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Abiri A, Bitner BF, Nguyen TV, Pang JC, Roman KM, Vasudev M, Chung DD, Tripathi SH, Harris JC, Kosaraju N, Shih RM, Ko M, Miller JE, Douglas JE, Lee DJ, Eide JG, Kshirsagar RS, Phillips KM, Sedaghat AR, Bergsneider M, Wang MB, Palmer JN, Adappa ND, Hsu FPK, Kuan EC. Clinical and technical factors in endoscopic skull base surgery associated with reconstructive success. Rhinology 2024; 0:3148. [PMID: 38189480 DOI: 10.4193/rhin23.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND In this study, we identified key discrete clinical and technical factors that may correlate with primary reconstructive success in endoscopic skull base surgery (ESBS). METHODS ESBS cases with intraoperative cerebrospinal fluid (CSF) leaks at four tertiary academic rhinology programs were retrospectively reviewed. Logistic regression identified factors associated with surgical outcomes by defect subsite (anterior cranial fossa [ACF], suprasellar [SS], purely sellar, posterior cranial fossa [PCF]). RESULTS Of 706 patients (50.4% female), 61.9% had pituitary adenomas, 73.4% had sellar or SS defects, and 20.5% had high-flow intraoperative CSF leaks. The postoperative CSF leak rate was 7.8%. Larger defect size predicted ACF postoperative leaks; use of rigid reconstruction and older age protected against sellar postoperative leaks; and use of dural sealants compared to fibrin glue protected against PCF postoperative leaks. SS postoperative leaks occurred less frequently with the use of dural onlay. Body-mass index, intraoperative CSF leak flow rate, and the use of lumbar drain were not significantly associated with postoperative CSF leak. Meningitis was associated with larger tumors in ACF defects, nondissolvable nasal packing in SS defects, and high-flow intraoperative leaks in PCF defects. Sinus infections were more common in sellar defects with synthetic grafts and nondissolvable nasal packing. CONCLUSIONS Depending on defect subsite, reconstructive success following ESBS may be influenced by factors, such as age, defect size, and the use of rigid reconstruction, dural onlay, and tissue sealants.
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Affiliation(s)
- A Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - B F Bitner
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - T V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - J C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - K M Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - M Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - D D Chung
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - S H Tripathi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - J C Harris
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - N Kosaraju
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R M Shih
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M Ko
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - J E Miller
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - J E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D J Lee
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - J G Eide
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - R S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, CA, USA
| | - K M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - M Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - M B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - J N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - N D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F P K Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
| | - E C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
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Phillips KM, Turner MT, Kuan EC. Preoperative, technical, and postoperative considerations for skull base reconstruction: a practical review of critical concepts. Rhinology 2023; 61:386-403. [PMID: 37453134 DOI: 10.4193/rhin23.127] [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: 07/18/2023]
Abstract
Despite widespread adoption and advances in endoscopic skull base surgery, with expanding indications and the ability to effectively treat larger and more complex pathologies, skull base reconstruction following tumor resection and prevention of cerebrospinal fluid leak remains a challenge for even the most seasoned of surgical teams. Mounting evidence in all areas have pushed our understanding of skull base reconstruction principles forward. In this narrative review, we summarize critical concepts and provide practical but comprehensive guiding principles on preoperative, intraoperative/technical, and postoperative management principles related to optimizing skull base reconstructive success. The goal is to provide an informative resource for skull base surgeons (both otolaryngologists and neurosurgeons) to reference regarding state-of-the-art evidence surrounding this ever-evolving topic.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - M T Turner
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - E C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, CA, USA
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Walker V, Trope M, Tichavakunda AA, Speth MM, Sedaghat AR, Phillips KM. Disease control in chronic rhinosinusitis: a qualitative study of patient perspectives. Rhinology 2022; 60:282-292. [PMID: 35608041 DOI: 10.4193/rhin21.448] [Citation(s) in RCA: 1] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND The definition of disease control in chronic rhinosinusitis (CRS) is an active area of study. However, investigations have not engaged CRS patients in how they think about disease control. This study seeks to understand the patient perspective on CRS disease control. METHODS Qualitative phenomenological study using constant comparative methodology was applied. The research team conducted 10, one-on-one interviews with CRS patients ranging from 22 to 55 minutes in length. The content of the interview protocol was determined through iterative discussion amongst all authors. Two authors served as coders to identify recurrent themes. Themes were analyzed for meaning and conclusions were summarized. RESULTS Three recurring themes determined from patients were that (1) use of the terminology "control" adequately represents this phenomenon, (2) components of control could be classified into four main themes relating to CRS symptomatology, exacerbation of comorbid disease, quality of life and acute exacerbations of CRS, and (3) when patients deem their CRS is uncontrolled they are more willing to escalate their treatment to include escalating their daily maintenance regimen, seeking otolaryngology referral, taking rescue medication or undergoing endoscopic sinus surgery. CONCLUSIONS CRS patients consider their daily symptoms, the severity and frequency of CRS exacerbations, impact on quality of life as well as exacerbation of comorbid disease when thinking about their disease control. Disease control is a goal of treatment for patients and uncontrolled disease motivates patients to seek further treatment. Physicians should explore all components of CRS control when considering disease status and need for further treatment.
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Affiliation(s)
- V Walker
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M Trope
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - A A Tichavakunda
- Department of Education Leadership, School of Education, University of Cincinnati, Cincinnati, OH, USA
| | - M M Speth
- Department of Otorhinolaryngology, Kantonsspital Aarau, Aarau, Switzerland
| | - A R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - K M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Phillips KM, Singerman KW, Sedaghat AR. Individual symptom visual analogue scale severity scores for determining EPOS guideline-based chronic rhinosinusitis disease control. Rhinology 2022; 60:229-235. [PMID: 35229832 DOI: 10.4193/rhin21.446] [Citation(s) in RCA: 1] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND The goal of this study was to determine how to translate visual analogue scale (VAS) symptom scores to the binary, descriptive symptom scales used in the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria for chronic rhinosinusitis (CRS) disease control. METHODS 309 CRS patients were recruited. All patients rated their burden of 5 symptoms (nasal blockage, rhinorrhea/postnasal drip, facial pain/pressure, smell loss, sleep disturbance or fatigue) using the binary EPOS descriptive symptom scales and a VAS (on a scale of 0 to 10). In addition, participants completed a 22-item Sinonasal Outcome Test (SNOT-22) and rated their overall CRS disease control as "controlled", "partly controlled" or "uncontrolled". RESULTS Symptom burdens measured by VAS, binary descriptive EPOS scale and SNOT-22 were associated with worsening CRS disease control reported by participants. Each symptom had a distinct VAS score cut-off that strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale. However, the predictive ability of VAS for rhinorrhea/ postnasal drip was disparately worse than the other 4 symptoms. When considering all symptom data simultaneously, a VAS score >3.5 strongly predicted the uncontrolled option on the corresponding binary descriptive EPOS symptom scale for all 5 symptoms. CONCLUSIONS A VAS symptom score of >3.5 translates to the uncontrolled option in the binary, descriptive symptom scale of the EPOS control criteria. The rhinorrhea/postnasal drip descriptive symptom scale translates disparately worse to VAS scores and may be considered for revision in future criteria.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - K W Singerman
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Phillips KM, Houssein FA, Singerman K, Boeckermann LM, Sedaghat AR. Patient-reported chronic rhinosinusitis disease control is a valid measure of disease burden. Rhinology 2021; 59:545-551. [PMID: 34762075 DOI: 10.4193/rhin21.282] [Citation(s) in RCA: 2] [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: 12/17/2022]
Abstract
BACKGROUND Disease control is an important treatment goal for chronic uncurable conditions such as chronic rhinosinusitis (CRS). The objective of this study was to determine whether patient-reported CRS disease control is a valid reflection of disease burden. METHODS Prospective longitudinal study of 300 CRS patients (35% CRS with nasal polyps, 65% CRS without nasal polyps). At enrollment and at a subsequent follow-up timepoint, all participants were asked to rate their CRS disease control as "not at all," "a little," "somewhat," "very," or "completely", as well as to complete a 22-item Sinonasal Outcome Test (SNOT-22) and the 5-dimension EuroQol general health questionnaire from which the visual analogue scale (EQ-5D VAS) was used. RESULTS At enrollment and follow-up timepoints, patient-reported CRS disease control was significantly correlated with SNOT-22 and EQ-5D VAS scores. The change in patient-reported CRS disease control was significantly correlated with change in SNOT-22 and change in EQ-5D VAS scores. There was significant cross-sectional and longitudinal correlation between patient-reported control and all SNOT-22 subdomain scores. A SNOT-22 score of ≤ 25 points or lower, or an EQ-5D VAS score of ≥77 was predictive of having well - (i.e. "very" or "completely") controlled CRS. CONCLUSIONS Patient-reported CRS disease control is a valid measure of CRS disease burden and general QOL. A patient-reported assessment of CRS disease control could be considered as a component of a more comprehensive measure of CRS disease control.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - F A Houssein
