breast cancer (aOR 2.307, 95% CI 1.142–4.658, P=0.020) were independently associated with an increased risk of breast cancer. This model showed an acceptable fit and had area under the receiver-operating characteristic curve of 0.877 (95% CI 0.851–0.903), with optimism-corrected area under the curve of 0.865. Conclusion The prediction model developed in this study has a high ability in predicting increased breast cancer risk in our facility. Combining information on age, use of hormone therapy, postmenopausal status, and family history of breast cancer improved the degree of discriminatory accuracy of breast cancer prediction. Our risk model may assist in initiating population-screening programs and prompt clinical decision making to manage cases and prevent unfavorable outcomes.
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Affiliation(s)
- Anwar E Ahmed
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia, .,College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Donna K McClish
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Thamer Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshehri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yasser Aljahdali
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid Aburayah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Almaymoni
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Monirah Albaijan
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia,
| | - Hamdan Al-Jahdali
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia, .,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulaziz Medical City, Riyadh, Saudi Arabia.,Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Abdul Rahman Jazieh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulaziz Medical City, Riyadh, Saudi Arabia.,Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
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Field JJ, Ballas SK, Campbell CM, Crosby LE, Dampier C, Darbari DS, McClish DK, Smith WR, Zempsky WT. AAAPT Diagnostic Criteria for Acute Sickle Cell Disease Pain. J Pain 2018; 20:746-759. [PMID: 30578848 DOI: 10.1016/j.jpain.2018.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 12/14/2022]
Abstract
Acute pain episodes are the most common complication in patients with sickle cell disease (SCD). Classically attributed to vaso-occlusion, recent insights suggest that chronic pain may also contribute to the pathogenesis of acute pain episodes, which adds complexity to their diagnosis and management. A taxonomy, or classification system, for acute pain in patients with SCD would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including SCD. To accomplish this, a working group of experts in SCD and pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific to SCD. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of chronic pain, are proposed to define the types of acute pain observed in patients with SCD. PERSPECTIVE: This article presents a taxonomy for acute pain in patients with SCD. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients with SCD.
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Affiliation(s)
- Joshua J Field
- JJF Medical Sciences Institute, BloodCenter of Wisconsin, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Samir K Ballas
- SKB Department of Medicine,Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claudia M Campbell
- CCM Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lori E Crosby
- LEC Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlton Dampier
- CD Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Deepika S Darbari
- DSD Division of Hematology, Children's National Medical Center, Washington, DC
| | - Donna K McClish
- DKM Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Wally R Smith
- WRS Department of Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - William T Zempsky
- WTZ Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut
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11
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Ahmed AE, Alzahrani FS, Gharawi AM, Alammary SA, Almijmaj FH, Alhusayni FM, McClish DK, Al-Jahdali H, Olayan AAA, Jazieh AR. Improving risk prediction for pancreatic cancer in symptomatic patients: a Saudi Arabian study. Cancer Manag Res 2018; 10:4981-4986. [PMID: 30464598 PMCID: PMC6208533 DOI: 10.2147/cmar.s173666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Imaging tests used in our center are usually inadequate to confirm the high risk for pancreatic cancer. We aimed to use a combination of potential predictors including imaging tests to quantify the risk of pancreatic cancer and evaluate its utility. Methods This was a retrospective cohort study of patients who were suspected as having pancreatic cancer and underwent biopsy examination of pancreatic mass at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 1, 2013, and December 31, 2016. We retrieved data on demographics, clinical history, imaging tests, and final pancreatic diagnosis from medical records. Results Of the 206 who underwent pancreatic biopsies, the mean age was 63.6 years; 54.4% were male. Of all the biopsies, 57.8% were malignant and 42.2% were benign masses. Nine factors contributed significantly to the risk of pancreatic cancer and were noted: older age (adjusted odds ratio [aOR] =1.048; P=0.010), male gender (aOR =4.670; P=0.008), weight loss (aOR =14.810; P=0.001), abdominal pain (aOR =7.053; P=0.0.001), blood clots (aOR =20.787; P=0.014), pancreatitis (aOR =4.473; P=0.021), jaundice (aOR =7.446; P=0.003), persistent fatigue (aOR =22.015; P=0.015), and abnormal imaging tests (aOR =67.124; P=0.001). The model yielded powerful calibration (P=0.953), excellent predictive utility (area under the receiver operating characteristic curve 96.3%; 95% CI =94.1, 98.6), with optimism-corrected area under the curve bootstrap resampling of 94.9%. An optimal cut-off risk probability of 0.513 yielded a sensitivity of 94% and specificity of 84.7% for risk classification. Conclusion The study developed and validated a risk model for quantifying the risk of pancreatic cancer. Nine characteristics were associated with increased risk of pancreatic cancer. This risk assessment model is feasible and highly sensitive and could be useful to improve screening performance and the decision-making process in clinical settings in Saudi Arabia.
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Affiliation(s)
- Anwar E Ahmed
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia, .,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Faris S Alzahrani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Ahmed M Gharawi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Salman A Alammary
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Fahad H Almijmaj
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Fahad M Alhusayni
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Donna K McClish
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Hamdan Al-Jahdali
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia, .,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,
| | - Ashwaq A Al Olayan
- King Abdulaziz Medical City, National Guards Health Affairs, Riyadh, Saudi Arabia
| | - Abdul Rahman Jazieh
- King Abdulaziz Medical City, National Guards Health Affairs, Riyadh, Saudi Arabia
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Smith WR, McClish DK, Levenson J, Aisiku I, Dahman B, Bovbjerg VE, Roseff S, Roberts J. Predictive Ability of Intermittent Daily Sickle Cell Pain Assessment: The PiSCES Project. Pain Med 2018; 19:1972-1981. [PMID: 29036363 PMCID: PMC6176749 DOI: 10.1093/pm/pnx214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Pain diary assessment in sickle cell disease (SCD) may be expensive and impose a high respondent burden. Objective To report whether intermittent assessment could substitute for continuous daily pain assessment in SCD. Design Prospective cohort study. Setting Academic and community practices in Virginia. Patients. A total of 125 SCD patients age 16 years or older in the Pain in Sickle Cell Epidemiology Study. Measurements. Using pain measures that summarized all diaries as the gold standard, we tested the statistical equivalence of four alternative strategies that summarized diaries only from the week prior or the month prior to study completion; one week per month; or one day per week (random day). Summary measures included percent pain days, percent crisis days (self-defined), mean pain (0-9 Likert scale) on all days, and mean pain on pain days. Equivalence tests included comparisons of means, regression intercepts, and slopes, as well as measurement of R2. Results Compared with the gold standard, the one-day-per-week and one-week-per-month strategies yielded statistically equivalent means of six summary pain measures, and the week prior and month prior yielded equivalent means as some of the measures. Regression showed statistically equivalent slopes and intercepts to the gold standard using one-day-per-week and one-week-per-month strategies for percent pain days and percent crisis days, but almost no other equivalence. R2 values ranged from 0.64 to 0.989. Conclusions It is possible to simulate five- to six-month daily assessment of pain in SCD. Either one-day-per-week or one-week-per-month assessment yields an equivalent mean and fair regression equivalence.
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Affiliation(s)
- Wally R Smith
- Section of Research, Division of General Internal Medicine
| | | | | | - Imoigele Aisiku
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Viktor E Bovbjerg
- College of Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Susan Roseff
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - John Roberts
- Department of Internal Medicine (Medical Oncology), Yale University, New Haven, Connecticut, USA
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Ahmed AE, ALMuqbil BI, Alrajhi MN, Almazroa HR, AlBuraikan DA, Albaijan MA, Nasim M, Alsalamah MA, McClish DK, AL-Jahdali H. Emergency department 72-hour revisits among children with chronic diseases: a Saudi Arabian study. BMC Pediatr 2018; 18:205. [PMID: 29945589 PMCID: PMC6020430 DOI: 10.1186/s12887-018-1186-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/21/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Emergency Department (ED) revisits have often been used as an indicator of medical care quality. This study aimed to quantify the frequency of ED revisits within 72 h of discharge and identify its factors among children with chronic diseases. METHODS We designed a retrospective cohort study of children with at least one chronic disease who were also under 18 years of age and had attended and were discharged from the ED at King Abdullah Specialist Children's Hospital (KASCH-RD), Riyadh, Saudi Arabia between April 19, 2015 and July 29, 2017. The outcome measure was the frequency of ED revisits during a period of 72 h after discharge. RESULTS The study included 11,057 ED discharges of children with at least one chronic disease. Their revisit rate was 1211 (11%), with 83 (6.9%) having had a second ED revisit within 72 h of ED discharge. According to ICD-10 codes, the most common causes of ED revisits were respiratory, digestive, genitourinary, symptoms, and external causes. Factors of frequent ED revisits within 72 h were young age, institutional health insurance coverage, year of new health information system (2015), external causes, and genitourinary. CONCLUSION The rate of 72-h ED revisits after discharge of children with chronic diseases treated at KASCH-RD was relatively high, and was associated with young age, institutional health insurance coverage, year of a new health information system implementation, and external causes of ED visit. These study findings amplify the need for intervention to reduce the rate of early ED revisits among children with chronic diseases.
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Affiliation(s)
- Anwar E. Ahmed
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
- Pulmonary Division Medical Director of sleep disorders, Center King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bashayr I. ALMuqbil
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
| | - Manair N. Alrajhi
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
| | - Hend R. Almazroa
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
| | - Doaa A. AlBuraikan
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
| | - Monirah A. Albaijan
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Maliha Nasim
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Majid A. Alsalamah
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
| | - Donna K. McClish
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Box 980032, Richmond, VA 23298 USA
| | - Hamdan AL-Jahdali
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
- McGill University, Montreal, Canada
- Pulmonary Division Medical Director of sleep disorders, Center King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Ahmed AE, Ali YZ, Al-Suliman AM, Albagshi JM, Al Salamah M, Elsayid M, Alanazi WR, Ahmed RA, McClish DK, Al-Jahdali H. The prevalence of abnormal leukocyte count, and its predisposing factors, in patients with sickle cell disease in Saudi Arabia. J Blood Med 2017; 8:185-191. [PMID: 29123434 PMCID: PMC5661844 DOI: 10.2147/jbm.s148463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction High white blood cell (WBC) count is an indicator of sickle cell disease (SCD) severity, however, there are limited studies on WBC counts in Saudi Arabian patients with SCD. The aim of this study was to estimate the prevalence of abnormal leukocyte count (either low or high) and identify factors associated with high WBC counts in a sample of Saudi patients with SCD. Methods A cross-sectional and retrospective chart review study was carried out on 290 SCD patients who were routinely treated at King Fahad Hospital in Hofuf, Saudi Arabia. An interview was conducted to assess clinical presentations, and we reviewed patient charts to collect data on blood test parameters for the previous 6 months. Results Almost half (131 [45.2%]) of the sample had abnormal leukocyte counts: low WBC counts 15 (5.2%) and high 116 (40%). High WBC counts were associated with shortness of breath (P=0.022), tiredness (P=0.039), swelling in hands/feet (P=0.020), and back pain (P=0.007). The mean hemoglobin was higher in patients with normal WBC counts (P=0.024), while the mean hemoglobin S was high in patients with high WBC counts (P=0.003). After adjustment for potential confounders, predictors of high WBC counts were male gender (adjusted odds ratio [aOR]=3.63) and patients with cough (aOR=2.18), low hemoglobin (aOR=0.76), and low heart rate (aOR=0.97). Conclusion Abnormal leukocyte count was common: approximately five in ten Saudi SCD patients assessed in this sample. Male gender, cough, low hemoglobin, and low heart rate were associated with high WBC count. Strategies targeting high WBC count could prevent disease complication and thus could be beneficial for SCD patients.
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Affiliation(s)
- Anwar E Ahmed
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yosra Z Ali
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | | | - Majid Al Salamah
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohieldin Elsayid
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Wala R Alanazi
- Al-Maarefa College for Science and Technology, Riyadh, Saudi Arabia
| | | | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hamdan Al-Jahdali
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Brian Cassel J, Kerr KM, McClish DK, Skoro N, Johnson S, Wanke C, Hoefer D. Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs. J Am Geriatr Soc 2016; 64:2288-2295. [PMID: 27590922 PMCID: PMC5118096 DOI: 10.1111/jgs.14354] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. Design Observational, retrospective study using propensity‐based matching. Setting A health system in southern California. Participants Individuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80. Intervention Home‐ and clinic‐based palliative care (PC) services provided by a multidisciplinary team. Measurements Outcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission. Results Intervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically. Conclusion In the context of an alternative payment model in which the provider was “at risk” of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.
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Affiliation(s)
- J Brian Cassel
- Division of Hematology, Department of Oncology and Palliative Care, School of Medicine, Richmond, Virginia
| | | | | | - Nevena Skoro
- Cancer Informatics Core, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | | | - Carol Wanke
- Managed Care Operations, Sharp HealthCare, San Diego, California
| | - Daniel Hoefer
- Outpatient Palliative Care, Sharp HealthCare, San Diego, California
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Ahmed AE, Alaskar AS, McClish DK, Ali YZ, Aldughither MH, Al-Suliman AM, Malhan HM. Saudi SCD patients' symptoms and quality of life relative to the number of ED visits. BMC Emerg Med 2016; 16:30. [PMID: 27543088 PMCID: PMC4992320 DOI: 10.1186/s12873-016-0096-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/12/2016] [Indexed: 11/12/2022] Open
Abstract
Background Individuals living with sickle cell disease (SCD) have significantly increased emergency department (ED) use compared to the general population. In Saudi Arabia, health care is free for all individuals and therefore has no bearing on increased ED visits. However, little is known about the relationship between quality of life (QoL) and frequency of acute care utilization in this patient population. Methods A cross-sectional study was conducted on 366 patients with SCD who attended the outpatient department at King Fahad Hospital, Hofuf, Saudi Arabia. Data were collected through self-administered surveys, which included: demographics, SCD-related ED visits, clinical issues, and QoL levels. We assessed the ED use by asking for the number of SCD-related ED visits within a 6-month period. Results The self-report survey of ED visits was completed by 308 SCD patients. The median number of SCD-related ED visits within a 6-month time period (IQR) was four (2-7 visits). According to the unadjusted negative binomial model, the rate of SCD-related ED visits increased by (46, 39.3, 40, and 53.5 %) for patients with fever, skin redness with itching, swelling, and blood transfusion, respectively. Poor QoL tends to increase the rate of SCD-related ED visits. Well education and poor general health positively influenced the rate of SCD-related ED visits. Well education tends to increase the rate of SCD-related ED visits by 50.2 %. The rate of SCD-related ED visits decreased by 1.4 % for every point increase in general health. Conclusion Saudi patients with sickle cell disease reported a wide range of SCD-related ED visits. It was estimated that six of 10 SCD patients had at least three ED visits within a 6-month period. Well education and poor general health resulted in an increase in the rate of SCD-related ED visits.
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Affiliation(s)
- Anwar E Ahmed
- King Saud bin Abdulaziz University for Health Sciences, College of Public Health and Health Informatics, MC 2350, P.O.Box 22490, Riyadh, 11426, KSA, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Ahmed S Alaskar
- King Saud bin Abdulaziz University for Health Sciences, College of Public Health and Health Informatics, MC 2350, P.O.Box 22490, Riyadh, 11426, KSA, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Yosra Z Ali
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Ahmed AE, Alaskar AS, Al-Suliman AM, Jazieh AR, McClish DK, Al Salamah M, Ali YZ, Malhan H, Mendoza MA, Gorashi AO, El-Toum ME, El-Toum WE. Health-related quality of life in patients with sickle cell disease in Saudi Arabia. Health Qual Life Outcomes 2015; 13:183. [PMID: 26573908 PMCID: PMC4647668 DOI: 10.1186/s12955-015-0380-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of research concerning health-related quality of life (HRQoL) in Saudi patients with sickle cell disease (SCD), particularly among adult populations. The aim of the current study was to describe the characteristics of SCD patients and their impact on their quality of life (QoL). METHODS Six hundred twenty-nine adult SCD patients who attended King Fahad Hospital in Hofuf and King Fahad Central Hospital in Jazan were included in the analysis. Demographic/clinical data were collected and an Arabic version of the Medical Outcomes 36-Item Short-Form Health Survey (SF-36) questionnaire was used to assess QoL. RESULTS SCD patients who hold a university degree reported positive impacts on the following domains of SF-36: physical role function, vitality, emotional well being, social function, pain reduction, and general health (P = .002, P = .001, P = .001, P = .003, P = .004, and P = .001, respectively). In general, patients with fever, skin redness, swelling, or history of blood transfusion tended to impair the health status of the SF-36. A multivariate analysis revealed that patients with a university degree tended to report high scores of physical role functions, emotional role function, and vitality. Patients with regular exercise tend to increase vitality, social function, general health, and reduce pain. Unemployment tends to lessen vitality and worsen pain. On average, pain, social function, and physical function scores tended to worsen in patients with swelling or history of blood transfusion. CONCLUSIONS This study highlighted that poor education, fever, skin redness, and swelling were negatively associated with specific components of SF-36. SCD patients with a history of blood transfusion found their QoL poorer, whereas regular exercise tended to improve QoL.