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - K Singerman
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - L M Boeckermann
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Phillips KM, Houssein FA, Boeckermann LM, Singerman KW, Liu DT, Sedaghat AR. Multi-institutional minimal clinically important difference of the 22-item Sinonasal Outcome Test in medically managed chronic rhinosinusitis. Rhinology 2021; 59:552-559. [PMID: 34708838 DOI: 10.4193/rhin21.253] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND With a rapid proliferation of clinical trials to study novel medical treatments for CRS, the objective of this study was to study the minimal clinically important difference (MCID) of the 22-item Sinonasal Outcome Test (SNOT-22) in medically-managed CRS patients. METHODS A total of 183 medically-treated CRS patients were recruited. All patients completed a SNOT-22 at enrollment and subsequent follow up visit. Distribution and anchor-based methods were used for MCID calculation. These data were combined with data from a previously published study on SNOT-22 MCID in 247 medically managed CRS patients to determine a final recommended MCID value using the combined cohort of 430 patients. RESULTS In our cohort, distribution- and anchor-based methods-using both sinus-specific and general health anchors-provided greatest support for a 12-point SNOT-22 MCID, which had approximately 55% sensitivity but 81% specificity for detecting patients explicitly reporting improvement in their sinus symptoms and general health. In the combined cohort of 430 patients, we also found greatest support for a 12-point SNOT-22 MCID, which had approximately 57% sensitivity and 81% specificity for detecting patients explicitly reporting improvement in their sinus symptoms and general health. We also find evidence that the MCID value may be higher in CRS patients without nasal polyps compared to those with nasal polyps. CONCLUSIONS Our results - which include data from patients from two different institutions and regions - confirm a SNOT-22 MCID of 12 in medically managed CRS patients. The SNOT-22 MCID was specific but not sensitive for identifying CRS patients experiencing improvement in symptoms or general health.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - F A Houssein
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - L M Boeckermann
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - K W Singerman
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - D T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - A R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Miller SN, Monahan CJ, Phillips KM, Agliata D, Gironda RJ. Mental health utilization among veterans at risk for suicide: Data from a post-deployment clinic. Psychol Serv 2020; 17:217-226. [DOI: 10.1037/ser0000311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Munson SO, Cabrera-Sanchez P, Miller SN, Phillips KM. Distress and Factors Associated with Suicidal Ideation in Veterans Living with Cancer. Fed Pract 2020; 37:S8-S15. [PMID: 32952383 PMCID: PMC7497877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUNDS AND OBJECTIVES Eliminating veteran suicide is a top priority for the US Department of Veterans Affairs (VA). Veterans with cancer may be at particular risk for suicidal ideation (SI). The current study aimed to understand factors associated with distress in veterans with cancer who were referred for psychology services, and identify problems associated with SI. METHODS Health records of veterans with cancer (N = 174) were reviewed to abstract data, including results of National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problems List and clinical suicide risk assessments. RESULTS Veterans with severe distress were significantly more likely to endorse SI and have a history of suicide attempt(s) when compared with veterans with mild or moderate distress (χ2 = 18.36, P < .001). Of the problems endorsed on the NCCN Problems List, family problems were most strongly linked to SI (χ2 = 5.54, degrees of freedom [df] = 1, P = .02). Specifically, veterans who endorsed problems with their partner were 5 times more likely to experience SI when compared with veterans who did not endorse this problem (Wald = 15.142; df = 1, P < .001). CONCLUSIONS This study is among the first to find partner problems as a suicide risk factor for veterans with cancer; and, underscore the importance of assessing for partner problems and suicidal ideation among veterans with cancer. This study supports the VA mission to end veteran suicide and addresses a gap in current literature by investigating the understudied population of veterans living with cancer and risk factors for SI.
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Affiliation(s)
- Samantha O Munson
- was a Clinical Psychology Resident in Psycho-Oncology, is a Clinical Psychologist in Primary Care Mental Health Integration, is a Clinical Psychologist in Suicide Prevention, and is a Clinical Psychologist in Psycho-Oncology, all in the Department of Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Patricia Cabrera-Sanchez
- was a Clinical Psychology Resident in Psycho-Oncology, is a Clinical Psychologist in Primary Care Mental Health Integration, is a Clinical Psychologist in Suicide Prevention, and is a Clinical Psychologist in Psycho-Oncology, all in the Department of Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Stephanie N Miller
- was a Clinical Psychology Resident in Psycho-Oncology, is a Clinical Psychologist in Primary Care Mental Health Integration, is a Clinical Psychologist in Suicide Prevention, and is a Clinical Psychologist in Psycho-Oncology, all in the Department of Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, Florida
| | - Kristin M Phillips
- was a Clinical Psychology Resident in Psycho-Oncology, is a Clinical Psychologist in Primary Care Mental Health Integration, is a Clinical Psychologist in Suicide Prevention, and is a Clinical Psychologist in Psycho-Oncology, all in the Department of Mental Health and Behavioral Science, James A. Haley Veterans' Hospital, Tampa, Florida
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Phillips KM, Talat R, Caradonna DS, Gray ST, Sedaghat AR. Quality of life impairment due to chronic rhinosinusitis in asthmatics is mediated by asthma control. Rhinology 2020; 57:430-435. [PMID: 31545327 DOI: 10.4193/rhin19.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) and asthma, when comorbid, may influence each other’s disease course and decrease quality of life (QOL). Our objective was to determine if poorer asthma control due to CRS symptoms could be a mechanism for decreased QOL in asthmatic CRS patients. METHODS A total of 120 asthmatic CRS patients were recruited. CRS symptom burden was measured using the 22-item Sinonasal Outcome Test (SNOT-22) and patient-reported CRS symptom control, general health-related QOL was measured using the visual analog scale of the 5-dimensional EuroQol quality of life survey (EQ-5D VAS), and asthma control was measured using the Asthma Control Test (ACT). Association was sought between these outcome measures. A mediation model was created and validated to show that asthma control mediated the association between CRS symptom burden and decreased general health-related QOL. RESULTS ACT score was associated with SNOT-22, EQ-5D VAS was associated with SNOT-22 score, and EQ-5D VAS was associated with ACT score. A statistically significant mediation effect for ACT score in the association between SNOT-22 and EQ-5D VAS), which represented 22.1% of the total effect of SNOT-22 on EQ-5D VAS, was identified. Similar findings were made for patientreported CRS symptom control instead of SNOT-22 score. CONCLUSIONS In asthmatic CRS patients, a sizeable portion of CRS impact on QOL is indirectly mediated through the effect of CRS on poorer asthma control which may then drive decreased QOL.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - R Talat
- Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A R Sedaghat
- Department of Otolaryngology â€" Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Abstract
Objectives: Eliminating Veteran suicide is a top priority for the Department of Veterans' Affairs (VA). This study identified factors associated with suicidal ideation (SI) among a rarely studied subgroup of Veterans: those with cancer.Methods: Veterans (age M = 61.83) with cancer (N= 175) referred for psychological evaluation completed measures of pain, sleep, depressive, anxiety, and PTSD symptoms. SI was defined by endorsing on paper-and-pencil questionnaire thoughts of killing oneself in the past 2 weeks or during clinical interview.Results: 25.1% reported SI. Compared to those without SI, Veterans with SI had higher ratings on measures of depression, anxiety, and PTSD symptoms. History of suicide attempt(s) was included in the model due to clinical significance. Logistic regression was performed with these variables as predictors of SI. The omnibus model was significant (p< .001). However, only anhedonia and depressed mood had a statistically significant contribution to the model (β = 0.540, p= .001).Conclusions: Anhedonia and depressed mood predicted SI among Veterans with cancer above and beyond other risk factors.Clinical Implications: This study's findings highlight the importance of incorporating suicide risk screenings in oncology clinics across VA medical centers.
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Affiliation(s)
- Candice C Johnson
- Mental Health and Behavioral Sciences, C. W. Bill Young Veterans Affairs Healthcare System, Bay Pines, Florida, USA
| | - Kristin M Phillips
- Mental Health and Behavior Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA
| | - Stephanie N Miller
- Mental Health and Behavior Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA
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Hoehle LP, Phillips KM, Speth MM, Caradonna DS, Gray ST, Sedaghat AR. Responsiveness and minimal clinically important difference for the EQ-5D in chronic rhinosinusitis. Rhinology 2019; 57:110-116. [PMID: 30175337 DOI: 10.4193/rhin18.122] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The 5-dimensional EuroQol questionnaire (EQ-5D) is validated to measure general health-related quality of life (QOL). Our objective was to determine the responsiveness and minimal clinically important difference (MCID) of the EQ-5D health utility value (EQ-5D HUV) and visual analog scale (EQ-5D VAS) in chronic rhinosinusitis (CRS). METHODS 203 adults undergoing medical management for CRS were prospectively recruited. General health-related QOL (using EQ-5D HUV and EQ-5D VAS) and CRS-specific QOL (using the 22-item Sinonasal Outcome Test [SNOT-22]) were measured at enrollment and a subsequent follow-up time point 2-12 months later. At follow-up, participants also rated change in general health as Much worse, A little worse, About the same, A little better or Much better compared to enrollment. The EQ-5D HUV and EQ-5D VAS MCIDs were calculated using distribution-based, anchor-based, and receiver operator characteristic (ROC) curve-based methods. RESULTS Change in SNOT-22 score was correlated with EQ-5D HUV and EQ-5D VAS change. Using the different methods of calculating MCID, we find the EQ-5D HUV MCID to be 0.04 and EQ-5D VAS MCID to be 8.0. The calculated EQ-5D MCIDs had approximately a sensitivity of 40-50% and specificity of 80% in detecting patients experiencing noticeable improvement in general health. CONCLUSIONS The EQ-5D responds well to changing CRS symptomatology. We propose MCIDs for EQ-5D HUV of 0.04 and EQ-5D VAS of 8 in CRS patients, which although specific, are not sensitive for detecting patients experiencing improvement in general health.