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Affiliation(s)
- Anwar E Ahmed
- King Saud bin Abdulaziz University for Health Sciences, MC 2350, P.O. Box 22490, Riyadh, 11426, KSA. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Ahmed S Alaskar
- King Saud bin Abdulaziz University for Health Sciences, MC 2350, P.O. Box 22490, Riyadh, 11426, KSA. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | | | | | - Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Majid Al Salamah
- King Saud bin Abdulaziz University for Health Sciences, MC 2350, P.O. Box 22490, Riyadh, 11426, KSA. .,King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Yosra Z Ali
- King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Hafiz Malhan
- King Fahad Central Hospital, Jazan, Saudi Arabia.
| | - May Anne Mendoza
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | | | - Mohamed E El-Toum
- King Saud bin Abdulaziz University for Health Sciences, MC 2350, P.O. Box 22490, Riyadh, 11426, KSA.
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Smith WR, McClish DK, Dahman BA, Levenson JL, Aisiku IP, de A Citero V, Bovbjerg VE, Roberts JD, Penberthy LT, Roseff SD. Daily home opioid use in adults with sickle cell disease: The PiSCES project. J Opioid Manag 2015; 11:243-253. [PMID: 25985809 DOI: 10.5055/jom.2015.0273] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use. OBJECTIVE To report on home opioid use among adults with SCD. DESIGN Cohort study. PARTICIPANTS Adults with SCD (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day. MAIN MEASURES Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics. KEY RESULTS Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p<0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables. CONCLUSIONS In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.
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Affiliation(s)
- Wally R Smith
- Florence Neal Cooper Smith Professor of Sickle Cell Disease, Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Donna K McClish
- Professor, Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Bassam A Dahman
- Assistant Professor, Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Imoigele P Aisiku
- Assistant Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vanessa de A Citero
- Dept. de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Viktor E Bovbjerg
- Associate Professor, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - John D Roberts
- Professor, Section of Medical Oncology, Department of Medicine, Director, Yale Adult Sickle Cell Program, Smilow Cancer Hospital at Yale - New Haven, New Haven, Connecticut
| | - Lynne T Penberthy
- Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Susan D Roseff
- Chair, Division of Clinical Pathology, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
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Ahmed AE, Schubert CM, McClish DK. Reducing cost in sequential testing: a limit of indifference approach. Stat Med 2013; 32:2715-27. [PMID: 23339070 DOI: 10.1002/sim.5741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/21/2012] [Indexed: 11/08/2022]
Abstract
In noninferiority studies, a limit of indifference is used to express a tolerance in results such that the clinician would regard such results as being acceptable or 'not worse'. We applied this concept to a measure of accuracy, the Receiver Operating Characteristic (ROC) curve, for a sequence of tests. We expressed a limit of indifference for the range of acceptable sensitivity values and examined the associated cost of testing within this range. In doing so, we generated the minimum cost maximum ROC (MCMROC) curve, which reflects the reduced sensitivity and cost of testing. We compared the MCMROC and its associated cost curve between limits of indifference set to 0.999 [a 0.1% reduction in true positive rate (TPR)], 0.95 (a 5% reduction in TPR), and 1 (no reduction in TPR). The limit of indifference tended to have less of an effect on the MCMROC curves than on the associated cost curves that were greatly affected. Cost was reduced at high false positive rates (FPRs) at higher limit of indifference (0.999) and at small FPRs as the limit of indifference decreased (0.95). These patterns were also observed as applied to sequential strategies used to diagnose diabetes in the Pima Indians.
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Affiliation(s)
- Anwar E Ahmed
- Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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McClish DK. A Review of: “Comparing Clinical Measurement Methods: A Practical Guide, by B. Carstensen”. J Biopharm Stat 2011. [DOI: 10.1080/10543406.2011.613364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Donna K. McClish
- a Department of Biostatistics , Virginia Commonwealth University , Richmond, Virginia
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Ahmed AE, McClish DK, Schubert CM. Accuracy and cost comparison in medical testing using sequential testing strategies. Stat Med 2011; 30:3416-30. [PMID: 21976377 DOI: 10.1002/sim.4358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 07/11/2011] [Indexed: 11/08/2022]
Abstract
The practice of sequential testing is followed by the evaluation of accuracy, but not by the evaluation of cost. This paper focuses on three logic rules for combining two sequences of tests: believe the positive (BP), which diagnoses disease if any of two tests is positive, believe the negative (BN), which diagnoses disease if any of two tests is negative, and believe the extreme (BE), which diagnoses disease if the first test is positive or, after a first inconclusive test, a second test is positive for disease. Comparisons of these strategies are provided in terms of accuracy using false positive rate, sensitivity pairs that make up the maximum receiver operating characteristic curve, and cost of testing, defined as the proportion of subjects needing two tests to diagnose disease. A method to incorporate the cost of testing into the definition of the optimal operating point is also presented. The performance of the testing strategies is examined with respect to the ratio of standard deviations and the correlation between test results under the bivariate normal assumptions. Under all parameter settings, the maximum receiver operating characteristic curve of the BE strategy never performed worse than the BN and BP strategies; the BE strategy also had the lowest cost. The use of body mass index and plasma glucose concentration to diagnose diabetes in Pima Indians was presented as a real-world application. The optimal operating points found by the BN and BE strategies produce lower false positive rate values than the BP strategy for these data.
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Affiliation(s)
- Anwar E Ahmed
- Advanced Analytics Department, King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh, Saudi Arabia
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Sogutlu A, Levenson JL, McClish DK, Rosef SD, Smith WR. Somatic symptom burden in adults with sickle cell disease predicts pain, depression, anxiety, health care utilization, and quality of life: the PiSCES project. Psychosomatics 2011; 52:272-9. [PMID: 21565599 DOI: 10.1016/j.psym.2011.01.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Somatic symptoms have been extensively studied in primary care, but infrequently in diseases causing pain in multiple sites. We therefore examined the impact of somatic symptom burden (SSB) on pain, depression, anxiety, health-care utilization, and quality-of-life in adults with sickle cell disease (SCD). METHODS Subjects were 230 adults in the prospective Pain in Sickle Cell Epidemiology Study (PiSCES). Baseline data included demographics, genotype, Patient Health Questionnaire (PHQ), and SF-36 health-related quality of life (HRQOL). In daily diaries for 6 months, patients recorded SCD pain and SCD health-care utilization. To exclude common SCD pain sites, we abridged the PHQ's 15 somatic symptoms to 11 (PHQscd). We divided subjects into two groups: PHQscd≥11 (high SSB), and PHQscd<11 (low SSB). RESULTS High SSB occurred in 18.3% of subjects and was more frequent in women than men (24.6% vs. 9.1%, p=0.0033). Sixty percent of subjects with anxiety and 37.5% of those with depression had comorbid high SSB. Percentage of pain days not in crisis pain was significantly higher in somatizers, but crisis pain did not differ between groups. The high SSB group's hospitalization, scheduled doctor visits, and overall utilization, particularly on non-crisis days were significantly higher than the low SSB group's (p values < 0.05). All SF-36 subscales were significantly negatively correlated with PHQscd (p<0.0001). CONCLUSIONS Even after excluding common SCD pain complaints, high somatic symptom burden was 1.5 to 2 times more prevalent in SCD patients than in primary care. High SSB in SCD predicts more non-crisis pain and healthcare utilization for pain, and is associated with depression, anxiety, and poorer HRQOL.