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Affiliation(s)
- L P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - K M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - M M Speth
- Klinik fur Hals-, Nasen-, Ohren- Krankheiten, Hals-und Gesichtschirurgie, Kantonsspital Aarau, Switzerland
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - S T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - A R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Phillips KM, Bergmark RW, Hoehle LP, Caradonna DS, Gray ST, Sedaghat AR. Chronic rhinosinusitis exacerbations are differentially associated with lost productivity based on asthma status. Rhinology 2019; 56:323-329. [PMID: 30042985 DOI: 10.4193/rhin18.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The frequency of chronic rhinosinusitis (CRS) exacerbations is an independent predictor of quality of life. The objective of this study was to evaluate if increased CRS exacerbations predict decreased productivity. METHODS Cross-sectional study of adult CRS patients. Number of patient-reported CRS-related antibiotic and oral corticosteroids courses and sinus infections in the past three months were used as metrics for acute exacerbations of CRS (AECRS). Productivity loss was measured by asking participants the number of lost days of work or school due to CRS in the past three months. Associations were sought between lost productivity and AECRS, controlling for clinical and demographic characteristics. RESULTS 371 participants were recruited. 28.8% of study participants had comorbid asthma. The mean number of lost days of productivity due to CRS in the last three months was 1.5 for asthmatic participants and 2.4 for non-asthmatic participants. In asthmatics, CRS-related lost productivity was significantly associated with number of CRS-related antibiotics used (and oral corticosteroids used, with a trend for sinus infections. No AECRS metric was significantly associated with lost productivity in non-asthmatics. However, when focusing on non-asthmatics reporting missed days of work or school due to CRS, we found statistically significant associations between AECRS metrics and lost productivity. CONCLUSIONS The frequency of AECRS is associated with CRS-related lost productivity in asthmatics and in the subset of non-asthmatics with moderate CRS-related productivity losses.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - R W Bergmark
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - L P Hoehle
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - S T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Campbell AP, Hoehle LP, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Symptom control in chronic rhinosinusitis is an independent predictor of productivity loss. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:237-241. [PMID: 29724671 DOI: 10.1016/j.anorl.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/22/2017] [Accepted: 05/15/2017] [Indexed: 12/29/2022]
Abstract
AIMS Sinonasal symptoms cause significant productivity losses in patients with chronic rhinosinusitis (CRS). Patient-perceived CRS symptom control is a longitudinal measure of CRS symptomatology and is directly associated with general health-related quality of life (QOL) in patients with CRS. The aim of this study was to better understand the relationship between symptom control and productivity loss in CRS. MATERIALS AND METHODS Prospective cross-sectional cohort study of 200 patients with CRS. Patients categorized their CRS symptom control as "Not at all", "A little", "Somewhat", "Very", and "Completely". Lost productivity was assessed by determining the number of work and/or school days missed in the last 3 months due to CRS symptoms. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22). Associations were sought between lost productivity and patient-perceived CRS symptom control. OBJECTIVE To determine the association between patient-perceived longitudinal symptom control and productivity in patients with CRS. RESULTS A total of 200 participants (48% male, 52% female), with a mean age of 52 years (Standard Deviation [SD]: 16) were enrolled. The mean SNOT-22 score of participants was 33.5 (SD: 22.4). Participants missed a mean of 3 days (SD: 10) of work or school due to CRS. CRS symptom control classified as "not at all" was associated with 11 days of lost productivity due to CRS on univariate analysis (β=11.16, 95% CI: 5.39-16.94, P<0.001) and 8 days of lost productivity on multivariate analysis (β=8.02, 95% CI: 1.92-14.13, P=0.011). None of the other categories of patient-reported CRS symptom control were associated with lost productivity due to CRS. CONCLUSIONS Patient-perceived control of CRS symptoms, an important metric previously shown to be significantly associated with QOL in CRS patients, is independently associated with lost productivity. These results motivate longitudinal studies to determine if improvement of CRS symptom control may reduce losses in productivity.
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Affiliation(s)
- A P Campbell
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - L P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - K M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - S T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America
| | - A R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States of America; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States of America; Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America; Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, United States of America.
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Phillips KM, Hoehle LP, Bergmark RW, Campbell AP, Caradonna DS, Gray ST, Sedaghat AR. Chronic rhinosinusitis severity is associated with need for asthma-related systemic corticosteroids. Rhinology 2017. [PMID: 28647751 DOI: 10.4193/rhin17.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is highly prevalent in patients with asthma. However, no study has evaluated the effect of CRS severity on asthma-related oral corticosteroid use - a marker of poor asthma control and prognosis. We therefore sought to evaluate the association between CRS severity and asthma-related oral corticosteroid use. METHODOLOGY Prospective cross-sectional study of 110 adult asthmatic CRS patients. CRS severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy score. Number of asthma-related courses of oral corticosteroids in the past year was queried at enrollment. Association was sought between metrics for CRS severity and asthma-related oral corticosteroids use in the last year. Receiver operating characteristic (ROC) curves defined whether SNOT-22 or endoscopy scores could be used for detecting asthma-related oral corticosteroid use. RESULTS The mean SNOT-22 score was 44.9 (standard deviation [SD] : 23.3) and mean endoscopy score was 4.1 (SD: 3.0). The mean number of asthma-related oral corticosteroid courses taken in the last year was 1.1 (SD: 1.9). SNOT-22, but not endoscopy score, was associated with requiring at least one course of asthma-related oral corticosteroids in the last year (odds ratio = 1.03, 95%CI: 1.02 - 1.06, p=0.003), which translates to an odds ratio of 2.0 for a 21-point increase in SNOT-22. ROC analysis identified equally optimal SNOT-22 scores of greater than 32 (sensitivity: 88.1%, specificity: 41.2%) or greater than 65 (sensitivity: 38.1%, specificity: 91.2%) for detecting the need for at least one course of oral corticosteroids within the past year. CONCLUSIONS CRS symptom severity is associated with past asthma-related oral corticosteroid use. SNOT-22 scores may be used as a versatile tool to screen for past asthma-related oral corticosteroid use in asthmatic CRS patients - i.e. those at greatest risk from their asthma - with either high sensitivity or high specificity.
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Affiliation(s)
- K M Phillips
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - L P Hoehle
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - R W Bergmark
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - A P Campbell
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - S T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - A R Sedaghat
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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15
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Hoehle LP, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. A contemporary analysis of clinical and demographic factors of chronic rhinosinusitis patients and their association with disease severity. Ir J Med Sci 2017; 187:215-221. [PMID: 28560517 DOI: 10.1007/s11845-017-1639-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/20/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is highly prevalent, significantly decreases quality of life and leads to tremendous health care costs every year. No recent study has characterised the prevalence of potentially CRS-modifying patient characteristics and simultaneously shown their impact on CRS severity. AIMS We sought to determine the prevalence of potential clinical and demographic CRS-modifying characteristics and their associations with CRS symptom severity in a large contemporary cohort of CRS patients. METHODS Retrospective review of CRS patients who visited our rhinology clinics between February 2016 and February 2017 was conducted. CRS symptom severity was measured using the 22-item Sinonasal Outcomes Test (SNOT-22) questionnaire, which all patients received. Association was sought between SNOT-22 score (as dependent variable) and patients' clinical and demographic characteristics using linear regression. RESULTS Of the 572 included patients, the mean age was 51.1 years (SD = 15.8) and the mean SNOT-22 score was 34.3 (SD = 22.6). Prevalence of granulomatous diseases, immunodeficiency and cystic fibrosis were each approximately 5%. Prevalence of aeroallergen hypersensitivity was 42.3% and prevalence of asthma was 27.8%. More severe CRS symptomatology was associated with smoking tobacco (adjusted β = 5.47, p = 0.034) and comorbid asthma (adjusted β = 12.02, p < 0.001), whilst less severe symptomatology was associated with older age (adjusted β = -0.23, p = 0.002) and diagnosis of cystic fibrosis (adjusted β = -11.87, p = 0.009). CONCLUSIONS In a contemporary cohort of CRS patients, prevalence of disease-modifying comorbidities ranged from approximately 5 to over 40%. Smoking tobacco and asthma were associated with more severe CRS symptomatology, whilst older age and diagnosis of cystic fibrosis were associated with less severe CRS symptomatology.
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Affiliation(s)
- L P Hoehle
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - K M Phillips
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - A R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA. .,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. .,Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, MA, USA.
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16
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Hoehle LP, Phillips KM, Bergmark RW, Caradonna DS, Gray ST, Sedaghat AR. Symptoms of chronic rhinosinusitis differentially impact general health-related quality of life. Rhinology 2016; 54:316-322. [PMID: 27665614 DOI: 10.4193/rhino16.211] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The degree to which different sinonasal symptoms contribute to the overall quality of life (QOL) detriment in chronic rhinosinusitis (CRS) patients remains unknown. In this study we sought to characterize the effect of different CRS symptoms on the general health-related QOL in patients. METHODOLOGY We performed a prospective cross-sectional study of 131 adult patients with CRS. Sinonasal symptoms were evaluated using the 22-item Sinonasal Outcomes Test (SNOT-22) and general health-related QOL was evaluated using the EuroQol 5-Dimensional general health-related QOL survey (EQ5D) and visual analog scale (EQ5D-VAS). Health utility values (HUV) were determined using responses to the EQ5D. SNOT-22 scores were broken down into subdomain scores for sleep, nasal, otologic/facial pain and emotional function symptoms. RESULTS The otologic/facial pain subdomain score consistently had the largest impact on EQ5D-VAS and HUV. After otologic/facial pain, the sleep subdomain score had the second largest effect while the nasal subdomain score had the least impact on general health-related QOL. CONCLUSIONS Different types of CRS symptoms - most prominently otologic/facial pain and sleep-related symptoms - and their underlying pathophysiologic mechanisms may differentially affect the general health-related QOL detriment associated with CRS. These findings raise the possibility that treatment of the various symptoms associated with CRS may lead to differential improvement in general-health related QOL.
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Affiliation(s)
- L P Hoehle
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - K M Phillips
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - R W Bergmark
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - D S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - S T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Quiñones AR, Thielke SM, Clark ME, Phillips KM, Elnitsky C, Andresen EM. Validity of Center for Epidemiologic Studies Depression (CES-D) scale in a sample of Iraq and Afghanistan Veterans. SAGE Open Med 2016; 4:2050312116643906. [PMID: 27127628 PMCID: PMC4834469 DOI: 10.1177/2050312116643906] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 09/22/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives: Optimal depression screening necessitates measurement tools that are valid across varied populations and in the presence of comorbidities. Methods: This study assessed the test properties of two versions of the Center for Epidemiologic Studies Depression scale against psychiatric diagnoses established by the Mini International Neuropsychiatric Interview among a clinical sample of US Veterans deployed during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Participants (N = 359) recruited from two Department of Veterans Affairs hospitals completed a clinical interview, structured diagnostic interview, and self-reported measures. Results: Based on diagnostic interview and the Diagnostic and Statistical Manual of Mental Disorders 4th Edition criteria, 29.5% of the sample met diagnostic criteria for major depressive disorder and 26.5% met diagnostic criteria for post-traumatic stress disorder. Both Center for Epidemiologic Studies Depression-20 and Center for Epidemiologic Studies Depression-10 scales performed well and almost identically against the Mini International Neuropsychiatric Interview-major depressive disorder in identifying Veterans with major depressive disorder (Center for Epidemiologic Studies Depression-20 area under the Receiver Operating Characteristic curve 91%; Center for Epidemiologic Studies Depression-10 area under the ROC curve 90%). Overall, higher cut points for the Center for Epidemiologic Studies Depression scales performed better in correctly identifying true positives and true negatives for major depressive disorder (Center for Epidemiologic Studies Depression-20 cut point 18+ sensitivity 92% specificity 72%; Center for Epidemiologic Studies Depression-10 cut point 10+ sensitivity 92% specificity 69%). Conclusions: The specificity of the Center for Epidemiologic Studies Depression scales was poor among Veterans with co-occurring post-traumatic stress disorder (13% and 16%). Veterans with post-traumatic stress disorder who have a positive depression screen should have a more thorough assessment of mental health symptoms and comorbidities, rather than immediate diagnosis of and treatment for depression.
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Affiliation(s)
- Ana R Quiñones
- School of Public Health, Oregon Health & Science University, Portland, OR, USA; Portland VA Medical Center, Portland, OR, USA
| | - Stephen M Thielke
- Geriatric Research, Education, and Clinical Centers, Puget Sound VA Medical Center, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Michael E Clark
- Chronic Pain Rehabilitation Program, VA National Polytrauma Pain Workgroup, James A. Haley Veterans' Hospital, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Kristin M Phillips
- Cancer and Palliative Care Programs, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Christine Elnitsky
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Elena M Andresen
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
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18
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Evans BJ, Phillips KM, Gonzalez BD, Apte S, Small BJ, Jacobsen PB, Jim HSL. Psychosocial resources and sleep disturbance before chemotherapy for gynecologic cancer. J Psychosoc Oncol 2016; 34:60-76. [PMID: 26771556 DOI: 10.1080/07347332.2015.1128507] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Personal psychosocial resources (e.g., positive affect, social support, perceived mastery, meaning in life) are associated with better sleep in noncancer populations, but there have been few studies in cancer patients. The present study examined psychosocial resources and sleep in gynecological cancer patients. Before chemotherapy, 72 participants completed self-report measures of sleep and psychosocial resources; 63 also completed actigraphic monitoring. Subjective sleep was associated with positive affect, social support, perceived mastery, and meaning in life; objective sleep was associated with social support. Future studies should examine whether interventions to enhance psychosocial resources result in improved sleep in this population.
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Phillips KM, Clark ME, Gironda RJ, McGarity S, Kerns RW, Elnitsky CA, Andresen EM, Collins RC. Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans. ACTA ACUST UNITED AC 2016; 53:413-32. [PMID: 27532156 DOI: 10.1682/jrrd.2014.05.0126] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/02/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Robert W. Kerns
- Pain Research, Informatics, Multi-morbidities, and Education, Center of Innovation, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT; and School of Medicine, Yale University, New Haven, CT
| | - Christine A. Elnitsky
- School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC
| | - Elena M. Andresen
- School of Public Health, Oregon Health and Science University; and Portland State University, Portland, OR
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20
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Murphy JL, Phillips KM, Rafie S. Sex differences between Veterans participating in interdisciplinary chronic pain rehabilitation. ACTA ACUST UNITED AC 2016; 53:83-94. [DOI: 10.1682/jrrd.2014.10.0250] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/09/2015] [Indexed: 11/05/2022]
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McGinty HL, Phillips KM, Jim HSL, Cessna JM, Asvat Y, Cases MG, Small BJ, Jacobsen PB. Cognitive functioning in men receiving androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. Support Care Cancer 2014; 22:2271-80. [PMID: 24859915 DOI: 10.1007/s00520-014-2285-1] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [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: 02/06/2014] [Accepted: 05/06/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Prior research examining the impact of androgen deprivation therapy (ADT) for prostate cancer on cognitive performance has found inconsistent relationships. The purpose of this study was to systematically review the existing literature and determine the effect of ADT on performance across seven cognitive domains using meta-analysis. METHODS A search of PubMed Medline, PsycINFO, Cochrane Library, and Web of Knowledge/Science databases yielded 157 unique abstracts reviewed by independent pairs of raters. Fourteen studies with a total of 417 patients treated with ADT were included in the meta-analysis. Objective neuropsychological tests were categorized into seven cognitive domains: attention/working memory, executive functioning, language, verbal memory, visual memory, visuomotor ability, and visuospatial ability. RESULTS Separate effect sizes were calculated for each cognitive domain using pairwise comparisons of patients who received ADT with (1) prostate cancer patient controls, (2) noncancer controls, or (3) ADT patients' own pre-ADT baselines. Patients treated with ADT performed worse than controls or their own baseline on visuomotor tasks (g = -0.67, p = .008; n = 193). The magnitude of the deficits was larger in studies with a shorter time to follow-up (p = .04). No significant effect sizes were observed for the other six cognitive domains (p = .08-.98). CONCLUSIONS Prostate cancer patients who received ADT performed significantly worse on visuomotor tasks compared to noncancer control groups. These findings are consistent with the known effects of testosterone on cognitive functioning in healthy men. Knowledge of the cognitive effects of ADT may help patients and providers better understand the impact of ADT on quality of life.