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Affiliation(s)
- Aslihan Sogutlu
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA
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Hart A, Smith WR, Tademy RH, McClish DK, McCreary M. Health decision-making preferences among African American men recruited from urban barbershops. J Natl Med Assoc 2009; 101:684-9. [PMID: 19634589 DOI: 10.1016/s0027-9684(15)30977-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine general health decision-making roles among African American men ages 40 to 70 recruited in barbershops in the Richmond, Virginia, metropolitan area. METHODS We adapted the 1-item Control Preference scale to study the associations between health decision-making role preferences and demographic variables. Forty African-American men were recruited from barbershops to complete a self-administered survey. After performing descriptive statistics, we dichotomized our outcome into active vs nonactive (collaborative or passive) decision makers. Data were then analyzed using chi2, Wilcoxon-Mann-Whitney rank sum, and multiple logistic regression. RESULTS Fifteen subjects responded that they engaged in active decision making, 20 in collaborative, and 5 in passive decision making. Almost all (86.7%) active decision makers were home owners, vs 41.7% of nonactive decision makers. Among active decision makers, 46.7% had incomes of more than $70000, vs 12.5% of nonactive decision makers. The active group reported health status that was good to excellent, while 20.8% of those in the nonactive group reported poor/fair health. CONCLUSION African American male barbershop clients preferred an active or collaborative health decision-making role with their physician, rather than a passive role. The relationship among home ownership, income, and decision style may best be understood by considering the historical and cultural influences on gender role socialization among African American males. More comprehensive assessment of decision styles is necessary to better understand health decision making among African American male patients.
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Affiliation(s)
- Alton Hart
- Division of Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University, PO Box 980306, Richmond, VA 23298-0306, USA.
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Munro CL, Grap MJ, Jones DJ, McClish DK, Sessler CN. Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. Am J Crit Care 2009; 18:428-37; quiz 438. [PMID: 19723863 DOI: 10.4037/ajcc2009792] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia is associated with increased morbidity and mortality. OBJECTIVE To examine the effects of mechanical (toothbrushing), pharmacological (topical oral chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care on the development of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation. METHODS Critically ill adults in 3 intensive care units were enrolled within 24 hours of intubation in a randomized controlled clinical trial with a 2 x 2 factorial design. Patients with a clinical diagnosis of pneumonia at the time of intubation and edentulous patients were excluded. Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control (usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS). RESULTS The 4 groups did not differ significantly in clinical characteristics. At day 3 analysis, 249 patients remained in the study. Among patients without pneumonia at baseline, pneumonia developed in 24% (CPIS >or=6) by day 3 in those treated with chlorhexidine. When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (P = .29) or toothbrushing (P = .95). However, chlorhexidine significantly reduced the incidence of pneumonia on day 3 (CPIS >or=6) among patients who had CPIS <6 at baseline (P = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine. CONCLUSIONS Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.
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Affiliation(s)
- Cindy L. Munro
- Cindy L. Munro and Mary Jo Grap are professors in the Adult Health Department, School of Nursing; Donna K. McClish is an associate professor, Department of Biostatistics; and Curtis N. Sessler is a professor in the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, at Virginia Commonwealth University, Richmond, Virginia. Deborah J. Jones is an assistant professor, Acute and Continuing Care Department, University of Texas School of Nursing at Houston
| | - Mary Jo Grap
- Cindy L. Munro and Mary Jo Grap are professors in the Adult Health Department, School of Nursing; Donna K. McClish is an associate professor, Department of Biostatistics; and Curtis N. Sessler is a professor in the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, at Virginia Commonwealth University, Richmond, Virginia. Deborah J. Jones is an assistant professor, Acute and Continuing Care Department, University of Texas School of Nursing at Houston
| | - Deborah J. Jones
- Cindy L. Munro and Mary Jo Grap are professors in the Adult Health Department, School of Nursing; Donna K. McClish is an associate professor, Department of Biostatistics; and Curtis N. Sessler is a professor in the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, at Virginia Commonwealth University, Richmond, Virginia. Deborah J. Jones is an assistant professor, Acute and Continuing Care Department, University of Texas School of Nursing at Houston
| | - Donna K. McClish
- Cindy L. Munro and Mary Jo Grap are professors in the Adult Health Department, School of Nursing; Donna K. McClish is an associate professor, Department of Biostatistics; and Curtis N. Sessler is a professor in the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, at Virginia Commonwealth University, Richmond, Virginia. Deborah J. Jones is an assistant professor, Acute and Continuing Care Department, University of Texas School of Nursing at Houston
| | - Curtis N. Sessler
- Cindy L. Munro and Mary Jo Grap are professors in the Adult Health Department, School of Nursing; Donna K. McClish is an associate professor, Department of Biostatistics; and Curtis N. Sessler is a professor in the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, at Virginia Commonwealth University, Richmond, Virginia. Deborah J. Jones is an assistant professor, Acute and Continuing Care Department, University of Texas School of Nursing at Houston
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Aisiku IP, Smith WR, McClish DK, Levenson JL, Penberthy LT, Roseff SD, Bovbjerg VE, Roberts JD. Comparisons of high versus low emergency department utilizers in sickle cell disease. Ann Emerg Med 2008; 53:587-93. [PMID: 18926599 DOI: 10.1016/j.annemergmed.2008.07.050] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 07/12/2008] [Accepted: 07/30/2008] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Patients with sickle cell disease often receive a substantial amount of their health care in the emergency department (ED) and some come to the ED frequently, seeking treatment for pain. As a result, patients with sickle cell disease are often stigmatized as opioid-seeking ED overutilizers. We describe the proportion of sickle cell disease patients who are high utilizers of the ED and compare them with other sickle cell disease patients on demographics, pain characteristics, health data, psychosocial characteristics, and quality of life. METHODS Two hundred thirty-two patients completed baseline data and at least 30 days of daily diary data. Baseline data included demographics, health data, and quality of life (Medical Outcome Study 36 Item Short Form). Daily diary data included ED utilization for sickle cell pain and descriptors of pain and distress. RESULTS Eighty-two (35.5%) patients were found to be high ED utilizers. Clinically important and statistically significant differences were found between high ED utilizers and all other sickle cell disease patients: lower hematocrit level, more transfusions, more pain days, more pain crises, higher mean pain and distress, and worse quality of life on Medical Outcome Study 36 Item Short Form physical function summary scales. After controlling for severity and frequency of pain, high ED utilizers did not use opioids more frequently than other sickle cell disease patients. CONCLUSION A substantial minority of sickle cell disease patients are high ED utilizers. However, high ED utilizers with sickle cell disease are more severely ill as measured by laboratory variables, have more pain, more distress, and have a lower quality of life.
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Affiliation(s)
- Imoigele P Aisiku
- Department of Anesthesiology, Virginia Commonwealth University Reanimation Engineering Shock Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Smith WR, Penberthy LT, Bovbjerg VE, McClish DK, Roberts JD, Dahman B, Aisiku IP, Levenson JL, Roseff SD. Daily assessment of pain in adults with sickle cell disease. Ann Intern Med 2008; 148:94-101. [PMID: 18195334 DOI: 10.7326/0003-4819-148-2-200801150-00004] [Citation(s) in RCA: 408] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Researchers of sickle cell disease have traditionally used health care utilization as a proxy for pain and underlying vaso-occlusion. However, utilization may not completely reflect the amount of self-reported pain or acute, painful episodes (crises). OBJECTIVE To examine the prevalence of self-reported pain and the relationship among pain, crises, and utilization in adults with sickle cell disease. DESIGN Prospective cohort study. SETTING Academic and community practices in Virginia. PATIENTS 232 patients age 16 years or older with sickle cell disease. MEASUREMENTS Patients completed a daily diary for up to 6 months, recording their maximum pain (on a scale of 0 to 9); whether they were in a crisis (crisis day); and whether they used hospital, emergency, or unscheduled ambulatory care for pain on the previous day (utilization day). Summary measures included both simple proportions and adjusted probabilities (for repeated measures within patients) of pain days, crisis days, and utilization days, as well as mean pain intensity. RESULTS Pain (with or without crisis or utilization of care) was reported on 54.5% of 31 017 analyzed patient-days (adjusted probability, 56%). Crises without utilization were reported on 12.7% of days and utilization on only 3.5% (unadjusted). In total, 29.3% of patients reported pain in greater than 95% of diary days, whereas only 14.2% reported pain in 5% or fewer diary days (adjusted). The frequency of home opiate use varied and independently predicted pain, crises, and utilization. Mean pain intensity on crisis days, noncrisis pain days, and total pain days increased as the percentage of pain days increased (P < 0.001). Intensity was significantly higher on utilization days (P < 0.001). However, utilization was not an independent predictor of crisis, after controlling for pain intensity. LIMITATIONS The study was done in a single state. Patients did not always send in their diaries. CONCLUSION Pain in adults with sickle cell disease is the rule rather than the exception and is far more prevalent and severe than previous large-scale studies have portrayed. It is mostly managed at home; therefore, its prevalence is probably underestimated by health care providers, resulting in misclassification, distorted communication, and undertreatment.
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Affiliation(s)
- Wally R Smith
- Division of Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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Quillin JM, Bodurtha JN, McClish DK, Hoy KN, Wallace IJ, Westerberg A, Danish SJ. The effect of a school-based educational intervention on gender differences in reported family cancer history. J Cancer Educ 2008; 23:180-185. [PMID: 18709590 DOI: 10.1080/08858190802235395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Gender differences in reported family cancer history could reduce the effectiveness of genetic screening for cancer risk. METHODS We randomized 6 schools to teach ninth graders about health genealogy through workshops or offered a delayed intervention. We assessed the effect of the intervention on reported family history of various cancers along with gender and side of the family from which cancer was reported. RESULTS Girls reported more breast cancer in the family. Both sexes reported more maternal relatives with breast cancer. There were no treatment group effects. CONCLUSIONS There are gender differences in reported family history of breast cancer.
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Affiliation(s)
- John M Quillin
- Department of Human Genetics, Virginia Commonwealth University, Richmond, VA 23298-0033, USA.
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Abstract
OBJECTIVES To examine parent closeness and its effect in predicting youth smoking when 0, 1, or 2 parents smoked. METHODS Youth and parent smoking, closeness to parents, family structure, and gender and ethnicity among middle (n=17,468) and high school (n=5457) students were measured using a questionnaire. RESULTS Number of parents smoking incrementally moderated the protective effect of all 4 measures of parent closeness, in predicting youth smoking. CONCLUSIONS Addressing parent smoking and strengthening family relationships need significantly greater emphasis in interventions to further reduce youth smoking.
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Affiliation(s)
- Diane B Wilson
- Department of Internal Medicine and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA 23298-0306, USA.
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McClish DK. ROC Volumes - Should They Be Used? Biom J 2007; 49:665-6; discussion 670-1. [DOI: 10.1002/bimj.200710369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Aisiku IP, Penberthy LT, Smith WR, Bovbjerg VE, McClish DK, Levenson JL, Roberts JD, Roseff SD. Patient satisfaction in specialized versus nonspecialized adult sickle cell care centers: the PiSCES study. J Natl Med Assoc 2007; 99:886-90. [PMID: 17722665 PMCID: PMC2574305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) patients can receive their ambulatory care from either SCD specialists (caregivers with sickle cell-only clinics) or nonspecialized care centers. Patient satisfaction, an important factor that may influence compliance and outcome, can differ between the two groups because of the perceived quality of care, outcomes or practice style. METHODS We administered a patient satisfaction survey to 308 participants in an SCD prospective cohort study. Of the 308 patients, 133 (43.2%) received the majority of their SCD care at specialized centers, 152 (49.3%) received their care from nonspecialized centers and 26 (7.5) did not provide information. The satisfaction surveys measured general satisfaction (GS), technical quality (TQ), interpersonal manner (IM), communication (CM), financial aspects (FA), time spent with doctor (TA), and accessibility and convenience (AC). Patients reported their levels of satisfaction using a five-point Likert scale. We compared unadjusted group means, as well as means adjusted for potential confounders such as marital status, on patient satisfaction between specialized and nonspecialized centers. RESULTS SCD patients who received their care from specialized centers had significantly higher mean satisfaction scores, compared to those who received their care from nonspecialized centers: GS 4.00(+/-0.93) vs. 3.66 (+/- 01.16, p=0.0326), TQ 3.98 (+/- 0.77) vs. 3.65 (+/- 0.91, p=0.0058), AC 3.83 (+/-0.79) vs. 3.51 (+/- 1.02, p=0.0142) , FA 3.88 (+/-0.96) vs. 3.49 (+/-1.25, p=0.0120). There were no statistically significant group differences in IM, TA and CM. CONCLUSION SCD patients who received most of their SCD care from specialized centers had somewhat higher satisfaction scores in some areas when compared with patients who received their care from nonspecialized centers.
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Affiliation(s)
- Imoigele P Aisiku
- Department of Anesthesia/Critical Care & Emergency Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Citero VDA, Levenson JL, McClish DK, Bovbjerg VE, Cole PL, Dahman BA, Penberthy LT, Aisiku IP, Roseff SD, Smith WR. The role of catastrophizing in sickle cell disease--the PiSCES project. Pain 2007; 133:39-46. [PMID: 17408858 DOI: 10.1016/j.pain.2007.02.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 02/14/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
In several types of chronic pain, catastrophizing has been related to higher pain intensity, and health care utilization but it has not been explored extensively in sickle cell disease (SCD). The objective of the study was to identify the role of catastrophizing in SCD, specifically in relation to painful crises, non-crisis pain, and responses to pain. Two hundred and twenty SCD adults were enrolled in a prospective cohort study of pain and completed between 30 and 188 daily diaries in 6 months. The Catastrophizing subscale (CAT) of the Coping Strategy Questionnaire (CSQ) was administered at baseline and at study exit. Depression and quality of life were measured by the Patient Health Questionnaire and SF-36, respectively, at baseline. The CAT mean was 13.6 (SD=8.4) and higher CAT was correlated with greater depression severity (r=0.48; p<0.001) and poorer quality of life in all domains (r=-0.24 to -0.47; p<0.001). There was no significance difference between CAT mean baseline and exit scores, and the measures were strongly correlated within patients (r=0.69; p<0.001). No difference was found between higher and lower catastrophizers in intensity of pain, distress, interference, and health service utilization, both on crisis or non-crisis SCD-related pain days, after controlling for depression. Adults with SCD had a higher mean catastrophizing score than found in studies of other chronic pain conditions that are not lifelong and life-threatening. CAT scores were not correlated with pain parameters or utilization. The role of catastrophizing in other conditions cannot be generalized to SCD.
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Affiliation(s)
- Vanessa de A Citero
- Department of Psychiatry, Division of Consultation-Liaison, Virginia Commonwealth University, Richmond, VA, USA.
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Levenson JL, McClish DK, Dahman BA, Penberthy LT, Bovbjerg VE, Aisiku IP, Roseff SD, Smith WR. Alcohol Abuse in Sickle Cell Disease: The Pisces Project. Am J Addict 2007; 16:383-8. [PMID: 17882609 DOI: 10.1080/10550490701525434] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Alcohol abuse is common in patients with chronic painful medical disorders, but it has not been studied in sickle cell disease (SCD). In a prospective cohort study of SCD adults, 31.4% were identified as abusing alcohol. There were no significant differences between alcohol abusers and nonabusers on demographics, biological variables, depression, anxiety, measures of crisis and noncrisis pain, or opioid use, but abusers reported more pain relief from opioids than nonabusers did. Alcohol abusers had fewer unscheduled clinic visits, emergency room visits, hospital days, and any health care utilization for SCD, but this was only significant for emergency room visits. Quality of life was similar between both groups, except that alcohol abusers unexpectedly had better overall physical summary scores. Alcohol abusers were more likely to report coping by ignoring pain, diverting attention, and using particular self-statements.
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Quillin JM, McClish DK, Jones RM, Burruss K, Bodurtha JN. Spiritual coping, family history, and perceived risk for breast cancer--can we make sense of it? J Genet Couns 2006; 15:449-60. [PMID: 17013546 DOI: 10.1007/s10897-006-9037-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 04/28/2006] [Indexed: 12/31/2022]
Abstract
Differences in spiritual beliefs and practices could influence perceptions of the role of genetic risk factors on personal cancer risk. We explored spiritual coping and breast cancer risk perceptions among women with and without a reported family history of breast cancer. Analyses were conducted on data from 899 women in primary care clinics who did not have breast cancer. Structural equation modeling (SEM), linear, and logistic modeling tested an interaction of family history of breast cancer on the relationship between spiritual coping and risk perceptions. Overall analyses demonstrated an inverse relationship between spiritual coping and breast cancer risk perceptions and a modifying effect of family history. More frequent spiritual coping was associated with lower risk perceptions for women with positive family histories, but not for those with negative family histories. Results support further research in this area that could influence communication of risk information to cancer genetic counseling patients.
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Affiliation(s)
- John M Quillin
- Department of Human Genetics, Virginia Commonwealth University, 1101 E. Marshall Street, Richmond, Virginia 23298-0033, USA.