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Jim HSL, Evans B, Jeong JM, Gonzalez BD, Johnston L, Nelson AM, Kesler S, Phillips KM, Barata A, Pidala J, Palesh O. Sleep disruption in hematopoietic cell transplantation recipients: prevalence, severity, and clinical management. Biol Blood Marrow Transplant 2014; 20:1465-84. [PMID: 24747335 DOI: 10.1016/j.bbmt.2014.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of recipients experiencing sleep disruption pre-transplant, with up to 82% of patients experiencing moderate to severe sleep disruption during hospitalization for transplant and up to 43% after transplant. These rates of sleep disruption are substantially higher than what we see in the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption and disorders (ie, insomnia, obstructive sleep apnea, restless legs syndrome) as a clinical problem in HCT in order to facilitate patient education, intervention, and research. We identified 35 observational studies published in the past decade that examined sleep disruption or disorders in HCT. Most studies utilized a single item measure of sleep, had small sample size, and included heterogeneous samples of patients. Six studies of the effects of psychosocial and exercise interventions on sleep in HCT have reported no significant improvements. These results highlight the need for rigorous observational and interventional studies of sleep disruption and disorders in HCT recipients..
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Affiliation(s)
| | - Bryan Evans
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Jiyeon M Jeong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Laura Johnston
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, California
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Anna Barata
- Moffitt Cancer Center, Tampa, Florida; Psychiatry and Legal Medicine PhD Program, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Phillips KM, Faul LA, Small BJ, Jacobsen PB, Apte SM, Jim HSL. Comparing the retrospective reports of fatigue using the Fatigue Symptom Index with daily diary ratings in women receiving chemotherapy for gynecologic cancer. J Pain Symptom Manage 2013; 46:282-8. [PMID: 23159686 PMCID: PMC3735814 DOI: 10.1016/j.jpainsymman.2012.08.008] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/02/2012] [Accepted: 08/06/2012] [Indexed: 11/24/2022]
Abstract
CONTEXT Fatigue, one of the most common side effects of chemotherapy, is typically assessed via retrospective recall (e.g., over the past week). It is unknown how such retrospective recall of fatigue correlates with daily ratings among people receiving chemotherapy. OBJECTIVES The current study compared fatigue recorded in daily diaries with retrospective ratings using the Fatigue Symptom Inventory (FSI) in patients receiving chemotherapy for gynecologic cancer. METHODS During the week before and the week after their first infusion of chemotherapy, patients completed daily diaries at 10 AM, 2, and 6 PM and the FSI at the end of each week. RESULTS FSI and diary ratings of peak, lowest, and average fatigue were significantly correlated (P < 0.001). When peak, end, average, and variance diary ratings were regressed separately on the average FSI item, each was significant pre-chemotherapy (P < 0.01) and post-chemotherapy (P < 0.05). However, when entered into a stepwise regression model, only the average fatigue diary rating was retained, explaining 52% of the variance pre-chemotherapy and 54% of the variance post-chemotherapy average FSI item (P < 0.001). CONCLUSION The FSI keyed to the past week accurately reflects daily ratings of fatigue among patients receiving chemotherapy. This study has important implications, as completing retrospective ratings of fatigue may be less burdensome for cancer patients than daily assessments.
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Affiliation(s)
- Kristin M Phillips
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Jim HSL, Jacobsen PB, Phillips KM, Wenham RM, Roberts W, Small BJ. Lagged relationships among sleep disturbance, fatigue, and depressed mood during chemotherapy. Health Psychol 2013; 32:768-74. [PMID: 23437852 DOI: 10.1037/a0031322] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Recent research suggests that sleep disturbance, fatigue, and depressed mood form a symptom cluster in patients treated with chemotherapy. To date, however, no studies have examined lagged relationships among these symptoms during chemotherapy, a time when symptom variability is high. The aim of the current study was to examine lagged changes among daily symptoms during platinum-based chemotherapy. METHOD Participants were 78 women with gynecologic cancer (mean age 63 years, SD = 11; 91% Caucasian, 97% non-Hispanic). Sleep disturbance was assessed via wrist actigraphy, whereas fatigue and depressed mood were assessed via daily diary in the week after participants' first chemotherapy infusion. Latent change score models (LCS) were used to examine lagged relationships between symptom pairs. RESULTS High levels of sleep disturbance (i.e., minutes awake at night) were associated with earlier subsequent peaks in fatigue, and high levels of fatigue were associated with higher subsequent levels of depressed mood. CONCLUSIONS These findings suggest that sleep disturbance, fatigue, and depressed mood occur in a cascade pattern during chemotherapy, in which increases in sleep disturbance contribute to fatigue, which, in turn, contributes to depressed mood. Interventions targeting symptoms early in the cascade, such as sleep disturbance, may provide benefits across multiple downstream symptoms.
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Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Phillips KM, Jim HSL, Small BJ, Tanvetyanon T, Roberts WS, Jacobsen PB. Effects of self-directed stress management training and home-based exercise on stress management skills in cancer patients receiving chemotherapy. Stress Health 2012; 28:368-75. [PMID: 22972771 DOI: 10.1002/smi.2450] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Received: 04/04/2012] [Revised: 08/07/2012] [Accepted: 08/08/2012] [Indexed: 11/09/2022]
Abstract
Although exercise may be used by some to decrease distress, little is known about how it may contribute to stress management (SM) among patients receiving chemotherapy. We evaluated whether exercise separately or in combination with SM training is effective at increasing perceived ability to manage stress. Patients receiving chemotherapy (N = 391) were randomized to receive usual care only (UCO), SM, exercise (EX), or stress management and exercise (SMEX). They completed the Measure of Current Status prior to receiving chemotherapy and 12 weeks after the first infusion. We hypothesized that participants randomized to an intervention condition would report improvements in relaxation, awareness of tension, getting needs met and coping confidence compared with those receiving UCO. Results indicated significant group-by-time interactions for the following: relaxation (UCO versus SM, p = 0.008), awareness of tension (UCO versus SMEX, p = 0.029 and UCO versus EX, p < 0.001), getting needs met (UCO versus SMEX, p = 0.020) and Measure of Current Status total score (UCO versus SMEX, p = 0.007 and UCO versus EX, p = 0.016). There were no group-by-time interactions for coping confidence (p-values >0.05). This study provides support for including an exercise component in SM interventions for cancer patients receiving chemotherapy (clinicaltrials.gov identifier: NCT00740038).
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Affiliation(s)
- Kristin M Phillips
- Division of Population Science, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-PSY, Tampa, FL 33612, USA
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Phillips KM, Pinilla-Ibarz J, Sotomayor E, Lee MR, Jim HSL, Small BJ, Sokol L, Lancet J, Tinsley S, Sweet K, Komrokji R, Jacobsen PB. Quality of life outcomes in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors: a controlled comparison. Support Care Cancer 2012. [PMID: 23179489 DOI: 10.1007/s00520-012-1630-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Tyrosine kinase inhibitors (TKIs) are now standard treatment for chronic myeloid leukemia (CML). While TKIs have less toxicity than previous treatments, they have side effects that can impact quality of life (QOL). METHODS This study compared CML patients taking a TKI for an average of 4.01 years (range 0.50-9.79 years) to age- and gender-matched controls with no history of cancer on measures of symptom burden, depression, fatigue, sleep, and health-related QOL. RESULTS Compared to controls (n = 62), CML patients (n = 62) taking a TKI (imatinib 55 %, nilotinib 31 %, and dasatinib 14 %) reported significantly worse fatigue severity (p < .001), fatigue interference (p < .001), depression (p = .007), symptom burden (p < .001), and physical QOL (p < .001). TKI patients were also more likely meet established cutoffs for clinically meaningful fatigue (p values < .001) and depression (p = .004). There were no differences in mental QOL or sleep (p values > .010). Regarding specific symptoms, TKI patients were more likely to report nausea, diarrhea, itching, skin changes, swelling of arms or legs, and not looking like themselves (p values < .001). CONCLUSIONS These data suggest the need for interventions to address QOL in CML patients taking TKIs.
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Affiliation(s)
- Kristin M Phillips
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
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Jim HS, Park JY, Permuth-Wey J, Rincon MA, Phillips KM, Small BJ, Jacobsen PB. Genetic predictors of fatigue in prostate cancer patients treated with androgen deprivation therapy: preliminary findings. Brain Behav Immun 2012; 26:1030-6. [PMID: 22475653 PMCID: PMC3399038 DOI: 10.1016/j.bbi.2012.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 02/22/2012] [Accepted: 03/02/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Fatigue is a common and distressing side effect of androgen deprivation therapy (ADT) for prostate cancer. The goal of the current study was to examine the relationship between changes in fatigue following initiation of ADT and single nucleotide polymorphisms (SNPs) in three pro-inflammatory cytokine genes: interleukin-1 beta (IL1B), interleukin-6 (IL6), and tumor necrosis factor alpha (TNFA). METHODS As part of a larger study, men with prostate cancer (n = 53) were recruited prior to initiation of ADT. Fatigue was assessed at recruitment and 6 months after initiation of ADT. DNA was extracted from blood drawn at baseline. RESULTS Patients with the IL6-174 (rs1800795) G/C or C/C genotype displayed greater increases in fatigue intrusiveness, frequency, and duration than the G/G genotype (p values ≤ 0.05), although inclusion of age, race, and baseline depressive symptomatology in the model attenuated these relationships (p values ≤ 0.09). Patients with the TNFA-308 (rs1800629) G/A genotype showed greater increases in fatigue severity than the G/G genotype (p = 0.02). IL1B-511 (rs16944) genotype did not significantly predict changes in fatigue (p values >0.46). Patients with higher numbers of variants displayed greater increases in fatigue duration and interference (p values ≤ 0.02) than patients with lower numbers of variants. CONCLUSIONS Prostate cancer patients treated with ADT who carry variant alleles of the IL6 and TNFA genes are susceptible to heightened fatigue. These preliminary data lend support for the role of genetic variation in the development of cancer-related fatigue secondary to ADT. Findings are relevant to attempts to develop personalized approaches to cancer treatment.
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Jim HSL, Phillips KM, Chait S, Faul LA, Popa MA, Lee YH, Hussin MG, Jacobsen PB, Small BJ. Meta-analysis of cognitive functioning in breast cancer survivors previously treated with standard-dose chemotherapy. J Clin Oncol 2012; 30:3578-87. [PMID: 22927526 DOI: 10.1200/jco.2011.39.5640] [Citation(s) in RCA: 274] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evidence is mixed regarding long-term cognitive deficits in patients treated with chemotherapy. Previous meta-analyses have not focused specifically on the postchemotherapy period and have not incorporated several recent studies. The goal of the current study was to conduct a meta-analysis of cognitive functioning in breast cancer survivors who were treated with chemotherapy ≥ 6 months previously. METHODS A search of PubMed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library yielded 2,751 abstracts, which were independently evaluated by pairs of raters. Meta-analysis was conducted on 17 studies of 807 patients previously treated with standard-dose chemotherapy for breast cancer. Neuropsychological tests were categorized according to eight cognitive domains: attention, executive functioning, information processing, motor speed, verbal ability, verbal memory, visual memory, and visuospatial ability. RESULTS Deficits in cognitive functioning were observed in patients treated with chemotherapy relative to controls or prechemotherapy baseline in the domains of verbal ability (g = -0.19; P < .01) and visuospatial ability (g = -0.27; P < .01). Patients treated with chemotherapy performed worse than noncancer controls in verbal ability and worse than patients treated without chemotherapy in visuospatial ability (both P < .01). Age, education, time since treatment, and endocrine therapy did not moderate observed cognitive deficits in verbal ability or visuospatial ability (all P ≥ .51). CONCLUSION Results indicate that, on average, observed cognitive deficits in patients with breast cancer previously treated with chemotherapy are small in magnitude and limited to the domains of verbal ability and visuospatial ability. This information can be used to inform interventions to educate patients with breast cancer regarding the long-term impact of chemotherapy on cognitive functioning.
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Affiliation(s)
- Heather S L Jim
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, MRC-PSY, 12902 Magnolia Dr, Tampa, FL 33612, USA.
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Jacobsen PB, Phillips KM, Jim HSL, Small BJ, Faul LA, Meade CD, Thompson L, Williams CC, Loftus LS, Fishman M, Wilson RW. Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: a randomized controlled trial. Psychooncology 2012; 22:1229-35. [DOI: 10.1002/pon.3122] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/14/2012] [Accepted: 05/24/2012] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Brent J. Small
- Moffitt Cancer Center; Tampa FL USA
- University of South Florida; Tampa FL USA
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Abstract
As the number of individuals pursuing lung transplantation to treat lung disease increases, transplant team members have an opportunity to maximize patients' chances for post-transplant success through identifying and addressing psychosocial factors that have been previously associated with patients' post-transplant survival, such as health locus of control (HLC). The purpose of this cross-sectional study was to understand the factors associated with HLC in lung transplant candidates. The aims were to (i) identify the demographic factors associated with internal (IHLC), chance (CHLC), and powerful others (PHLC) HLC; (ii) examine the associations between HLC and anxiety, depression, and optimism; and (iii) determine whether these factors explain a significant proportion of variance in HLC. Hierarchical regression analyses indicated that age, education, trait anxiety, and optimism explained 20% of the variance in CHLC; gender, trait anxiety, and depression accounted for 9% of the variance in IHLC; and lower education accounted for 5% of the variance in PHLC. Helping transplant team members understand the factors that influence patients' perceptions that their own behaviors impact their health status is important for maximizing post-transplant success.
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Affiliation(s)
- Eileen J Burker
- Division of Rehabilitation Counseling & Psychology, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA.
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Phillips KM, McGinty HL, Gonzalez BD, Jim HSL, Small BJ, Minton S, Andrykowski MA, Jacobsen PB. Factors associated with breast cancer worry 3 years after completion of adjuvant treatment. Psychooncology 2012; 22:936-9. [PMID: 22419546 DOI: 10.1002/pon.3066] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/03/2012] [Accepted: 02/14/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence. METHODS Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman's Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables. RESULTS Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p < 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p < 0.01). CONCLUSIONS The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease.
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Affiliation(s)
- Kristin M Phillips
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
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Phillips KM, Jim HS, Small BJ, Laronga C, Andrykowski MA, Jacobsen PB. Cognitive functioning after cancer treatment: a 3-year longitudinal comparison of breast cancer survivors treated with chemotherapy or radiation and noncancer controls. Cancer 2011; 118:1925-32. [PMID: 22161750 DOI: 10.1002/cncr.26432] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/24/2011] [Accepted: 05/31/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study examined the influence of prior treatment on the course of cognitive functioning in breast cancer survivors. Changes in cognitive functioning over time were compared in breast cancer survivors treated with chemotherapy plus radiotherapy, breast cancer survivors treated with radiotherapy only, and women with no history of cancer. METHODS Stage 0-II breast cancer patients treated with chemotherapy plus radiotherapy (CT group; n = 62) or radiotherapy only (RT group; n = 67) completed neuropsychological assessments 6 months after completing treatment and again 36 months later. Women with no history of cancer (NC group; n = 184) were assessed over a similar interval. RESULTS A significant group × time effect was found for processing speed (P = .009) that reflected a tendency for the NC group but not the RT and CT groups to improve over time. There was also a significant group effect for executive functioning (P = .006) that reflected the NC group performing better than the CT and RT groups. Additional analyses found the administration of hormonal therapy was not associated with change over time in cognitive performance. CONCLUSIONS Findings provide limited support for the view that changes in cognitive functioning in cancer survivors are attributable to chemotherapy administration and illustrate the importance of including a radiotherapy comparison group. Future research should seek to examine possible mechanisms that could explain the apparent prolonged impact of both chemotherapy and radiotherapy on cognitive functioning in breast cancer survivors.
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Affiliation(s)
- Kristin M Phillips
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida 33612, USA
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Goedendorp MM, Andrykowski MA, Donovan KA, Jim HS, Phillips KM, Small BJ, Laronga C, Jacobsen PB. Prolonged impact of chemotherapy on fatigue in breast cancer survivors: a longitudinal comparison with radiotherapy-treated breast cancer survivors and noncancer controls. Cancer 2011; 118:3833-41. [PMID: 22086766 DOI: 10.1002/cncr.26226] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/22/2011] [Accepted: 03/31/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND In this study, the authors examined the influence of prior treatment on the course of fatigue in breast cancer survivors. Patients who received chemotherapy were expected to have greater fatigue than patients who received radiotherapy and noncancer controls 6 months after the completion of treatment, but they were expected to recover to levels similar to those of the other 2 groups 3 years later. METHODS Patients with stage 0 through II breast cancer completed the Fatigue Symptom Inventory (FSI) and the Profile of Mood States Fatigue Scale (POMS-FAT) 6 months (T1) and 42 months (T2) after completing chemotherapy with or without radiotherapy (the CT group; n = 103) or radiotherapy only (the RT group; n = 102). An age-matched group of women with no history of cancer (the NC group; n = 193) was assessed over a similar interval. RESULTS A significant (P = .041) group × time effect for FSI severity scores revealed that fatigue worsened over time in the CT group but remained stable and lower in the RT and NC groups. There also were significant group effects for FSI days (P < .001) and POMS-FAT (P = .010) scores, indicating that fatigue was significantly greater across time in the CT group than in the NC group (POMS-FAT) or the RT and NC groups (FSI days). CONCLUSIONS Contrary to expectations, fatigue did not diminish over time in patients with breast cancer who received chemotherapy. This finding has important implications for patient education and for fatigue monitoring during follow-up. The authors concluded that future research should seek to examine possible mechanisms to explain the apparent prolonged impact of chemotherapy on fatigue in breast cancer survivors.