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Quillin JM, McClish DK, Jones RM, Wilson DB, Tracy KA, Bowen D, Borzelleca J, Bodurtha JN. Duration of an Intervention's Impact on Perceived Breast Cancer Risk. Health Educ Behav 2006; 35:855-65. [DOI: 10.1177/1090198108325912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study explored risk perceptions after breast cancer risk appraisal. The study involved a randomized trial of Women's Health clinic patients (≥ 40 years old). Primary outcome was perceived breast cancer risk at baseline, 1 month, 6 months, and 18 months. Perceived breast cancer risks were higher than actual calculated risks at baseline. At baseline, 45% reported moderate/strong risk and 43% reported lower-than-average risk; 53% said that their risk was lower than 15%. Mean perceived lifetime risk was 31 out of 100. Throughout follow-up, the treatment group reported lower risks by all measures, as compared to controls. However, for African American women, perceived risk “out of 100 women” did not change. A brief health risk appraisal tends to lower breast cancer risk perceptions for at least 18 months, but the impact may vary by race/ethnicity. These findings could affect health behaviors, such as annual mammograms, which are influenced by perceived risk.
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McClish DK, Levenson JL, Penberthy LT, Roseff SD, Bovbjerg VE, Roberts JD, Aisiku IP, Smith WR. Gender Differences in Pain and Healthcare Utilization for Adult Sickle Cell Patients: The PiSCES Project. J Womens Health (Larchmt) 2006; 15:146-54. [PMID: 16536678 DOI: 10.1089/jwh.2006.15.146] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many studies have found gender differences in frequency and intensity of pain. Women often report lower pain thresholds, higher pain ratings, and lower tolerance for pain. People with sickle cell disease (SCD) experience both chronic and acute pain throughout life. OBJECTIVES To compare adult men and women with SCD in terms of reported pain, crises, healthcare utilization, and opioid usage. METHODS Two hundred twenty-six adults with SCD in Virginia were enrolled in a prospective cohort study of pain and completed daily diaries for 1-6 months. Subjects reported for the previous day their maximum SCD-related pain, distress, and interference (0-9 scale), whether they were in a sickle cell crisis, had unplanned utilization (clinic, emergency room, or hospitalization), or used opioids. Episodes of pain, crisis, or utilization were defined as consecutive days of such. Men and women were compared, using analysis of covariance (ANCOVA), controlling for age, SCD genotype, depression, and education. RESULTS There were no significant differences between men and women in the percentage of days subjects experienced pain (men 58.6% vs. women 56.5%) or the number of pain episodes/6 months (7.7 vs. 9.6). Mean pain scores were comparable, when subjects were in crisis (5.5 vs. 5.6) or not (2.5 vs. 2.2). Distress and interference results were similar. Men with the SS genotype reported a higher percentage of days with crisis(18.5% vs. 11.6%) and utilization (5.1% vs. 2.7%) than women with the SS genotype. CONCLUSIONS Contrary to many studies of pain, particularly chronic pain, men and women with SCD reported generally similar pain experiences.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, 23298-0032, USA.
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McClish DK, Penberthy LT, Bovbjerg VE, Roberts JD, Aisiku IP, Levenson JL, Roseff SD, Smith WR. Health related quality of life in sickle cell patients: the PiSCES project. Health Qual Life Outcomes 2005; 3:50. [PMID: 16129027 PMCID: PMC1253526 DOI: 10.1186/1477-7525-3-50] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 08/29/2005] [Indexed: 11/16/2022] Open
Abstract
Background Sickle cell disease (SCD) is a chronic disease associated with high degrees of morbidity and increased mortality. Health-related quality of life (HRQOL) among adults with sickle cell disease has not been widely reported. Methods We administered the Medical Outcomes Study 36-item Short-Form to 308 patients in the Pain in Sickle Cell Epidemiology Study (PiSCES) to assess HRQOL. Scales included physical function, physical and emotional role function, bodily pain, vitality, social function, mental health, and general health. We compared scores with national norms using t-tests, and with three chronic disease cohorts: asthma, cystic fibrosis and hemodialysis patients using analysis of variance and Dunnett's test for comparison with a control. We also assessed whether SCD specific variables (genotype, pain, crisis and utilization) were independently predictive of SF-36 subscales, controlling for socio-demographic variables using regression. Results Patients with SCD scored significantly worse than national norms on all subscales except mental health. Patients with SCD had lower HRQOL than cystic fibrosis patients except for mental health. Scores were similar for physical function, role function and mental health as compared to asthma patients, but worse for bodily pain, vitality, social function and general health subscales. Compared to dialysis patients, sickle cell disease patients scored similarly on physical role and emotional role function, social functioning and mental health, worse on bodily pain, general health and vitality and better on physical functioning. Surprisingly, genotype did not influence HRQOL except for vitality. However, scores significantly decreased as pain levels increased. Conclusion SCD patients experience health related quality of life worse than the general population, and in general, their scores were most similar to patients undergoing hemodialysis. Practitioners should regard their HRQOL as severely compromised. Interventions in SCD should consider improvements in health related quality of life as important outcomes.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Lynne T Penberthy
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Viktor E Bovbjerg
- Department of Health Evaluation Sciences, University of Virginia, Charlottesville, VA, USA
| | - John D Roberts
- Division of Hematology/Oncology, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Imoigele P Aisiku
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan D Roseff
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Wally R Smith
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Baillargeon JP, McClish DK, Essah PA, Nestler JE. Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab 2005; 90:3863-70. [PMID: 15814774 DOI: 10.1210/jc.2004-1958] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT The long-term cardiovascular safety of widely used oral contraceptives (OCs) is still debated, and no meta-analysis assesses the modern use of OCs and the associated cardiovascular risks. OBJECTIVE We aimed to assess the risk of cardiovascular diseases associated with current use of low-dose combined OCs. DATA SOURCES All studies published between January 1980 and October 2002 were searched using MEDLINE, BIOSIS, and Scientific Citations. STUDY SELECTION Original studies were selected independently by two investigators (J.P.B., P.A.E.) based on inclusion criteria: low-dose combined OC (<50 mug of ethinyl-estradiol); more than 10 cases in low-dose users; clear definition of cases; concurrent controls; and control for age. A third investigator (J.E.N.) adjudicated disagreements. From 2715 identified articles, 14 independent studies were included. DATA EXTRACTION All data were abstracted by one investigator (J.P.B.) in a systematic manner. Classification of OCs and types of exposure were directly abstracted from studies. Current use was defined as use at the time of the event or within 3 months. Only peer-reviewed studies with definition of events as definite or possible, based on prespecified criteria, were included. DATA SYNTHESIS The summary risk estimates associated with current use of low-dose OCs were 1.84 [95% confidence interval (CI) = 1.38, 2.44] for myocardial infarctions and 2.12 (95% CI = 1.56, 2.86) for ischemic strokes. The overall summary odds ratio for both outcomes was 2.01 (95% CI = 1.63, 2.48). Second generation OCs were associated with a significant increased risk of both myocardial infarction and ischemic stroke events [1.85 (95% CI = 1.03,3.32) and 2.54 (95% CI = 1.96,3.28), respectively]; and third-generation OCs, for ischemic stroke outcome only [2.03 (95% CI = 1.15,3.57)]. CONCLUSIONS In conclusion, a rigorous meta-analysis of the literature suggests that current use of low-dose OCs significantly increases the risk of both cardiac and vascular arterial events, including a significant risk of vascular arterial complications with third generation OCs.
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Affiliation(s)
- Jean-Patrice Baillargeon
- Department of Internal Medicine, Université de Sherbrooke, Endocrine Division, 3001 12th North Avenue, Sherbrooke, Quebec J1H 5N4, Canada.
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Smith WR, Bovbjerg VE, Penberthy LT, McClish DK, Levenson JL, Roberts JD, Gil K, Roseff SD, Aisiku IP. Understanding pain and improving management of sickle cell disease: the PiSCES study. J Natl Med Assoc 2005; 97:183-93. [PMID: 15712781 PMCID: PMC2568749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Until recent decades, sickle cell disease (SCD) was associated with recurrent, disabling pain, organ failure and death in childhood or early adulthood. SCD treatment advances have now decreased pain and prolonged survival, but episodic or chronic pain may still require substantial analgesic use and frequent hospitalization for pain episodes. This pain is poorly characterized and often poorly treated. Adult patients may face barriers to comprehensive SCD care, stigmatization of their care-seeking behavior by providers and lack of family support, forcing them into maladaptive coping strategies. The Pain in Sickle Cell Epidemiology Study (PiSCES) attempts to develop and validate a biopsychosocial model of SCD pain, pain response and healthcare utilization in a large, multisite adult cohort. PiSCES participants complete a baseline survey and six months of daily pain diaries in which they record levels of SCD-related pain and related disability and distress as well as responses to pain (e.g., medication use, hospital visits). PiSCES will advance methods of measuring pain and pain response in SCD by better describing home-managed as well as provider-managed pain. PiSCES will assess the relative contributions of biological (disease-related), psychosocial and environmental (readiness to utilize) factors to overall pain and pain response in SCD, suggesting targets for biobehavioral interventions over time. Importantly, PiSCES will also identify "triggers" of SCD pain episodes and healthcare utilization in the moment of pain, suggesting targets for timely care that mutes pain episodes.
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Affiliation(s)
- Wally R Smith
- Virginia Commonwealth University, Division of Quality Health Care, Box 980306, Richmond, VA 23298, USA.
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Abstract
Certain toxic effects of cytotoxic anticancer agents typically evolve over weeks. When such agents are administered weekly, these effects are cumulative. With such schedules, good medical practice mandates dose modifications with mild or moderate toxicity in order to avoid progression to serious or life-threatening toxicity. These modifications lead to differences between scheduled and delivered doses. Phase I studies are designed to identify the maximum tolerated dose for a given schedule. Yet neither standard phase I study designs nor the theoretical literature acknowledge the existence or incorporate the impact of dose modifications upon phase I study outcomes. Our purpose was to better understand the impact of dose reductions/omissions upon outcomes of phase I studies of weekly administration of cytotoxic agents. We created a mathematical model in which toxicity was represented as a power function of dose in order to represent extremes of behavior observed with actual cytotoxic agents in the clinic. We used the model to simulate dosing and toxicity experiences across a wide range of doses. From these simulations we identified "best doses" according to a variety of traditional and novel criteria. We find the concept of maximum tolerated dose inadequate for the determination of best doses. We also suggest a strategy for a new phase I study design which can be used to estimate the "best dose" corresponding to a specified delivery rate. In summary, identification of best doses requires attention, not only to dose limiting toxic events, but also to delivered dose rates and schedule adherence.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Department of Internal Medicine, Division of Quality Health Care, and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
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Theofrastous JP, Wyman JF, Bump RC, McClish DK, Elser DM, Bland DR, Fantl JA. Effects of pelvic floor muscle training on strength and predictors of response in the treatment of urinary incontinence. Neurourol Urodyn 2003; 21:486-90. [PMID: 12232886 DOI: 10.1002/nau.10021] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The objectives of this study were (1) to determine the effect of training on pelvic floor muscle strength; (2) to determine whether changes in pelvic floor muscle strength correlate with changes in continence; and (3) to determine whether demographic characteristics, clinical incontinence severity indices, or urodynamic measures predict response to pelvic floor muscle training. METHODS One hundred thirty-four women with urinary incontinence (95=genuine stress incontinence [GSI]; 19=detrusor instability [DI]; 20=mixed incontinence [GSI+DI]) were randomized to pelvic floor muscle training (n=67) or bladder training (n=67). Urinary diaries, urodynamic evaluation, and vaginal pressure measurements by using balloon manometry were performed at baseline and after 12 weeks of therapy. Primary outcome measures consisted of incontinent episodes per week and vaginal pressure measurements. RESULTS Both treatment groups had a reduction in incontinent episodes (P</=0.004). Vaginal pressures increased more with pelvic floor muscle training than with bladder training (P=0.0003). Other than a weak correlation between a reduction in incontinent episodes/week and an increase in maximum sustained vaginal pressure in women with GSI (r=0.32, P=0.04), there were no significant correlations between increases in pelvic floor muscle strength and improvement in continence status. There were no significant correlations between baseline demographic characteristics, clinical incontinence severity, or urodynamic measures and increases in vaginal pressure or improvement in clinical severity after pelvic floor muscle training. CONCLUSIONS Pelvic floor muscle training improves continence and increases vaginal pressure measurements, but the direct correlations between these alterations are weak. A woman's response to behavioral treatment does not depend on her demographic characteristics, clinical incontinence severity, urodynamic measures, or initial pelvic floor muscle strength.
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Affiliation(s)
- J P Theofrastous
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
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Cotter JJ, Bramble JD, Bovbjerg VE, Pugh CB, McClish DK, Tipton G, Smith WR. Timeliness of immunizations of children in a Medicaid primary care case management managed care program. J Natl Med Assoc 2002; 94:833-40. [PMID: 12392047 PMCID: PMC2594144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE This study assessed the timeliness of immunization for children in a Medicaid managed care primary care case management program controlling for patient and provider predictors of immunization status. METHODS Using administrative data and patient medical records, up-to-date (UTD) and age appropriate immunization (AAI) status were reviewed for 5598 children. The 4:3:1 immunization series (four diphtheria, pertussis, tetanus vaccinations; three polio vaccinations; and one measles, mumps, rubella vaccination) was the standard. RESULTS Childhood immunization rates were low when assessed using strict adherence to vaccination recommendations. At age 18 months, 28.3% were classified as UTD, and 6.3% were classified as AAI. Compared to children not up-to-date, UTD children were more likely to have public rather than private providers, to have had older mothers, and less likely to have been African American. Among UTD children, AAI children were more likely to reside in urban areas. CONCLUSIONS Low-income children continue to be under-immunized, even under a managed care initiative. Health care providers and child health advocates need to continue pressure for programs that will increase adherence to nationally recommended guidelines.
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Affiliation(s)
- James J Cotter
- Department of Gerontology, Virginia Commonwealth University, Richmond 23298-0228, USA.
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Smith WR, Poses RM, McClish DK, Huber EC, Clemo FLW, Alexander D, Schmitt BP. Prognostic judgments and triage decisions for patients with acute congestive heart failure. Chest 2002; 121:1610-7. [PMID: 12006451 DOI: 10.1378/chest.121.5.1610] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY OBJECTIVES To determine how well triage physicians judge the probability of death or severe complications that require treatment only available in an ICU to maintain life for patients with acute congestive heart failure (CHF). DESIGN Prospective cohort study. SETTING An urban university hospital, a Veteran's Administration hospital, and a community hospital. PATIENTS OR PARTICIPANTS Patients were those visiting the emergency department (ED) with acute CHF, excluding those who already required a treatment only available in an ICU to maintain life, and those with possible or definite myocardial infarction. Physician participants were those caring for the patients in the ED. MEASUREMENTS AND RESULTS We performed chart reviews to ascertain whether each patient died or had severe complications develop by 4 days. We collected judgments of the probability of this outcome from the physicians taking care of the study patients in the ED. The prevalence of death or severe complications was 43 per 1,032 patients (4.2%). The mean +/- SD of physicians' judgments of the probability of this outcome was 32.1 +/- 28.4%. A calibration curve that stratified these judgments by decile demonstrated that physicians consistently overestimated this probability (p < 0.01). Physicians' judgments were only moderately good at discriminating which patients would have the outcome (receiver operating characteristic curve area, 0.715). Patients admitted to an ICU received the highest average predicted probability (56.4%), followed by those admitted to a telemetry unit (34.1%), to a regular hospital ward (29.8%), and those sent home (17.9%.) CONCLUSIONS Physicians drastically overestimated the probability of a severe complication that would require critical care for patients with acute CHF who were candidates for ICU admission. Their judgments of this probability were associated with their triage decisions, as they should be according to several guidelines for ICU triage. Overestimation of the probability of severe complications may have lead to overutilization of scarce critical care resources. Current critical care triage guidelines should be revised to take this difficulty into account, and better predictive models for patients potentially requiring critical care should be developed.
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Affiliation(s)
- Wally R Smith
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298-0306, USA.
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Smith WR, Cotter JJ, McClish DK, Bovbjerg VE, Rossiter LF. Access, satisfaction, and utilization in two forms of Medicaid managed care. Clin Perform Qual Health Care 2001; 8:150-7. [PMID: 11185830 DOI: 10.1108/14664100010351297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We determined access and satisfaction of 2,598 recipients of Virginia's Medicaid program, comparing its health maintenance organizations (HMOs) to its primary care case management (PCCM) program. Positive responses were summed as sub-domains either of access, satisfaction, or of utilization, and adjusted odds ratios were calculated for HMO (vs. PCCM) sub-domain scores. The response rate was 47 per cent. We found few significant differences in perceived access, satisfaction, and utilization. Both HMO adults and children more often perceived good geographic access (adults, OR, [CI] = 1.50, [1.04-2.16]; children, OR, [CI] = 1.773 [1.158, 2.716]). But HMO patients less often reported good after-hours access (adults, OR, [CI] = 0.527 [0.335, 0.830]; children, OR, [CI] = 0.583 [0.380, 0.894]). Among all patients reporting poorer function, HMO patients more often reported good general and preventive care (OR, [CI] = 2.735 [1.138, 6.575]). We found some differences between Medicaid HMO versus PCCM recipients' reported access, satisfaction, and utilization, but were unable to validate concerns about access and quality under more restrictive forms of Medicaid managed care.