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Affiliation(s)
- Martine M Goedendorp
- Expert Center for Chronic Fatigue, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Affiliation(s)
- Kristin M. Phillips
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (KMP), University of North Carolina at Chapel Hill (EJB, HCW)
| | - Eileen J. Burker
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (KMP), University of North Carolina at Chapel Hill (EJB, HCW)
| | - Hayley C. White
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (KMP), University of North Carolina at Chapel Hill (EJB, HCW)
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Phillips KM, Jim HS, Donovan KA, Pinder-Schenck MC, Jacobsen PB. Characteristics and correlates of sleep disturbances in cancer patients. Support Care Cancer 2011; 20:357-65. [DOI: 10.1007/s00520-011-1106-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 01/24/2011] [Indexed: 11/29/2022]
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Patterson KY, Phillips KM, Horst RL, Byrdwell WC, Exler J, Lemar LE, Holden JM. Vitamin D content and variability in fluid milks from a US Department of Agriculture nationwide sampling to update values in the National Nutrient Database for Standard Reference. J Dairy Sci 2011; 93:5082-90. [PMID: 20965322 DOI: 10.3168/jds.2010-3359] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/02/2010] [Indexed: 11/19/2022]
Abstract
This study determined the vitamin D(3) content and variability of retail milk in the United States having a declared fortification level of 400 IU (10 μg) per quart (qt; 1 qt=946.4 mL), which is 25% daily value per 8 fluid ounce (236.6 mL) serving. In 2007, vitamin D(3) fortified milk (skim, 1%, 2%, whole, and 1% fat chocolate milk) was collected from 24 statistically selected supermarkets in the United States. Additionally, 2% milk samples from an earlier 2001 USDA nationwide collection were reanalyzed. Vitamin D(3) was determined using a specifically validated method involving HPLC with UV spectroscopic detection and vitamin D(2) as an internal standard. Quality control materials were analyzed with the samples. Of the 120 milk samples procured in 2007, 49% had vitamin D(3) within 100 to 125% of 400 IU (10 μg)/qt (label value), 28% had 501 to 600 IU (12.5-15 μg)/qt, 16% had a level below the label amount, and 7% had greater than 600 IU (15 μg)/qt (>150% of label). Even though the mean vitamin D(3) content did not differ statistically between milk types, a wide range in values was found among individual samples, from nondetectable [<20 IU (0.5 μg)/qt] for one sample to almost 800 IU (20 μg)/qt, with a trend toward more samples of whole milk having greater than 150% of the labeled content. On average, vitamin D(3) in 2% milk was higher in 2007 compared with in 2001 [473 vs. 426 IU (11.8 vs. 10.6 μg)/qt].
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Affiliation(s)
- K Y Patterson
- USDA, ARS, Beltsville Human Nutrition Research Center, Nutrient Data Laboratory, Beltsville, MD 20705, USA.
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Trainer D, Pehrsson PR, Haytowitz DB, Holden JM, Phillips KM, Rasor AS, Conley NA. Development of sample handling procedures for foods under USDA's National Food and Nutrient Analysis Program. J Food Compost Anal 2010; 23:843-851. [PMID: 21516233 DOI: 10.1016/j.jfca.2010.03.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The National Food and Nutrient Analysis Program (NFNAP) was implemented in 1997 to update and improve the quality of food composition data maintained by the United States Department of Agriculture (USDA). NFNAP was designed to sample and analyze frequently consumed foods in the U.S. food supply using statistically rigorous sampling plans, established sample handling procedures, and qualified analytical laboratories. Methods for careful handling of food samples from acquisition to analysis were developed to ensure the integrity of the samples and subsequent generation of accurate nutrient values. The infrastructure of NFNAP, under which over 1500 foods have been sampled, mandates tested sample handling protocols for a wide variety of foods. The majority of these foods were categorized into several major areas: 1) frozen foods; 2) fresh produce and/or highly perishable foods requiring refrigeration; 3) fast foods and prepared foods; 4) shelf-stable foods; 5) specialized study and non-retail (point of production) foods; and 6) foods from remote areas (e.g. American Indian reservations). This paper describes the sample handling approaches, from the collection and receipt of the food items to the preparation of the analytical samples, with emphasis on the strategies developed for those foods. It provides a foundation for developing sample handling protocols of foods to be analyzed under NFNAP and for other researchers working on similar projects.
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Affiliation(s)
- D Trainer
- Nutrient Data Laboratory, ARS, USDA, Beltsville, MD 20705, USA
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Abstract
This case study describes the use of eye movement desensitization and reprocessing (EMDR) for a woman who met criteria for posttraumatic stress disorder (PTSD) related to past domestic violence. Outcome measures were used to assess the client’s symptoms at intake, after the third and sixth active EMDR sessions, and at 1- and 3-month follow-ups. In addition to the use of outcome measures, at 3-month follow-up the client was evaluated by a therapist who was blind to the type of treatment the client had received. Results indicated that after nine active sessions of EMDR, the client no longer met criteria for PTSD and no longer endorsed symptoms of depression or intrusive thoughts. Thus, EMDR was successful in treating PTSD symptoms associated with past domestic violence, and effects were maintained at 3-month follow-up.
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Lechner SC, Carver CS, Antoni MH, Weaver KE, Phillips KM. Curvilinear associations between benefit finding and psychosocial adjustment to breast cancer. J Consult Clin Psychol 2006; 74:828-40. [PMID: 17032087 DOI: 10.1037/0022-006x.74.5.828] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [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: 11/08/2022]
Abstract
Two previously studied cohorts of women with nonmetastatic breast cancer (Ns = 230 and 136) were reexamined. Participants were assessed during the year after surgery and 5-8 years later. Associations were examined between benefit finding (BF) and several indicators of psychosocial adjustment (e.g., perceived quality of life, positive affect, negative affect, social disruption, and intrusive thoughts). Significant curvilinear relations between BF and other outcomes were observed cross-sectionally during initial assessment and at long-term follow-up in both samples. Compared with the intermediate BF group, low and high BF groups had better psychosocial adjustment. Further analyses indicated that the high BF group reported higher optimism and more use of positive reframing and religious coping than the other BF groups. Discussion highlights the need to examine nonlinear as well as linear relationships.
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Affiliation(s)
- Suzanne C Lechner
- Biobehavioral Oncology and Cancer Control Program, University of Miami School of Medicine, Miami, FL 33101, USA.
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Phillips KM, Brandon TH. Do Psychologists Adhere to the Clinical Practice Guidelines for Tobacco Cessation? A Survey of Practitioners. ACTA ACUST UNITED AC 2004. [DOI: 10.1037/0735-7028.35.3.281] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Parker KJ, Kinney LF, Phillips KM, Lee TM. Paternal behavior is associated with central neurohormone receptor binding patterns in meadow voles (Microtus pennsylvanicus). Behav Neurosci 2002. [PMID: 11770064 DOI: 10.1037//0735-7044.115.6.1341] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Paternal and nonpaternal voles (microtus) have different arginine-vasopressin (AVP) and oxytocin (OT) receptor patterns in the extended amygdala, a neural pathway associated with parental behavior. Using receptor autoradiography, the authors examined whether AVP and OT receptor patterns were associated with facultative paternal behavior in either sexually and parentally inexperienced or experienced meadow voles (Microtus pennsylvanicus). Experienced, in contrast to inexperienced, males had less AVP binding in the lateral septum (LS), more AVP binding in the anterior olfactory nucleus (AON), and more OT binding in the AON, bed nucleus of the stria terminalis, LS, and lateral amygdala. Thus, specific AVP receptor patterns, which co-occur with paternal care in consistently paternal voles, also may be associated with paternal care (when present) in typically nonpaternal species. This study also demonstrated a possible relationship between OT receptor patterns and paternal state in male mammals.
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Affiliation(s)
- K J Parker
- Department of Psychology and Reproductive Sciences Program, University of Michigan, Ann Arbor 48109-1109, USA
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Parker KJ, Kinney LF, Phillips KM, Lee TM. Paternal behavior is associated with central neurohormone receptor binding patterns in meadow voles (Microtus pennsylvanicus). Behav Neurosci 2001; 115:1341-8. [PMID: 11770064 DOI: 10.1037/0735-7044.115.6.1341] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 11/08/2022]
Abstract
Paternal and nonpaternal voles (microtus) have different arginine-vasopressin (AVP) and oxytocin (OT) receptor patterns in the extended amygdala, a neural pathway associated with parental behavior. Using receptor autoradiography, the authors examined whether AVP and OT receptor patterns were associated with facultative paternal behavior in either sexually and parentally inexperienced or experienced meadow voles (Microtus pennsylvanicus). Experienced, in contrast to inexperienced, males had less AVP binding in the lateral septum (LS), more AVP binding in the anterior olfactory nucleus (AON), and more OT binding in the AON, bed nucleus of the stria terminalis, LS, and lateral amygdala. Thus, specific AVP receptor patterns, which co-occur with paternal care in consistently paternal voles, also may be associated with paternal care (when present) in typically nonpaternal species. This study also demonstrated a possible relationship between OT receptor patterns and paternal state in male mammals.