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Affiliation(s)
- W R Smith
- Medical College of Virginia, Virginia Commonwealth University, Richmond, USA
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Bovbjerg VE, Smith WR, Cotter JJ, McClish DK, Rossiter LF. Assessing Medicaid recipient access and satisfaction. Fee-for-service, case management, and capitation. Eval Health Prof 2000; 23:422-40. [PMID: 11139869 DOI: 10.1177/01632780022034705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medicaid increasingly requires enrollment in managed care programs. This study assessed access to care, satisfaction with care, and appointment wait times during the transition from fee for service to managed care using three annual Medicaid recipient surveys. There was little evidence of dissatisfaction or poorer access among managed care recipients. Fee-for-service recipients, compared to primary care case management, reported greater general (91 vs. 78%, p < .01) and specialty care access (92 vs. 80%, p < .01). When appointments were required, adult HMO enrollees, compared to case management, had longer waits for routine care in the second (5.8 +/- 8.2 days vs. 4.0 +/- 6.6) and third surveys (5.5 +/- 6.9 days vs. 3.8 +/- 7.3); waits for other appointments did not consistently differ by program. There were no significant program differences in overall satisfaction. Findings are tempered by the potential for response bias and geographic confounding. Continued monitoring is crucial to assure that access and satisfaction remain high in Medicaid managed care.
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Cotter JJ, McDonald KA, Parker DA, McClish DK, Pugh CB, Bovbjerg VE, Tipton GA, Rossiter LF, Smith WR. Effect of different types of Medicaid managed care on childhood immunization rates. Eval Health Prof 2000; 23:397-408. [PMID: 11139867 DOI: 10.1177/01632780022034688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medicaid managed care can improve access to prevention services, such as immunization, for low-income children. The authors studied immunization rates for 7,356 children on Medicaid in three managed care programs: primary care case management (PCCM; n = 4,605), a voluntary HMO program (n = 851), and a mandatory HMO program (n = 1,900). Immunization rates (3:3:1 series) in PCCM (78%) exceeded rates in the voluntary HMO program (71%), which in turn exceeded those in the mandatory HMO program (67%). Adjusting for race, urban residence, and gender, compared to children in PCCM, children in the voluntary HMO program were less likely to complete the 3:3:1 series (OR = 0.75, CI = 0.63, 0.90), and children in the mandatory HMO program were even less likely to complete the series (OR = 0.59, CI = 0.51, 0.68). Results differed by individual HMOs. Monitoring of outcomes for all types of managed care by Medicaid agencies is imperative to assure better disease prevention for low-income children.
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Poses RM, McClish DK, Smith WR, Huber EC, Clemo FL, Schmitt BP, Alexander D, Racht EM, Colenda CC. Results of report cards for patients with congestive heart failure depend on the method used to adjust for severity. Ann Intern Med 2000; 133:10-20. [PMID: 10877735 DOI: 10.7326/0003-4819-133-1-200007040-00003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The validity of outcome report cards may depend on the ways in which they are adjusted for risk. OBJECTIVES To compare the predictive ability of generic and disease-specific survival prediction models appropriate for use in patients with heart failure, to simulate outcome report cards by comparing survival across hospitals and adjusting for severity of illness using these models, and to assess the ways in which the results of these comparisons depend on the adjustment method. DESIGN Analysis of data from a prospective cohort study. SETTING A university hospital, a Veterans Affairs (VA) medical center, and a community hospital. PATIENTS Sequential patients presenting in the emergency department with acute congestive heart failure. MEASUREMENTS Unadjusted 30-day and 1-year mortality across hospitals and 30-day and 1-year mortality adjusted by using disease-specific survival prediction models (two sickness-at-admission models, the Cleveland Health Quality Choice model, the Congestive Heart Failure Mortality Time-Independent Predictive Instrument) and generic models (Acute Physiology and Chronic Health Evaluation [APACHE] II, APACHE III, the mortality prediction model, and the Chadson comorbidity index). RESULTS The community hospital's unadjusted 30-day survival rate (85.0%) and the VA medical center's unadjusted 1-year survival rate (60.9%) were significantly lower than corresponding rates at the university hospital (92.7% and 67.5%, respectively). No severity model had excellent ability to discriminate patients by survival rates (all areas under the receiver-operating characteristic curve < 0.73). Whether the VA medical center, the community hospital, both, or neither had worse survival rates on simulated report cards than the university hospital depended on the prediction model used for adjustment. CONCLUSIONS Results of simulated outcome report cards for survival in patients with congestive heart failure depend on the method used to adjust for severity.
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Affiliation(s)
- R M Poses
- Brown University Center for Primary Care and Prevention and Memorial Hospital of Rhode Island, Pawtucket 02860, USA.
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Theofrastous JP, Wyman JF, Bump RC, McClish DK, Elser DM, Robinson D, Fantl JA. Relationship between urethral and vaginal pressures during pelvic muscle contraction. The Continence Program for Women Research Group. Neurourol Urodyn 2000; 16:553-8. [PMID: 9353804 DOI: 10.1002/(sici)1520-6777(1997)16:6<553::aid-nau5>3.0.co;2-d] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Condensation is the performance of an effective pelvic muscle contraction increases urethral and vaginal pressures and is independent of demographic, clinical, and urodynamic factors. Our objective was to examine the relationship between urethral closure pressure and vaginal pressure during a pelvic muscle contraction in minimally trained women. Our secondary aim was to determine whether demographic, clinical, or urodynamic factors predict pelvic muscle contraction performance. Two hundred two women with urinary incontinence underwent multichannel urodynamic evaluation, including urethral profilometry and measurement of vaginal pressure during pelvic muscle contraction. One hundred forty-four women were diagnosed with genuine stress incontinence, 28 with detrusor instability, and 30 with mixed incontinence. Urethral and vaginal pressures correlated significantly during pelvic muscle contraction (P < or = 0.006). The ability to perform an adequate pelvic muscle contraction was independent of subject age, parity, hormonal or hysterectomy status, clinical severity, urethral support, and urethral profilometry measures (P > or = 0.42).
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Affiliation(s)
- J P Theofrastous
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
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Bump RC, Hurt WG, Elser DM, Theofrastous JP, Addison WA, Fantl JA, McClish DK. Understanding lower urinary tract function in women soon after bladder neck surgery. Continence Program for Women Research Group. Neurourol Urodyn 1999; 18:629-37. [PMID: 10529711 DOI: 10.1002/(sici)1520-6777(1999)18:6<629::aid-nau13>3.0.co;2-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this work was to correlate anatomic and urodynamic measures with function following bladder neck surgery. Eighty-seven women who underwent bladder neck surgery at two tertiary academic medical centers in the southeastern U.S. were studied in this prospective outcomes analysis. Preoperative and 6-week and 6-month postoperative status was assessed with urodynamic testing, physical examination, and condition-specific quality of life instruments. Correlations of dynamic urethral obstruction (quantified by pressure transmission ratio, PTR, determinations) and urethral support (quantified by urethral axis measurements) with functional status were determined. At 6 weeks, 50% of the subjects with inadequate dynamic obstruction (PTR < 90%) had genuine stress incontinence (GSI) compared to 5% of those with PTR >/= 90% (P = .00002). Of those with excessive obstruction (PTR > 110%), 32% had detrusor instability (DI) and 47% had emptying phase dysfunction (EPD) compared to 6% and 24%, respectively, of those with PTR </= 110% (P = .006 and P = .04). At 6 months, subjects with excessive obstruction were more likely to have EPD than other subjects (75% vs. 27%, P = .001). Those with optimal dynamic obstruction (PTR >/= 90% but </= 110%) were more likely to have normal function (no GSI, no DI, and no EPD) than those with higher or lower PTRs (59% vs. 34%, P = .04). Urethral axis measurements did not correlate with functional status at either follow-up session. The magnitude of dynamic urethral obstruction is related to function after bladder neck surgery. Excessive obstruction is associated with DI and EPD, inadequate obstruction with GSI, and optimal obstruction with normal function. Neurourol. Urodynam. 18:629-637, 1999.
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Affiliation(s)
- R C Bump
- Department of Obstetrics and Gynecology, Medical College of Virginia, Richmond, Virginia, USA
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