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Affiliation(s)
- K J Parker
- Department of Psychology and Reproductive Sciences Program, University of Michigan, Ann Arbor 48109-1109, USA
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Webster J, Hood RH, Burridge CA, Doidge ML, Phillips KM, George N. Water or antiseptic for periurethral cleaning before urinary catheterization: a randomized controlled trial. Am J Infect Control 2001; 29:389-94. [PMID: 11743486 DOI: 10.1067/mic.2001.117447] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [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: 11/22/2022]
Abstract
BACKGROUND Despite a lack of empiric data to support the practice, traditionally, antiseptic solutions have been used to clean the periurethral area before inserting an indwelling catheter. The purpose of this study was to compare urinary colonization rates of subjects whose periurethral area was cleaned with water versus chlorhexidine 0.1% before the insertion of an indwelling urinary catheter. METHODS Obstetric patients who required urinary catheterization as part of their routine care were randomly assigned to either the "water" or "chlorhexidine" group with a sealed envelope. A sterile specimen of urine was collected 24 hours after insertion of the catheter. RESULTS Of the 436 patients (86.2%) with complete data (water group, 219; antiseptic group, 217), 38 (8.7%) had urinary tract bacteriuria >10(6) cfu/L. Rates of urinary tract infection were similar in each group (water group, 8.2%; antiseptic group, 9.2%; odds ratio 1.13; 95% confidence interval 0.58-2.21). CONCLUSION The practice of periurethral cleaning with an antiseptic did not decrease the rates of bacteriuria in this population and is probably not useful.
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Affiliation(s)
- J Webster
- Nursing and Women's Health Research Centre, Royal Brisbane Hospital, Australia
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Parker KJ, Phillips KM, Kinney LF, Lee TM. Day length and sociosexual cohabitation alter central oxytocin receptor binding in female meadow voles (Microtus pennsylvanicus). Behav Neurosci 2001; 115:1349-56. [PMID: 11770065] [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: 02/23/2023]
Abstract
In voles (Microtus), central oxytocin (OT) receptor patterns are associated with interspecific social organization. Social, monogamous voles have more OT receptors in the extended amygdala than asocial, nonmonogamous voles. Nonmonogamous meadow voles (Microtus pennsylvanicus), which exhibit seasonal changes in social organization (long day [LD] females are territorial, short day [SD] females live socially), provide a model for examining whether OT receptor patterns are associated with seasonal changes in intraspecific social behaviors. The authors examined whether sexually inexperienced (naive) SD females had more OT receptor binding than naive LD females. Naive SD females had greater OT receptor binding in the lateral septum (LS), lateral amygdala (LatAmyg), and central amygdala (CenAmyg) than less social, naive LD females. Because both SD and LD females acquire partner preferences, the authors assessed whether OT receptor binding was associated with partner preference onset. For LD females, partner preference onset corresponded with greater OT receptor binding in the anterior olfactory nucleus, LS, and bed nucleus of the stria terminalis, compared with naive LD females. In contrast, naive SD females and those exhibiting partner preferences did not differ. However, SD females that failed to acquire partner preferences showed less OT binding in the LatAmyg and CenAmyg. This study is the first to show that central OT receptor patterns are associated with seasonal changes in intraspecific social organization and partner preference onset in a nonmonogamous rodent.
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Affiliation(s)
- K J Parker
- Department of Psychology and Reproductive Sciences Program, University of Michigan, Ann Arbor 48109-1109, USA
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45
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Mitrani R, Rubenstein JE, Kois JC, Phillips KM. Alternative uses of a visible light-polymerized material. J Prosthet Dent 2001; 86:107-10. [PMID: 11491073 DOI: 10.1067/mpr.2001.115505a] [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: 11/22/2022]
Abstract
Three different procedures that involve the use of Triad gel are described. This light-polymerized resin material is versatile and easy to use in the dental clinic and laboratory. The procedures described include the transfer of ridge topography for ovate pontic sites, implant lab analog fixation, and solid/soft tissue cast fabrication.
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Affiliation(s)
- R Mitrani
- School of Dentistry, University of Washington, Seattle 98195, USA.
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46
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Phillips KM, Simpkins AH, Amanna KR, Wolf W, Stewart KK, Clark S, Kim KP, Beecher GR, Holden J. Long-term stability of nutrients in a frozen mixed food control material. Fresenius J Anal Chem 2001; 370:297-302. [PMID: 11451255 DOI: 10.1007/s002160100785] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A mixed food homogenate was prepared as a quality control material for two multi-center clinical feeding trials. Approximately 100 kg of homogenized human diet material was prepared under controlled conditions to maintain the stability of lipid components. More than 4,800 20-25 g aliquots were prepared and stored at -60 degrees C in glass jars with Teflon-lined lids. The homogeneity of the composite was validated by analysis of moisture and total fat in aliquots taken throughout the dispensing sequence. A portion of the material was reserved at the National Institute of Standards and Technology and further characterized as SRM 1544-Fatty Acids in Diet Composite. Moisture, protein, ash, total lipid, fatty acids, cholesterol, sodium, potassium, calcium, and magnesium were assayed as part of routine quality-control analyses. Components were analyzed over a total time period ranging from 29 months (minerals) to 60 months (moisture), and up to 319 values per nutrient were generated. Results for all components assayed were stable over the time period studied. For example, moisture (n = 319; 60 months) ranged from 70.66 to 72.58 g/100 g with a mean, standard deviation (SD), and relative standard deviation (RSD) of 71.90, 0.27, and 0.4%, respectively. The range, mean, SD, and RSD for cholesterol (mg/100 g; n = 98; 49 months) were 13.54-17.96, 15.14, 0.64, and 4%.
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Affiliation(s)
- K M Phillips
- Department of Biochemistry, Virginia Tech, Blacksburg 24061, USA.
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Mitrani R, Rubenstein JE, Kois JC, Phillips KM. Alternative uses of a visible light-polymerized material. J Prosthet Dent 2001; 85:501-3. [PMID: 11357078 DOI: 10.1067/mpr.2001.115505] [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: 11/22/2022]
Abstract
Three different procedures that involve the use of Triad gel are described. This light-polymerized resin material is versatile and easy to use in the dental clinic and laboratory. The procedures described include the transfer of ridge topography for ovate pontic sites, implant lab analog fixation, and solid/soft tissue cast fabrication.
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Affiliation(s)
- R Mitrani
- School of Dentistry, University of Washington, Seattle, Washington 98195, USA.
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Mitrani R, Nicholls JI, Phillips KM, Ma T. Accuracy of electronic implant torque controllers following time in clinical service. Int J Oral Maxillofac Implants 2001; 16:394-9. [PMID: 11432659] [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: 02/20/2023] Open
Abstract
Tightening of the screws in implant-supported restorations has been reported to be problematic, in that if the applied torque is too low, screw loosening occurs. If the torque is too high, then screw fracture can take place. Thus, accuracy of the torque driver is of the utmost importance. This study evaluated 4 new electronic torque drivers (controls) and 10 test electronic torque drivers, which had been in clinical service for a minimum of 5 years. Torque values of the test drivers were measured and were compared with the control values using a 1-way analysis of variance. Torque delivery accuracy was measured using a technique that simulated the clinical situation. In vivo, the torque driver turns the screw until the selected tightening torque is reached. In this laboratory experiment, an implant, along with an attached abutment and abutment gold screw, was held firmly in a Tohnichi torque gauge. Calibration accuracy for the Tohnichi is +/- 3% of the scale value. During torque measurement, the gold screw turned a minimum of 180 degrees before contact was made between the screw and abutment. Three torque values (10, 20, and 32 N-cm) were evaluated, at both high- and low-speed settings. The recorded torque measurements indicated that the 10 test electronic torque drivers maintained a torque delivery accuracy equivalent to the 4 new (unused) units. Judging from the torque output values obtained from the 10 test units, the clinical use of the electronic torque driver suggests that accuracy did not change significantly over the 5-year period of clinical service.
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Affiliation(s)
- R Mitrani
- University of Washington, Seattle 98195, USA
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Phillips KM, Ruggio DM, Bailey JA. Precise quantitative determination of phytosterols, stanols, and cholesterol metabolites in human serum by capillary gas-liquid chromatography. J Chromatogr B Biomed Sci Appl 1999; 732:17-29. [PMID: 10517218 DOI: 10.1016/s0378-4347(99)00257-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Total lipid extraction, solid-phase extraction, saponification, derivatization to trimethylsilyl ether derivatives, then capillary gas-liquid chromatography were used for quantitative analysis of sitosterol, campesterol, stigmasterol, sitostanol, campestanol, lathosterol, desmosterol, and lanosterol in human serum. Details of quality control integral to the accuracy and precision of analyses are included. The method limits of detection and quantitation, respectively, ranged from 0.05 microg/ml and 0.2 microg/ml for sitostanol to 0.4 microg/ml and 1.2 microg/ml for campesterol and campestanol. Analytes were measured at concentrations of 120 ng/ml to 6 microg/ml with standard deviations of 0.02 to 0.12 microg/ml for 55 analyses of a control serum sample conducted over a 2-month period.
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Affiliation(s)
- K M Phillips
- Department of Biochemistry, Virginia Polytechnic Institute and State University, Blacksburg 24061-0308, USA.
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